Total laryngectomy and readmission: causes, rates and predictors

BACKGROUND

Total laryngectomy (TL) is a complex procedure, and patients undergoing TL are at high risk for readmission, which exposes them to hospital-acquired complications. Readmission rate is a metric for quality of care. We aimed to identify the rate, causes, and predictors of hospital readmission within 60 days after discharge following TL.

METHODS

This is a 12-year retrospective study where we included all patients undergoing TL in a single tertiary care center between 2008 and 2022. Patient charts were reviewed for demographics, comorbidities, and causes for readmission.

RESULTS

Of 83 patients who underwent TL, 12 (14.50%) were readmitted within 60 days. Common causes were surgical site infection (33.33%) and mucocutaneous fistula (25%). Significant predictors for readmission were tobacco use (P = 0.003), African ethnicity (P = 0.004), being unmarried (P < 0.001), lower preoperative serum albumin (P < 0.001), higher preoperative TSH (P = 0.03), higher preoperative neutrophil count (P = 0.035), higher American Society of Anesthesiology (ASA) score (P = 0.028), and higher Cumulative Illness Rating Scale (CIRS) score (P = 0.029).

CONCLUSION

One in every seven patients were readmitted following TL. Frequent causes include wound infection and fistulas. Predictors include preoperative hypoalbuminemia, hypothyroidism, African ethnicity, being unmarried, tobacco use, and a higher baseline burden of comorbidities. Such factors can be targeted to reduce hospital readmission rates.

Positron Emission Tomography With Fluorodeoxyglucose Incidental Detection of Colon Cancer in a Patient's Follow-Up for Nasopharyngeal Carcinoma During the COVID-19 Pandemic: A Case Report

Colorectal cancer (CRC) is a type of widespread, deadly malignancy that took thousands of lives around the globe. In the last two decades, CRC represented the most common cancer among men and ranked third among women in Saudi Arabia. Positron emission tomography with fluorodeoxyglucose (FDG-PET), can incidentally detect malignancy, as in our case, FDG-PET disclosed high abnormal FDG far away from the first primary malignancy. The current case is of a 65-year-old female who was following up on her nasopharyngeal carcinoma (first primary). During her last management, FDG-PET was requested to find any FDG uptake in the nasopharyngeal region; stunning FDG uptake was incidentally found at the ascending colon diagnosed as early-stage (pT2N0) colon cancer. Colonoscopy was done and India Ink was injected to facilitate localizing the mass during the laparoscopic removal of the tumor, which was delayed due to the pandemic of COVID-19. This took place in March 2020 at King Abdul-Aziz University Hospital in Jeddah.

Cecal Volvulus Post Cesarean Section: A Case Report

Cecal volvulus is a very rare cause of large bowel obstruction (LBO) that develops when a part of the bowel twists around the mesentery. Cases of acute abdomen, regardless of age, race, and ethnicity, should be examined to exclude volvulus from differential diagnoses. Surgery is the only confirmatory method to diagnose and treat this life-threatening condition. Here, we report a case of a 35-year-old female patient who presented with abdominal pain, distension, constipation, and vomiting. Abdominal computed tomography (CT) aided in accurately diagnosing the cecal volvulus, and the patient immediately underwent an exploratory laparotomy.

Diagnostically Challenging Case of Renal Artery Stenosis in a Pediatric Patient

In this study we report a diagnostically challenging case of bilateral renal artery stenosis (RAS) in a nine-year-old boy presenting as uncontrolled hypertension (HTN). The objective of this clinical case report is to draw attention to the unlikely combination of a classical clinical presentation with several normal investigations.

This is a nine-year-old boy, known to have uncontrolled HTN, later diagnosed as a case of bilateral RAS. This patient underwent several imaging studies including: renal Doppler ultrasonography (US), diethylenetriamine pentaacetic acid (DTPA) scan, and mercaptuacetyltriglycine (MAG3) renal scintigraphy with captopril challenge, with the aim of determining the cause of his uncontrolled HTN. The previously mentioned imaging procedures were carried out at two different medical centers over an extended period of time; however, the images failed to show any anatomical abnormalities to explain his clinical presentation. Due to this unexpected result the primary team in charge of this case opted for a percutaneous transluminal angioplasty, as a diagnostic and therapeutic approach, by which the final diagnosis of bilateral RAS was concluded. During follow-up the patient was asymptomatic in all outpatient clinic appointments.

Even though several initial investigations failed to indicate RAS, clinicians may pursue further investigations in cases of classical clinical presentation of uncontrolled HTN in pediatric population so as to not miss any diagnostically challenging cases.

Human chorionic villous mesenchymal stem/stromal cells modify the effects of oxidative stress on endothelial cell functions

Mesenchymal stem/stromal cells derived from chorionic villi of human term placentae (pMSCs) produce a unique combination of molecules, which modulate important cellular functions of their target cells while concurrently suppressing their immune responses. These properties make MSCs advantageous candidates for cell-based therapy. Our first aim was to examine the effect of high levels of oxidative stress on pMSC functions. pMSCs were exposed to hydrogen peroxide (H₂O₂) and their ability to proliferate and adhere to an endothelial cell monolayer was determined. Oxidatively stressed pMSCs maintained their proliferation and adhesion potentials. The second aim was to measure the ability of pMSCs to prevent oxidative stress-related damage to endothelial cells. Endothelial cells were exposed to H₂O₂, then co-cultured with pMSCs, and the effect on endothelial cell adhesion, proliferation and migration was determined. pMSCs were able to reverse the damaging effects of oxidative stress on the proliferation and migration but not on the adhesion of endothelial cells. These data indicate that pMSCs are not only inherently resistant to oxidative stress, but also protect endothelial cell functions from oxidative stress-associated damage. Therefore, pMSCs could be used as a therapeutic tool in inflammatory diseases by reducing the effects of oxidative stress on endothelial cells.

Spontaneous return of function after surgical excision of the seventh cranial nerve in parotid tumor surgery

Spontaneous return of function after surgical excision of the seventh cranial nerve in surgery of parotid tumors is not impossible. This seems to occur through the several existing neural pathways between the fifth and seventh cranial nerves. It is probable that voluntary motor impulses by reeducation find their way from the cortex through the fifth cranial nerve to the respective muscles.

Renal artery embolectomy

A patient with rheumatic heart disease developed right renal artery embolism and was treated by renal artery embolectomy. After a brief historical data, etiologic factors, clinicopathologic points, and treatment of the disease have been discussed.

Triorchidism with normal spermatogenesis: an unusual cause for failure of vasectomy

The wife of a vasectomized man became pregnant by her husband. He was examined and a supernumerary testis with intact vas and with normal histology and normal spermatogenesis were discovered.

Reversed jejunal segment used to treat the short bowel syndrome

Two cases of antiperistaltic bowel segment in the treatment of the short bowel syndrome are presented here. We think that this is the best procedure for the treatment of this syndrome. The length of the reversed segment should be 9 cm.

Hernia through the foramen of Winslow

The authors present a patient who has ascarid-containing jejunum herniated through the foramen of Winslow and incarcerated. Some remarkable anatomic abnormalities were noticed upon operation. These consisted of a short ascending colon, an unusually large foramen of Winslow, and smallness of the greater omentum. Before reduction, resection of the herniated and incarcerated segment of jejunum were performed. Barium enema and swallow are valuable diagnostic acids, as well as the plain film of the abdomen, but we prefer gastrographin study. With it the dangers of perforation and peritonitis are avoided.