43 patients with stage III NSCLC (non-small cell lung cancer) entered a phase II study aimed at evaluating the toxicity and the activity of a combined modality programme including an accelerated ...split-course schedule (type B) of thoracic radiation therapy and a combination chemotherapy with vinorelbine and carboplatin. An objective response was achieved in
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evaluable patients (5 complete and 13 partial responses), for an overall response rate of 43% (95% confidence interval, 28–58%). Four complete responses had a duration which exceeded 16 months. Treatment was well tolerated; grade III myelotoxicity occurred in only 14% of patients and treatment was delayed in only 2 cases because of grade 3 oesophagitis. Both tolerability and efficacy data suggest that this regimen holds promise for the treatment of patients with stage III NSCLC.
Anorectal manometric and electromyographic studies assess anorectal and pelvic floor neuromuscular disorders and can help in the diagnosis and management of incontinence, prolapse, megarectum, and ...other functional anorectal disorders. These studies can assess preoperative and postoperative anorectal function and help in the differential diagnosis of anorectal disorders, and thus they assist the surgeon in carrying out rational therapy.
Pseudo-obstruction of the colon is characterized by an adynamic unobstructed colon which rapidly progresses to marked dilatation of the cecum and transverse colon. Disagreements exist regarding the ...etiology or pathogenesis of this syndrome; it has been associated with metabolic, traumatic, postoperative, and idiopathic causes. In reviewing the literature we have concluded that in pseudo-obstruction of the colon after cesarean section, the mean age of occurrence is 35 years. The symptoms occur in the first 72 hours after operation. Straight x-ray examination of the abdomen is the most useful diagnostic measure. All cecal perforations occurred by the fifth postoperative day. For this reason, we recommend early diagnosis and prompt surgical intervention before that time. In cases when the cecal distention is 12 cm or more, decompression is urgent.
Preoperative chemoradiation allows downstaging of locally advanced rectal cancer and in selected patients also a sufficient downsizing to ensure sphincter preservation. Selection of patients ...warranting a preoperative approach is improved by magnetic resonance imaging (MRI) which is able to define the involvement of mesorectal circumferential margin. Similarly it would be crucial to define the response to chemoradiation during the treatment but traditional morphologic imaging techniques may fail in differentiating neoplastic tissue from scarring. PET-FDG has been successfully used in the detection of metastatic colorectal cancer allowing imaging of deposits as small as 0.5 cm and may have a role in evaluating early response to chemoradiation.
In the present study, in patients with T3-T4 rectal cancer undergoing preoperative chemoradiation PET-FDG and flow cytometry analysis on endoscopic biopsy specimen have been performed before, during and after preoperative chemoradiation.
Chemoradiation treatment has been successful in terms of downsizing and downstaging of the tumor. PET-FDG was able to demonstrate local response at only ten-fifteen days after the beginning of neoadjuvant therapy, also identifying non responding patients.
FDG-PET may have a role in defining the response to chemoradiation and modulate the treatments strategy in patients with advanced rectal cancer.
A modified technique of an intracolonic bypass procedure after an anastomosis has already been completed is described. Its use would be in place of those situations where the surgeon is contemplating ...protecting the completed anastomosis with a temporary colostomy/ileostomy.
A prospective study was carried out in 14 patients with rectal cancer. Tumors were staged preoperatively by endoluminal ultrasonography (EU) and computed tomography (CT). Patients were followed ...postoperatively for 2 years by the same modalities. Extramural spread was 100% (9/9), accurately assessed by EU and 77.8% (7/9) with CT. Lymph node sensitivity was 87.5% for EU and 37.5 for CT (P less than 0.05). Overall accuracy of lymph node metastases was 85.7% for EU and 57.1% for CT (P less than 0.1). In conclusion, the study shows EU to be statistically more accurate for nodal metastases than CT; therefore, its routine use can be recommended in the preoperative staging of rectal carcinoma in those patients for whom a sphincter-saving procedure is considered.
The one-stage intracolonic bypass procedure prevents gastrointestinal secretions and fecal content from coming in contact with an anastomotic site without interrupting the intraluminal continuity of ...the fecal flow from proximal to distal colon. This can be achieved by the intraluminal implantation of a soft, pliable tube above the anastomotic site. Previous clinical and experimental data have indicated that the intracolonic bypass procedure can protect an anastomosis in the presence of maximal colonic loading, gross dehiscences, or fecal peritonitis. This report presents 28 patients with perforated diverticulitis, all of whom were treated by one-stage intracolonic bypass procedures. Ten of the 28 patients had peritonitis, and 18 had pericolic abscesses. Results indicate no deaths and no anastomotic leakages. Three patients (10.7%) had a complicated postoperative course. One patient with fecal peritonitis had prolonged ileus and a pulmonary effusion, and one had a myocardial infarction. Both of these patients responded to medical therapy. Another patient had a wound infection. The hospital stay ranged from 10 to 18 postoperative days. All patients passed the tubes spontaneously 2 to 3 weeks after operation. The one-stage intracolonic bypass procedure can be recommended as a viable alternative to the two- or three-stage procedures commonly used for perforated diverticulitis.
