[SARCOPENIA IS AN INDEPENDENT RISK FACTOR FOR DELAYED GASTRIC EMPTYING AFTER PANCREATICODUODENECTOMY].

BACKGROUND: Sarcopenia is defined as the degenerative loss of skeletal muscle and can be measured using the cross-sectional diameter of the psoas muscle on computed tomography. Sarcopenia has been associated with a variety of post-operative complications. We propose that sarcopenia acts as an independent factor predictive of delayed gastric emptying (DGE) after elective pancreaticoduodenectomy (PD). METHODS: A retrospective analysis of a prospectively maintained database of all patients undergoing PD at our tertiary hepatobiliary center was performed for the period December 2014 - March 2017. For each patient, the preoperative cross-sectional diameter of the psoas muscle at the upper border of L4 was calculated. Measurements in the lowest third of gender specific groups were considered to be sarcopenic. The presence of DGE, post-operative pancreatic fistulas (POPF) and major postoperative complications graded as Clavien Dindo III or more were included in the analysis. RESULTS: A total of 40 patients were included, 15 (37.5%) of whom were classified as sarcopenic. Comparison between the sarcopenic and non-sarcopenia groups revealed homogeneity in terms of gender, age, BMI and pre-operative albumin levels. DGE occurred in 11 patients (27.5%) of whom 7 were sarcopenic. Significantly more sarcopenic patients suffered from DGE (7/15 vs 4/25, p = 0.042). Major postoperative complications and POPF occurred in 15 patients each (37.5%). Nevertheless, sarcopenia was not significantly associated with POPF or other complications. The presence of sarcopenia was found to have a significant relationship with the incidence of DGE (OR 4.594, 95% CI 1.052-20.057). DISCUSSION: Sarcopenia acted as an independent risk factor predicting DGE after PD but not for POPF or other major postoperative complications.

Sarcopenia is associated with a greater incidence of delayed gastric emptying following pancreaticoduodenectomy.

BACKGROUND AND AIMS: Sarcopenia is the degenerative loss of skeletal muscle and has been associated with a variety of post-operative complications. We propose sarcopenia is associated with delayed gastric emptying (DGE) following elective pancreaticoduodenectomy (PD). METHODS: A retrospective analysis of a computerised database maintained in real time of all patients undergoing PD within our hepatobiliary unit was performed. The cross-sectional area of the psoas muscle at the upper border of L3 was calculated and corrected for patient height. The lowest quartile of gender specific groups was considered to be sarcopenic. RESULTS: 61 patients were included, 32 male and 29 female of whom 8 from each group were sarcopenic (26.2%). Although the sarcopenic and non-sarcopenia groups were found to be comparable, significantly more sarcopenic patients were older (75 vs 64 years, p = 0.003), had a lower body mass index (21.9 vs 25.0 kg/m2, p = 0.003) and suffered from DGE (7/16 vs 8/45, p = 0.045). On multivariate analysis, these variables maintained their significance with DGE having an OR of 6.042 (p = 0.036). CONCLUSION: Sarcopenia is significantly associated with DGE, older age and lower BMI in this specific cohort of patients. Further research into the reversibility of this phenomenon is warranted.

[Pleural effusion following coronary bypass surgery].

BACKGROUND: Pleural effusion is a common finding after coronary artery bypass surgery (CABG). We sought to determine the incidence and patient characteristics predictive of its appearance, in addition to the effect of post-operative treatment with enoxaparin. METHODS: We retrospectively examined 893 patients undergoing CABG: 520 consecutive patients did not receive enoxaparin, and 373 patients received it. All early (up to 10 days) peri-operative chest radiograms were examined and graded by the amount of pleural effusion: (i) small--obliteration of the costophrenic angle; (ii) moderate-- < 50% of lung field; (iii) large-- > 50% of lung field. Patient characteristics as well as operative and post-operative parameters were analyzed in order to identify predictors for pleural effusion. RESULTS: Pleural effusion was small in 415 patients (46%), moderate in 346 (39%) and large in 132 (15%). Older age, female gender and congestive heart failure were found to be predictors for pleural effusion by multi-variate analysis (p <0.05). Routine use of enoxaparin was not found to be associated with pleural effusion after CABG. CONCLUSIONS: Over 50% of patients will develop a significant pleural effusion following CABG. Prophylactic treatment with enoxaparin does not increase the risk for pleural effusion.

Increased mammographic screening and use of percutaneous image-guided core biopsy in non-palpable breast cancer: impact on surgical treatment.

BACKGROUND: Major efforts are being directed at the early diagnosis of breast cancer. The diagnosis rate of non-palpable tumors is steadily growing as a result of increased screening by mammography. In most patients with non-palpable lesions, percutaneous image-guided biopsies have replaced wire localization with surgical excision for obtaining tissue diagnosis. In recent years the Israel Ministry of Health initiated a mammograpy screening program. Percutaneous image-guided biopsies have also become widely available. OBJECTIVE: To assess the impact of these changes on breast cancer surgical treatment in our hospital. METHODS: The charts of 483 patients operated on in our department for primary breast carcinoma during the years 1997 to mid-2001 were reviewed. Data on the mode of diagnosis, tumor stage, resection margins, and number and types of operations were recorded and analyzed. The term non-palpable tumors relates to tumors necessitating wire localization for surgical excision. RESULTS: The percentage of patients diagnosed with non-palpable tumors rose from 16.2% in 1997 to 47.4% in 2001, with an average size of 2.6 cm for palpable and 1.7 cm for non-palpable tumors. The rate of preoperative diagnosis for non-palpable tumors rose from 6.2% in 1997 to 96.4% in 2001. The rate of involved or very close margins was reduced by 73% in the patient group diagnosed preoperatively as compared to those without a preoperative diagnosis (10.6% vs. 39.4%). Finally, the percentage of patients who had two operations fell from 56.2% in 1997 to 11.1% in 2001. CONCLUSIONS: The mammography screening program in Jerusalem in 1997-2001 was effective in increasing the relative percentage of non-palpable breast cancers with reduced tumor size at diagnosis. The improved availability of preoperative tissue diagnosis in these patients reduced the number of surgical procedures needed.

Doxil-induced regression of pleuro-pulmonary metastases in a patient with malignant meningioma.

Metastatic meningioma is a rare disease, which has no effective chemotherapy. We report on a treatment of this condition with Doxil, a liposomal doxorubicin formulation. A 60-year-old woman with massive pleuro-pulmonary metastases from recurrent cranial meningioma was treated with Doxil (50-37.5 mg/m2) for 18 months with near-complete resolution of metastases and disappearance of pleural fluid. The only significant toxicities observed were stomatitis and hand-foot syndrome, which resolved with dose reduction and increase of dosing intervals. Doxil was cleared very slowly in this patient with a monoexponential half-life of 108 h. The patient remains in near-complete response for 6 months after treatment discontinuation. This is the first report on an effective chemotherapy in a patient with typical metastatic meningioma. The exact mechanism accounting for such an effective drug action is not clear, but may be related to a particularly high microvascular permeability to the liposome carriers in these metastatic lesions.