Awake nasotracheal intubation with a 300-mm working length fiberscope: a prospective observational feasibility trial

BACKGROUND

Awake fiberoptic tracheal intubation is an established method of securing difficult airways, but there are some reservations about its use because many practitioners find it technically complicated, time-consuming, and unpleasant for patients. Our main goal was to test the safety and efficacy of a 300-mm working length fiberscope (video rhino-laryngoscope) when used for awake nasotracheal intubation in difficult airway cases.

METHODS

This was a prospective, single-center study involving adult patients, having an ASA physical status between I and IV, with laryngopharyngeal pathology causing distorted airway anatomy. Awake nasotracheal intubation, using topical anesthesia and light sedation, was performed using a 300 mm long and 2.9 mm diameter fiberscope equipped with a lubricated reinforced endotracheal tube. The primary outcomes were the success and duration of the procedure. Patients' periprocedural satisfaction and other incidents were recorded.

RESULTS

We successfully intubated all 25 patients included in this study. The mean ±SD duration of the procedure, starting from the passage of the intubating tube through one of the nostrils until the endotracheal intubation, was 76 ± 36 seconds. Most of the patients showed no discomfort during the procedure with statistical significance between the No reaction Group with the Slight grimacing Group (95%CI 0.13, 0.53, p = 0.047) and the Heavy grimacing Group (95%CI 0.05, 0.83, p = 0.003). The mean ±SD satisfaction score 24 hours post-intervention was 1.8 ± 0.86 - mild discomfort. No significant incidents occurred.

CONCLUSIONS

Our study showed that a 300-mm working length flexible endoscope is fast, safe, and well-tolerated for nasotracheal awake intubation under challenging airways.

Surgical management of hydatid cyst disease of the liver: An improvement from our previous experience?

BACKGROUND

Hydatid liver disease remains an important issue in endemic areas, which may require immediate surgery. Although laparoscopic surgery is on the rise, the presence of certain complications may require conversion to the open approach.

AIM

To compare the results of laparoscopic treatment and the open approach in the context of a 12-year single institution experience, and to perform a further comparison between results from the current study and those from a previous study.

METHODS

Between January 2009 and December 2020, 247 patients underwent surgery for hydatic disease of the liver in our department. Of the 247 patients, 70 underwent laparoscopic treatment. A retrospective analysis between the two groups was performed, as well as a comparison between current and previous laparoscopic experience (1999-2008).

RESULTS

There were statistically significant differences between the laparoscopic and open approaches regarding the cyst dimension, location, and presence of cystobiliary fistula. There were no intraoperative complications in the laparoscopic group. The cutoff value for the cyst size regarding the presence of cystobiliary fistula was 6.85 cm (P = 0.001).

CONCLUSION

Laparoscopic surgery still plays an important role in the treatment of hydatid disease of the liver, with an increase in its usage over the course of years that has shown benefits regarding the postoperative recovery with a decreased rate of intraoperative complications. Although experienced surgeons can perform laparoscopic surgery in the most difficult conditions, there are some selection criteria that need to be maintained for higher quality results.

Epidermal Growth Factor Receptor and Its Role in Pancreatic Cancer Treatment Mediated by Nanoparticles

Pancreatic adenocarcinoma (PDAC) is a disease with a high incidence and a dreary prognosis. Its lack of symptomatology and late diagnosis contribute to the dearth and inefficiency of therapeutic schemes. Studies show that overexpressed epidermal growth factor receptor (EGFR) is a common occurrence, linking this to the progression of pancreatic cancer, although the association between its expression and the survival rate is rather controversial. EGFR-targeted therapy has not shown the results expected, leaving at hand more questions than answers; clearly, there is a need for a better understanding of the molecular pathways involved. Nanoparticles have been used in trying to improve the efficacy of antitumor treatment; thus, using EGFR's ligand, EGF, for nanoconjugation, showed promising results in increasing the cellular uptake mechanisms and apoptosis of the targeted cells.

Nanotechnology in metastatic cancer treatment: Current Achievements and Future Research Trends

The systemic spread of malignant cells from a primary site, a process termed metastasis represents a global challenge in cancer treatment. There is a real need to develop novel therapy strategies and nanomedicine may have remarkable and valuable contribution through specific and selective delivery of chemotherapeutic agents, through its intrinsic cytotoxic activity or through imaging applications, appealing also in the context of cancer personalized therapy. This review is focused on the applications of nanoparticles in the treatment of metastatic cancer, particularly on the possible effect on cell stabilization, growth inhibition, eventual interaction with adhesion molecules and antiangiogenic effect.

Laparoscopic splenectomy for hereditary spherocytosis. A case series and review of the literature

Hereditary spherocytosis (HS) is a common inherited hemolytic anemia caused by a defective erythrocyte cellular membrane. Irrespective of type of surgery performed, several case reports comparing the two type of procedures, have not proven any significant difference between serum bilirubin, serum hemoglobin, red blood cells' and platelets' count, in the followup period at 6 and 12 months respectively, even if platelet count has maintained high for the first 6 months postoperatively, justifying an oral antiplatelet therapy for this time interval. In the present work, we present the use of LS as the treatment of choice for HS as a case series, with all the characteristics.

