Ephraim Eviatar MD, Koby Pitaro MD, Haim Gavriel MD and Daniel Krakovsky MD
Background: Over the past 20 years, advances in endoscopic sinus surgery (ESS) techniques have led to widespread applications of this technology in both adult and pediatric populations with better results and lower morbidity.
Objectives: To update data regarding the rate of minor and major complications following ESS procedures that used powered instrumentation.
Methods: We retrospectively reviewed the charts of all patients who, with general anesthesia, underwent ESS utilizing powered instrumentation between January 1996 and December 2006. Age, gender, indication for surgery, length of hospitalization, and type and rate of surgical complications were recorded.
Results: A total of 1190 patients were included in our study (1309 surgeries). The male:female ratio was 1.7:1.0 and the average age was 39 years (range 4–86 years). The most common indication for surgery was chronic rhinosinusitis. The rate of major complications was 0.31% and that of minor complications 1.37%. The only major complication that occurred was cerebrospinal fluid leak. The minor complications included epistaxis, periorbital emphysema, ecchymosis and mucocele formation.
Conclusions: Compared to previously published series, the rate of major and minor complications in our study was low. The results indicate that the use of powered instruments during ESS is safe.
Vanya Tsvetkova-Vicheva PhD, Emiliana Konova PhD, Tcvetan Lukanov PhD, Svetla Gecheva MD, Angelika Velkova PhD Dsc and Regina Komsa-Penkova PhD
Background: Interleukin-17A (IL-17A)-producing CD4+T helper cells have been implicated in allergic inflammation; however, the role of IL-17A in allergic rhinitis (AR) patients with different degrees of atopy and airway reactivity to methacholine (Mch) has not been examined.
Objectives: To explore IL-17A-producing CD3+CD4+T cells in peripheral blood of patients with persistent AR and assess the degree of atopy, eosinophil count (Eo count), and bronchial hyper-responsiveness (BHR) to methacholine.
Methods: The study involved 61 patients and 30 controls. The percentage of CD3+CD4+IL-17A+T cells in peripheral blood was measured by flow cytometry, bronchial challenges with Mch were performed, as was skin prick tests with standard inhalant allergens, and Eo count was measured. Atopic status was determined by the number of positive SPT results and wheal mean diameter.
Results: A statistically significant difference in Th17 cell percentage was found in the AR and control groups (2.59 ± 1.32% and 1.24 ± 0.22% respectively, P = 0.001). Forty-one patients (67.2%) were polysensitized to indoor and outdoor allergens, while 20 (32.8%) had positive skin prick tests to indoor allergens. CD4+T cells were significantly higher in the patient group compared to the control group (2.91 ± 1.5% versus 1.91 ± 0.62%, P = 0.005), as was Eo count (4.48 ± 2.13 vs. 2.32 ± 1.83) (P = 0.0001). Forty-one in the AR group (67%) and 7 (23%) in the control group were Mch-positive (P = 0.001). The percentage of IL-17A-producing CD4+T cells was significantly higher in males compared to females (3.15 ± 1.8% versus 2.31 ± 0.9%, P = 0.02)
Conclusions: Polysensitized AR patients exhibited higher IL-17A-producing CD4+T cell levels and eosinophil counts. Male patients displayed a higher frequency of IL-17A-producing T cells.
Nasser Sakran MD, David Goitein MD, Asnat Raziel MD, Dan Hershko MD and Amir Szold MD
Background: Modifications to conventional laparoscopic cholecystectomy (CLC) are aimed at decreasing abdominal wall trauma and improving cosmetic outcome. Although single-incision laparoscopic surgery (SILS) provides excellent cosmetic results, the procedure is technically challenging and expensive compared to the conventional laparoscopic approach.
Objectives: To describe a novel, hybrid technique combining SILS and conventional laparoscopy using minimal abdominal wall incisions.
Methods: Fifty patients diagnosed with symptomatic cholelithiasis were operated using two reusable 5 mm trocars inserted through a single 15 mm umbilical incision and a single 2–3 mm epigastric port. This technique was dubbed “minimal incision laparoscopic cholecystectomy” (MILC).
Results: MILC was completed in 49 patients (98%). In five patients an additional 3 mm trocar was used and in 2 patients the epigastric trocar was switched to a 5 mm trocar. The procedure was converted to CLC in one patient. Mean operative time was 29 minutes (range 18–60) and the average postoperative hospital stay was 22 hours (range 6–50). There were no postoperative complications and the cosmetic results were rated excellent by the patients.
Conclusions: MILC is an intuitive, easy-to-learn and reproducible technique and requires small changes from CLC. As such, MILC may be an attractive alternative, avoiding the cost and complexity drawbacks associated with SILS.
Bernard Belhassen MD, Sami Viskin MD and Galit Aviram MD
Joshua Feinberg*, Laurel Grabowitz*, Pnina Rotman-Pikielny MD, Maya Berla MD and Yair Levy MD