Superiority of the sonication method against conventional periprosthetic tissue cultures for diagnosis of prosthetic joint infections.

INTRODUCTION: Diagnosis of periprosthetic infections is challenging. The aim of this study was to compare the diagnostic accuracy of conventional periprosthetic tissue culture and culture of sonication fluid of the explanted prostheses. METHODS: We prospectively enrolled 114 patients undergoing revision hip or knee arthroplasty because of loosening of the prostheses, at our institution, between July 2012 and July 2016. Patients' medical history and demographic characteristics were recorded. The explanted hardware was separated in sterile containers and sonicated under sterile conditions. At least five samples of periprosthetic tissue were sent for culture and histological examination. We compared the culture of samples obtained by sonication of explanted hip and knee prostheses with conventional culture of periprosthetic tissue for the microbiological diagnosis of prosthetic joint infection. RESULTS: Infectious Diseases Society of America guidelines were used for the definition of prosthetic joint infection. Sixty-one patients had periprosthetic infection and 53 aseptic loosening (73 hip prostheses and 41 knee prostheses). The sensitivity of sonication fluid culture was 77.04%, and the sensitivity of conventional tissue cultures was 55.73% (p value = 0.012). The specificities of the two methods were 98.11 and 94.34%, respectively. The sensitivity of the histopathological examination of the periprosthetic tissue was 72.10%. There were 17 patients with PJI where the isolated pathogen was detected in SFC but not in PTC, while in five cases the pathogen was detected only in PTC. There were nine patients where no bacteria were detected by any microbiological method and the diagnosis was based on clinical and histological findings, according to the guidelines. CONCLUSIONS: The sonication method represents a reliable test for the diagnosis of prosthetic joint infections with a greater sensitivity and specificity than the conventional periprosthetic tissue cultures.

Fast-track recovery after major liver and pancreatic resection from the nursing point of view.

Postoperative fast-track recovery protocols combine various methods to support immediate care of patients who undergo major surgery. These protocols include control of postoperative pain and early beginning of oral diet and mobilization. The combination of these approaches may reduce the rate of postoperative complications and facilitate hospital discharge. The aim of this study was to evaluate progress and parameters of fast-track recovery after major liver and pancreatic resection. A descriptive bibliographical review from 2001 to 2012 via electronic databases such as MEDLINE, PubMed, and Google Scholar was undertaken. Articles that focused on a fast-track protocol were studied. Reports focusing on the implementation of a fast-track protocol in the postoperative recovery of patients after major hepatectomy or pancreatectomy were selected. Fast-track protocols may be applicable to patients recovering after major liver or pancreatic resection. Future research should be focused on particular parameters of the fast-track protocol separately.

Investigation of the Use of Circulating Long Non-coding RNA HOXA Transcript at the Distal Tip (LncRNA HOTTIP) as a Biomarker in Breast Cancer.

The critical need for new diagnostic and prognostic methods is highlighted by the fact that breast cancer continues to be the top cause of cancer-related deaths globally. Due to the dysregulation of long non-coding RNAs (lncRNAs) in numerous malignancies, they have become potential biomarkers in cancer. Recent research has focused on the lncRNA HOTTIP (HOXA transcript at the distal tip), which has a function in breast cancer metastasis and carcinogenesis. Until recently, HOTTIP had only been measured in cancer tissues and specimens. The aim of this study is to assess the amounts of the lncRNA HOTTIP in the blood serum of 46 breast cancer patients using real-time PCR analysis and identify the relationships between HOTTIP expression and several known clinical and pathological factors, including tumor grade, stage, lymph node involvement, hormone receptor status, and cell proliferation. The results of the study confirmed a positive relation of HOTTIP expression and breast cancer aggressiveness and metastatic behavior. The analysis results showed elevated HOTTIP values in stage III and T3/T4 tumors with multifocal characteristics and in lymph node involvement. Our findings raise the possibility of HOTTIP serving as a future prognostic biomarker for breast cancer patients.

Evidence based electronic system to ensure quality of care in trauma patients.

