Impact of laparoscopic right hemicolectomy for colon cancer

INTRODUCTION

This study specifically examined right colonic cancer resection, a common operation for colorectal surgeons starting laparoscopic resection, to assess the impact of commencing laparoscopy.

PATIENTS AND METHODS

A total of 56 patients undergoing open (n = 34) and attempted laparoscopic (n = 22) elective right hemicolectomy for colorectal cancer between November 2003 and March 2007 were compared. Postoperative stay was the primary outcome. Secondary outcomes included analgesic requirements, bowel recovery, morbidity and mortality. Frequency of laparoscopic versus open surgery over time was also examined.

RESULTS

Resections attempted laparoscopically increased from 9.1% to 75% in the first and last quarters of the study period, respectively (P = 0.0002). Uptake of ‘enhanced recovery’ was mainly in the laparoscopic group. Conversion was required in two of 22 patients. Attempted laparoscopic cases had a shorter median postoperative stay (6 vs 10 days; P < 0.0001), duration of parenteral or epidural analgesia (48 vs 72 h; P < 0.0001) and time to first bowel action (3 vs 4 days; P = 0.001) compared with open cases. Demography, tumour characteristics, morbidity and mortality were comparable between groups. Multivariate analysis identified decreased age, attempted laparoscopic surgery, use of enhanced recovery and absence of complications as independently shortening postoperative stay.

CONCLUSIONS

Advantages of laparoscopic surgery and enhanced recovery, even early in a surgeon''s experience, suggest this is the preferred mode for elective right colon cancer resection.     

Changes in hospital costs after introducing an intermediate care unit: a comparative observational study

Introduction  

The high cost of critical care resources has resulted in strategies to reduce the costs of ruling out low-risk patients by developing intermediate care units (IMCs). The aim of this study was to compare changes in total hospital costs for intensive care patients before and after the introduction of an IMC at the University Hospital Maastricht.     

Follow-up of newborns treated with extracorporeal membrane oxygenation: a nationwide evaluation at 5 years of age

Introduction  

Extracorporeal membrane oxygenation (ECMO) is a supportive cardiopulmonary bypass technique for babies with acute reversible cardiorespiratory failure. We assessed morbidity in ECMO survivors at the age of five years, when they start primary school and major decisions for their school careers must be made.     

香烟提取物诱导牛冠状动脉内皮细胞损伤的机制

目的通过观察香烟提取物对牛冠状动脉内皮细胞(BCAEC)的损伤作用,为研究吸烟与心血管疾病之间的关系提供依据。方法以吸烟者体内通常的尼古丁浓度为基准,分别用尼古丁、香烟主流烟雾提取物(MSW)和侧流烟雾提取物(SSW)对 BCAEC 进行染毒(尼古丁染毒终浓度分别为1×10~(-5)、0.8×10~(-5)、0.9×10~(-5)mol/L),用显微数码成像系统记录细胞形态变化,检测凋亡细胞与坏死细胞的发生比例,测定 caspase 酶活力。结果经尼古丁、MSW 处理的 BCAEC 形态上发生凋亡样变化,处理24 h 后凋亡细胞发生率为5.89%和11.94%。而 SSW 处理后的 BCAEC 呈坏死样变化.处理24 h 后62.84%的细胞发生坏死。尼古丁和 MSW 可诱导 caspase-3活力增高。结论香烟提取物可诱导牛冠状动脉内皮细胞损伤,MSW 可引起细胞凋亡,SSW 导致细胞坏死,caspase-3的激活可能是香烟提取物诱导牛冠状动脉内皮细胞凋亡的机制。     

Use of etidronate (ehdp) in paget's disease of bone

Etidronate used in recommended doses (usually 5 mg/kg/day for 6 months) produces symptomatic improvement in approximately 60% of patients. The serum alkaline phosphatase and urinary hydroxyproline are reduced to about 50% of initial values. A sustained remission occurs in many patients and retreatment is usually effective upon relapse. The abnormally elevated osteoclast count and resorption surfaces are reduced, and at the low dose there is no accumulation of osteoid. The medication is generally well tolerated and at the recommended dosage there is no evidence of increased fracture rate.     

Giant appendiceal mucocele as a first manifestation in a patient with silent ulcerative colitis: A case report

Appendiceal mucocele (AM) is a rare lesion found in only 0.3% of all appendectomies and it is characterized by distention of the appendix by the accumulating intraluminal mucinous material. Four main histopathological subtypes of appendiceal mucocele has been described including: retention cyst, mucosal hyperplasia, mucinous cystadenoma, and cystadenocarcinoma. We report a case of 48-year-old middle eastern female, previously healthy, presented to the primary health center with right iliac fossa discomfort, and referred to our hospital for further evaluation. Contrast enhanced computed tomography of the abdomen and pelvis and focused ultrasonography over the right iliac fossa showed the characteristic CT and sonographic appearance of appendiceal mucocele. An additional incidental note of lack of colonic haustral pattern involving the rectum and descending colon was noted on abdominal CT raising the suspicion of Ulcerative Colitis which was then confirmed by colonoscopy and histopathology. Although no causal relationship between appendicular mucocele and inflammatory bowel disease has been established yet and few case reports had reported appendicular mucocele in patients with ulcerative colitis, close surveillance in these patients, and early recognition of the characteristic imaging features is crucial in preventing dreadful complications like pseudomyxoma peritonei.