Visual Impairment in Hemodialyzed Patients-An IVIS Study.

Background and Objectives: The growing and aging population of hemodialysis patients has become increasingly disabled, with more complex comorbidities, and are older upon initiating dialysis. Visual impairment can adversely affect their quality of life and life satisfaction. Treatment evaluation should not only consider remission of the disease, but also the improvement of quality of life and life satisfaction. This is a single-center cross-sectional study. It was designed to evaluate visual impairment in hemodialyzed patients, its correlation with quality of life and life satisfaction, and its relationship to clinical outcomes in hemodialyzed patients. Materials and Methods: Seventy patients with chronic kidney disease undergoing hemodialysis and aged 18 years or older were recruited from a single Dialysis Unit. The Impact of Visual Impairment Scale (IVIS), WHOQOL-BREF, and Cantril Ladder questionnaires were utilized to assess both sociodemographic and clinical variables. Results: It was found that, among all assessed variables (i.e., sex, marital status, level of education, months on hemodialysis, history of kidney transplantation, Kt/V, URR, and UF), only age and central venous catheter placement were positively correlated with IVIS scores, while arteriovenous fistula and willingness to become a kidney transplant recipient were negatively correlated. Furthermore, a comparison between patients with moderate and severe visual impairment yielded supplemental data indicating that individuals whose dialysis access was through a dialysis catheter and those ineligible or unwilling to undergo transplantation suffered more often from severe visual impairment. This finding may be attributed to age. Conclusions: Older patients were predominantly observed to experience visual impairment. Patients intending to receive a kidney transplant and whose dialysis access was through an arteriovenous fistula were less prone to visual impairment, compared to those who may be ineligible or unwilling to receive transplantation and those with hemodialysis catheters. This phenomenon can be attributed to age-related distinctions in patients' suitability for specific dialysis access and transplantation. Those reporting visual impairment gave lower ratings in all four domains of their quality of life (comprising physical health, psychological health, social relationships, and environment) and in both present and anticipated five-year life satisfaction. More severe visual impairment was related to an additional reduction in physical health, social relationship, and environment domains, and in life satisfaction.

Return to play after brain tumor surgery in children.

PURPOSE: Children with a history of brain tumors do not appear to be at a significantly higher risk of sports-related injuries. Nevertheless, according to the systematic review and survey conducted by Perreault et al., 75% of healthcare professionals restrict their patients' participation in physical activities after brain tumor surgery. The aim of our study was to verify whether children after brain tumor surgery return to physical education (PE) classes. It was also an attempt to explore factors limiting return to physical activity. METHODS: Patients after brain tumor surgery, ≤ 18 years old on admission with ≥ 1 year follow-up were included in the analysis. Data concerning the disease were collected and summarized in search of factors limiting return to physical activity. Meticulous information about return to sports and physical education at school was gathered during follow-up visits. RESULTS: 71.43% of patients returned to school sports activities. Children who did not return to PE had markedly higher neoplasm WHO grade. Significant differences were also found between the groups in terms of hydrocephalus occurrence and need for additional oncological treatment. In univariate analysis, we identified neoplasm WHO grade, tumor location, presence of neurological deficit after the procedure, additional oncological treatment, and occurrence of hydrocephalus needing shunting as the risk factors for not returning to school physical education. CONCLUSIONS: The majority of pediatric brain tumor survivors return safely to physical education. Higher neoplasm WHO grade, presence of neurological deficit after the procedure, additional oncological treatment, and occurrence of hydrocephalus are risk factors for not returning to physical education.

Decision-making based on 3D printed models in laparoscopic liver resections with intraoperative ultrasound: a prospective observational study.

