Short-term outcomes of single-incision robotic colectomy versus conventional multiport laparoscopic colectomy for colon cancer.

Since the da Vinci SP (dVSP) surgical system was introduced, single-incision robotic surgery (SIRS) for colorectal diseases has gained increasing acceptance. Comparison of the short-term outcomes between SIRS using dVSP and those of conventional multiport laparoscopic surgery (CMLS) was performed to verify its efficacy and safety in colon cancer. The medical records of 237 patients who underwent curative resection for colon cancer by a single surgeon were retrospectively reviewed. Patients were divided into two groups according to surgical modality: SIRS (RS group) and CMLS (LS group). Intra- and postoperative outcomes were analyzed. Of the 237 patients, 140 were included in the analysis. Patients in the RS group (n = 43) were predominantly female, younger, and had better general performance than those in the LS group (n = 97). The total operation time was longer in the RS group than in the LS group (232.8 ± 46.0 vs. 204.1 ± 41.7 min, P < 0.001). The RS group showed faster first flatus passing (2.5 ± 0.9 vs. 3.1 ± 1.2 days, P = 0.003) and less opioid analgesic requirement (analgesic withdrawal within 3 postoperative days: 37.2% vs. 18.6%, P = 0.018) than the LS group. The RS group showed a higher immediate postoperative albumin level (3.9 ± 0.3 vs. 3.6 ± 0.4 g/dL, P < 0.001) and lower C-reactive protein level (6.6 ± 5.2 vs. 9.3 ± 5.5 mg/dL, P = 0.007) than the LS group during the postoperative period. On multivariate analysis after adjusting for deviated patient characteristics, no significant difference was observed in short-term outcomes, except for operation time. SIRS with dVSP showed short-term outcomes comparable with those of CMLS for colon cancer.

Emergency decompression for patients with ureteral stones and SIRS: a prospective randomized clinical study.

OBJECTIVE: Patients with ureteral calculi and systemic inflammatory response syndrome (SIRS) often require emergency drainage, and percutaneous nephrostomy (PCN) and retrograde ureteral stent insertion (RUSI) are the most commonly used methods. Our study aimed to identify the best choice (PCN or RUSI) for these patients and to examine the risk factors for progression to urosepsis after decompression. METHODS: A prospective, randomized clinical study was performed at our hospital from March 2017 to March 2022. Patients with ureteral stones and SIRS were enrolled and randomized to the PCN or RUSI group. Demographic information, clinical features and examination results were collected. RESULTS: Patients (n = 150) with ureteral stones and SIRS were enrolled into our study, with 78 (52%) patients in the PCN group and 72 (48%) patients in the RUSI group. Demographic information was not significantly different between the groups. The final treatment of calculi was significantly different between the two groups (p < .001). After emergency decompression, urosepsis developed in 28 patients. Patients with urosepsis had a higher procalcitonin (p = .012) and blood culture positivity rate (p < .001) and more pyogenic fluids during primary drainage (p < .001) than patients without urosepsis. CONCLUSION: PCN and RUSI were effective methods of emergency decompression in patients with ureteral stone and SIRS. Patients with pyonephrosis and a higher PCT should be carefully treated to prevent the progression to urosepsis after decompression.Key messageIn this study, we evaluate the best choice (PCN or RUSI) for patients who have ureteral stones and SIRS and to examine the risk factors for progression to urosepsis after decompression. This study found that PCN and RUSI were effective methods of emergency decompression. Pyonephrosis and higher PCT were risk factors for patients to develop to urosepsis after decompression.

Effect of enteral immunonutrition compared with enteral nutrition on surgical wound infection, immune and inflammatory factors, serum proteins, and cellular immunity in subjects with gastric cancer undergoing a total gastrectomy: A meta-analysis.

