Browsing by Author "Böckelman, Camilla"

Abstract Background and aims: Diagnosis based solely on symptoms may lead to a high negative appendectomy rate and unnecessary surgery. We investigated the outcomes of appendectomies and determined if changes in the diagnostic work-up routines of acute appendicitis are necessary. Material and methods: We conducted a retrospective analysis of all emergency appendectomies performed in our hospital during a five-year period (2010–2014). We included a total of 805 consecutive patients undergoing open or laparoscopic appendectomy. Elective appendectomies (n=13) were excluded. Outcomes were compared by the chi-square and Mann-Whitney U tests. Results: Out of 805 patients, 345 (42.9%) were operated on by a laparoscopic approach; the laparoscopic technique was increasingly used during the study years. Women underwent laparoscopic appendectomy (58.6%) more often than men (29.8%; p<0.001). The mean operating time was marginally shorter with the open approach (55 versus 58 min; p=0.027). Postoperative hospital stay was shorter for the laparoscopic group (1.8 versus 2.3 days; p=0.014). The negative appendectomy rate was 7.8%. Conclusion: The negative appendectomy rate in this cohort of consecutive emergency appendectomies without systematic diagnostic imaging was low. Keywords: Appendicitis, appendectomy, appendectomy rate, laparoscopic approach, open approach, observational study

BACKGROUND: Toll-like receptors (TLRs) play an essential role in our innate immune system and are a focus of interest in contemporary cancer research. Thus far, TLRs have shown promising prognostic value in carcinomas of the oral cavity, colon, and ovaries, but the role of TLRs in pancreatic ductal adenocarcinoma (PDAC) awaits exploration. We set out to investigate whether TLR expression could serve in prognostic evaluation in PDAC, as well. METHODS: Our study comprised 154 stage I – III PDAC patients surgically treated at Helsinki University Hospital between 2000 and 2011. Patients who received neoadjuvant therapy were excluded. Tissue microarrays and immunohistochemistry allowed assessment of the expression of TLR2 and TLR4 in PDAC tissue, and we matched staining results against clinicopathological parameters using Fischer's test. For survival analysis, we used the Kaplan-Meier method and the log-rank test, and the Cox regression proportional hazard model for univariate and multivariate analyses. RESULTS: Strong TLR2 expression was observable in 51 (34%) and strong TLR4 in 50 (33%) patients. Overall, neither marker showed any direct coeffect on survival. However, strong TLR2 expression predicted better survival when tumor size was less than 30 mm (HR=0.32; 95% CI 0.13 – 0.75; p=0.009), and strong TLR4 expression predicted better survival in patients with lymph-node-negative disease (HR=0.21; 95% CI 0.07 – 0.65; p=0.006). CONCLUSION: We found strong TLR2 and TLR4 expression to be independent factors of better prognosis in PDAC patients with stage I-II disease.