Continuing Medical Education Activity in Echocardiography

Article Title: Transesophageal Echocardiographic Assessment of Pulmonary Veins and Left Atrium in Patients Undergoing Atrial Fibrillation Ablation (Echocardiography 2011;28:774)     

Optimizing Colorectal Cancer Care in Older Patients

Colorectal cancer is a disease affecting mainly older people, a fact that is becoming more apparent with the global population aging. However, this patient group is more likely to be subjected to suboptimal treatment due to a number of factors, but most commonly as a result of the physician’s weakness to recognize those fit for the full spectrum of cancer therapy. In this regard, clinical screening tests, such as the Comprehensive Geriatric Assessment, can be invaluable in guiding treatment decisions. Fluoropyrimidine-based adjuvant chemotherapy clearly confers a survival advantage in older individuals with node-positive disease; however, the benefit from the administration of oxaliplatin-based regimens is less clear. Palliative chemotherapy also has an important role in managing metastatic disease, and with the use of novel targeted agents it can potentially prolong survival and improve quality of life. The management of rectal cancer in this population can present a challenge, since it appears that the optimal treatment of chemoradiation followed by total mesorectal excision can be applied in select few. Indeed, the morbidity and mortality rates in older people treated with these combined modalities can be too high, guiding many physicians to opt for more conservative approaches, directed at providing palliation and local control, especially in those with limited life expectancy. In conclusion, in order to provide the best care in an older colorectal cancer patient, we need to individualize our approach, selecting the right patient for the right treatment.     

Transthoracic Repair of Asymptomatic Morgagni Hernia in an Adult

Morgagni hernia represents a rare type of diaphragmatic hernia which usually occurs on the right side, in the anterior mediastinum. Predisposing factors of Morgagni hernia include pregnancy, obesity or other causes of increased intraabdominal pressure, and a history of trauma. Most of adults diagnosed with a foramen of Morgagni are asymptomatic. We report a case of an overweight 23-year-old asymptomatic patient with a Morgagni hernia incidentally diagnosed on chest x-ray. There was a satisfactory result after the repair by a transthoracic approach.     

Laparoscopic versus open appendectomy： Which way to go？

AIM： To compare the outcome of laparoscopic versus open appendectomy. METHODS： Prospectively collected data from 293 consecutive patients with acute appendicitis were studied. These comprised of 165 patients who underwent conventional appendectomy and 128 patients treated laparoscopically. The two groups were compared with respect to operative time, length of hospital stay, postoperative pain, complication rate and cost. RESULTS： There were no statistical differences regarding patient characteristics between the two groups. Conversion to laparotomy was necessary in 2 patients （1.5%）. Laparoscopic appendectomy was associated with a shorter hospital stay （2.2 d vs 3.1 d, P = 0.04）, and lower incidence of wound infection （5.3% vs 12.8%, P = 0.03）. However, in patients with complicated disease, intra-abdominal abscess formation was more common after laparoscopic appendectomy （5.3% vs 2.1%, P = 0.002）. The operative time and analgesia requirements were similar in the two groups. The cost of treatment was higher by 370 in the laparoscopic group. CONCLUSION： Laparoscopic appendectomy is as safe and efficient as open appendectomy, provided surgical experience and equipment are available.