30-Day postoperative COVID-19 outcomes in 398 patients from regional hospitals utilising a designated COVID-19 minimal surgical site pathway.

INTRODUCTION: Postoperative pulmonary complications and mortality rates during the COVID-19 pandemic have been higher than expected, leading to mass cancellation of elective operating in the UK. To minimise this, the Guy's and St Thomas' Hospital NHS Foundation Trust elective surgery hub and the executive team at London Bridge Hospital (LBH) created an elective operating framework at LBH, a COVID-19 minimal site, in which patients self-isolated for two weeks and proceeded with surgery only following a negative preoperative SARS-CoV-2 polymerase chain reaction swab. The aim was to determine the rates of rates of postoperative COVID-19 infection. METHODS: The collaboration involved three large hospital trusts, covering the geographic area of south-east London. All patients were referred to LBH for elective surgery. Patients were followed up by telephone interview at four weeks postoperatively. RESULTS: Three hundred and ninety-eight patients from 13 surgical specialties were included in the analysis. The median age was 60 (IQR 29-71) years. Sixty-three per cent (252/398) were female. In total, 78.4% of patients had an American Society of Anesthesiologists grade of 1-2 and the average BMI was 27.2 (IQR 23.7-31.8) kg/m2. Some 83.6% (336/402) were 'major' operations. The rate of COVID-19-related death in our cohort was 0.25% (1/398). Overall, there was a 1.26% (5/398) 30-day postoperative all-cause mortality rate. Seven patients (1.76%) reported COVID-19 symptoms, but none attended the emergency department or were readmitted to hospital as a result. CONCLUSION: The risk of contracting COVID-19 in our elective operating framework was very low. We demonstrate that high-volume major surgery is safe, even at the peak of the pandemic, if patients are screened appropriately preoperatively.

Neuroprotective Strategies Can Prevent Permanent Paraplegia in the Majority of Patients Who Develop Spinal Cord Ischaemia After Endovascular Repair of Thoracoabdominal Aortic Aneurysms.

OBJECTIVES: Spinal cord ischaemia (SCI) following endovascular thoracoabdominal aortic aneurysm (TAAA) repair is a devastating and unpredictable complication. This study describes a single unit's experience of SCI in patients who have had endovascular TAAA repair. METHODS: A prospectively maintained database of patients having endovascular TAAA repair using branched and fenestrated stent grafts between 2008 and 2014 at a single high volume centre was reviewed. Patients who developed neurological symptoms and signs related to SCI were identified and factors associated with onset and recovery of neurology were analysed. RESULTS: Sixty-nine patients (median age 73 years, 52 male; Crawford classification type I [n = 4], type II [n = 11], type III [n = 33], type IV [n = 14], type V [n = 7]) underwent endovascular TAAA repair. Twelve patients developed neurological symptoms/signs related to SCI but this was successfully reversed in eight patients, leaving four (5.8%) with permanent paraplegia. The median length of aorta covered was not significantly different in the 12 patients who developed SCI compared with the cohort that did not. Eleven of the patients who developed SCI had an intraoperative mean arterial pressure (MAP) below 80 mmHg. Cutaneous atheroemboli were noted in half of the patients in the SCI group compared with 11% of the non-SCI group (p < .05). Strategies used to reverse SCI included raising MAP, cerebrospinal fluid drainage, angioplasty of stenosed internal iliac arteries, and restoring perfusion to the aneurysm sac. CONCLUSIONS: This series highlights some of the risk factors associated with the development of SCI after endovascular repair of TAAAs. It also illustrates the importance of a dedicated institutional protocol aimed at ensuring the early diagnosis of SCI and prompt intervention to reverse permanent paraplegia in the majority of cases.

SILS (single incision laparoscopic surgery) - new surgical approach to peritoneal cavity.

PURPOSE: The objective of the modern surgery is not only to perform surgical procedures aiming to improve the health condition of the patient, but whenever possible to use minimally invasive approach and to ensure the satisfying cosmetic result. During the last years we can observe an intense development of surgical technique minimizing the access to peritoneal cavity to just one small incision, most frequently localized in the umbilicus. MATERIAL/METHODS: Between October 2009 and May 2010 an overall number of 34 laparoscopic procedures through a single abdominal wall incision were performed at the 2nd Department of Surgery, Jagiellonian University, Medical College in Krakow. There were 28 women and 6 men in the study group ranging in age from 19 - 76 years. Among indications for surgery there were: symptomatic gallbladder stones (21 patients), adrenal gland tumours (8 patients), ITP - Immune Thromocytopenic Purpura (2 patients), appendicitis (2 patients) and splenic cyst (one patient). RESULTS: There were 31 out of 34 procedures completed with pure Single Incision Laparoscopic Surgery (SILS) technique as intended preoperatively without any intraoperative complications. In 3 patients additional trocars were needed for safe continuation of the procedure. There were no intraoperative complications. The mean operating time was 82 minutes ranging from 25 minutes (appendectomy) to 180 minutes (right adrenalectomy). Mean intraoperative blood loss was 0 - 30 ccm. CONCLUSIONS: SILS surgical procedures constitute the next step in the development of minimally invasive surgery. In the hands of experienced surgeon this particular technique may constitute a safe alternative for classical laparoscopy.

Treatment of cutaneous T-cell lymphomas with purine analogues (fludarabine and 2-chlorodeoxyadenosine).