Electronic patient records are important for quality health services. Aim of this study is to support the trauma patient care with the development of an electronic system. A survey was conducted in the Emergency Department (ED) of a University hospital to study the effectiveness of an electronic monitoring system in a group of trauma patients, as well as the acceptance of this electronic system by the health professionals of the ED. A questionnaire collected information about the perceptions of 50 health professionals working in the ED on various aspects of patient care. The 86% (Nu=43) replied that there is lack of staff working in their department, 44% (N=22) is satisfied with the co-operation with other departments and 48% (N=24) believe that they spend precious time in administrative work during the care. For the purpose of a more efficient patient monitoring there was developed an electronic trauma patient monitoring system which was evaluated by the above mentioned professionals. The severity, length of care and the health outcomes of 200 trauma patients, were investigated. Half of the patients (N=100) have been monitored by the electronic system and the other 100 were monitored without the use of the system. The time between the admission and completion of the planned care was significantly lower in the electronic monitoring patient group (100±92 minutes) compared to the control group (149±29 minutes).

Prospective comparison of peritumoral and subareolar injection of blue dye alone, for identification of sentinel lymph nodes in patients with early stage breast cancer.

BACKGROUND AND OBJECTIVES: Various techniques are used for the identification of the sentinel node (SLN). We prospectively compare the efficacy of SLN biopsy and the number of SLNs identified, by injecting methylene blue (MB) alone in the subareolar area (SA) or peritumorally (PT) in patients with early stage breast cancer. METHODS: Patients were randomized in two groups (SA or PT injection). A linear regression model was used to estimate the effect of various parameters on the identification rate and on the number of SLNs retrieved. RESULTS: At least one SLN was identified in 61 of 66 (92.4%) procedures in the SA group and in 57 of 60 (95%) procedures in the PT group (P = 0.55). The mean number of SLNs removed with the SA injection method was 1.64 ± 0.6 nodes compared with 2.23 ± 0.7 nodes identified with the PT injection (range: 1-4, P < 0.001). The injection site was the only factor affecting the number of SLNs retrieved. CONCLUSION: The use of MB alone is an efficient method for identification of the SLN. The PT injection route yields a higher number of SLNs than the SA route, comparable with the number of SLNs retrieved, when combined tracing agents and multiple injection sites are used.

Breast angiosarcoma that is not related to radiation exposure: a comprehensive review of the literature.

Breast angiosarcomas that are not related to previous radiotherapy are very rare. Surgical resection is the primary treatment for these tumors, but there is no general agreement on the extent of surgery. The role of multimodality adjuvant treatment also remains controversial. The aim of this study was to summarize the available data from the largest published series of patients in terms of management and outcome. We also sought to identify prognostic factors influencing patient survival. We have included studies presenting detailed data on multimodality therapy and survival of patients with breast angiosarcoma. Ten studies presenting data on 280 patients were included in the review. Seventy-five percent of patients underwent a total mastectomy and 25% had breast-conserving treatment (BCT). In 42% of patients, an axillary node dissection was combined with mastectomy or BCT. Thirty-six percent of patients received chemotherapy and 35% were treated with radiotherapy in an adjuvant or neoadjuvant setting. Survival varied significantly according to tumor size and grade. Adjuvant multimodality therapy may improve the outcome in selected patients with breast angiosarcoma. Tumor size, grade, and margin status are the most important prognostic factors for survival.

Necessity of the Periodical Ultrasound Assessment of the Peripheral Venous System in Intensive Care Unit Patients.

The utility of periodic sonographic assessment and monitoring for early diagnosis of deep vein thrombosis (DVT) in patients hospitalized in intensive care units (ICUs) was investigated. Of 314 patients hospitalized in an ICU over a 24-mo period, 248 were examined. The first examination of the patients was carried out within the first 48 h of ICU admission, and weekly examination followed until discharge. Peripheral veins were examined according to the general principles of the ultrasound study using the compression test in B-mode imaging (image to gray scale). The criterion for the absence or presence of a clot within the lumen was the presence or absence of full compressibility of the venous lumen, respectively. Intermittent compression was applied to multiple cross sections along the entire extent of the limbs. Three patients (1.2%) were diagnosed with sub-clinical DVT. The diagnoses were made on the third (sapheno-femoral junction), fourth (right internal jugular) and fifth (left gastrocnemius) weeks of hospitalization, respectively, although patients received full anticoagulation prophylaxis. DVT in a general-population ICU patient on anticoagulation prophylaxis did not seem to occur very frequently, and hence, regular ultrasound monitoring is not recommended. However, it may have value after the third week or in a selected population of ICU patients with very severe and/or multiple predisposing factors or who are not undergoing anticoagulant treatment because of contraindications.