KEY WORDS

Hereditary Spherocytosis, Laparoscopic Splenectomy.

Clinical Experiences with the FRONT Formula for Pre-Operative Airway Assessment and Documentation: a Multi-Centre Study

OBJECTIVE

The prediction of difficult airway is one of the most important challenges before general anaesthesia. This study aimed to assess the clinical usefulness of the FRONT score, a recently developed scoring system to predict and document airway difficulties.

METHODS

This multi-centre, inter-observer, prospective and double-blinded study included 976 patients from two university centres. The pre-operative evaluation of the patients was performed by a pre-operative team of anaesthesiologists (team A) who evaluated and scored the expected difficulty of airway management. An intra-operative team of evaluators (team B) working independently of team A, performed the actual instrumentation of the airway and scored the actual findings. Both teams used the FRONT scoring system and worked independently of each other to ensure blinded assessments. The statistical analysis of the pre- and intra-operative FRONT scores was performed in an off-line blinded manner.

RESULTS

Our results show a fair and promising association between pre-operative composite FRONT score and that observed at the induction phase (Spearman=0.43). Among the score components, the best correlation was observed for the F and R components (kappa=0.44 and 0.36, respectively), and the worse correlation was observed for the O and T components (kappa=0.25 and 0.24, respectively).

CONCLUSION

The FRONT formula for the prediction and documentation of the airway status is a simple and effective method for assessing and defining airway management difficulties. Further prospective studies are required to assess the sensitivity and specificity of the system.

Laser thermal ablation of multidrug-resistant bacteria using functionalized gold nanoparticles

The issue of multidrug resistance (MDR) has become an increasing threat to public health. One alternative strategy against MDR bacteria would be to construct therapeutic vectors capable of physically damaging these microorganisms. Gold nanoparticles hold great promise for the development of such therapeutic agents, since the nanoparticles exhibit impressive properties, of which the most important is the ability to convert light into heat. This property has scientific significance since is exploited to develop nano-photothermal vectors to destroy bacteria at a molecular level. The present paper summarizes the latest advancements in the field of nanotargeted laser hyperthermia of MDR bacteria mediated by gold nanoparticles.

Laparoscopic rectal resection versus conventional open approach for rectal cancer - a 4-year experience of a single center

PURPOSE

This study was carried out to compare the therapeutic outcomes and complications of the laparoscopic and the conventional open surgery technique used for treating rectal cancer. Another goal was to find the fastest and most accurate method of treatment for rectal cancer, along with establishing the advantages and disadvantages of the two surgical techniques, depending on cancer location and its stage.

METHODS

A total of 172 patients diagnosed with rectal cancer and hospitalized in the Department of Surgery III between January 1st 2008 and December 31st 2011 were studied. The laparoscopic approach was performed on 29 (16.8%) patients, and the remaining 143 (83.2%) underwent the conventional Miles/Lloyd-Davies abdominoperineal resection. A longitudinal study was conducted on patients with rectal resection, the used data being obtained from the database of the Department of Surgery III, hospital records, protocols and clinical charts of rectal cancer cases.

RESULTS

There were no statistically significant differences regarding symptoms, gender, age, body mass index (BMI), tumor site, TNM stage, intraoperative accidents, operative time, and postoperative mortality between the two groups. The laparoscopic group presented advantages regarding antibiotic and analgesic therapy, early mobilization, hospital stay, intraoperative blood loss, resuming oral nutrition, bowel transit resumption, postoperative complications and wound complications.

CONCLUSION

Laparoscopic abdominoperineal resection for rectal cancer is feasible, safe and effective. It can be safely performed by an experienced team, reducing the rate of postoperative complications, the need for blood transfusions, the adminstration of antibiotics and painkillers, allowing faster bowel transit resumption, shortening hospital stay and providing superior aesthetic results.

Surface plasmon resonance-induced photoactivation of gold nanoparticles as mitochondria-targeted therapeutic agents for pancreatic cancer

BACKGROUND

Noble metal nanoparticles such as gold nanoparticles can strongly absorb light in the visible region by inducing coherent collective oscillation of conduction band electrons in strong resonance with visible frequencies of light. This phenomenon is frequently termed as surface plasmon resonance (SPR).

OBJECTIVES

The main objective was to study the effects of laser photoactivated gold nanoparticles (by means of SPR) on human pancreatic cancer cells.

RESULTS

Gold nanoparticles obtained using standard wet chemical methods (with sodium borohydride as a reducing agent) underwent photoexcitation using 2w 808 nm laser and further administered to 1.4E7 pancreatic cancer cell lines. Flow cytometry, transmission electron microscopy, phase contrast microscopy, quantitative proteomics and confocal microscopy combined with immunochemical staining were used to examine the interaction between photo excited gold nanoparticles and pancreatic cancer cells.

CONCLUSION

The study shows that phonon-phonon interactions following laser photoexcitation of gold nanoparticles exhibit increased intracellular uptake, as well as mitochondrial swelling, closely followed by mitochondrial inner membrane permeabilization and depolarization. This unique data may represent a major step in mitochondria-targeted anticancer therapies using laser-activated gold nanoparticles.