PURPOSE: The aim of this study was to evaluate the efficacy and toxicity of the purine analogues 2-chlorodeoxyadenosine (2-CdA) and fludarabine (FAMP) combined with cyclophosphamide (CY) in the treatment of stage III and IV cutaneous T-cell lymphoma (CTCL). PATIENTS AND METHODS: From January 1998 to December 2002, 10 heavily pretreated patients with CTCL, hospitalized at the Department of Dermatology in Wroclaw, were administered monotherapy with 2-CdA (6 patients) or FAMP plus CY combination chemotherapy (4 patients). 2-CdA was administered at a dose of 0.12 mg/kg daily for 7 days every 28 days. FAMP was administered at a dose of 25 mg/m(2) daily, days 1-3, and cyclophosphamide 400 mg/m(2), day 1. The combination was repeated every 28 days. RESULTS: Five out of 6 patients treated with 2-CdA showed a transient partial remission of the skin lesions lasting for a median of 2 months, and 1 patient showed disease progression with dissemination of the skin lesions. Of the 4 patients who received FAMP plus CY 1 achieved complete remission lasting for 6 months, and 2 attained a partial response lasting for a median of 3 months. CONCLUSION: Purine analogues such as 2-CdA and FAMP may be used in the treatment of advanced stages of CTCL. The combination of FAMP plus CY, based on the restrictive effect of FAMP on the repair mechanisms of DNA damaged by CY, seems to be a promising therapeutic modality. Decreased immunity, leucopenia, thrombocytopenia and anaemia are common side effects of 2-CdA and FAMP.

[Ovarian teratomas: some clinical and statistical factors based on 456 patients operated on in the Institute of Gynecology and Obstetrics Academy of Medicine in Lodz]. / Potworniaki jajników: niektóre wspólczynniki kliniczno-statystyczne w oparciu o dane u 456 chorych operowanych w Instytucie Ginekologii i Poloznictwa Akademii Medycznej w Lodzi.

In the years 1977-1994 456 cases of teratomas located in one ovary and 47 in two ovaries were diagnosed. 88,8% of patients were between 16 and 50 years old, with the peak of occurrence between 25 and 30 years. In 5% malignant teratomas were diagnosed.

[Cytologic picture of smears from the cervix uteri of women using intrauterine contraceptive devices (IUD)]. / Obrazy cytologiczne rozmazów z szyjki macicy kobiet stosujacych wewnatrzmaciczne wkladki antykoncepcyjne (wwa).

PIP: During 1986-87, cervical smears were taken at various phases of menstrual cycles from 63 women aged 25-53 (average age of 34.8 years) wearing IUDs for 3 months to 17 years for the sake of cytological evaluation. 43 patients had Copper T-devices of Finnish make, 8 women had Spider Ws of Polish make, 1 had a Lippes Loop, and 10 had IUDs whose manufacturer could not be verified. The samples were preserved in an alcohol-ether solution, dyed with hematoxylin and eosin, and evaluated according to the 5-degree Papanicolaou scale. The presence of granulocytes indicative of inflammation was ranked: few granulocytes (+), the normal count in healthy women during anovulation wearing no IUDs; an adequate number of granulocytes (++); numerous granulocytes (+++); and a high number of granulocytes (++++). Cytogram II of the Papanicolaou scale was found in 49 women, and cytogram I in 14 women. 5 of 25 women wearing IUDs for 3 years had cytogram I, while 20 had cytogram II. Among 21 patients wearing IUDs for 2 years, there were 4 cases of cytogram I and 17 instances of cytogram II. Women with IUD use of 4-17 years were put into the second group, while all 4 of those with 3 months to 1.5 years of IUD use were listed in the first group. The remaining 6 were sorted into the second group. In 45 (71%) women, varying degrees of inflammation were detected in the presence of neutrophilic granulocytes. In 14 cases (22%) the presence of erythrocytes was demonstrated: few in 7 cases, an adequate number of 4, and an excess number in 3 cases caused either by the IUD or by hormone-induced cervical bleeding. Numerous neutrophilic granulocytes were found in 4 cases and a high number of them in 1 case. The granulocyte count was 10 (+), 17 or 16 (++), 12 (+++), and 6 (++++) indicating moderate or severe inflammation in most preparations. The presence of cytologically suspect or atypical cells was absent in the cervical smears of longterm IUD users. In most women, IUD use was associated with inflammation indicated by the increased number of granulocytes. The persistence of such inflammation may justify the removal of the IUD.^ieng

[Some steroid hormone excretion in the urine during gestagen therapy]. / Wydalanie niektórych hormonów sterydowych z moczem w przebiegu leczenia gestagenami.

PIP: The urinary excretion of certain steroid hormones, estrone, estradiol-17(EZ), estriol (E3), 17-ketosteroids and pregnanediol was studied from the vaginal smears of 23 women using gestagens (Anovular and Lyndiol 2.5) as treatment for menstrual disorder, functional sterility, secondary amenorrhea, and endometriosis. The reactivity of women treated with gestagens for genital problems was different from that of women using gestagens as contraceptives. This difference is related to the initial state of the endocrine secretion prior to the therapy. The KI was depressed during the course of the treatment and returned to its normal levels after discontinuation of the drug. Increased urinary excretion of estrogens (especially E2 and E3) was accompanied by low KI values and vice versa. Evaluation of the endocrine activity should be based on both cytologic smears and urinary steroid tests in order to estimate the doses and duration of the therapy.^ieng