Preoperative management involves patients fasting from midnight on the evening prior to surgery. Fasting period is often long enough to change the metabolic condition of the patient which increases ...perioperative stress response. That could have a detrimental effect on clinical outcome. The aim of the present study was to investigate the possible effects of carbohydrate-rich beverage on stress response after colon resection.
Randomized and double blinded study included 40 patients with colon, upper rectal or rectosigmoid cancer. Investigated group received a carbohydrate-rich beverage the day before and two hours before surgery. In the control group patients were in the standard preoperative regime: nothing by mouth from the evening prior to operation. Peripheral blood was sampled 24h before surgery, at the day of the surgery, and 6, 24 and 48h postoperatively.
Colonic resection in both groups caused a significant increase in serum interleukin 6 (IL-6) levels 6, 24 and 48h after the operation. Increase was more evident and statistically significant in the group with fasting protocol. More significant increase of interleukin 10 (IL-10) occurred in patients who received preoperative nutrition.
Smaller increase in IL-6 and higher in IL- 10 are indicators of reduced perioperative stress.
Fasting period before surgery may change metabolic status of the patient and have influence on perioperative stress response. The aim of the study was to investigate effects of preoperative ...carbohydrate-rich beverage on stress response after laparoscopic cholecystectomy.
Patients admitted for laparoscopic cholecystectomy were included into study and they were randomized into a group that was fed prior to surgery and in a group that was in the regime of nothing by mouth from the evening one day before surgery. Concentrations of C-reactive protein and cortisol, were measured before and subsequently up to 48 h postoperatively.
Postoperative serum C-reactive protein increased significantly in both groups, but the increase was more evident in the group with fasting protocol both 24 and 48 hours postoperatively. In fed patients cortisol concentration measured in the afternoon immediately after the operation showed physiological decline. In patients with fasting protocol postoperative cortisol values rise above the values measured in the morning.
Preoperative feeding has advantage over overnight fasting by reducing preoperative discomfort in patients after laparoscopic cholecystectomy. In fed patients, smaller increase in C-reactive protein and better regulation of cortisol levels are an indicator of decreased perioperative stress response.
This study is an analysis of the large series of laparoscopic cholecystectomies and compare our results with those reported in the literature concerning complications.
From December 1993 to September ...2010, 10,317 patients with gallstone disease underwent laparoscopic cholecystectomy. Previously operated patients were also included in the study. We analyzed the successfulness of the results, intraoperative and postoperative complications, conversions in open cholecystectomy, mortality and reoperation rate.
We registered 23.28% complications. Intraoperative complications were bleeding in 9.84%, gallbladder perforation in 8.63%, stone loss in 1.37%, common bile duct injury in 0.24% and injury of intraabdominal organs in 0.07% of cases. Postoperative complications were bleeding in 1.12%, wound infection in 0.59%, bile leakage in 0.5%, incisional umbilical hernias in 0.37%, subhepatal collection in 0.33%, residual gallstones in choledocus in 0.09%, urine retention in 0.08% and biliary peritonitis in 0.01% of patients. Conversion to open cholecystectomy was necessary in 2.13%. Reoperation was performed in 0.27%. The mortality rate was 0.019%.
Our results on large number of patients are similar to other series in the newer literature but the rate of complications should be decreased. The incidence of complications decreases with growing laparoscopic experience.
Pylorus-preserving pancreaticoduodenectomy (PPPD) is the standard treatment for periampullary and pancreatic head tumors. Delayed gastric emptying (DGE) is the most common (ranging from 15-45%) but ...not life threatening complication and impairs patient recovery and prolongs the hospital stay after PPPD. The precise pathomechanism of DGE is still unclear. The aim of this study was to evaluate whether the method of pyloric dilatation performed at the time of PPPD could improve gastric emptying.