We performed a meta-analysis to evaluate the effect of enteral immunonutrition compared with enteral nutrition on surgical wound infection, immune and inflammatory factors, serum proteins, and cellular immunity in subjects with gastric cancer undergoing a total gastrectomy. A systematic literature search up to November 2021 was done, and 10 studies included 1056 subjects with gastric cancer undergoing a total gastrectomy at the start of the study: 505 of them were provided with enteral immunonutrition, and 551 were enteral nutrition. They were reporting relationships about the effect of enteral immunonutrition compared with enteral nutrition on surgical wound infection, immune and inflammatory factors, serum proteins, and cellular immunity in subjects with gastric cancer undergoing a total gastrectomy. We calculated the odds ratio (OR) or mean difference (MD) with 95% confidence intervals (CIs) to assess the effect of enteral immunonutrition compared with enteral nutrition on surgical wound infection, immune and inflammatory factors, serum proteins, and cellular immunity in subjects with gastric cancer undergoing a total gastrectomy using the dichotomous or contentious method with a random or fixed-effect model. Enteral immunonutrition had no significant difference in the surgical wound infection (OR, 0.77; 95% CI, 0.50-1.19, P = .24), the infectious complication (OR, 0.72; 95% CI, .48-1.09, P = .13), the systemic inflammatory response syndrome (MD, -0.50; 95% CI, -1.40 to 0.39, P = .27), the CD8+ level (MD, 1.34; 95% CI, 0-2.68, P = .05), the CD4+ level (MD, 1.21; 95% CI, -7.65 to 10.07, P = .79), the CD4-CD8+ (MD, 0.55; 95% CI, 0-1.10, P = .05), the lymphocyte (MD, -0.77; 95% CI, -1.87 to 0.33, P = .17), and the transferrin (MD, 0.03; 95% CI, -0.01 to 0.08, P = .14) compared with enteral nutrition in subjects with gastric cancer undergoing a total gastrectomy. However, enteral immunonutrition had significantly higher proalbumin (MD, 22.15; 95% CI, 3.57-40.72, P = .02), IgM (MD, 0.47; 95% CI, 0.43-0.50, P < .001), and IgG (MD, 1.98; 95% CI, 1.08-2.89, P < .001) compared with enteral nutrition in subjects with gastric cancer undergoing a total gastrectomy. Enteral immunonutrition had no significant difference in the surgical wound infection, the infectious complication, the systemic inflammatory response syndrome, the CD8+ level, the CD4+ level, the CD4+/CD8+, the lymphocyte, and the transferrin, and had significantly higher proalbumin, IgM, and IgG compared with enteral nutrition in subjects with gastric cancer undergoing a total gastrectomy. Further studies are required to validate these findings or to affect the confidence level.

The prognostic role of preoperative systemic immune-inflammation index and albumin/globulin ratio in patients with newly diagnosed high-grade glioma.

OBJECTIVE: Preoperative systemic immune-inflammation index (SII) and the albumin/globulin ratio (AGR) have been used as prognostic markers in many malignancies. This study was conducted to evaluate the clinical significance of the preoperative SII and AGR in high-grade glioma (HGG) patients. PATIENTS AND METHODS: A total of 169 patients with newly diagnosed HGG were enrolled in the current study. Overall survival (OS) of these patients was estimated by Kaplan-Meier analyses. Univariate and multivariate Cox regression analyses were performed to examine the relationships between OS and prognostic variables in patients with HGG. RESULTS: The cut-off values for SII and AGR were 324.38 × 109/L and 1.35, respectively. An inverse correlation was observed between SII and AGR. The Kaplan-Meier survival analyses demonstrated that high SII and low AGR were associated with poor OS of patients with HGG (P = 0.002 and P = 0.012, respectively). Multivariate analyses revealed that both SII (HR 1.641, 95% CI: 1.071-2.515; P = 0.023) and AGR (HR 0.566, 95% CI: 0.335-0.956; P = 0.033) were independent predictive indicators of OS of HGG patients. CONCLUSIONS: In conclusion, this study demonstrated that high SII and low AGR values may serve as promising prognostic markers to identify HGG patients with poor prognosis.