OBJECTIVES: The aim of this study was to evaluate impact of 3D printed models on decision-making in context of laparoscopic liver resections (LLR) performed with intraoperative ultrasound (IOUS) guidance. METHODS: Nineteen patients with liver malignances (74% were colorectal cancer metastases) were prospectively qualified for LLR or radiofrequency ablation in a single center from April 2017 to December 2018. Models were 3DP in all cases based on CT and facilitated optical visualization of tumors' relationships with portal and hepatic veins. Planned surgical extent and its changes were tracked after CT analysis and 3D model inspection, as well as intraoperatively using IOUS. RESULTS: Nineteen patients were included in the analysis. Information from either 3DP or IOUS led to changes in the planned surgical approach in 13/19 (68%) patients. In 5/19 (26%) patients, the 3DP model altered the plan of the surgery preoperatively. In 4/19 (21%) patients, 3DP independently changed the approach. In one patient, IOUS modified the plan post-3DP. In 8/19 (42%) patients, 3DP model did not change the approach, whereas IOUS did. In total, IOUS altered surgical plans in 9 (47%) cases. Most of those changes (6/9; 67%) were caused by detection of additional lesions not visible on CT and 3DP. CONCLUSIONS: 3DP can be helpful in planning complex and major LLRs and led to changes in surgical approach in 26.3% (5/19 patients) in our series. 3DP may serve as a useful adjunct to IOUS. KEY POINTS: • 3D printing can help in decision-making before major and complex resections in patients with liver cancer. • In 5/19 patients, 3D printed model altered surgical plan preoperatively. • Most surgical plan changes based on intraoperative ultrasonography were caused by detection of additional lesions not visible on CT and 3D model.

"Analysis of readmissions to the emergency department among patients presenting with abdominal pain".

BACKGROUND: Abdominal pain is one of the most common complaints among patients admitted to the Emergency Department (ED). Diagnosis and management of abdominal pain may be a challenge and there are patients who require admission to the ED more than once in a short period of time. Our purpose was to assess the incidence of readmissions among patients treated in the ED due to abdominal pain and to investigate the impact of readmission on the further course of treatment. METHODS: We conducted a prospective observational study, which included patients admitted to the ED in one academic, teaching hospital presenting with non-traumatic abdominal pain in a three-month period. Analyzed factors included demographic data, details related to first and subsequent visits in the ED and the course of hospitalization. RESULTS: Overall, 928 patients were included to the study and 101 (10.88%) patients were admitted to the ED more than once during three-month period. Patients visiting ED repeatedly were older (p = 0.03) and more likely to be hospitalized (p < 0.01) compared to single-visit patients. Patients during their subsequent visits spent more time in the ED (p = 0.01), had greater chance to repeat their appointment (p = 0.04), be admitted to the hospital (p < 0.01) and were more likely diagnosed with cholelithiasis (p = 0.03) compared to patients on their initial visit. If admitted to the surgical department they were also more often qualified for surgical procedure than patients on their first visit (p < 0.01). In a group of patients admitted to the surgical department there were no significant differences in rates of conversion, postoperative complications and mortality between subgroups. CONCLUSIONS: Readmissions among patients presenting with abdominal pain are a common phenomenon with prevalence of 10.88%. They are most commonly associated with cholelithiasis and occur more frequently among older patients, which suggests, that elderly require more attention during ED managements.

Gender as a predictive factor in cholecystectomy - is it true or false?

INTRODUCTION: Cholecystolithiasis is one of the most frequent disorders of the human digestive system in a present population. It is common to point out that male gender is one of strong risk factors for complications during cholecystectomy, however the debate about that seems to be still open. AIM OF THE STUDY: The aim of this study was to compare the values related to the course and treatment effects between gender in patients undergoing cholecystectomy, based on own material. MATERIALS AND METHODS: The study encompassed 504 patients who were admitted to General Surgery And Polytraumatic Injury Department of University Hospital in Kraków, Poland between 2013 and 2018, with the initial diagnosis of cholecystolithiasis (scheduled cases) and acute cholecystitis (emergency cases). The patients underwent surgical gallbladder removal. In this group there were 326 (64.7%) female and 178 (35.3%) male patients. RESULTS: Statistically significant differences between both genders were found containing age, type of admission, numeric rating scale of pain during admission, results in American Society of Anesthesiologists physical status classification system, outcomes in Acute Physiology And Chronic Health Evaluation II severity-of-disease classification system, percentage of conversions, mortality, period of time from admission to surgical procedure, mean duration of the procedure, blood tests and histopathological results. CONCLUSIONS: Subgroups of the cases where determining factor is gender are strongly heterogeneous. Although treatment results were different for both subgroups and these differences were partly statistically significant, it cannot be clearly determined on the basis of a study with such selection of patients, that gender is an independent risk factor for surgical gallbladder removal.

Meta-analysis of short- and long-term outcomes after pure laparoscopic versus open liver surgery in hepatocellular carcinoma patients.

