��ֱ�����������������Ʊ�׼����TME��CME——�µĸ�������ٴ�����Ч���Ľ���

直肠癌全系膜切除(TME)概念的提出和应用显著改善了直肠癌外科治疗效果,"概念带来的进步"得到了充分体现。借鉴直肠癌治疗的经验,以外科、解剖和胚胎学理论为基础,德国学者Hohenberger总结大量的临床证据提出了完整结肠系膜切除(CME)。CME概念的提出为结肠癌治疗效果进一步改善带来了希望,有望成为结肠癌根治性手术的质量控制标准。     

Surgical resection for pulmonary metastases from colorectal cancer

Background : Isolated pulmonary metastases from colorectal cancer are rare. The present study reports on the 15‐year experience of the Royal Prince Alfred Unit and discusses means of improving survival outcomes. Methods : This was a retrospective review, over a 15‐year period, of 41 patients who had resectable pulmonary metastases of colorectal origin. Results : Most were asymptomatic at the time of diagnosis. Seventy‐two per cent had solitary metastases. The most common procedure performed was a lobectomy. Median follow up was 21 months. Five‐year survival was 24%. There were no significant prognostic indicators except for the ability to achieve clear surgical margins. Conclusion : Morbidity and mortality have not altered significantly over time. But an improved selection process such as the use of preoperative positron emission tomography will potentially improve survival outcomes.     

Survival from colorectal cancer in Victoria: 10-year follow up of the 1987 management survey

Background: In 1987, the Victorian Cancer Registry identified a population‐based sample of patients who underwent surgery for colorectal cancer for an audit of management following resection. Over 10 years have passed since this survey, and data on the survival of these patients (incorporating various prognostic indicators collected at the time of the survey) are now discussed in the present report. Methods: Relative survival analysis was conducted for each prognostic indicator separately and then combined in a multivariate model. Results: Relative survival at 5 years for patients undergoing curative resections was 76% compared with 7% for those whose treatment was considered palliative. Survival at 10 years was little changed (73% and 7% respectively). Survival did not differ significantly by sex or age irrespective of treatment intention. In the curative group, only stage was a significant predictor of survival. Multivariate analysis was performed only for the curative group. Adjusting for all variables simultaneously, stage was the only ­significant predictor of survival. Patients with Dukes’ stage C disease were at a significantly greater risk (OR 5.5 (1.7?17.6)) than those with Dukes’ A. Neither tumour site, sex, age, surgeon activity level nor adjuvant therapies made a significant contribution to the model.     

Anxiety among university students during the SARS epidemic in Hong Kong

A questionnaire survey was conducted during the Severe Acute Respiratory Syndrome (SARS) epidemic to assess the anxiety level and the perceived sources of stress among students from two universities where the outbreak occurred in the teaching hospital of one of the universities. The anxiety level caused by SARS in medical students at the teaching hospital was higher than in non‐medical students in the same university and lowest in students of the other university situated 20km away from the affected hospital. Copyright © 2006 John Wiley & Sons, Ltd.     

Resection of hepatic metastases from colorectal cancer

Summary Background: The aim of this paper is to analyze our experience with liver resection for metastatic colorectal cancer and to evaluate the prognostic significance of various parameters. Methods: 40 consecutive patients treated with potentially curative liver resection between 1984 and 1996 were included. The prognostic significance of various parameters was evaluated with respect to survival. Univariate and multivariate analyses were performed for following factors: age, gender, site and stage and grading of the primary tumor, size of metastases, number of metastases, lobar distribution of metastases, diagnostic interval, type of liver resection, resection margin, perioperative blood transfusion and preoperative carcinoembryonic antigen (CEA) level. Results: 3-year- and 5-year survival was 54% and 33%, median survival was 37 months. The 30 day mortality rate was 0%, postoperative complications occurred in 8 patients (20%). As single factors the following significantly affected the prognosis: number of metastases (p=0.0001), mesenteric lymphnode involvement of the primary tumor (p=0.002), lobar distribution (p=0.002) and intraoperative units of blood (p=0.05). Multivariate analysis revealed that age, gender, mesenteric lymphnode involvement, number of metastases and synchronous versus metachronous metastatic disease were independent predictors of survival. Conclusions: Liver resection is effective in selected patients with hepatic metastases from colorectal cancer. In resectable patients it is not possible to establish a clear prognosis based on the investigated factors. Therefore, patients with adverse prognostic factors should not be denied resection.      

The uptake of laparoscopic colorectal surgery in Great Britain and Ireland: a questionnaire survey of consultant members of the ACPGBI

Objective  The National Institute for Clinical Excellence (NICE) has recommended laparoscopic resection as an alternative to open surgery for patients with colorectal cancer. The aim of this study was to evaluate the current uptake of laparoscopic colorectal surgery in Great Britain and Ireland.
Method  A questionnaire was distributed to members of the Association of Coloproctology of Great Britain and Ireland (ACPGBI) regarding their current surgical practice. Results were analysed individually, by region, and nationwide .
Results  Information was received on 436 consultants (in 155 replies), of whom 233 (53%) perform laparoscopic colorectal procedures. During the previous year, 25% of colorectal resections were performed laparoscopically by the respondents. However, of those surgeons who were performing laparoscopic resections, only 30% performed more than half of all their resections laparoscopically. Right hemicolectomy, left-sided resections, and rectopexy were the most frequently performed laparoscopic resections. There was an even distribution throughout the country of consultants performing laparoscopic resections (regional IQR 48–60%). The main reason for consultants not performing laparoscopic procedures was a lack of training or funding.
Conclusion  Laparoscopic colorectal surgery is being performed by more than half (53%) of colorectal consultants nationwide, although only a quarter of all procedures are being undertaken laparoscopically.     