Evaluation of a Laboratory e-Learning Course in Health Informatics.

The current paper presents the students' evaluation of a laboratory e-learning course in Health Informatics. After attending the e-learning course, students assessed the e-learning course through an anonymous questionnaire. The study results present the positive attitude of the students towards the e-learning course in Health Informatics. The current e-learning course is easy to use, and it is preferred on the same extent as the hybrid one (e-learning and in-class learning combination). The majority of the participants believed that the e-learning method is at least the same or more efficient compared to the traditional learning approach. Based on the study findings, it seems that this e-learning course could offer important advantages on the learning process as long as it helps students learn in a more effective manner than traditional learning.

Soil contamination by Toxocara canis and human seroprevalence in the Attica region, Greece.

BACKGROUND: Toxocara canis is one of the most widespread public health and economically important zoonotic parasitic infections humans share with canids, mainly dogs. Human infection occurs by the accidental ingestion of embryonated eggs or larvae from a range of wild and domestic paratenic hosts. The aim of the present study was to examine the soil contamination of public places by the parasitic ova and to estimate serologically the prevalence of T. canis human infection in the Attica region, Greece. METHODS: In this region, public areas are permanently inhabited by dogs, mostly stray dog population that is hardly kept down to a manageable level. A total of 1,510 soil samples were collected from 33 public places of six regional units of Attica from March 2014 to April 2014 and ova were detected using a microscopic assay. In addition, sera were collected from 250 residents, routinely active in the sampled areas, and tested for T. canis IgG antibodies using an enzyme immunoassay. RESULTS: T. canis eggs were isolated from 31 (94%) of the examined public areas. Of the total samples, T. canis ova were recovered from 258 samples, suggesting an overall T. canis ova contamination of 17.2%. The areas of higher socioeconomic status presented lower percentages of soil contamination in a statistically significant level, compared to the areas of lower socioeconomic status. T. canis IgG seropositivity was detected in 40 (16%) serum samples. Similar rates were established among T. canis seropositivity and soil contamination within the same geographical areas. The proportion of seropositive samples in the group of children was significantly higher compared to the proportion of adults (48% versus 8%, p<0.001). CONCLUSION: The level of environmental T. canis contamination as well as human infection found in the Attica region calls for a greater awareness towards this public issue. Preventing measures should be implemented to control the spread of this parasitic infection.

Surgical anatomy of double pyramidal lobe on total thyroidectomy: a rare case report.

Double pyramidal lobe is a scarce anatomical variation of the thyroid gland. Its presence impinges on the completeness of total and subtotal thyroidectomy and the postoperative treatment. Surgeons should be always aware of this variation in order to perform sufficient resection of the thyroid gland and minimize the possibility of recurrence of benign and malignant thyroidopathies.

Aberrant subvesical bile ducts identified during laparoscopic cholecystectomy: A rare case report and review of the literature.

INTRODUCTION: Aberrant subvesical bile ducts are a scarce anatomical variation, consisted by a network of bile ducts located in the peri-hepatic capsule of the gallbladder fossa. These rare ducts are usually discovered intraoperatively and their presence poses the risk of bile injury and clinically significant bile leak. PRESENTATION OF CASE: Aberrant subvesical bile ducts were unexpectedly identified in a young woman during laparoscopic cholecystectomy. These three ducts were clipped carefully for avoidance of bile duct injury and subsequent bile leak. The operation was uneventful. A meticulous review of the recent literature was conducted as well. DISCUSSION: This unusual anatomical variation of the biliary tract is mainly discovered during the operation. Thus, surgical injury of these ducts is nearly inevitable and it provokes the severe complication of bile leak. Bile injury represents the most crucial and life-threatening postoperative complication of cholecystectomies. Surgeons in the right upper quadrant of the abdomen should be constantly aware of this rare anatomical variation. CONCLUSION: Aberrant subvesical bile ducts are associated with a high risk of surgical bile duct injury. Nevertheless, meticulous operative technique combined with surgeons' perpetual awareness concerning this peculiar anatomical aberration leads to a safe laparoscopic cholecystectomy.