BACKGROUND: The advantages of laparoscopy are widely known. Nevertheless, its legitimacy in liver surgery is often questioned because of the uncertain value associated with minimally invasive methods. Our main goal was to compare the outcomes of pure laparoscopic (LLR) and open liver resection (OLR) in patients with hepatocellular carcinoma. METHODS: We searched EMBASE, MEDLINE, Web of Science, and The Cochrane Library databases to find eligible studies. The most recent search was performed on December 1, 2017. Studies were regarded as suitable if they reported morbidity in patients undergoing LLR versus OLR. Extracted data were pooled and subsequently used in a meta-analysis with a random-effects model. Clinical applicability of results was evaluated using predictive intervals. Review was reported following the PRISMA guidelines. RESULTS: From 2085 articles, forty-three studies (N = 5100 patients) were included in the meta-analysis. Our findings showed that LLR had lower overall morbidity than OLR (15.59% vs. 29.88%, p < 0.001). Moreover, major morbidity was reduced in the LLR group (3.78% vs. 8.69%, p < 0.001). There were no differences between groups in terms of mortality (1.58% vs. 2.96%, p = 0.05) and both 3- and 5-year overall survival (68.97% vs. 68.12%, p = 0.41) and disease-free survival (46.57% vs. 44.84%, p = 0.46). CONCLUSIONS: The meta-analysis showed that LLR is beneficial in terms of overall morbidity and non-procedure-specific complications. That being said, these results are based on non-randomized trials. For these reasons, we are calling for randomization in upcoming studies. Systematic review registration: PROSPERO registration number CRD42018084576.

Compliance with the ERAS Protocol and 3-Year Survival After Laparoscopic Surgery for Non-metastatic Colorectal Cancer.

INTRODUCTION: Enhanced recovery after surgery (ERAS) pathways have been proven to enhance postoperative recovery, reduce morbidity, and reduce length of hospital stay after colorectal cancer surgery. However, despite the benefits of the ERAS program on short-term results, little is known about its impact on long-term results. OBJECTIVE: The aim of the study was to determine the association between adherence to the ERAS protocol and long-term survival after laparoscopic colorectal resection for non-metastatic cancer. MATERIAL AND METHODOLOGY: Between 2013 and 2016, 350 patients underwent laparoscopic colorectal cancer resection in the 2nd Department of General Surgery, Jagiellonian University Medical College, and were enrolled for further analysis. The relationship between the rate of compliance with the ERAS protocol and 3-year survival was analyzed according to the Kaplan-Meier method with log-rank tests. Patients were divided into two groups according to their degree of adherence to the ERAS interventions: Group 1 (109 patients), < 80% adherence, and Group 2 (241 patients), ≥ 80% adherence. The primary outcome was overall 3-year survival. The secondary outcomes were postoperative complications, length of hospital stay, and recovery parameters. RESULTS: The groups were similar in terms of demographics and surgical parameters. The median compliance to ERAS interventions was 85.2%. The Cox proportional model showed that AJCC III (HR 3.28, 95% CI 1.61-6.59, p = 0.0021), postoperative complications (HR 2.63, 95% CI 1.19-5.52, p = 0.0161), and compliance with ERAS protocol < 80% (HR 3.38, 95% CI 2.23-5.21, p = 0.0102) were independent predictors for poor prognosis. Additionally, analysis revealed that adherence to the ERAS protocol in Group 2 with ≥ 80% adherence was associated with a significantly shorter length of hospital stay (6 vs. 4 days, p < 0.0001), a lower rate of postoperative complications (44.7% vs. 23.3%, p < 0.0001), and improved functional recovery parameters: tolerance of oral diet (53.4% vs. 81.5%, p < 0.0001) and mobilization (77.7% vs. 96.1%, p < 0.0001) on the first postoperative day. CONCLUSIONS AND RELEVANCE: This study reports an association between adherence to the ERAS protocol and long-term survival after laparoscopic colorectal resection for non-metastatic cancer. Lower adherence to the protocol, independent from stage of cancer and postoperative complications, was an independent risk factors for poorer survival rates.

Functional outcomes after resections for low rectal tumors: comparison of Transanal with laparoscopic Total Mesorectal excision.

