Summary Background 80% of individuals with cancer will require a surgical procedure, yet little comparative data exist on early outcomes in low-income and middle-income countries (LMICs). We compared postoperative outcomes in breast, colorectal, and gastric cancer surgery in hospitals worldwide, focusing on the effect of disease stage and complications on postoperative mortality. Methods This was a multicentre, international prospective cohort study of consecutive adult patients undergoing surgery for primary breast, colorectal, or gastric cancer requiring a skin incision done under general or neuraxial anaesthesia. The primary outcome was death or major complication within 30 days of surgery. Multilevel logistic regression determined relationships within three-level nested models of patients within hospitals and countries. Hospital-level infrastructure effects were explored with three-way mediation analyses. This study was registered with ClinicalTrials.gov , NCT03471494 . Findings Between April 1, 2018, and Jan 31, 2019, we enrolled 15 958 patients from 428 hospitals in 82 countries (high income 9106 patients, 31 countries; upper-middle income 2721 patients, 23 countries; or lower-middle income 4131 patients, 28 countries). Patients in LMICs presented with more advanced disease compared with patients in high-income countries. 30-day mortality was higher for gastric cancer in low-income or lower-middle-income countries (adjusted odds ratio 3·72, 95% CI 1·70–8·16) and for colorectal cancer in low-income or lower-middle-income countries (4·59, 2·39–8·80) and upper-middle-income countries (2·06, 1·11–3·83). No difference in 30-day mortality was seen in breast cancer. The proportion of patients who died after a major complication was greatest in low-income or lower-middle-income countries (6·15, 3·26–11·59) and upper-middle-income countries (3·89, 2·08–7·29). Postoperative death after complications was partly explained by patient factors (60%) and partly by hospital or country (40%). The absence of consistently available postoperative care facilities was associated with seven to 10 more deaths per 100 major complications in LMICs. Cancer stage alone explained little of the early variation in mortality or postoperative complications. Interpretation Higher levels of mortality after cancer surgery in LMICs was not fully explained by later presentation of disease. The capacity to rescue patients from surgical complications is a tangible opportunity for meaningful intervention. Early death after cancer surgery might be reduced by policies focusing on strengthening perioperative care systems to detect and intervene in common complications. Funding National Institute for Health Research Global Health Research Unit.
BackgroundBreast cancer is a disease that continues to plague females during their entire lifetime. IL-6 and CRP are found to be elevated in various inflammatory and malignant diseases and their levels are found to correlate with the extent of the disease. The primary objective of this study was to determine the preoperative serum levels of IL-6 and CRP in breast carcinoma, and to correlate them with the staging of the disease and the prognosis.Methods59 female patients admitted for breast cancer were identified for the study and were subjected to thorough evaluation. Serum levels of IL-6 were assessed via Enzyme-Linked Immuno-Sorbent Assay (ELISA), and CRP was measured via immunoturbidimetry. Histological findings included tumour size, lymph node (LN) metastasis, and tumour staging. Relevant investigations were made to find out the presence of distant metastasis. Statistical analysis of the data was then processed.ResultsIncreases in cancer invasion and staging are generally associated with increases in preoperative serum IL-6 levels. IL-6 and CRP levels correlated with LN metastasis (P < 0.001, P < 0.001) and TNM stage (P < 0.001, P < 0.001). Tumour invasion and the presence of distant metastasis is associated with higher IL-6 levels (P = 0.001, P = 0.009). When we established the cutoff value for IL-6 level (20.55 pg/dl) by ROC curve, we noted a significant difference in overall survival (OS; P = 0.008). However, CRP evidenced no significance with regard to patient's OS levels. Serum IL-6 levels were correlated positively with CRP levels (r2 = 0.579, P < 0.01)ConclusionSerum levels of IL-6 correlates well with the extent of tumor invasion, LN metastasis, distant metastasis and TNM staging thus enveloping all aspects of breast cancer.
In the present scenario, doctors have to rely on radiological methods for diagnosis of acute abdomen in addition to their clinical skill. The use of serum markers for assessing the outcome of such patients is still debatable. Our aim was to evaluate whether the combined use of serum lactate, interleukin (IL)-6, and C-reactive protein (CRP) is able to simultaneously establish both the septic status and the prognosis of acute abdomen. Ninety-nine patients undergoing surgery for acute abdomen were taken up for the study. The patients were divided into 4 groups based on the level of sepsis. Serum lactate, IL-6, and CRP were determined in the serum of all the subjects. It was found that serum lactate determination, using the cutoff value < 3.9 mM, had a high sensitivity (100%) and specificity (83%) in differentiating patients with severe sepsis from those with sepsis. IL-6 came next with a sensitivity of 87% and a specificity of 81%. The AUC for serum lactate (0.922), IL-6 (0.912), and CRP (0.719) in differentiating between patients with severe sepsis and those with sepsis also proves the superiority of serum lactate and IL-6. The combined use of serum lactate and IL-6 would allow us to simultaneously establish the prognosis of patients with acute abdomen (r(2) = 0.368, P = 0.008). The combined use of serum lactate and IL-6 is useful in simultaneously establishing both the severity of sepsis and, hence, the prognosis of acute abdomen.
This is a case report about a 35 year old man admitted with complains of obstructed left sided inguinal hernia. On exploration of the left inguinal canal to our surprise a normal appendix was found in addition to a gangrenous omentum. Resection of the gangrenous omentum was done. Appendectomy was done. This case is reported for its rare occurance as only three such cases of left sided amyand's hernia has been reported so far in literature [4][5][6].Keywords Amyand's hernia . Obstucted inguinal hernia . appendix Case HistoryA 35 year old male patient was admitted with complaints of obstructed left inguinal hernia to the emergency department. The patient was in severe pain and an emergency laparotomy was planned. Basic blood investigations were taken. X-ray of the abdomen showed dilated small intestinal bowel loops. The patient was prepared and shifted to the operation theatre (Fig. 1).Using an inguinoscrotal incision the left inguinal canal was opened. An indirect inguinal hernia with omentum and the small bowel as contents were noted. The fundus of the sac was opened and about 30 ml of dark fliud was suctioned out careful not to soil the wound. The omentum was found to be gangrenous. The gangrenous omentum was excised. The small intestine was found to be normal with normal peristalsis and so the same was preserved. To our surprise we also noted an appendix as one of the contents of the sac. The appendix was about 10 cm in length. The appendix was normal and not gangrenous. An appendicectomy was done to avoid any future diagnostic dilemma. Since this was a case of obstructed inguinal hernia only a herniorraphy was done. The patient recovered well. An ultrasound of the abdomen was done and it showed non-rotation of the intestines, one of the causes of a left sided appendix. DisscusionAmyand is credited with the first appendicectomy in 1736, when he operated on a boy with an enterocutaneous fistula within an inguinal hernia [1]. On exploration of the hernia sac, he discovered the appendix, which had been perforated by a pin resulting in a fecal fistula. As a result of his original description, an inguinal hernia containing the appendix carries Amyand's eponym to this day [2].There are four conditions that can result in a left-sided appendix. In order of frequency, they are: (1) situs inversus viscerum, (2) nonrotation of the intestines, (3) "wandering" cecum with a long mesentery, and (4) an excessively long appendix crossing the midline. Nisolle et al.[3] described a case of left-sided appendicitis in which the extremity of a dilated right appendix was located in the left lower quadrant (LLQ) along the lateral pelvic wall.The occurrence of herniated appendices is mostly reported in a right inguinal hernial sac, probably as a
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.