Accuracy and inter-operator variability of small bowel length measurement at laparoscopy.

BACKGROUND: Measurement of bowel length is an essential surgical skill for laparoscopic and open gastrointestinal surgery in order to achieve favorable outcomes and avoid long-term complications. Variations in accuracy between the two surgical approaches may exist. However, only few studies have tried to assess these differences. Our aim was to assess reliability and inter-rater variability of small bowel length assessment during laparoscopy in an in vivo porcine model. METHODS: This is a single-institution, double-blinded, technical assessment study in a porcine in vivo model. Fourteen participants (ten senior surgeons with >1000 laparoscopic procedures and four junior surgeons) had to assess and mark lengths of small bowel in both laparoscopic and open surgical approaches. Each participant was assigned to measure and mark specific, randomized distances (range 25-197 cm) in both laparoscopic and open approaches using color-coded vessel loops. Actual participant-marked distances were compared to the assigned distances followed by Bland-Altman plots and linear regression analysis to determine accuracy and proportional error trends. Study data were further compared to available data sets from previously published studies. RESULTS: Laparoscopy measurements were significantly shorter than required (difference 33.8 ± 28.7 cm, P < 0.001, 95% CI 17.8-49.7). The measuring error was proportional to the length of the measured segment (63% of the required distances, IQR 58.9-79.0%, P = 0.02). At laparotomy, mean difference and standard deviation were lower (1.5 cm ± SD 15 cm) and not statistically significant (P = 0.7). Re-analysis of previously published data sets validated the observed errors in laparoscopic bowel measurement (P < 0.01). CONCLUSIONS: Small bowel length assessment during laparoscopy is inaccurate and associated with substantial variability. There is a need to develop a standardized laparoscopic technique for measuring small bowel length which is simple, reproducible, and easy to learn.

Treatment of Cystic Echinococcosis in Children: A Single Center Experience.

BACKGROUND: Cystic echinococcosis (CE) treatment is complicated, relying on cysts characteristics, host factors and possible treatment adverse events. We assessed childhood CE treatment characteristics. METHODS: A retrospective cohort study, 2005-2021, which presents our experience with treating children with CE. We compared therapeutic interventions use in association with the location, size and number of cysts. Additionally, we assessed complications rate following those interventions. RESULTS: Sixty six children had CE; 97% were Bedouins. Overall, 183 cysts were identified in 74 organs: liver (n = 47, 64%), lungs (n = 23, 31%), brain, para-ovarian, kidney and peritoneum (other-grouped, n = 4, 5%). Mean ± Standard deviation largest cyst size (per patient) was 6.6 ± 3.2 cm. Treatment with albendazole was administered to 94% of CE, while albendazole monotherapy was used in 27% (n = 18, including 4 cases with extra-hepatic cysts). Surgical interventions included drainage/puncture, aspiration, injection and reaspiration (PAIR; n = 20), mainly performed in hepatic-CE (40% vs. 4% in pulmonary-CE, and 0% in other-CE), excision and drainage (n = 34) and complete excision (n = 10), mainly done in other-CE (50% vs. 26% and 4% in pulmonary-CE and hepatic-CE, respectively). Larger cyst size was associated with complete excision compared with albendazole monotherapy. The number of cysts was not associated with the chosen intervention. Fever was recorded following 39% of surgical interventions. Local surgical complications were relatively rare. CONCLUSIONS: Cysts location and size affected treatment choice among CE patients. Procedures with drainage had relatively higher rate of complications, including recurrence. Albendazole monotherapy may be a viable therapeutic option in selected CE cases.

Natural antioxidants from tomato extract reduce blood pressure in patients with grade-1 hypertension: a double-blind, placebo-controlled pilot study.

BACKGROUND: Treatment of hypertension (HT) can reduce the risk for cardiovascular diseases. Tomato extract contains carotenoids such as lycopene, beta carotene, and vitamin E, which are known as effective antioxidants, to inactivate free radicals, and to slow the progression of atherosclerosis. The purpose of our study was to evaluate the effect of tomato extract on systolic and diastolic blood pressure in grade-1 HT, on serum lipoproteins, plasma homocysteine, and oxidative stress markers. METHODS: This study is a single-blind, placebo-controlled trial. Thirty-one subject with grade-1 HT, without concomitant diseases, who required no antihypertensive or lipid-lowering drug therapy, who were recruited from primary care clinics, completed the trial. Subjects entered a 4-week placebo period, then an 8-week treatment period with tomato extract, 250 mg Lyc-O-Mato, and a 4-week control period with placebo. RESULTS: Systolic blood pressure decreased from 144 (SE +/- 1.1) to 134 mm Hg (SE +/- 2, P < .001), and diastolic blood pressure decreased from 87.4 (SE +/- 1.2) to 83.4 mm Hg (SE +/- 1.2, P < .05). No changes in blood pressure were demonstrated during placebo periods. Thiobarbituric acid-reactive substances, a lipid peroxidation products marker, decreased from 4.58 (SE +/- 0.27) to 3.81 nmol/mg (SE +/- 0.32, P < .05). No significant changes were found in lipid parameters. CONCLUSIONS: A short-term treatment with antioxidant-rich tomato extract can reduce blood pressure in patients with grade-1 HT, naive to drug therapy. The continuous effect of this treatment and the long-term beneficial effect on cardiovascular risk factors still need to be demonstrated.

Clinicopathologic Presentation and Natural History of Anorectal Melanoma: A Case Series of 18 Patients.

Anorectal melanoma is a rare malignant neoplasm with variable natural history and nonspecific presentation. We describe the clinicopathologic and prognostic parameters of a series of 18 patients (16 [88.9%] white; 10 [55.6%] male; median age, 64.0 years [interquartile range, 45.8-74.3 years]) with histologically proven anorectal melanoma treated at our institution during a 21-year period between October 1991 and August 2012. Late diagnosis was common (44.5% of patients had stage II disease or worse at diagnosis), likely owing to a delay in presentation, nonspecific presenting symptoms, and frequent incorrect diagnoses (16 cases [88.9%]). Overall disease-specific mortality was 66.7% (12 of 18 patients), with a median time to death of 15.5 months (interquartile range, 7.3-25.5 months). Disease-specific survival was significantly better following wide local excision vs abdominoperineal resection (P = .04), although patients undergoing the former tended to have fewer rectal lesions (P = .04), smaller lesions (P = .02), and a trend toward less advanced stage (P = .06). Larger studies assessing optimal medical and surgical management for anorectal melanoma are needed to improve outcomes.