BACKGROUND: Aim of this study was to evaluate functional outcomes of transanal total mesorectal excision (TaTME) in comparison to conventional laparoscopic approach (LaTME) in terms of low anterior resection syndrome (LARS). METHODS: Forty-six patients who underwent total mesorectal excision for low rectal cancer between 2013 and 2017 were enrolled. Primary outcome was the severity of faecal incontinence, assessed both before the treatment and 6 months after ileostomy reversal. LARS score and Jorge-Wexner scale were utilized to analyze its severity. RESULTS: Twenty (87%) from TaTME and 21 (91%) from LaTME group developed LARS postoperatively. There were no significant differences between groups in terms of LARS occurrence (p = 0.63) and severity. The median Wexner score was comparable in both groups (8 [IQR: 4-12] vs 7 [3-11], p = 0.83). Univariate analysis revealed that postoperative complications were a risk factor for LARS development (p = 0.02). Perioperative outcomes, including operative time, blood loss and intraoperative adverse events did not differ significantly between groups either. Five TaTME patients developed postoperative complications, while there were morbidity 6 cases in LaTME group. Quality of mesorectal excision was comparable with 20 and 19 complete cases in TaTME and LaTME groups, respectively. CONCLUSIONS: TaTME provided comparable outcomes in terms of functional outcomes in comparison to LaTME for total mesorectal excision in low rectal cancers. Having said that, LARS prevalence is still high and requires further evaluation of the technique.

What Makes Bariatric Operations Difficult-Results of a National Survey.

Background and objective: The most commonly performed bariatric procedures include laparoscopic sleeve gastrectomy (LSG), laparoscopic Roux-en-Y gastric bypass (LRYGB), and one anastomosis gastric bypass-mini gastric bypass (OAGB-MGB). A study comparing the degree of difficulty among those procedures could serve as a guide for decision making in bariatric surgery and further improve training programs for general surgery trainees. The aim of this study was to compare the subjective level of technical difficulty of LSG, LRYGB, and OAGB-MGB as perceived by surgeons and surgical residents. Materials and Methods: An anonymous internet-based survey was designed to evaluate the subjective opinions of surgeons and surgical residents in training in Poland. It covered baseline characteristics of the participants, difficulty of LSG, OAGB-MGB, LRYGB and particular stages of each operation assessed on a 1-5 scale. Results: Overall, 70 surgeons and residents participated in our survey. The mean difficulty degree of LSG was 2.34 ± 0.89. The reinforcing staple line with sutures was considered most difficult stage of this operation (3.17 ± 1.19). The LRYGB operation had an average difficulty level of 3.87 ± 1.04. Creation of the gastrojejunostomy was considered the most difficult stage of LRYGB with a mean difficulty level (3.68 ± 1.16). Responders to our survey assessed the mean degree of difficulty of OAGB-MGB as 2.34 ± 0.97. According to participating surgeons, creating the gastrojejunostomy is the most difficult phase of this operation (3.68 ± 1.16). Conclusion: The LSG is perceived by surgeons as a relatively easy operation. The LRYGB was considered to be the most technically challenging procedure in our survey. Operative stages, which require intra-abdominal suturing with laparoscopic instruments, seem to be the most difficult phases of each operation.

Perioperative changes in lymphocyte subpopulations in patients undergoing surgery for colorectal cancer.

Surgical procedure has immense impact on the immune balance. However, little is known about perioperative changes in T regulatory and Th17 lymphocyte subpopulations in patients undergoing colorectal resection. Patients with resectable colon cancer were enrolled in the study. Blood samples were obtained on two occasions, i.e. before the procedure and two days after the surgery. We also recruited a control group of young, healthy individuals. Lymphocyte subpopulations were analyzed with the use of flow cytometry. Investigated subpopulations consisted of total lymphocyte count, CD4+, CD8+, T regulatory Foxp3+ (Tregs), Th17 lymphocytes and white blood cell (WBC) count. There were significant differences in immune cell levels before and after the surgery. Reduction was recorded in the CD4+, CD8+, Tregs and total lymphocyte counts (p=0.002, p=0.01, p=0.008 and p=0.001, respectively). Increase was observed in total WBC and Th17 cells, however, Th17 lymphocytes did not reach statistical significance (p=0.01 and p=0.5, respectively). In conclusion, surgical intervention caused changes in all lymphocyte subpopulations investigated in patients undergoing surgery for colorectal cancer. However, it seemed to be an effect of perioperative trauma. Further studies are needed to investigate the impact of surgical intervention on lymphocyte subpopulations.

