Laparoscopic Versus Open Surgery for Rectal Cancer: A Meta-Analysis

Background Laparoscopic rectal cancer surgery aims to provide patients with curative resection while minimizing postoperative morbidity and mortality. This study used meta-analytical techniques to compare laparoscopic and open surgery as the primary treatment for patients with rectal cancer with regard to short-term and long-term outcomes. Methods A literature search was performed on all studies between 1993 and 2004 comparing laparoscopic and open surgery for rectal cancer. Subgroup analysis was performed on patients undergoing abdominoperineal excision of the rectum. The following end points were evaluated: operative outcomes, postoperative recovery, and early and late adverse events. Results Twenty studies matched the selection criteria and reported on 2071 subjects, of whom 909 (44%) underwent laparoscopic and 1162 (56%) underwent open surgery for rectal cancer. Time to stomal function (weighted mean difference [WMD], −1.52; 95% confidence interval [95% CI], −2.20, −1.01), first bowel movement (WMD, −.72; 95% CI, −1.21, −.22), feeding solids (WMD, −.92; 95% CI, −1.35, −.50), and length of hospital stay (WMD, −2.67; 95% CI, −3.81, −1.54) were all significantly reduced after laparoscopic surgery. In patients who underwent abdominoperineal excision of the rectum, wound infection (odds ratio, .15; 95% CI, .03, .73) and requirement for postoperative parenteral analgesia (WMD, −.63; 95% CI, −1.22, −.04) were also significantly reduced. There was no difference between groups in the extent of oncological clearance. Conclusions Laparoscopic rectal cancer surgery results in an earlier postoperative recovery and a resected specimen that is oncologically comparable to open surgery. Results from randomized trials reporting long-term outcomes such as cancer recurrence (local and metastatic) and 5-year survival are eagerly awaited.     

The effect of ICI 74,917 on asthma and bronchial provocation tests

A study was made of the protective action of the anti-allergic drug ICI 74,917, a phenanthroline derivative, in specific allergen provocation tests and in combating clinical symptoms in thirteen asthmatic out-patients. It was found that ICI 74,917 was able to diminish allergen-induced bronchoconstriction significantly (P< 0.01) during both the placebo period and during chronic treatment with ICI 74,917 for 4 weeks. The results obtained during these two periods did not differ significantly. There was not, however, any statistically significant difference in the symptom scores or PEF rates during the treatment with ICI 74,917 or placebo for 1 month. This may indicate that although ICI 74,197 is able to prevent bronchoconstriction in an allergen provocation test, it failed to improve asthma clinically. No signs of the phenomenon of tachyphylaxis were observed in the present study. The Student's t-test was used in the statistical analysis.     

Surface membrane changes of T cells induced by syngeneic tumour cells. I. Formation and uptake of complexes of Ig and tumour antigens by T cells.

A large dose of tumour cells (10(7)) from two different tumours produced a significant increase of Ig-bearing spleen cells 6 h after intraperitoneal administration in syngeneic mice, like conventional antigens previously tested. Incubation of normal spleen cells in serum taken 6 h after administration of tumour cells reproduced in vitro the changes observed in the spleen cell population of the serum donors, demonstrating the presence of a cytophilic Ig, which was shown to be taken up by T cells. Serum collected 6 h after tumour cell inoculation contains also a 4S factor which can generate in vitro cytophilic Ig for T cells in the presence of a foreign soluble protein or tumour antigen. Extracts obtained from tumours cells, which were shown to contain tumour antigens, were labelled with 125I and mixed with the 4S factor and normal 7S Ig. Upon fractionation of the mixture, high molecular weight material containing radioactivity and 7S Ig were eluted in the void volume, well ahead of the position of both the tumour cell preparation and the 7S Ig. This material contained Ig cytophilic for splenic T cells and it is likely that it represents cytophilic complexes of Ig and tumour antigens. It is postulated that the cytophilic Ig detected in the serum of animals 6 h after injection of a large number of tumour cells represents cytophilic complexes of Ig and tumour antigens formed through the mediation of a soluble factor.     