Forty patients underwent PPPD for pancreatic or periampullary lesions from January 1999 to July 2004 were included in this study. In twenty patients mechanical dilatation of the pylorus after duodenal transaction was performed (PPPD+PD group) while in other twenty PPPD was not followed with pyloric dilatation (PPPD group). The incidence of DGE as well as other complications was analyzed. Delayed gastric emptying was defined as gastric stasis requiring nasogastric intubation for more than 4 postoperative days (POD), or the inability to tolerate a regular diet on the 8th POD.
Delayed gastric emptying occurred in seven (35%) out of the 20 patients in the PPPD group, while none of the 20 patients in the PPPD+PD group developed DGE.
Pyloric dilatation reduces DGE after PPPD enabling patients to return sooner to a normal diet.
Recent evidence suggests that decline of regulatory T cells (Tregs) play a critical role in the prevalence of autoimmune diseases inhibiting the maintenance of peripheral self tolerance, while its ...augmentation leads to insufficient antitumor response, accompanied with poor prognosis in various malignancies. Increased number of Tregs (CD4+CD25+FoxP3+) were noticed in peripheral blood mononuclear cells (PBMCs), tumor-infiltrating lymphocytes (TILs) and/or regional lymph nodes lymphocytes (LNLs) of patients with gastrointestinal tumors. The aim of our study was to investigate the correlation between the percentage of Tregs in peripheral blood of patients with colorectal carcinoma, using flow cytometric technique and tumor stages, classified as Dukes' A, B, C or D and by stage of differentiation. Peripheral blood venous samples were obtained from 92 patients with colorectal cancer and from 30 healthy adult volunteers.
Linear regression equations were generated using a least-squares method and analyzed for differences of covariance. Statistical significance was calculated by Mann Whitney U-test. Our data has shown that 15% patients with colorectal cancer were classified as Dukes' A, 41% were Dukes' B, 35% were Dukes' C and 9% were Dukes' D. 54% patients with CRC were well differentiated, 11% were poorly differentiated, 20 were moderately differentiated, tage, 4% were mucinous carcinoma and rest of 11% were partly good differentiated with mucinous components. The increased percentage of Tregs in colorectal cancer patients correlates with tumor stage. These results indicate a possible involvement of regulatory T cells in disease progression. New strategies using inhibition or depletion of Tregs are necessary to elucidate the complexity of defective tumor immunity.
Summary
We report a case of a 20-year-old male with isolated complete duodenal transection at two duodenal segments after blunt abdominal trauma. On admission, the patient underwent physical ...examination, laboratory analysis, abdominal ultrasound and plain abdominal x-ray. Physical examination revealed diffuse and rebound tenderness and extreme rigidity of the abdomen, guarding and decreased bowel sounds. Standard surgical techniques were used (median laparotomy, primary anastomosis, nasojejunal three-luminal tube for feeding and gastric decompression). At exploration, we found complete transection of the duodenum just below the pylorus and between the second and third part of the duodenum. We performed primary anastomosis of both transections with interrupted sutures in two layers. Prior to discharge magnetic resonance imaging (MRI) was performed. Early diagnosis of duodenal rupture is important. When dealing with trauma patients with pain greater than local findings, the mechanism of injury should always be taken into account.
The "round block" surgical technique in the treatment of a female patient with multiple, multicentric fibroadenomas in both breasts is presented. The advantages of this technique for patients with ...multicentric benign breast lesions are minimal postoperative scar and a favourable aesthetic result. Breast dimensions and the areolar diameter were measured in 203 subjects of Primorsko-Goranska county during examination in the Out-Patient Hospital for Breast Diseases, including the operated patient. Smaller breast dimensions and a larger areolar diameter provide an easier access to any part of the breast due to a smaller distance between the incision and a fibroadenoma and a larger circumference of circular periareolar incision, thus facilitating the surgery. The analysis of average, maximum and minimum values measured shows that the "round block" technique can be performed in all cases of multiple and multicentric fibroadenomas regardless of breast size, areolar diameter and the location of fibroadenoma in the breast.