A quest for sphincter-saving surgery in ultralow rectal tumours-a single-centre cohort study.

INTRODUCTION: Despite the progress in the treatment of colorectal cancer, there is still no optimal strategy for tumours located adjacent to the anal sphincter. This study aims to evaluate oncological and functional results of surgery for rectal cancer in unfavourable locations in proximity to anal sphincters. MATERIALS AND METHODS: Patients with rectal cancer, which was either initially infiltrating the anal sphincter or located in the close proximity of the sphincter, were included in the study. Patients were submitted to extralevator abdominoperineal resection (APR), intersphincteric resection, or transanal total mesorectal excision (TaTME). Primary outcomes were perioperative data: operative time, blood loss, complications, length of stay (LOS), and 30-day mortality. Secondary outcomes were pathological quality of the specimens and functional outcome 6 months after defunctioning ileostomy closure. RESULTS: Among patients with cancer adjacent to the anal sphincter, 13 (25%) underwent APR, 14 (27%) patients were submitted to intersphincteric resection, and 25 (48%) patients were treated with the TaTME approach. Operative time was 240 (210-270 IQR) for APR, 212.5 (170-260 IQR) for intersphincteric resection, and 270 (240-330 IQR) for TaTME (p = 0.018). Perioperative morbidity was 31% for APR, 36% for intersphincteric resections, and 12% for the TaTME group (p = 0.181). Complete mesorectal excision was achieved in 92% of specimens in the TaTME group, 93% in intersphincteric resections, and 78% in the APR group (p = 0.72). Median circumferential resection margin in APR was 6 mm (4-7 IQR), in intersphincteric resections 7.5 mm (2.5-10 IQR), and in the TaTME group 4 mm (2.8-8 IQR). All patients after intersphincteric resections developed major low anterior resection syndrome (LARS). Four patients in the TaTME group developed minor LARS, and 21 had major LARS. CONCLUSION: Sphincter-saving rectal resections are a feasible alternative to APR with good clinical, pathological, and oncological outcomes. Intersphincteric resections and TaTME seem to be equal in terms of clinicopathological results. The functional outcome is yet to be investigated. TRIAL REGISTRATION: The study was retrospectively registered in Thai Clinical Trials Registry (23-07-2018, ID TCTR20180724001 ).

Laparoscopic Gastrectomy with Enhanced Recovery After Surgery Protocol: Single-Center Experience.

BACKGROUND Surgery remains the mainstay of gastric cancer treatment. It is, however, associated with a relatively high risk of perioperative complications. The use of laparoscopy and the Enhanced Recovery After Surgery (ERAS) protocol allows clinicians to limit surgically induced trauma, thus improving recovery and reducing the number of complications. The aim of the study is to present clinical outcomes of patients with gastric cancer undergoing laparoscopic gastrectomy combined with the ERAS protocol. MATERIAL AND METHODS Fifty-three (21 female/32 male) patients who underwent elective laparoscopic total gastrectomy due to cancer were prospectively analyzed. Demographic and surgical parameters were assessed, as well as the compliance with ERAS protocol elements, length of hospital stay, number of complications, and readmissions. RESULTS Mean operative time was 296.4±98.9 min, and mean blood loss was 293.3±213.8 mL. In 3 (5.7%) cases, conversion was required. Median length of hospital stay was 5 days. Compliance with ERAS protocol was 79.6±14.5%. Thirty (56.6%) patients tolerated an early oral diet well within 24 h postoperatively; in 48 (90.6%) patients, mobilization in the first 24 hours was successful. In 17 (32.1%) patients, postoperative complications occurred, with 7 of them (13.2%) being serious (Clavien-Dindo 3-5). The 30-day readmission rate was 9.4%. CONCLUSIONS The combination of laparoscopy and the ERAS protocol in patients with gastric cancer is feasible and allows achieving good clinical outcomes.

Creatine kinase-MB and red cell distribution width as predictors of contrast-induced nephropathy after percutaneous coronary intervention in acute myocardial infarction.