Neuromusculoskeletal disorders following SARS: a case series

Objective:

To detail the presentation of three health care workers diagnosed with sudden acute respiratory syndrome (SARS) who later presented to a CMCC teaching clinic with neuromusculoskeletal sequelae and underwent conservative treatments. This case series aims to inform practitioners of the potential pathogenesis of these neuromuscular complaints and describes their treatment in a chiropractic practice.

Clinical Features:

Three patients presented with a variety of neurological, muscular and joint findings. Conservative treatment was aimed at decreasing hypertonic muscles, increasing joint mobility, and improving ability to perform activities of daily living.

Intervention and Outcome:

The conservative treatment approach utilized in these cases involved spinal manipulative therapy, soft tissue therapy, modalities, and rehabilitation. Outcome measures included subjective pain ratings, disability indices, and return to work.

Conclusion:

Three patients previously diagnosed with SARS presented with neuromusculoskeletal complaints and subjectively experienced intermittent relief of pain and improvement in disability status after conservative treatments.     

Suggested management of immunocompromized kidney patients suffering from SARS

The treatment of severe acute respiratory syndrome (SARS) is still empirical and controversial. Herein we report our experience in treating approximately 40 SARS children and adolescents. Treatment of SARS kidney patients is limited. Paediatric nephrologists should be on the alert for SARS in order to care for immunocompromised patients. Precautions should be made for both staff and patients with protective measures for infection control.     

Laparoscopic colorectal surgery in Great Britain and Ireland – Where are we now?

OBJECTIVE: We aimed to gather information from the members of the Association of Coloproctology of Great Britain and Ireland (ACPGBI) to assess trends in the current practice of laparoscopic colorectal surgery. METHODS: A postal questionnaire survey of the members of ACPGBI. RESULTS: The response rate was 37% (200/540). Only 45 surgeons currently perform laparoscopic colorectal work in Great Britain and Ireland mainly right hemicolectomy and laparoscopic stoma formation, of these about one third practiced laparoscopy for benign colorectal conditions only. The majority (68%) of surgeons had enough resources at their place of work, but further training seemed to be a major issue. Nearly 22% of surgeons had not had any formal training. Only 50% of surgeons trained their specialist registrars. The incidence of conversion rate was not different for benign or malignant conditions and also did not appear to be related to the duration of experience. Only four surgeons had noted port a site recurrence during the past 10 years. Seventy-five percent (150/200) felt that laparoscopic colorectal work could be carried out safely in a District General Hospital. CONCLUSION: Laparoscopic colorectal surgery was being performed by a small minority of members of the ACPGBI although more surgeons had started to work in this field in recent years. The main areas of concern appeared to be a wide variation in the range of experience as indicated by the number of operations performed and limited formal training for consultants.     

Paratesticular metastasis from colorectal adenocarcinoma

Paratesticular tumors are rare, especially when they are metastatic. Most of them originate in the prostate, kidney, gastrointestinal tract, lung, and breast. The most common site of metastasis from the gastrointestinal tract is the colon. A 75-year-old male presented with a painless and tense right scrotal mass. He underwent a radical right orchiectomy, and the pathology revealed mucinous cystadenocarcinoma of the paratesticular tissue. Computed tomography revealed focal wall thickening at the rectosigmoid junction and liver nodules. The colonoscopic biopsy of the mass showed adenocarcinoma. Immunohistochemical staining of both sites confirmed the diagnosis of colorectal adenocarcinoma metastatic to the scrotum.     

Pulmonary resection for metastases from colorectal cancer

Aim: The prognosis of patients with disseminated colorectal carcinoma is poor except for those with single organ pulmonary or hepatic metastases. The objective of the present study was to evaluate the result of pulmonary metastasectomy for colorectal secondary and to identify the prognostic factors. Methods: This was a retrospective study of 80 patients who had pulmonary metastasectomy for pulmonary secondary from colorectal carcinoma in Queen Elizabeth Hospital, Hong Kong. Results: The overall 5‐year and 10‐year survival rates of the entire cohort were 42.5% and 35.5%, respectively. High premetastasectomy carcinoembryonic antigen (> 20 μg/dL), short disease‐free interval (< 12 months) and incomplete resection were the independent prognostic factors. Neither the characteristics of the primary colorectal tumour nor the number of metastatic nodules had a significant contribution to the long‐term survival. Six patients underwent second pulmonary metastasectomy and three were still free from tumour recurrence after the second operation. Conclusion: Patients with pulmonary metastases from colorectal carcinoma would benefit from pulmonary metastasectomy. High premetastasectomy carcinoembryonic antigen and short disease‐free interval were negative predictive factors for survival. Long‐term follow‐up study is required, as recurrence can occur more than 5 years after pulmonary metastasectomy. Also, whether the survival benefit is due to surgical treatment effect or lead‐time bias remains undecided.