World journal of surgery
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World journal of surgery · Jan 2000
Comparative StudyIntraoperative ultrasonography versus helical computed tomography and computed tomography with arterioportography in diagnosing colorectal liver metastases: lesion-by-lesion analysis.
Helical computed tomography with arterioportography (CTAP) and intraoperative sonography (IOUS) are both recognized to be extremely sensitive in the detection of liver metastases measuring <2 cm in diameter. As sensitivity and specificity values for both techniques differ significantly in the literature and in default of sufficient published data regarding this subject, a lesion-by-lesion analysis was considered necessary. Accuracy of IOUS was compared with helical computed tomography (CT) and portal-phase contrast enhancement (CTAP) in the preoperative detection of liver metastases from colorectal carcinoma projected as a prospective blinded study. ⋯ IOUS and CTAP are of comparable value regarding the detection of liver metastases <10 mm. Both techniques may be used if resections of synchronous or metachronous metastases are planned in order not to miss limiting small lesions and to prevent superfluous liver surgery. Helical CT scan with dynamic intravenous contrast enhancement is considered the most cost-effective preoperative staging method, although local staging may not be achieved because of insufficient intraabdominal survey.
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World journal of surgery · Jan 2000
Randomized Controlled Trial Comparative Study Clinical TrialVideo-assisted thoracoscopic lobectomy achieves a satisfactory long-term prognosis in patients with clinical stage IA lung cancer.
We designed a prospective trial to determine the long-term prognosis of video-assisted thoracoscopic (VATS) lobectomy versus conventional lobectomy for patients with clinical stage IA (T1N0M0) lung cancer. Between January 1993 and June 1994, 100 consecutive patients with clinical stage IA non-small cell lung carcinoma underwent either conventional lobectomy through an open thoracotomy (open group; n = 52) or VATS lobectomy (VATS group; n = 48). Lymph node dissections were performed in a similar manner in both groups. ⋯ Two and one of the open and VATS group patients developed second primary cancers, respectively. The overall survival rates 5 years after surgery were 85% and 90% in the open and VATS groups, respectively (log-rank test, p = 0.74; generalized Wilcoxon test, p = 0.91). VATS lobectomy with lymph node dissection achieved an excellent 5-year survival, similar to that achieved by the conventional approach.
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World journal of surgery · Jan 2000
Comparative StudyOperative management of civilian rectal gunshot wounds: simpler is better.
Extraperitoneal rectal gunshot wounds have been managed with a variety of methods from simple diverting colostomy to combinations of rectal repair, proximal diversion, transperitoneal or presacral drainage, and distal bowel irrigation techniques. Treatment methodology is chosen based on anecdotal experience, and there is no clear evidence that any technique is superior to the others. The objective of this study was to compare 3 methods of managing civilian extraperitoneal gunshot wounds. ⋯ In conclusion, diverting colostomy without rectal repair or drainage appears to be safe for the management of most civilian retroperitoneal rectal gunshot wounds. Additional surgical maneuvers may be required for combined rectal and urinary trauma or other complex rectal injuries. Sound surgical principles, tailored to the individual case, should overrule any unproven dogmas.
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World journal of surgery · Jan 2000
Comparative StudyActivation of monocytes and endothelial cells depends on the severity of surgical stress.
Surgical injury not only induces a systemic endocrine-metabolic response but also influences the function of the leukocytes and endothelial cells leading to various systemic responses. These responses appear to depend on the severity of surgical stress, which differs according to the surgical procedures. In this study, we investigated the response of monocytes and endothelial cells, and the development of systemic inflammatory response syndrome (SIRS) in relation to the severity of surgical stress. ⋯ The serum IL-6 levels, TNF-alpha production of monocytes, and CD11b intensity on monocytes or granulocytes in the ER group were higher than those in the DG group. In the ER group, the ICAM-1 intensity on HUVECs with monocytes immediately after operation significantly increased compared with before the operation. In conclusion, both the CD11b expression on monocytes and the TNF-alpha production of monocytes are considered to reflect the degree of surgical stress, and the activation of endothelial cells stimulated with these activated leukocytes may therefore lead to both tissue and organ injury.
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World journal of surgery · Jan 2000
Comparative StudyFate of the rectum and ileal recurrence rates after total colectomy for Crohn's disease.
The aim of this study was to examine the fate of the rectum and ileal recurrence rates after total colectomy for Crohn's disease. One hundred thirty patients who underwent total colectomy between 1970 and 1997 were reviewed; 65 patients underwent end ileostomy with an oversewn rectal stump (TC+I) and 65 had ileorectal anastomosis (IRA). Patients treated by TC+I had significantly more rectal involvement (93%) than those having IRA (43%) (p < 0.0001). ⋯ Using Kaplan-Meier methods, the 10-year cumulative probability of proctectomy was significantly higher after TC+I than IRA (58% versus 22%; p = 0.0001), whereas the 10-year cumulative probability of ileal resection was significantly higher after IRA than TC+I (37% versus 18%; p = 0.03). In conclusion, the proctectomy rate is higher after colectomy and ileostomy probably due to a higher incidence of preoperative rectal involvement. By contrast, the ileal recurrence rate is higher after colectomy and IRA.