Peri-operative SARS-CoV-2 infection increases postoperative mortality. The aim of this study was to determine the optimal duration of planned delay before surgery in patients who have had SARS-CoV-2 infection. This international, multicentre, prospective cohort study included patients undergoing elective or emergency surgery during October 2020. Surgical patients with pre-operative SARS-CoV-2 infection were compared with those without previous SARS-CoV-2 infection. The primary outcome measure was 30-day postoperative mortality. Logistic regression models were used to calculate adjusted 30-day mortality rates stratified by time from diagnosis of SARS-CoV-2 infection to surgery. Among 140,231 patients (116 countries), 3127 patients (2.2%) had a pre-operative SARS-CoV-2 diagnosis. Adjusted 30-day mortality in patients without SARS-CoV-2 infection was 1.5% (95%CI 1.4-1.5). In patients with a pre-operative SARS-CoV-2 diagnosis, mortality was increased in patients having surgery within 0-2 weeks, 3-4 weeks and 5-6 weeks of the diagnosis (odds ratio (95%CI) 4.1 (3.3-4.8), 3.9 (2.6-5.1) and 3.6 (2.0-5.2), respectively). Surgery performed ≥ 7 weeks after SARS-CoV-2 diagnosis was associated with a similar mortality risk to baseline (odds ratio (95%CI) 1.5 (0.9-2.1)). After a ≥ 7 week delay in undertaking surgery following SARS-CoV-2 infection, patients with ongoing symptoms had a higher mortality than patients whose symptoms had resolved or who had been asymptomatic (6.0% (95%CI 3.2-8.7) vs. 2.4% (95%CI 1.4-3.4) vs. 1.3% (95%CI 0.6-2.0), respectively). Where possible, surgery should be delayed for at least 7 weeks following SARS-CoV-2 infection. Patients with ongoing symptoms ≥ 7 weeks from diagnosis may benefit from further delay.
There was no statistically significant difference in the frequency or severity of gonadal dysfunction between MVPP- and ChIVPP/EVA-treated patients. We conclude that both of these chemotherapy schedules cause substantial damage to gonadal function in both sexes.
SARS-CoV-2 has been associated with an increased rate of venous thromboembolism in critically ill patients. Since surgical patients are already at higher risk of venous thromboembolism than general populations, this study aimed to determine if patients with peri-operative or prior SARS-CoV-2 were at further increased risk of venous thromboembolism. We conducted a planned sub-study and analysis from an international, multicentre, prospective cohort study of elective and emergency patients undergoing surgery during October 2020. Patients from all surgical specialties were included. The primary outcome measure was venous thromboembolism (pulmonary embolism or deep vein thrombosis) within 30 days of surgery. SARS-CoV-2 diagnosis was defined as peri-operative (7 days before to 30 days after surgery); recent (1-6 weeks before surgery); previous (≥7 weeks before surgery); or none. Information on prophylaxis regimens or pre-operative anti-coagulation for baseline comorbidities was not available. Postoperative venous thromboembolism rate was 0.5% (666/123,591) in patients without SARS-CoV-2; 2.2% (50/2317) in patients with peri-operative SARS-CoV-2; 1.6% (15/953) in patients with recent SARS-CoV-2; and 1.0% (11/1148) in patients with previous SARS-CoV-2. After adjustment for confounding factors, patients with peri-operative (adjusted odds ratio 1.5 (95%CI 1.1-2.0)) and recent SARS-CoV-2 (1.9 (95%CI 1.2-3.3)) remained at higher risk of venous thromboembolism, with a borderline finding in previous SARS-CoV-2 (1.7 (95%CI 0.9-3.0)). Overall, venous thromboembolism was independently associated with 30-day mortality ). In patients with SARS-CoV-2, mortality without venous thromboembolism was 7.4% (319/4342) and with venous thromboembolism was 40.8% (31/76). Patients undergoing surgery with peri-operative or recent SARS-CoV-2 appear to be at increased risk of postoperative venous thromboembolism compared with patients with no history of SARS-CoV-2 infection. Optimal venous thromboembolism prophylaxis and treatment are unknown in this cohort of patients, and these data should be interpreted accordingly.
(Finkelstein et al., 1992). Men who undergo bilateral orchidectomy have a rapid and progressive loss of lumbar spine integral bone with time from orchidectomy (Stepan et al., 1989). In men with hyperprolactinaemic hypogonadism restoration of normal testicular function is assocated with a significant increase in cortical BMD (Greenspan et al., 1986). Siilarly, restoration of normal serum testosterone in men with idiopathic hypogonadotrophic hypogonadism is also associated with a significant increase in cortical BMD (Finkelstein et al., 1989 puted tomography. There was, however, a significant reduction in cortical and trabecular BMD in women with chemotherapy-induced premature ovarian failure compared with similarly treated women with normal ovarian function.We have studied BMD in 29 men in complete remission following treatment of Hodgkin's disease. We have studied the relationship between serum testosterone and BMD, and the effect on BMD of time elapsed since completion of chemotherapy, type of chemotherapy received and number of cycles of chemotherapy. S and methodsWe studied 29 caucasian men who had previously received chemotherapy for Hodg9in's disease. The study subjects were drawn from 50 consecutive men who presented to the Medical Oncology Dertment at Christie Hospital with newly diagosed Hodgkin's diseas and who were randomised to receive MVPP or hybrid chemotherapy. The 50 men took part in a study investigating the effects of MVPP and hybrid chemotherapy on gonadal function, and 29 of these men consented to have measurements of BMD performed. In the 29 men who underwent measurements of BMD, age at onset of chemotherapy was 31.0 ± 1.9 (mean + standard error, range 16.4-54.0) years. Twelve men had received a mean of 7.5 (range 5-8) cycles of MVPP (mustine 10 mg i.v. and vinblasin 10 mg i.v. on days 1 and 8 with procarbazine 150 mg daily and prednisolone 50 mg daily on days 1-14 of a 42 day cycle) and 17 men had received a mean of 7.5 (range 6-8) cycles of hybrid chemotherapy (vinblastine lOmgi.v. on day 1, with chlorambucil 1Omg daily, procarbazine 150 mg daily and prednisolone 50 mg daily on days 1-7, and etoposide 200mg m-2 i.v., viris 2 mg i.v. and doxorubicin 50 mg m-2i.v. on day 8 of a 28 day cycle). Twenty-four men received radiotherapy (15 to chest and mediastinum, eight to neck and one to axilla) but none in a radiation field which included the testes or the parts of the skeleton studied. All men were in complete remission at the time of study, and all had azoospermia.Blood samples were taken for estimation of serum testosterone, sex hormone-binding globulin (SHBG), LH and FSH. Seven men had blood samples taken on one occasion, 19 on two occasions and three on three occasions. There were therefore a total of 54 blood samples taken 2.7 ± 0.2
Summary Semen analysis was performed in 14 men a median of 13.5 months after completion of VAPEC-B chemotherapy for Hodgkin's disease or non-Hodgkin's lymphoma. Semen from 12 patients contained motile spermatozoa, and in nine cases the count was >20 million ml'. One patient was azoospermic (VAPEC-B followed by pelvic radiotherapy) and another had a count of 21 millionml1' but sperm were non-motile. These findings suggest that, in the majority of cases, VAPEC-B chemotherapy does not cause permanent damage to the male germinal epithelium. A more detailed study of gonadal function in males and females before and after treatment with VAPEC-B for Hodgkin's disease is currently in progress.
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