Protein Compositions Changes of Circulating Microparticles in Patients With Valvular Heart Disease Subjected to Cardiac Surgery Contribute to Systemic Inflammatory Response and Disorder of Coagulation.

We recently demonstrated that circulating microparticles (MPs) from patients with valvular heart diseases (VHD) subjected to cardiac surgery impaired endothelial function and vasodilation. However, it is unknown whether or not the protein composition of these circulating MPs actually changes in response to the disease and the surgery. Circulating MPs were isolated from age-matched control subjects (n = 50) and patients (n = 50) with VHD before and 72 h after cardiac surgery. Proteomics study was performed by liquid chromatography and mass spectrometry combined with isobaric tags for relative and absolute quantification technique. The differential proteins were identified by ProteinPilot, some of which were validated by Western blotting. Bio-informatic analysis of differential proteins was carried out. A total of 849 proteins were identified and 453 proteins were found in all three groups. Meanwhile, 165, 39, and 80 proteins were unique in the control, pre-operation, and postoperation groups respectively. The unique proteins were different in localization, molecular function, and biological process. The pro-inflammatory proteins were increased in VHD patients and more so postoperatively. Proteins related to coagulation were dramatically changed before and after surgery. The protein composition of circulating MPs was changed in patients with VHD undergoing cardiac surgery, which may lead to activation of the systemic inflammatory response and disorders of coagulation.

Sternal Wires-Induced Severe Systemic Inflammatory Response and Cardiac Tamponade.

Nickel hypersensitivity has been reported in up to 15% of the general population, and cases of nickel allergy have been correlated with use of stainless steel wires. This is a case report of a 48-year-old woman with history of contact allergy to metal who underwent elective coronary artery bypass grafting. Severe systemic inflammatory response and cardiac tamponade due to edema of mediastinal tissues developed postoperatively. The patient required removal of stainless steel wires and delayed sternal closure with Ethibond (Ethicon, Somerville, NJ) sutures in addition to intravenous steroids. In patients with hypersensitivity to nickel, other alternatives closure methods should be considered.

The Relationship Between 18F-FDG Uptake on PET/CT and Markers of Systemic Inflammatory Response in Patients Undergoing Surgery for Intrahepatic Cholangiocarcinoma.

BACKGROUND/AIM: This study evaluated the prognostic relationship between tumor 18F-fluorodeoxyglucose (FDG) uptake on positron-emission tomography (PET)/computed tomography (CT) imaging and markers of systemic inflammatory response (SIR) in patients undergoing surgery for intrahepatic cholangiocarcinoma (ICC). PATIENTS AND METHODS: Between 2002 and 2016, 94 patients with ICC who underwent 18F-FDG-PET scans before surgery were analyzed. 18F-FDG uptake was quantified as a maximum standardized uptake value (SUVmax). The neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR) and C-reactive protein (CRP) were selected as SIR markers. RESULTS: There was no strong correlation between SUVmax and, NLR, PLR and CRP (all Pearson's |r| <0.40). Multivariate Cox regression analyses identified high tumor SUVmax (≥8) and high NLR (≥5) as independent predictors of poor overall survival (p=0.013 and p=0.002) and disease-free survival (p<0.001 and p=0.004). CONCLUSION: Prognostic information provided by tumor SUVmax and SIR markers may be independent prognostic factors in patients undergoing surgery for ICC.

Prognostic Significance of Sarcopenia and Systemic Inflammatory Response in Patients With Esophageal Cancer.

