Risk Factors for Hepatocellular Carcinoma After Splenectomy in Liver Cirrhotic Patients

Background Splenectomy is sometimes indicated for portal hypertension caused by cirrhosis, which is a risk for hepatic carcinogenesis. This study aimed to identify risk factors for hepatocellular carcinoma (HCC) development after splenectomy. Methods This retrospective study included 65 patients who underwent splenectomy for portal hypertension between 2009 and 2017. Cox regression analyses were performed to identify factors related to HCC development after splenectomy. The predictive index for HCC development was constructed from the results of multivariate analysis, and 3 risk-dependent groups were defined. Discrimination among the groups was estimated using Kaplan-Meier curves and the log-rank test. Results Post-splenectomy, 36.9% of patients developed HCC. In the univariate analysis, the etiology of cirrhosis (hepatitis C virus antibody, P = .005, and hepatitis B surface antigen, P = .008, referring to non-B and non-C patients, respectively), presence of HCC history ( P < .001), and preoperative hemoglobin level ( P = .007) were related to HCC development, and the presence of HCC history ( P = .002) and preoperative hemoglobin level ( P = .022) were independent risk factors. The predictive index classified three groups at risk; the hazards in each group were significantly different (low vs middle risk, P = .035, and middle vs high risk, P = .011). Discussion The etiology of cirrhosis, presence of HCC history, and hemoglobin level were associated with HCC development after splenectomy. The predictive model may aid in HCC surveillance after splenectomy for patients with portal hypertension.

Risk Factors for Pelvic Lymph Node Metastasis and Recurrence in Patients Undergoing Radical Hysterectomy for Cervical Cancer

Background: Radical hysterectomy and bilateral pelvic lymphadenectomy are standard treatments for early-stage cervical cancer. Pelvic lymph node metastasis (PLNM) is one of the critical factors affecting the postoperative prognosis of patients. Therefore, the identification of preoperative risk factors for PLNM will minimize its occurrence and improve prognosis. The purpose of this study was to investigate the risk factors for PLNM and its recurrence in patients undergoing radical hysterectomy for cervical cancer.Methods: Medical records of 245 patients who underwent radical hysterectomy and bilateral pelvic lymphadenectomy as primary treatment for the International Federation of Gynaecology and Obstetrics (FIGO) stage IA-IIA cervical cancer between January 2010 and December 2015 at our hospital were reviewed. Age, FIGO stage, preoperative hemoglobin level, depth of stromal invasion, lymphovascular space invasion (LVSI), human papillomavirus(HPV) infection, parametrial infiltration, tumor diameter, number of lymphadenectomies, and pathological type were retrospectively analyzed. All patients were followed up for 5–10 years.Results: Among the 245 patients, 185 (75.51%) had no PLNM, whereas 60 (24.49%) had PLNM. Preoperative hemoglobin level, FIGO stage, LVSI, parametrial infiltration, and tumor diameter differed significantly between the two groups (P<0.05). Multivariate analysis revealed preoperative hemoglobin <110 g/L, FIGO stage II, LVSI, parametrial infiltration, and tumor diameter ≥4 cm as significant risk factors for PLNM and recurrence of cervical cancer after surgery (P<0.05). PLNM was identified as the independent risk factor for recurrence in patients with cervical cancer after surgery (P<0.05).Conclusions: PLNM is an important prognostic indicator for the clinical treatment of cervical cancer. Patients at a high risk of recurrence, especially PLNM patients, should be followed up closely after surgery to ensure the timely detection of recurrence and treatment.