Surgical outcome of inflammatory bowel disease - experience of a tertiary center

BACKGROUNDS/AIM: Despite advances in medical treatment, a large number of patients with inflammatory bowel disease(IBD) require surgery. We aim to evaluate the efficacy and outcome of surgical interventions in patients with chronic inflammatory bowel diseases.

MATERIAL AND METHODS

We retrospectively analysed the medical records from 221 patients admitted to our institution between 2009-2012 with the diagnosis of IBD. Out of these patients, 55 (24.88 %) were diagnosed with Crohn's disease,while the remaining 166 patients (75.11%) had ulcerative colitis.

RESULTS

Seventeen of 55 patients with Crohn's disease (30.91%)required surgical management before or during this period. Nine with disease proximal to the transverse colon underwent segmental resections (enteral or colonic) with primary anastomosis, without morbidity. The other 8 patients, with disease distal to the transverse colon, underwent segmental colonic resections (two with primary anastomosis, three with stoma formation) or major colonic resection- subtotal colectomy with ileostomy (1 case) and total proctocolectomy with ileostomy(2 cases). Sixteen of 166 patients with ulcerative colitis(9.64%) required surgery before or during this period. The surgical procedure used included total proctocolectomy with definitive ileostomy (3 cases) and total colectomy with ileostomy(13 cases). 7 of the 13 patients had restorative surgery after total colectomy, 1 remaining with definitive ileostomy due to short vascular pedicle and 5 patients refused restorative surgery. Median daily stool frequency after reconstructive surgery was 7(range 3-12).

CONCLUSION

For patients with Crohn's disease proximal to the transverse colon, limited resection with primary anastomosis is safe. Major colonic resection (subtotal colectomy or proctocolectomy)is indicated if the disease is located distal to the transverse colon and primary anastomosis should be avoided. Due to unsatisfactory quality of live after reconstructive surgery(stool frequency remains high), total proctocolectomy with end-ileostomy remains a viable alternative for patients with ulcerative colitis.

[Improvement in the quality of life for patients with adjustable gastric banding: initial results]

The aim of the study was to evaluate the improvement in quality of life for patients that have undergone the laparoscopic gastric banding, using the BAROS and Moorehead-Ardelt II questionnaires.

METHODS

We selected a 20 patient group (65% women) that underwent this surgical procedure in our clinic. The initial average weight was 123.45kg, and the body-mass index of 42.36. The average age was 29.25 years. The pars flaccida technique was used in 18, and the perigastric approach in 2 cases.

RESULTS

No complications or intraoperative accidents occurred. The mean operation time was 115.5 minutes. Elective conversion was needed in one case with a BMI of 55. The average hospital stay was of 3.2 days. The follow-up was conducted at least through phone in 95% of cases, and its average duration was of 10 months. The only postoperative complications were infections of the subcutaneous port (5 cases - 25%) which needed removal of the port, but not of the banding. The average loss of excess weight was 48.23%. Using the BAROS score to determine the overall improvement of quality of life, 30% of the patients scored as "Very Good", 50% as "Good", 20% as "Fair". Using the Moorehead-Ardelt QLQ II score, 65% scored as "Very Good", 30% as "Good" and 5% as "Fair".

CONCLUSION

The laparoscopic adjustable gastric banding significantly improves the quality of life for most patients with this procedure.

[Diagnosis, therapeutic attitude and prognostic factors of the tumors of body and tail of the pancreas--a case presentation and a review of the literature]

Neoplasms of the body and tail of the pancreas are rarer in comparison to those occurring in the head of the pancreas, representing only 10% of the total number of pancreatic malignancies. They poses even in present one of the greatest therapeutic challenge for the surgeon as their diagnosis and treatment are difficult to be done mainly due to specific anatomic position of the pancreas as well as due to the absence of any specific symptomatology belonging to the tumors of the body and tail of the pancreas having smaller dimensions. Here we are presenting two cases of neoplasms of the body and tail of the pancreas from the archives of 3rd Surgical Clinic, Cluj Napoca, hereby illustrating the experience of this clinic in the domain of high class pancreatic surgery. The two patients, having 55 and 43 years of age respectively, were diagnosed with neoplasm of the body and tail of the pancreas for which they had undergone the procedure of distal pancreatectomy along with the resection of the spleen. Out of those two cases, the first case had an invasive process of the tumor in the region of the superior mesenteric vein for what it was performed a segmental resection of the superior mesenteric vein with a termino-terminal anastomosis of the remaining two proximal and distal ends, while the second case inspite of its large dimension of the tumor (approximately 10 c.m in diameter) did not have any loco-regional invasion or any kind of distal metastasis which rendered it possible for a radical intervention. The aim of this case presentation as well as the reviews of the literatures belonging to this specialised domain is to sustain the idea that pancreatic surgery should be performed in those specialised surgical centres having profound knowledge as well as all the existing information about the diagnostic procedures, therapeutic attitude and prognostic factors of this specific pathology.