Left-sided gallbladder (Sinistroposition) encountered during laparoscopic cholecystectomy: A rare case report and review of the literature.

INTRODUCTION: True Left-sided gallbladder (LSG) is a rare anatomical variation with a prevalence of 0.3%. Mainly discovered during the operation, its surgical approach in the laparoscopic setting may be challenging even for an experienced surgeon. PRESENTATION OF CASE: LSG was unexpectedly discovered in a young man during laparoscopic cholecystectomy. There were no pre-operative indications of this sinistroposition. The laparoscopic cholecystectomy was performed with minor surgical modifications and it was uneventful. A meticulous review of recent literature about LSGs was conducted as well. DISCUSSION: LSG is a scarce anatomical aberration that is difficultly identified pre-operatively. Surgeons should be aware of this aberration and of its accompanying anatomical variations in order to perform a safe laparoscopic cholecystectomy. CONCLUSION: Surgeons, by placing the patient to left-side up position, are able to expose the Calot's triangle and possible accompanying anatomical anomalies and thus perform a safe laparoscopic cholecystectomy without difficult surgical modifications.

Leiomyomatosis peritonealis disseminata: A case report and meticulous review of the literature.

INTRODUCTION: Leiomyomatosis peritonealis disseminata (LPD) is a peculiar benign clinical disorder characterized by proliferation of peritoneal and subperitoneal nodules. LPD is a difficultly diagnosed benign disease that rarely degenerates into malignancy. PRESENTATION OF CASE: A 40-year-old Caucasian female with vaginal bleeding proceeded to our institution for elective excision of abdominal and pelvic masses which were firstly considered as leiomyosarcomas. The histologic diagnosis of the mass lesions revealed smooth muscle benign cells. This is the first case of LPD reported in Greece. A meticulous review of the literature was conducted as well. DISCUSSION: The differential diagnosis of LPD is difficult due to its clinical resemblance with peritoneal carcinomatosis or metastatic lesions and with benign metastasizing leiomyoma (BML) as well. Etiological factors, pathophysiology and clinical manifestations which lead to a safe diagnosis of LPD are adequately described. CONCLUSION: Surgeons' thorough knowledge concerning this rare clinical condition is fundamental and crucial in order to establish a correct diagnosis and assert the appropriate treatment and the minimization of the probability of malignant transformation of LPD.

The effect of a multimedia health educational program on the postoperative recovery of patients undergoing laparoscopic cholecystectomy.

Aim of this study is the evaluation of the impact of preoperative informative session using a Multimedia Health Educational Program (MHEP) on patients undergoing elective Laparoscopic Cholecystectomy (LC) for cholelithiasis, preoperative anxiety and postoperative pain and nausea. Sixty consecutive patients scheduled for elective LC were considered for enrollment in the trial. Patients were assigned randomly to four groups: Group A included 15 patients, preoperatively informed regarding LC through the MHEP presented by a Registered Nurse (RN). Group B included 15 patients preoperatively informed through a leaflet (designed and developed using the exact contents of the MHEP). In Group C, there were 15 patients who were being informed verbally from the RN. Finally, the control Group D included 15 patients, who had the conventional preoperative information about the operation and postoperative course by the attending surgeon and anesthesiologist, as every other patient included in groups A, B, C. Preoperative assessment of patient's knowledge about cholelithiasis and LC was performed after informative session, and was based on a specifically developed "closed, true-false" questionnaire. Preliminary results suggest that conventional information provided by the attending surgeon (Group D) is inadequate. Specifically developed informative sessions with the contribution of MHEP seems to be effective on reducing preoperative anxiety and postoperative pain, in patients undergoing elective LC.

The e-Learning Effectiveness Versus Traditional Learning on a Health Informatics Laboratory Course.

This paper presents a comparison between e-Learning and traditional learning methods of a University course on Health Informatics domain. A pilot research took place among University students who divided on two learning groups, the e-learners and the traditional learners. A comparison of the examinations' marks for the two groups of students was conducted in order to find differences on students' performance. The study results reveal that the students scored almost the same marks independently of the learning procedure. Based on that, it can be assumed that the e-learning courses have the same effectiveness as the in-classroom learning sessions.