Aim:
The aim of our study was to assess diagnostic value of magnetic resonance cholangiography (MRC) in patients with suspected common bile duct (CBD) stones focusing on the capability of this ...noninvasive method to replace invasive diagnostic procedures in these patients and to limit the use of endoscopic retrograde cholangiography (ERC) to the patients who need simultaneous therapeutic intervention.
Materials and methods:
Single‐shot fast‐spin‐echo rapid‐acquisition thick‐section MRC images were obtained in 310 patients recruited into this prospective study. There were 136 male and 174 female patients aged 21–95 years mean ± standard deviation (SD) 64.9 ± 13.6 years. Patients were subsequently classified into different risk groups (high, moderate, low) according to biochemical abnormalities or morphological features on abdominal ultrasonography and computed tomography. Direct cholangiography was the reference method of CBD evaluation.
Results:
CBD stones were diagnosed in 115 (37%) patients; 86 of 175 patients in the high‐risk group, 24 of 83 patients in the moderate‐risk group, and 5 of 50 patients in the low‐risk group. In dependent risk groups, the mean CBD caliber was 9.7 ± 4.5, 7.1 ± 2.0, and 4.8 ± 1.2 mm, respectively. The difference was significant between all three groups (P < 0.05). The median size of CBD stones was 7 mm (range 3–21 mm). MRC achieved accuracy and positive and negative predictive values of 97%, 94%, and 98%, respectively.
Conclusions:
MRC has a potential to substitute diagnostic ERC in all patients with suspected choledocholithiasis due to its high accuracy, reducing invasive direct cholangiography to patients who require therapeutic intervention.
Dupuytren's disease predominantly occurs among Europeans, with higher reported prevalence in Northern than in Mediterranean European countries. We evaluated the recurrence and extension rates among ...Caucasian patients from Primorsko-goranska County in Croatia who underwent partial fasciectomy as treatment for Dupuytren's disease. Furthermore, we investigated the influence of diathesis factors on disease progression. Recurrent disease was observed in 68 out of 93 patients (73%). There where 48 (52%) patients with extension of the disease. Differences were found between patients with recurrent disease and those without recurrence regarding age at onset, age at operation and duration of disease. We compared patients younger and older than 50 years at disease onset, and found that older patients had a significantly higher recurrence rate. Characteristics of our patients fit into the picture of typical Dupuytren's disease except for the influence of early age at onset. Among our patients late age at onset proved to be a diathesis factor.
To compare a limited palmar incision for carpal tunnel release (CTR) with a traditional open technique, which is still considered the gold standard.
Seventy-two patients with a carpal tunnel syndrome ...were individually randomized into the trial (limited incision CTR) (n=36) and control group (traditional technique CTR) (n=36). In the trial group, skin incision parallel to the thenar crease was made up to 2.5 cm in length, under an operating microscope and endoscopic transillumination. Skin incision in the control group began at the distal border of the carpal ligament, followed the longitudinal crease of the palm, and crossed the base of the palm in a zigzag fashion. Three months after surgery, the patients were asked about symptomatic relief and intervals between the operation and return to their daily activities and work, and examined for scar tenderness and esthetic outcome. Distal motor latency, conduction velocity, scar length, scar width, and operation time were measured.
There were no differences between the two groups in symptomatic relief and electrophysiological parameters. Intervals between the operation and return to daily activities (median 5 days, range 2-15) were shorter in the trial group than in the control group (median 10 days, range 2-21; p<0.001), as well as the intervals between the operation and return to work (median 15 days, range 5-45 vs median 30 days, range 10-60; p<0.001). Scar/pillar tenderness, scar length and width, esthetic outcome, and operation time were significantly better in the trial group.
Limited palmar incision CTR is as effective and safe as traditional CTR technique, but with better postoperative recovery and cosmetic results.
