Diseases of the colon and rectum
-
Free malignant cells in the peritoneal cavity might play a role in the metastasis process. However, this phenomenon needs further elucidation. The aims of this study were to investigate the frequency of free cancer cells detected on cytologic examination of lavage fluid after peritoneal washing in patients undergoing curative surgery for colorectal cancer, to explore risk factors for exfoliation of cancer cells into the peritoneal cavity, and to evaluate the influence peritoneal lavage cytology as a prognostic tool. ⋯ Conventional peritoneal cytology is a useful prognostic tool in patients undergoing curative surgery for colorectal cancer and may be helpful in making decisions whether to select intraperitoneal or systemic chemotherapy.
-
Lateral pelvic recurrence is considered a poor prognostic variable and a relative contraindication to surgery because of the difficulty in achieving clear margins. The aim of this study was to outline our surgical approach to lateral pelvic sidewall involvement and assess the oncologic and long-term outcomes. ⋯ Despite the complexity of this technique, it is safe and feasible. Careful preoperative radiologic assessment and a multidisciplinary approach are paramount to achieving clear margins.
-
Elective cesarean section at patient request is becoming common place. Women are requesting the intervention for preservation of the pelvic floor, but there is conflicting evidence to suggest that this mode of delivery has such benefits. ⋯ This review outlines the current available evidence of the risks and benefits associated with vaginal delivery and elective cesarean section and the incidence and mechanisms of injury that lead to pelvic floor dysfunction. As in most surgical conditions, a better understanding of causality of pelvic floor dysfunction may help treatment effectiveness.
-
Randomized Controlled Trial
Effect of prednisolone on local and systemic response in laparoscopic vs. open colon surgery: a randomized, double-blind, placebo-controlled trial.
This study was designed to assess whether preoperative, short-term, intravenously administered high doses of methylprednisolone (30 mg/kg 90 minutes before surgery) influence local and systemic biohumoral responses in patients undergoing laparoscopic or open resection of colon cancer. ⋯ Preoperative administration of methylprednisolone in colon cancer patients may improve pulmonary performance and postoperative pain, and shorten length of stay regardless of the surgical technique used (laparoscopy, open colon resection).
-
Excision followed by natal cleft depth reduction should be performed, with no leftover midline scar tissue, to prevent recurrence of pilonidal sinus, which is the main problem in the treatment of this disease. We investigated the potential advantages of this advancing flap technique, which we developed. ⋯ We suggest that this surgical procedure may successfully be applied to a large majority of the patients. It does not lead to unnecessary excision of healthy tissue because of its significantly simpler nature compared with the full-layer flap technique and its S-type incision, it does not create a midline scar tissue, and it is able to flatten the gluteal sulcus.