The European journal of surgery. Supplement. : = Acta chirurgica. Supplement最新文献

Objective: To evaluate the prognosis of papillary microcarcinoma (PMC) of the thyroid.

Design: Prospective study.

Setting: Teaching hospital, Italy.

Subjects: 89 patients treated for papillary micro carcinoma of thyroid and followed up for at least 6 years (range 6-12).

Intervention: Total thyroidectomy and, for lymph node metastases, laterocervical lymphadenectomy.

Main outcome measures: Sex distribution, mode of onset of disease, diameter of tumour, histological type, histological stage, presence of lymph node metastases at the time of operation and type of operation.

Results: When the disease presented with laterocervical lymph nodes it was histologically more aggressive and included follicular (n = 3) and sclerosing (n = 4) types.

Conclusion: Papillary microcarcinoma has an excellent prognosis if managed initially by total thyroidectomy.

Objective: To compare the classification of gastric cancer adopted by the American Joint Committee on Cancer and the Union International contre le Cancer (AJCC/UICC) (number of nodes involved) with the Japanese classification (sites of nodes involved).

Design: Retrospective study.

Setting: Teaching hospital, Turkey.

Subjects: 134 consecutive patients whose gastric cancer was treated by D2 resection.

Interventions: Kaplan-Meier survival analysis and Cox's regression model.

Main outcome measure: Accuracy of prognosis.

Results: There were no significant differences in survival rates when pN1 and pN2 categories of the AJCC/UICC classification were subdivided into the n1 and n2 categories of the Japanese classification. However, when those in the n1 and n2 categories of the Japanese classification were subdivided into the pN1, pN2 and pN3 categories of the AJCC/UICC classification, survival differed significantly (p = 0.00001). When both classifications were combined in a multivariate analysis the pN category of the AJCC/UICC classification was found to be the most significant independent prognostic factor (p = 0.0001).

Conclusion: Classification of lymph node status by number of nodes (AJCC/UICC) rather than anatomical site (Japanese) gives a more accurate prognosis.

Objective: To study the effect of rectopexy and sigmoid resection (resection rectopexy) on symptoms in patients with internal rectal intussusception.

Design: Retrospective and prospective study.

Setting: University hospital, Norway.

Patients: 22 patients with internal rectal intussusception.

Interventions: Resection rectopexy by an open (n = 13) or laparoscopically-assisted (n = 9) technique.

Main outcome measures: Symptomatic outcome, patients' satisfaction, and morbidity. Outcome was based mainly on the validated KESS score, which covers 10 symptoms included in the definiton of constipation.

Results: There was a significant reduction in all 10 symptoms. Two patients complained of incontinence which improved after operation. The number of patients with constipation was reduced from 20 to 8 (p = 0.000) and none became constipated. Mean (95% CI) colonic transit times before and after operation in 10 patients with constipation were 5.3 (4.1 to 6.4) and 4.0 (2.6 to 5.4) days (p = 0.083). Seven of these 10 patients had a reduction of both transit time and constipation score. Six patients had complications after open operations. These included one damaged ureter, reoperations for bleeding, incomplete intestinal obstruction, and 2 wound infections.

Conclusion: Rectopexy with sigmoid resection resulted in improvement in symptoms, including constipation and feeling of incomplete rectal evacuation, and acceptable morbidity.

Objective: To highlight the in vivo protein markers in human peritoneal mesothelial cells according to their anatomical distribution and their interest in theories of peritoneal repair.

Design: Clinical laboratory study.

Setting: University Hospital, France.

Patients: Sampling of mesothelial cells during 8 laparotomies by impression smears.

Main outcome measures: Immunochemical semiquantitative measures of proteins.

Results: There were uniform ratios of protein markers among the whole peritoneal mesothelial cell population, whatever their anatomical origin (liver, stomach, omentum, small bowel, and abdominal wall).

Conclusion: This is consistent with the surrounding uninjured mesothelial cells or the exfoliated mesothelial cells, or both, having a role in postoperative peritoneal mesothelial repair.