INTRODUCTION: Contrast-induced nephropathy (CIN) is acute kidney injury (AKI), caused by administration of iodinated contrast media. The reported risk factors of CIN are: pre-existing renal dysfunction, admission anemia, diabetic nephropathy, old age, dehydration, high volume and osmolarity of administered contrast media. Patients with acute myocardial infarction (AMI) have threefold higher risk of developing CIN. The aim of the study was to identify risk factors of CIN among patients who underwent percutaneous coronary intervention (PCI) due to AMI. METHODS: This retrospective single-centre study included 257 patients (mean age, 69.19 ± 1.4 years; men 66.15%) undergoing PCI for AMI between January 2012 and January 2013. Demographic data, type and location of MI, co-morbidities and laboratory results were analysed. RESULTS: CIN was found in 50 out of 257 patients (19.5%). Patients who developed CIN were older (p = 0.001), more commonly had chronic kidney disease (p = 0.01) and lower LVEF (p = 0.01). Baseline Red Cell Distribution Width (RDW) was significantly higher in the CIN group (14.85 ± 4.6 vs. 13.62 ± 1.3, p = 0.001). CK-MB levels on admission were significantly higher in the CIN group compared to the non- CIN group (95.6 ± 129.9 vs. 47.03 ± 61.3, p = 0.001). Multivariate model including "classical" CIN risk actors revealed that only baseline CK-MB level (p = 0.001), age >75 years (p = 0.001) and baseline RDW (p = 0.03) were independent predictors for the development of CIN. CONCLUSION: In conclusion, increased CK-MB on admission as a surrogate of time of ischemia, and increased RDW levels on admission as a marker of chronic in ammation are independently associated with higher risk of CIN among patients treated with primary PCI.

Prostate cancer with different ERG status may show different FOXP3-positive cell numbers.

Prostatic carcinoma is the most frequent cancer in males in the Western world. A significant proportion of these cancers have a recurrent translocation involving ETS family genes, which leads to the overexpression of ERG transcription factor. Prostate cancers, which bear this mutation, differ in a number of features, including tumor microenvironment. One of the components of the tumor microenvironment is FOXP3 positive lymphocytes, which may participate in breaking immunosurveillance and promoting tumor growth. The aim of the study was to analyze the relationships between ERG expression, number of FOXP3 positive cells and other features of the tumor. The study group consisted of 65 cases. Tissue microarrays composed of 2 mm tissue cores were used for immunohistological evaluation. Immunohistochemistry for ERG and FOXP3 was performed according to the routinely applied protocol. The FOXP3 positive cells were counted and the results were expressed as the number of cells per mm2. The average number of FOXP3 positive cells was 33.30/mm2 for all cases, 21.43/mm2 for the ERG negative and 42.28/mm2 for the ERG positive group (p < 0.02). There were no significant relationships between FOXP3 positive cell count and any other parameters studied. Our results suggest that the immune response may differ between ERG negative and ERG positive prostatic carcinomas.

Foxp3+ lymphocyte count in Barrett's esophagus tissue is higher than in in amed esophageal tissue.

INTRODUCTION: The number of Foxp3+ lymphocytes is increased in patients with esophageal carcinoma. Little is known about Foxp3+ cells count in Barret's esophagus, which is a precancerous state for esophageal cancer. A i m: To count the number of Foxp3+ lymphocytes in tissue samples from patients with Barrett's and compare it with samples from individuals with esophagitis and esophageal cancer. MATERIALS AND METHODS: 43 patients were enrolled to the study: 14 with esophageal carcinoma, 15 with Barrett's esophagus and 14 with non-metaplastic esophagitis. Every patient undergone gastroscopy during which a tissue sample was taken. Foxp3+ lymphocytes and CD4+ lymphocytes were detected by using immunohistochemistry. RESULTS: Mean density of Foxp3+ cells in patients with esophagitis was 7.37/10HPF (range: 1-9), 18.5/10HPF (range: 5-29) and 26.8/10HPF (range: 16-40) in patients with dysplastic and non-dysplastic BE, respectively and 47.92/10HPF in individuals with esophageal a carcinoma. These intergroup differences turned out to be statistically significant (p = 0.000; Fig. 3). Patients, either with dysplasia or without, presented with significantly higher Foxp3+ cell counts than the subjects with esophagitis (p = 0.0003 and p = 0.0006, respectively). Also the number of Foxp3+ lymphocytes in esophageal adenocarcinoma specimens turned out to be significantly higher than in esophagitis (p = 0.0001), non-dysplastic and dysplastic BE tissue (p = 0.016 and p = 0.00047, respectively). CONCLUSIONS: Barrett's metaplasia, either with dysplasia or without, is associated with an evident increase in the number of Foxp3 lymphocytes within the esophagogastric junction mucosa. Restoration of lymphocyte balance in esophageal tissue might prevent malignant transformation of Barrett's metaplasia.