Risk factors of blood transfusion in knee arthroplasty

Objectives: The amount of blood transfusion after knee arthroplasty seem to vary in different reported study. We carried out a retrospective study to analysis pre-operative risk factors for blood transfusion in patient whom underwent knee arthroplasty in our institution. Methods: A retrospective study of 190 patients treated with 194 procedure (186 unilateral knee arthroplasty, 4 bilateral knee arthroplasty) from November 2014 to October 2015 was analyzed. A univariate analysis was performed to establish the relationship between all variables and the need for postoperative transfusion. Variables that were determined to have significant relationship were include in a multivariable analysis.. Results: The univariate analysis revealed a significant relationship between need for postoperative blood transfusion and preoperative hemoglobin levels, surgical technique, arthrotomy approach, DVT prophylaxis, operative blood loss, surgical technique and surgeon experience. The multivariate analysis identified a significant relationship between need for transfusion and preoperative hemoglobin level, surgical technique and operative blood loss. Patients with a preoperative hemoglobin less than 12 g/dL had a 5.1 times greater risk of having a transfusion than those with a hemoglobin level ≥ 12 g/dL. The surgical technique with computer assisted surgery had a 0.15 times lesser risk of having a transfusion than those with the conventional technique. Conclusion: The preoperative hemoglobin level < 12 g/dL was shown to increase risk of the need for blood transfusion after knee arthroplasty, while computer assist surgery total knee arthroplasty was shown to decrease risk of blood transfusion. We suggest that patients with preoperative hemoglobin < 12 g/dL need to be crossmatching PRC in pre-operative steps.

Preoperative anemia and total hospitalization time are the independent factors of preoperative deep venous thromboembolism in Chinese elderly undergoing hip surgery

Background This study was designed to explore the prevalence and risk factors of preoperative deep venous thromboembolism (DVT) in Chinese elderly with hip fracture. Methods From January 1, 2012, to December 31, 2018, 273 elderly patients over 70 years old with elective hip surgery were collected from the electronic medical records. Collected data included demographic characteristics, comorbidities, ASA classification, types of previous operations, types of anesthesia, operation time, fracture to operation time, preoperative hemoglobin level, anemia, blood-gas analysis, cardiac function, whether transfusion, preoperative hospitalization, postoperative hospitalization, electrocardiograph, lower limb venous ultrasonography and total hospitalization time. Results In these 273 patients, 15(5.6%) had ultrasonography evidence of DVT in affected limbs before surgery. Three of all patients received an temporary inferior vena cave filter placement preoperatively. Fracture to surgery time, preoperative hemoglobin level, anemia, preoperative hospitalization, pulmonary disease and total hospitalization time were statistically different between DVT group and non-DVT group (P < 0.05 for all). Moreover, preoperative anemia (OR: 0.144, 95%CI: 0.026–0.799, P = 0.027) and total hospitalization time (OR: 1.135; 95%CI: 1.023–1.259, P = 0.017) were the two independent risk factors for preoperative DVT. Conclusion Preoperative anemia and total hospitalization time were independent risk factors for venous DVT in Chinese elderly with hip fracture.

Preoperative anemia and total hospitalization time are the independent factors of preoperative deep venous thromboembolism in Chinese elderly undergoing hip surgery

Background This study was designed to explore the prevalence and risk factors of preoperative deep venous thromboembolism (DVT) in Chinese elderly with hip fracture. Methods From January 1, 2012, to December 31, 2018, 273 elderly patients over 70 years old with elective hip surgery were collected from the electronic medical records. Collected data included demographic characteristics, comorbidities, ASA classification, types of previous operations, types of anesthesia, operation time, fracture to operation time, preoperative hemoglobin level, anemia, blood-gas analysis, whether transfusion, preoperative hospitalization, postoperative hospitalization, cardiac function, electrocardiograph, lower limb venous ultrasonography and hospitalization time. Results In these 273 patients, 15(5.6%) had ultrasonography evidence of DVT in affected limbs before surgery. Three of all patients received an temporary inferior vena cave filter placement preoperatively. Fracture to surgery time, preoperative hemoglobin level, anemia, preoperative hospitalization, pulmonary disease and total hospitalization time were statistically different between DVT group and non-DVT group (P<0.05 for all). Moreover, preoperative anemia (OR: 0.144, 95%CI: 0.026-0.799, P=0.027) and total hospitalization time (OR: 1.135; 95%CI: 1.023-1.259, P=0.017) were the two independent risk factors for preoperative DVT. Conclusion Preoperative anemia and total hospitalization time were independent risk factors for venous DVT in Chinese elderly with hip fracture.