BACKGROUND/AIM: The association between the presence of sarcopenia and systemic inflammatory response is unclear in patients with esophageal cancer. This study was performed to investigate the relationship between sarcopenia and systemic inflammatory response and clarify the effect of these factors on the prognosis in patients with esophageal cancer. PATIENTS AND METHODS: This study included 163 patients with esophageal cancer. The patients' body composition was assessed before esophagectomy using multifrequency bioelectrical impedance. The relationship between sarcopenia and inflammatory factors were investigated before surgery. RESULTS: Sarcopenia was significantly associated with a high C-reactive protein-to-albumin (CRP/Alb) ratio (p=0.046). Patients with sarcopenia significantly associated with worse overall survival (OS) (p=0.025) and tended to show a worse recurrence-free survival (RFS) (p=0.065). A high CRP/Alb ratio was significantly associated with worse OS and RFS. Multivariate analysis revealed that among all inflammatory factors, only a high CRP/Alb ratio was an independent prognostic factor for RFS (p=0.022). CONCLUSION: Sarcopenia is associated with systemic inflammatory response such as high CRP/Alb ratio, while the latter is an independent prognostic marker in patients with esophageal cancer.

Development of a novel UHPLC-MS/MS-based platform to quantify amines, amino acids and methylarginines for applications in human disease phenotyping.

Amine quantification is an important strategy in patient stratification and personalised medicine. This is because amines, including amino acids and methylarginines impact on many homeostatic processes. One important pathway regulated by amine levels is nitric oxide synthase (NOS). NOS is regulated by levels of (i) the substrate, arginine, (ii) amino acids which cycle with arginine and (iii) methylarginine inhibitors of NOS. However, biomarker research in this area is hindered by the lack of a unified analytical platform. Thus, the development of a common metabolomics platform, where a wide range of amino acids and methylarginines can be measured constitutes an important unmet need. Here we report a novel high-throughput ultra-high performance liquid chromatography-tandem mass spectrometry (UHPLC-MS/MS) platform where ≈40 amine analytes, including arginine and methylarginines can be detected and quantified on a molar basis, in a single sample of human plasma. To validate the platform and to generate biomarkers, human plasma from a well-defined cohort of patients before and after coronary artery bypass surgery, who developed systemic inflammatory response syndrome (SIRS), were analysed. Bypass surgery with SIRS significantly altered 26 amine analytes, including arginine and ADMA. Consequently, pathway analysis revealed significant changes in a range of pathways including those associated with NOS.

Volume kinetics of Ringer's lactate solution in acute inflammatory disease.

BACKGROUND: Little is known about the turnover of crystalloid fluids infused in patients with acute systemic inflammation. We hypothesised that systemic inflammation would be associated with altered distribution and elimination of Ringer's lactate solution (volume kinetics). METHODS: Ringer's lactate solution (15 ml kg-1) was infused intravenously over 35 min in patients undergoing cholecystectomy (n=20) or appendectomy (n=20) starting before induction of general anaesthesia. Blood samples and urine were collected over the following 2 h. Plasma concentrations of inflammatory (tumour necrosis factor-α, interleukin-10, and C-reactive protein) and endothelial damage (syndecan-1) biomarkers were quantified by enzyme-linked immunosorbent assay. The volume kinetics was studied using mixed-effect modelling. RESULTS: Ongoing surgery (duration: 30-45 min) increased the rate constant for fluid transfer from the plasma to the extravascular space (k12; from 32 to 57×10-3 min-1; P<0.001), and decreased the elimination rate constant (k10; from 5.3 to 0.6×10-3 min-1; P<0.001). A lower mean arterial pressure was associated with reduced elimination, independent of conscious/anaesthetised state. The redistribution of fluid back to the plasma occurred more slowly in the group with appendicitis (P<0.02), in whom higher plasma concentrations of C-reactive protein were measured [median: 38.1 (range 1.8-143.6) vs 1.3 (0.1-159.0) µg ml-1; P<0.001]. However, no biomarkers for inflammation or endothelial damage were significantly associated covariates in the kinetic model. CONCLUSIONS: No association was found between the volume kinetics of Ringer's lactate solution and the degree of inflammation as indicated by established biomarkers in patients with cholecystitis or appendicitis. However, the rate of elimination was greatly retarded by general anaesthesia in both groups. CLINICAL TRIAL REGISTRATION: ChiCTR-IOR-15006063.

Pressure Sores and Systemic Inflammatory Response Syndrome: UC Davis Quality Improvement Initiative.