Developing a new electromyography-based algorithm to diagnose the etiology of fecal incontinence.

PURPOSE: For surface electromyography (sEMG) to become widely used in fecal incontinence (FI) etiology assessment, one would have to create a simple, step-by-step, computer-aided, electromyography-based algorithm that would become the basis for a computer-aided diagnosis (CAD) system. Thus, the aim of this work was to develop such an algorithm. METHODS: Each patient included in the study underwent a structured medical interview, a general physical examination, and a proctological examination. Patients that scored more than 10 points on the fecal incontinence severity index (FISI) underwent further tests that included rectoscopy, anorectal manometry, transanal ultrasonography, multichannel sEMG, and assessment of anal reflexes. Patients with fully diagnosed FI were included into the study group. The control group consisted of healthy volunteers that scored five or less points on the FISI and had no known anal sphincters dysfunction. RESULTS: Forty-nine patients were qualified to the study group (age ± SD 58.9 ± 13.8). The control group was number- and gender-matched (age ± SD 45.4 ± 15.1). The sensitivity and specificity of classification tree number I, to diagnose neurogenic FI, were 89.5 and 86 %, respectively. For patients with idiopathic FI, these values were 82 and 91 %, respectively. The sensitivity and specificity of classification tree number III, to diagnose neurogenic FI, were 84 and 78 %, respectively. For patients with idiopathic FI, these values were 78 and 87 %, respectively. CONCLUSIONS: The relative simplicity and low classification costs allow to assume that algorithms based on classification trees I and III will serve to be the basis for a FI etiology CAD system.

Low-profile versus standard-profile stent grafts in the treatment of abdominal aortic aneurysm: a case-matched study.

Introduction: Endovascular aortic repair (EVAR) is nowadays a widespread method of managing abdominal aortic aneurysm (AAA). Low-profile stent grafts (LPSGs) enable treatment of patients with complex and anatomically challenging aneurysms, and facilitate a percutaneous and thus less invasive procedure. Aim: To assess the outcomes of EVAR with low-profile versus standard-profile stent grafts (SPSGs). Material and methods: Thirty-one patients with abdominal aortic aneurysms (AAA) were treated by endovascular aortic repair (EVAR) using LPSGs. The control group of patients treated with SPSGs was matched with MedCalc software. The clinical records and the preoperative and follow-up computed tomography angiography of patients who underwent endovascular treatment of AAA were included in this study. Results: Patients in the LPSG group had significantly more often low access vessel diameter (< 6 mm) compared to the SPSG group (38.7% vs. 6.7%, p = 0.003). In 1-year follow-up, there was no rupture, no infection, no conversion to open repair and no aneurysm-related death. Five secondary interventions were necessary in the SPSG group and only 1 in the LPSG group (p = 0.09). Type of stent graft was not a risk factor of perioperative complications, presence of endoleak or reintervention (p > 0.05). Risk factors for perioperative complications were COPD and conical neck (OR = 6.3, 95% CI: 1.5-25, p = 0.01 and OR = 6.2, 95% CI: 1-39.76, p = 0.04). The risk factor for endoleak was lower maximal aneurysm diameter. The risk factor for reintervention was proximal neck diameter (OR = 0.77, 95% CI: 0.-0.97, p = 0.03). Conclusions: Our study showed that use of LPSGs is a safe and viable method for patients with narrow access vessels who are not eligible for standard-profile systems.

A longer pelvis is associated with longer operative time in transanal total mesorectal excision (TME) but not in laparoscopic TME. Results from a retrospective cohort study.