Objective: To identify the risk factors affecting the outcome of operations for differentiated and aggressive thyroid carcinoma which may indicate the need for a more aggressive surgical treatment.

Design: Retrospective study.

Setting: University hospital.

Patients and interventions: 143 patients underwent total thyroidectomy with or without central neck lymphadenectomy or modified neck dissection. There were 85 papillary, 34 follicular, 6 widely-invasive follicular, 6 insular, five oxyphilic, five tall cell, and two diffuse sclerosing papillary carcinomas.

Main outcome measure: Disease-related survival.

Results: At 12-years, the survival was 96%, being 98% among patients with differentiated and 83% among those with aggressive carcinoma (p = 0.0006). Insular and oxyphilic carcinomas had the worst prognosis (at 10 years, 67% and 60%, respectively, p < 0.0001). The high-risk age, metastases, and extent score (AMES) group had worse survival than the low-risk group (12 years, 84% compared with 98%, p = 0.001). Among patients with differentiated carcinoma, the low-risk AMES group had also better outcome than those in the high-risk AMES group (at 12 years, 100% compared with 86%, p < 0.0001), but there was no such difference among patients with aggressive disease. Multivariate analysis showed that women (RR 14.28, 95% confidence interval (CI) 1.13 to 180.28), patients with tumours > or = 5 cm in size (RR 9.60, 95%CI 1.01 to 91.43) and AMES high-risk patients (RR 30.17, 95% CI 1.57 to 577.48) had the worst outcome.

Conclusion: In patients with differentiated thyroid carcinoma, total thyroidectomy and, if the AMES score indicates a high risk, central neck lymphadenectomy with or without modified neck dissection, is associated with a favourable outcome. Poorer outcome is expected if the carcinoma is aggressive, and an aggressive surgical approach is advocated as a routine.

Objective: To compare a systemic transdermal therapeutic system with local application of glyceryl trinitrate ointment in the treatment of anal fissure.

Design: Prospective, multicentre, randomised trial.

Setting: Three teaching hospitals, Turkey.

Subjects: 89 outpatients with chronic anal fissure were randomly assigned to be treated with either transdermal (n = 52) or 0.2% glyceryl trinitrate ointment (n = 37).

Interventions: The patients were assessed at the sixth and the twelfth week after initial evaluation by physical examination, anoscopy, and anal manometry.

Main outcome measures: Changes in the maximal anal resting pressure, healing rate.

Results: Anal fissure was completely healed in 38 (73%) and 24 (64%) of the patients after 6 weeks and 48 (81%) and 27 (79%) of the patients in transdermal group and ointment group, respectively. Maximal anal resting pressure was reduced by 24% and 21% in transdermal and ointment groups, respectively.

Conclusion: Systemic transdermal application of glyceryl trinitrate gave a satisfactory healing rate, which was comparable to that of local application of ointment.

Objective: To evaluate the long-term outcome of patients treated in the surgical intensive care unit (SICU) for abdominal sepsis.

Design: Retrospective study.

Setting: University hospital, Sweden.

Subjects: 210 consecutive patients treated for abdominal sepsis in the SICU at Lund University Hospital during the period January 1983 to December 1995.

Main outcome measures: Background information, morbidity, and mortality. Follow-up of surviving patients with interview and completion of a quality of life (QoL) assessment. Information collected postmortem from the registers of the Swedish National Board of Health and Welfare.

Results: At follow-up, 45 patients of the 151 who survived the initial hospital stay had died, 41 were lost to follow up and 16 chose not to participate in the study; 49 patients completed the study. Median QoL scores were significantly impaired (p < 0.01) although subjective QoL did not change significantly. In-hospital mortality was 28% (59/210) and total mortality over the time period 50% (104/210).

Conclusion: Most patients who survived after treatment of abdominal sepsis in the SICU regained good health and their functional status was restored. Subjective QoL remained unchanged.