BACKGROUND: The National Pressure Ulcer Advisory Panel estimates pressure sore care to approach $11 billion annually. It is not uncommon for these patients to present to the emergency department (ED) with a chief concern of a pressure sore, while concurrently carrying an undiagnosed infectious process that is the culprit for the acute presentation, rather than the chronic pressure injury. We aim to identify patients who met systemic inflammatory response syndrome (SIRS) criteria at ED presentation who were referred to plastic and reconstructive surgery for pressure sore debridement prior to a complete medical workup. We hypothesize that a restructuring of the ED triaging system would help conserve hospital resources, reduce costs of pressure sore management, and improve patient care and outcomes by first treating primary, underlying pathologies. METHODS: This is a retrospective chart review of 36 patients who presented to the University of California, Davis Medical Center Emergency Department with a pressure sore and met SIRS criteria, but obtained a plastic surgery consult prior to a full medical workup. We defined SIRS based on standardized criteria: temperature greater than 100.4°F or less than 96.8°F, pulse rate greater than 90 beats/min, respiratory rate greater than 20 breaths/min or PaCO2 less than 32 mm Hg, white blood cell count greater than 12,000, less than 4000, or greater than 10% bands. RESULTS: Fifty percent of patients (18/36) met SIRS criteria at ED presentation for their pressure sores. Of these SIRS patients, 9 (50%) had a diagnosis of urinary tract infection or urosepsis, 6 (33.3%) had sepsis of undefined origin, and 3 (16.7%) had other diagnoses such as osteomyelitis or acute respiratory distress syndrome. CONCLUSIONS: Half of patients consulted while in the University of California, Davis Medical Center Emergency Department with pressure sores met SIRS criteria and received a plastic and reconstructive surgery consult prior to a full medical workup. We propose a new algorithm for triaging pressure sore patients be established in our institution that emphasizes a medical and surgical collaborative approach in order to reduce cost, conserve resources, and improve patient care.

Microcirculatory response during on-pump versus off-pump coronary artery bypass graft surgery.

OBJECTIVES: The use of cardiopulmonary bypass (CPB) during coronary artery bypass graft surgery (CABG) is associated with a systemic inflammatory response, resulting in altered microcirculation. The aim of this study was to evaluate whether beating heart surgery can preserve the microcirculation. METHODS: Sublingual microcirculation was characterized by a Sidestream Darkfield Imaging Microscope during off-pump (OPCABG) and on-pump (ONCABG) surgery. Microcirculatory parameters were evaluated during eight precise perioperative time points. RESULTS: The quality of the microcirculation decreased during early ONCABG. OPCABG resulted in a significantly better microcirculation compared to ONCABG for three of six parameters during surgery. However, by the end of surgery and postoperatively, the microcirculatory parameters were no different between the groups. CONCLUSIONS: While the results do not show a marked preservation of the microcirculation during and after OPCABG compared to ONCABG, they coincide with the body temperature fluctuations of each group during and after surgery. Our work suggests that active warming could impact the microcirculation parameters.

[Periprosthetic infections in systemic inflammatory rheumatic disease. Review article on diagnostics and therapy]. / Periprothetische Infekte bei rheumatisch-entzündlicher Systemerkrankung. Übersichtsartikel zu Diagnostik und Therapie.

BACKGROUND: Patients with an inflammatory disease have an elevated risk for periprosthetic joint infections due to impairment of the immune system caused by the disease itself in combination with disease-modifying antirheumatic drugs (DMARD). These infections can cause life-threatening sepsis. Unfortunately recommendations on the diagnostics and treatment are mostly based on studies with a level of evidence grade IV or V. OBJECTIVES: This article gives an overview of recent publications evaluating the level of evidence of recommendations on diagnostics and treatment of periprosthetic joint infections in patients with inflammatory diseases. METHODS: A systematic literature search was performed in the Medline database in January and February 2014. The search included all articles on diagnostic and/or treatment of periprosthetic joint infections in patients with inflammatory diseases. Articles in languages other than English or German were excluded, as well as case reports, studies with less than 20 patients and articles only referring to patients with inflammatory diseases without periprosthetic infections. RESULTS: Nearly all recommendations are based on retrospective studies or expert opinions (level of evidence IV or V). Conflicting results are common but there is good evidence on preoperative aspiration of joint fluid (level of evidence I) and a doubled risk of joint infections under treatment with anti-tumor necrosis factor (level of evidence II). An increased mortality has been reported in multiple studies. Two-stage revision seems to have a slightly better outcome than retention of prosthesis or one-stage revision. Generally, therapeutic recommendations for periprosthetic joint infections lack a good level of evidence. Future studies are urgently needed.