Handheld computers and the 21<Superscript>st</Superscript> century surgical team: a pilot study

Background  

The commercial development and expansion of mobile phone networks has led to the creation of devices combining mobile phones and personal digital assistants, which could prove invaluable in a clinical setting. This pilot study aimed to look at how one such device compared with the current pager system in facilitating inter-professional communication in a hospital clinical team.     

Optimal rinsing time for intra-oral distribution (spread) of mouthwashes

AIM: To investigate the intra-oral spread of an erythrosine mouthwash in relation to the rinsing period. MATERIAL AND METHODS: Thirty subjects were randomly divided into two equal groups and asked to rinse with 10 ml erythrosine mouthwash for cumulative periods of 15, 30 and 60 s (Group I) and 30, 60 and 90 s (Group II). Each rinsing session was followed by new plaque measurements. After rinsing plaque was finally assessed using the erythrosine mouthwash applied by means of a cotton swab. RESULTS: In Group I there was a difference observed between the 15 s rinsing period and those of 30 and 60 s. Explorative analysis for Group I suggested that differences in both jaws and approximal sites on both vestibular and lingual surfaces appeared to have contributed to the overall difference seen between 15 and 30 s rinsing periods. Also, pre-molars and front teeth seem to have contributed to this observed difference. No differences were noted between rinsing sessions and cotton swab application for Group II or Groups I+II combined. CONCLUSIONS: Rinsing for 30 s appeared to be sufficient for all plaque-covered surfaces of the dentition to come into contact with the mouthwash.     

The cognitive effects of cholinesterase inhibitor treatment in every-day practice

OBJECTIVE: Cholinesterase inhibitors (ChEIs) are the treatment of choice in Alzheimer's disease (AD). Their efficacy has been proven in many clinical trials. The aim of the present study was to confirm their cognitive benefit in every day practice as to whether it is similar to that expected from clinical trials. PATIENTS AND METHODS: We reviewed the files of 41 patients suffering from AD or mixed dementia and treated by ChEIs in terms of every day practice. RESULTS: During the first year MMSE scores remained better than or at baseline levels. Following that a gradual decline was noted. However, at any time point, the observed scores were significantly better than the expected ones calculated according to the pre-treatment rate of decline. The post-treatment rate of decline was significantly better than the pre-treatment one, while progression to the next stage of dementia was delayed by 8 months. CONCLUSION: The present observations from every-day practice indicate that there is a small but significant effect of ChEIs in cognition, similar to that observed in clinical trials. Furthermore, a small but significant delay in dementia progression may occur after treatment with ChEIs.     

Assay of the synthetic estrogen fosfestrol in pharmaceutical formulations using capillary electrophoresis

This study reports--for the first time--a capillary electrophoretic method for the determination of fosfestrol, a synthetic estrogen used in the treatment of metastatic prostate cancer. The effects of the carrier ion concentration, injected volume and applied voltage were studied and optimized. A 10 mM sodium tetraborate solution was selected as the carrier electrolyte solution, while the sample was injected hydrodynamically by applying a 20 mmHg vacuum for 1 s. The driving voltage was 30 kV and the absorbance of the analyte (peak height) was monitored at 240 nm. Under the above-mentioned conditions, the migration time of fosfestrol was 6.6 min. Linearity was achieved in the analyte range 3-150 mgL(-1) with the detection limit being 1 mgL(-1). The proposed method is adequately precise (s(r)=2.8% at 100 mgL(-1) fosfestrol, n=10) without the use of an internal standard and was applied to the determination of fosfestrol in a pharmaceutical formulation. The results obtained by the proposed method were in good agreement with those derived from the USP reference method.     

Mesothelial mesenteric cyst in patient with ascending colon cancer. Case report

Mesenteric cysts are rare cystic malformations of the mesentery. They are usually located at the iliac mesentery. Clinically most mesenteric cysts are asymptomatic, but sometimes they present with non-specific abdominal symptoms. Diagnosis can be aided using US, CT and MRI but careful interpretation of the images and high index of suspicion of this rare condition is essential for the correct diagnosis, which cannot always be preoperatively established. The therapeutic method of choice is complete surgical excision of the cyst which minimizes the possibility of recurrence. Histopathologically they are classified in six group. We present a case of a mesothelial mesenteric cyst in patient with colon cancer. The cyst was misdiagnosed as urinary bladder diverticulum in the preoperative CT scan.