Introduction: A narrow pelvis, obesity, and bulky low rectal tumor are perceived as risk factors for intraoperative difficulties during total mesorectal excision (TME), particularly in the laparoscopic approach. A transanal approach has been developed to overcome the difficulties encountered during laparoscopic TME. There is no clear definition of a narrow pelvis that would guide preoperative surgical planning. Aim: To evaluate different MRI-based pelvic measurements in patients undergoing TME to identify factors predictive of intraoperative difficulties in transabdominal compared to the transanal approach. Material and methods: A retrospective analysis of 48 patients treated with laparoscopic TME and 62 with transanal TME for rectal tumors was performed. Multiple logistic regressions analyzed demographic, tumor, and pelvimetry factors that correlate with intraoperative difficulties measured as intraoperative blood loss, operation time, and perioperative complications in both surgical approaches. Results: Multivariate analysis showed that age was associated with higher blood loss (OR = 1.09, 95% CI: 1.00-1.18, p = 0.038), male gender (OR = 0.13, 95% CI: 0.02-0.86, p = 0.029) and body mass index with longer operating time (OR = 1.32, 95% CI: 1.06-1.64, p = 0.010) in the LAR group. Multivariate analysis showed that age increased the odds of intraoperative blood loss > 100 ml (OR = 1.08, 95% CI: 1.02-1.15, p = 0.013), and pelvic length > 119 mm increased operating time (OR = 5.76, 95% CI: 1.33-25.01, p = 0.016) in the TaTME group. Conclusions: Pelvic measurements are not associated with intraoperative difficulties in LAR. Longer pelvis was associated with longer operative time in TaTME.

Modified Frailty Index and Brief Geriatric Assessment does not predict prolonged hospitalization in elderly patients undergoing appendectomy due to Acute Appendicitis.

INTRODUCTION: Epidemiology and the outcomes of acute appendicitis in elderly people are very different from the younger patients. Aim of this study was to investigate the significance of frailty syndrome in the course of acute appendicitis. METHODS: All patients over 65 years old who underwent laparoscopic appendectomy between 2013 and 2021 in 2nd Department of General Surgery were included in the study. In our assessment Modified Frailty Index and Brief Geriatric Assessment were performed. RESULTS: In the analyzed period 106 appendectomies were performed in patients over 65 years old. Postoperative complications occurred in 13 patients (12.3%). Prolonged hospitalization (over 3 days) was observed in 48 patients (45.3%). Multivariate analysis showed that every ASA class (OR=2.406; 95% CI 1.089-5.316; p=0.030) and postoperative complication (OR=5.692; 95% CI 1.077-30.073; p=0.041) are risk factors for prolonged hospitalization. Our study identified diabetes (OR=5.956; 95% CI 1.391-25.510; p=0.016) as a risk factor for postoperative complications. CONCLUSIONS: According to our study Modified Frailty Index and Brief Geriatric Assessment does not correlate with prolonged hospitalization or higher risk for postoperative complication after appendectomy in elderly people.

Radiological Features for Frailty Assessment in Patients Requiring Emergency Laparotomy.

INTRODUCTION: As the number of elderly patients requiring surgical intervention rises, it is believed that frailty syndrome has a greater impact on perioperative course than on chronological age. The aim of this study was to evaluate the efficacy of various imaging features for frailty assessment in patients undergoing emergency laparotomy. METHODS: The study included all patients that qualified for emergency surgery with preoperative CT scans between 2016 and 2020 in the Second Department of General Surgery. Multiple trauma patients were excluded from the analysis. The modified frailty index and brief geriatric assessment were used in the analysis. CT images were reviewed for the assessment of osteopenia, sarcopenia, sarcopenic obesity, renal volume and abdominal aorta calcification rate. RESULTS: A total of 261 patients were included in the analysis. Multivariate logistic regression identified every next ASA class (OR: 4.161, 95%CI: 1.672-10.355, p = 0.002), intraoperative adverse events (OR: 12.397, 95%CI: 2.166-70.969, p = 0.005) and osteopenia (OR: 4.213, 95%CI: 1.235-14.367, p = 0.022) as a risk factor for 30-day mortality. Our study showed that every next ASA class (OR: 1.952, 95%Cl: 1.171-3.256, p = 0.010) and every point of the BGA score (OR: 1.496, 95%Cl: 1.110-2.016, p = 0.008) are risk factors for major complications. CONCLUSIONS: Osteopenia was the best parameter for perioperative mortality risk stratification in patients undergoing emergency surgical intervention. Sarcopenia (measured as psoas muscle area), sarcopenic obesity, aortic calcifications and mean kidney volume do not predict poor outcomes in those patients. None of the radiological markers appeared to be useful for the prediction of perioperative morbidity.