[Atrial myxoma with clinical signs of systemic inflammatory disease]. / Vorhofmyxom mit klinischem Bild einer entzündlichen Systemerkrankung.

Atrial myxomas are detectable in 0.3 % of all autopsies and women are affected three times more often than men. The overall incidence of myxoma is relatively rare with 0.5 per one million inhabitants per year. Clinical signs, such as palpitations, dyspnea, dizziness and syncope or thromboembolic events may be found. Microembolic infarction or a higher expression of interleukin 6 may lead to misdiagnosis, such as vasculitis. This article presents the case of a 25-year-old woman with arthralgia, dysesthesia, staggering vertigo, cutaneous nodules and disturbed vision. Diagnostic procedures did not reveal a reason for these complaints. A therapeutic test with prednisolone did not improve the symptoms. Finally echocardiography showed a large space-occupying lesion in the left atrium which oscillated into the left ventricle during diastole. The patient was transferred to the department of cardiac surgery where the atrial myxoma could be removed without any complications and the patient ultimately made a complete recovery.

Diagnostics, therapy and outcome prediction in abdominal sepsis: current standards and future perspectives.

PURPOSE: In the perioperative phase, sepsis and sepsis-associated death are the most important problems for both the surgeon and the intensivist. Critically ill patients profit from an early identification and implementation of an interdisciplinary therapy. The purpose of this review on septic peritonitis is to give an update on the diagnosis and its evidence-based treatment. RESULTS: Rapid diagnosis of sepsis is essential for patient´s survival. A bundle of studies was performed on early recognition and on new diagnostic tools for abdominal sepsis. Although surgical intervention is considered as an essential therapeutic step in sepsis therapy the time-point of source control is still controversially discussed in the literature. Furthermore, the Surviving Sepsis Campaign (SSC) guidelines were updated in 2012 to facilitate evidence-based medicine for septic patients. CONCLUSION: Despite many efforts, the mortality of surgical septic patients remains unacceptably high. Permanent clinical education and further surgical trials are necessary to improve the outcome of critically ill patients.

[Pathophysiology of multiple trauma : intensive care medicine and timing of treatment]. / Pathophysiologie des Polytraumas : Intensivmedizin und "Timing" der Versorgung.

After severe multiple injuries (first hit) a two-phase immunological response with early hyperinflammation followed by immunosuppression can be observed. This process involves a variety of humoral and cellular factors. Depending on the individual predisposition, overall injury severity and injury pattern, both reactions can lead to sepsis and multiorgan failure. Various clinical and intensive care parameters indicate stabilization of specific organ functions. The clinical course can be positively influenced by adequate intensive care therapy, avoiding iatrogenic second hits by non-emergency surgical interventions during a phase of immunological dysregulation. Important decision parameters besides time to initial trauma include adequate oxygenation, no coagulopathy, declining inflammatory mediators and normalized serum lactate.

Trefoil factor 2 expression and its significance as a predictor of severity of sepsis in children.

