To compare the diagnostic accuracy of clinical examination, white blood cell and differential count, and C-reactive protein as routine tests for acute appendicitis with that of interleukin-6 (IL-6) ...and ultrasonography.
Eighty-two children were admitted to the Department of Pediatric Surgery and Intensive Care, Ljubljana, Slovenia because of suspected acute appendicitis. Among them, 49 children underwent surgery for acute appendicitis and 33 had abdominal pain but were not treated surgically and were diagnosed with non-specific abdominal pain or mesenteric lymphadenitis on sonography. Clinical signs of acute appendicitis were determined by surgeons on admission. White blood cell count and differential and serum concentrations of C-reactive protein and IL-6 were measured and abdominal ultrasonography was performed.
Ultrasonography showed the highest diagnostic accuracy (92.9%; 95% confidence interval CI, 84.5%-98.0%, Bayes' theorem), followed by serum IL-6 concentration (77.6%; 67.1-86.1%, receiver-operating characteristic ROC curve analysis), clinical signs (69.5%; 59.5-79.0%, Bayes' theorem), white blood cell count (68.4%; 57.2-78.3%, ROC curve analysis), and serum C-reactive protein concentration (63.7%; 52.174.3%, ROC curve analysis). Ultrasonography achieved also the highest specificity (95.2%) and positive (93.8%) and negative (93.3%) predictive values, whereas clinical signs showed the highest sensitivity (93.9%).
Ultrasonography was a more accurate diagnostic method than IL-6 serum concentration, laboratory marker with the highest diagnostic accuracy in our study, and hence it should be a part of the diagnostic procedure for acute appendicitis in children.
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DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
OBJECTIVETo determine factors influencing radioguided surgery of neuroendocrine tumours using Tc-ethylenediamine N,N′-diacetic acid/6-Hydrazinopyridine-3-carboxylic acid-D-Phe-Tyr-octreotide and ...γ-probe.
METHODSPatients with 17 neuroendocrine tumours were operated on. Three to 6 h before surgery, 550–650 MBq of Tc-labelled octreotide were injected into the patients. Scintigraphy was performed immediately before surgery to confirm uptake of the radiopharmaceutical by the tumour. The uptake was graded on a scale from 0 to 4. Local measurements of radioactivity were performed during surgery using a γ-probe and small lead shields.
RESULTSIntraoperatively 12 tumours in 11 patients were successfully localized using a γ-probethree tumours with uptake grade 4, seven with grade 3 and two with grade 2. Seven tumours were localized in the region of the pancreas, two next to the aortic bifurcation, one in the mesentery and two in the ileocecal region. Tumours were not found in five patients. They were all positive on scintigraphy with tracer uptake grade 4 in one patient, grade 3 in one, and grade 2 in three patients. Localization was confirmed by endoscopic ultrasound, computed tomography and/or MRI. All five tumours were located in the pancreatic area. In four of these patients, tumours were seen in the same localization as preoperatively on follow-up scintigraphy 6–12 months later.
CONCLUSIONFactors influencing the success of surgery were high octreotide uptake (grades 3 and 4) and localization of the tumour away from kidneys and spleen. Positive localization on endoscopic ultrasound, computed tomography or MRI, size of tumour, pathohistology and reoperations did not influence surgical success.
The 5th edition of TNM classification (1997) grades lymph node involvement in gastric cancer by the number of metastatic lymph nodes. Their prognostic significance as defined by the new (5th edn., ...1997) and old (4th edn., 1987) TNM classification was evaluated and survival in pN categories between both versions was compared. It was demonstrated in our analysis that comparison of old and new TNM systems is possible. Categories pN1 and pN2 contain patients selected by different criteria in both versions of TNM classification but with similar survival probabilities. Anatomic location of lymph nodes as described in the 4th edn. and number of involved nodes in the 5th edn. of TNM classification have about the same prognostic value in categories pN1 and pN2. The advantage of the 5th edn. is the identification of a group of patients (pN3, >15 involved lymph nodes) with significantly poor prognosis, which, in our series, includes 15% of R0 resected patients with lymph node metastases.