Preoperative anemia and hospitalization time are the independent factors of preoperative deep venous thromboembolism in Chinese elderly undergoing hip surgery

Aim This study was designed to explore the prevalence condition and risk factors of preoperative deep venous thromboembolism (DVT) in Chinese elderly with hip fracture. Methods From January 1, 2012, to December 31, 2018, 273 elderly over 70 years old with elective hip surgery were collected from the electronic medical records. Collected Data included demographic characteristics, comorbidities, ASA classification, types of surgeries, types of anesthesia, operation time, fracture to operation time, perioperative blood transfusion, preoperative hemoglobin level, anemia, blood-gas analysis, cardiac function, electrocardiograph, lower limb venous ultrasonography and hospitalization time. Results In all patients, 15 patients (5.6%) had ultrasonography evidence of DVT in affected limbs before surgery. Three of all patients received an temporary inferior vena cave filter placement. Fracture to surgery time, preoperative hemoglobin level, anemia, pulmonary disease and hospitalization time were statistically different between DVT group and non-DVT group (P<0.05 for all). Moreover, preoperative anemia (OR: 0.144, 95%CI: 0.026-0.799, P=0.027) and hospitalization time (OR: 1.135; 95%CI: 1.023-1.259, P=0.017) were the two independent risk factors for preoperative DVT. Conclusion Preoperative anemia and hospitalization time were independent risk factors for venous DVT in Chinese elderly with hip fracture.

Preoperative anemia and hospitalization time are the independent factors of preoperative deep venous thromboembolism in Chinese elderly with hip fracture

Aim This study was designed to explore the prevalence condition and risk factors of preoperative deep venous thromboembolism (DVT) in Chinese elderly with hip fracture. Methods From January 1, 2012, to December 31, 2018, 273 elderly over 70 years old with elective hip surgery were collected from the electronic medical records. Collected Data included demographic characteristics, comorbidities, ASA classification, types of surgeries, types of anesthesia, operation time, fracture to operation time, perioperative blood transfusion, preoperative hemoglobin level, anemia, blood-gas analysis, cardiac function, electrocardiograph, lower limb venous ultrasound and hospitalization time. Results In all patients, 15 patients (5.6%) had venographic evidence of DVT in affected limbs before surgery. Three of all patients received an temporary inferior vena cave filter placement. Fracture to surgery time, preoperative hemoglobin level, anemia, pulmonary disease and hospitalization time were statistically different between DVT group and non-DVT group (P<0.05 for all). Moreover, preoperative anemia (OR: 0.144, 95%CI: 0.026-0.799, P=0.027) and hospitalization time (OR: 1.135; 95%CI: 1.023-1.259, P=0.017) were the two independent risk factors for preoperative DVT. Conclusion Preoperative anemia and hospitalization time were independent risk factors for venous DVT in Chinese elderly with hip fracture.

Operative hysteroscopy platform at a university teaching hospital: a retrospective study

Objective This study was performed to investigate the prevalence, indications, effectiveness, outcomes, and complications of operative hysteroscopy in gynecological patients with an emphasis on the need for further training and equipping facilities as performed by consultant gynecologists. Methods This was a retrospective descriptive study of operative hysteroscopic procedures from 19 September 2016 to 31 December 2018. Results In total, 1919 hysteroscopic procedures were performed [1829 (95.3%) diagnostic and 90 (4.7%) operative hysteroscopies]. The patients’ mean age was 42.4 years (range, 20–69 years). The most common operative procedure was hysteroscopic fibroid polypectomy in 31 patients (34.4%), followed by transcervical resection of the endometrium in 23 (25.6%) and endometrial polypectomy in 16 (17.8%). The most common indication was menorrhagia in 57 patients (63.33%), followed by recurrent miscarriages in 9 (10.00%) and primary infertility in 5 (5.56%). Sixty-six patients (73.33%) were treated under general anesthesia and 24 (26.67%) under spinal anesthesia. Fifteen fibroids (48.4%) were 3 to 4 cm in size and 11 (35.5%) were >4 cm. Eight polyps (50%) were 3 to 4 cm. The mean uterine size and endometrial thickness were 8.9 ± 2.16 weeks and 11.1 ± 3.01 mm, respectively. The mean preoperative hemoglobin level was 10.9 g/dL and the mean estimated blood loss was 65.9 ± 48.7 mL (range, 10–200 mL). Thirty-eight patients (60.3%) with heavy bleeding improved with no need for further medical or surgical intervention. Eleven patients (44%) with reproductive issues conceived or regained their normal menstrual pattern. Two patients (2.2%) had excessive fluid absorption and one (1.1%) had uterine perforation. Conclusions Operative hysteroscopy was an effective and safe option in certain uterine pathologies. Specific training in operative hysteroscopy should be promoted to make this type of surgery an integral part of gynecological services in the developing world.