Intestinal injury significantly contributes to critical illness, sepsis and multiorgan failure. TFF2 (Trefoil Factor 2) is expressed and secreted preferentially by gastric mucous neck cells. TFF2 gene expression is promptly increased after gut injury, and its expression profile broadens to include the regenerative epithelia of virtually the entire gastrointestinal tract. The first objective of our study was an analysis of TFF2 levels dynamics in patients with Systemic Inflammatory Response Syndrome (SIRS) or septic condition during a 5-day period after admission. The second objective was to determine optimal cut-off value and quantify diagnostic characteristics of TFF2 between controls and patients with various septic states. The study included 57 children aged 0-19 years, with expected or proven SIRS and septic condition. The degree of severity was evaluated according to PELOD Score (Pediatric Logistic Organ Dysfunction). Blood samples to determine levels of TFF2 factor were taken during the time patient met the criteria of SIRS or sepsis. Control group samples to determine the serum levels of TFF2 were taken from patients undergoing elective surgery. Analysis of TFF2 levels dynamics revealed that TFF2 levels kept steady state during the 5-day period. Significantly higher levels of TFF2 were in patients with Multiple Organ Dysfunction Syndrome (MODS). The difference was noticed also in ROC analysis.

Laparoscopic versus open Hartmann procedure for the emergency treatment of diverticulitis: a propensity-matched analysis.

BACKGROUND: A laparoscopic approach has been proposed to reduce the high morbidity and mortality associated with the Hartmann procedure for the emergency treatment of diverticulitis. OBJECTIVE: The objective of our study was to determine whether a laparoscopic Hartmann procedure reduces early morbidity or mortality for patients undergoing an emergency operation for diverticulitis. DESIGN: This is a comparative effectiveness study. A subset of the entire American College of Surgeons National Surgical Quality Improvement Program patient sample matched on propensity for undergoing their procedure with the laparoscopic approach were used to compare postoperative outcomes between laparoscopic and open groups. SETTING: This study uses data from the American College of Surgeons National Surgical Quality Improvement Program Participant User Files from 2005 through 2009. PATIENTS: All patients who underwent an emergency laparoscopic or open partial colectomy with end colostomy for colonic diverticulitis were reviewed. MAIN OUTCOME MEASURES: The main outcome measures were 30-day mortality and morbidity. RESULTS: Included in the analysis were 1186 patients undergoing emergency partial colectomy with end colostomy for diverticulitis. Among the entire cohort, the laparoscopic group had fewer overall complications (26% vs 41.7%, p = 0.008) and shorter mean length of hospitalization (8.9 vs 11.6 days, p = 0.0008). Operative times were not significantly different between groups. When controlling for potential confounders, a laparoscopic approach was not associated with a decrease in morbidity or mortality. In comparison with a propensity-match cohort, the laparoscopic approach did not reduce postoperative morbidity or mortality. LIMITATIONS: This study is limited by its retrospective nature and the absence of pertinent variables such as postoperative pain indices, time for return of bowel function, and rates of readmission. CONCLUSIONS: A laparoscopic approach to the Hartmann procedure for the emergency treatment of complicated diverticulitis does not significantly decrease postoperative morbidity or mortality in comparison with the open technique.

Simultaneous appearance of leukemoid reaction and phlegmasia cerulea dolens.

A leukemoid reaction is an extreme form of reactive leukocytosis defined as granulocytic leukocytosis above 50 × 10(9)/L produced by normal bone marrow, mostly in response to systemic infection or cancer. The mechanism as to how the haematopoetic system is altered to elevate production of myeloid cells is not known. A 69-year-old man presented with phlegmasia cerulea dolens caused by massive iliofemoral thrombosis. His workout at admission revealed absolute white blood cell count of 73.4 × 10(9)/L, with neutrophil granulocyte of 68.5 × 10(9)/L. The new increase in white blood cell count happened at day 5 after admission, when the haematoma of the anteromedial thigh was evacuated in general anaesthesia. There was a gradual decrease in counts until they reached the normal range. Deteriorated general condition with signs of systemic inflammatory response syndrome improved with supportive therapy, and the patient was discharged from hospital after 30 days. During hospitalization we did not identify any infectious focus, or any malignancy. We could not exclude other occult chronic conditions (malignancy) but the patient did not develop any other condition during 4.5 years of follow-up.