Background. Pancreatoduodenectomy – the procedure of choice in patients with pancreatic head cancer – has the reputation as a high risk operation with frequent postoperative complications, high ...postoperative mortality and poor 5-year survival. The development of the operative technique in the world and in Slovenia is presented. The autor’s own 20-year series of patients resected by this method is analysed.Patients and methods. In the period from Jan. 1981 to Dec. 2000 the author resected 58 patients with pancreatic head or periampular cancer. They underwent presumably radical or only paliative procedure (R0, R1, R2) – 30 patients with periampullary tumours and 28 patients with ductal adenocarcinoma. In 52 patients classical Whipple pancreatoduodenectomy was performed and in 6 patients pylorus preserving pancreatoduodenectomy. In 8 patients it was necessary to enlarge the resection – 4 times to partial resection of portal vein, once to total pancreatectomy, once to extended right hemicolectomy and twice to simultaneous resection of liver methastasis.Results. During postoperative course 6 patients had to be reoperated for surgical complications. Three patients died in the 30 days after operation – postoperative mortality rate 5.2%. Five-year survival rate is known only for the patients who are Slovene residents (38/58). Among them 5 patients lived longer than 5 years (107, 100, 87, 80 and 69 months). At the end of 2001 only 4 resected patients were alive – 2 women (3.5 and 3 years after surgery) and 2 men (4 and 3.5 year after surgery). The 5-year survival rate calculated by Kaplan-Meier method is 22.6%.Conclusions. In spite of numerous postoperative complications and high postoperative mortality pancreatoduodenectomy is the method of choice in pancreatic head cancer patients. It is possible to improve the outcome to lower the postoperative mortality below 5% and to raise the 5-year survival of resected patients over 25%.
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BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SAZU, SBCE, SBMB, UL, UM, UPUK
7.
Results of rectal cancer treatment Zdravko Štor; Robert Juvan; Franci Jelenc ...
Zdravniški vestnik (Ljubljana, Slovenia : 1992),
10/2007, Volume:
76, Issue:
10
Journal Article
Peer reviewed
Open access
Background: In Slovenia the incidence of colorectal cancer is growing rapidly. In 2000 591 new cases of colon cancer and 503 new cases of rectal cancer were registered. Our study compares results of ...two groups of patients with rectal cancer.Methods: In the period from January 1, 1991, to December 31, 2000, 528 patients with rectal carcinoma underwent resection. We divided them in two groups, one operated in the first 5-year and the other in later 5-year period. 5-year survival was estimated by means of Kaplan-Meier statistical analysis. Patients who died within 30 days after the operation were censored. Differences in survival curves between both groups were assessed by the log rank test.Results: We resected 528/591 (90.6 %) patients. R0 resection was performed in 431 (81.6 %) patients, R1 in 13 (2.5 %), and R2 in 84 (15.9 %) patients. Postoperative mortality rate in resected patients was 3.6 % (19/528), in the group with paliative operations was 12.7 % (7/55). Overall five-year survival rate was 52.4 % for rectal cancer. Five-year survival rate for the patients with radical resection (R0) was 59.5 %.Conclusions: 5-year survival for R0-resected patients with rectal cancer was in the period from 1996 to 2000 statistically significantly better compared with the period from 1991 to 1995 (63 % vs. 55 %) (p = 0.03627) in stage III (p = 0.01663).
Background: Colorectal cancer (CRC) is one of the most frequent malignant diseases in Slovenia. Its incidence rises constantly in the last years while the outcome of treatment is poorer than in other ...developed countries.Methods: In a retrospective study we analysed 940 colorectal cancer patients diagnosed in Slovenia in 1997.Results: Differences in outcome between the Slovenian institutions are due to different stage-distributions and differences in surgical radicality. Differences in pathohistological staging and medical oncological treatment are probably less important. The same can be said regarding some of the examples from abroad.Conclusions: With constant and objective auditing, the improvement of all aspects of treatment can be achieved, resulting in better survival of all Slovenian colorectal cancer patients.
Background. Colorectal cancer (CRC) is the third most common malignancy and the first most frequent cancer of the gastrointestinal tract occurring in Slovenia. In the Slovene Cancer Registry, there ...were 1022 new CRC cases and 598 deaths from CRC in 1998.Methods. In 2000 a survey of patients with CRC was conducted in all surgical departments in Slovenia and the data were compared with those obtained in 1995.Results. In year 2000 976 patients with CRC were admitted to all surgical departments in Slovenia: 346 (35.45%) out of 976 received treatment in Ljubljana (UMC 318, OI 28), 233 (23.87%) in two bigger regional hospitals and 397 (40.67%) in other 9 surgical units. In 1995 a total of 803 patients with CRC were treated in all surgical departments in Slovenia. The overall operability rate was 98% and resectability rate 81% and in 2000 97% and 83% respectively. Postoperative mortality rate in patients with resected CRC was 3.3% in 1995 and 4.1% in 2000.Conclusions. In the last decade early results of surgical treatment of CRC patients (operability, resectability and postoperative mortality) are unchanged but late results (5-year survival, quality of life and paliative care) have improved
Background. The paper deals with the tertiary level of care provided to patients at the Departments of Cardiology, Haematology, Nephrology, Gastroenterology and Abdominal Surgery of the University ...Medical Centre Ljubljana. The scope of these activities are described and the main problems outlined. Problems noted were mainly those connected with long waiting periods and appropriateness of referral for diagnostic evaluation and treatment. Indications for transplantation of solid organs and haematopoietic stam ceels were presented. In addition, discrepancy between the number of patients waiting for a transplant procedure and the number of organ donors was discussed. Data on patients that we wish to obtain from primary and secondary care physicians is listed including information that must be provided to the referring doctor.
