ABSTRACT
Background and study aims: colonoscopy remains the gold standard for the examination of the colon. However, its use in the elderly is not well tolerated, and there is often a need for general anaesthesia, thus increasing the risk, especially if there are co-morbidities. Water enema computed tomography has been suggested to be a satisfactory alternative as a non-invasive, fast and effective means for the diagnosis of colorectal supra-centimetric lesions
Background and study aims: the aim of our study was to assess the performance of water enema computed tomography as first-line examination by calculating its negative predictive value [NPV] for the diagnosis of supra-centimetric lesions in symptomatic elderly referred to colonoscopy
Patients and methods: this was a prospective study including 57 symptomatic patients older than 65 years. All patients were explored by water enema computed tomography at first, followed by colonoscopy, and responded to a questionnaire on the tolerance to the preparation and both procedures
Results: the mean age of patients was 73 years. The M:F sex ratio was 1.59. The most frequent indication for colonoscopy was bowel disorders associated with abdominal pain [30%]. Water enema computed tomography allowed the diagnosis of tumours [n = 2], polyps [n = 6], diverticulosis [n = 7], inflammatory wall thickening [n = 1] and extra-colic lesions [n = 28]. NPV of water enema computed tomography for supra-centimetric lesions was 96.5%. Sensitivity and specificity were 87.3% and 98%, respectively. However, for sub-centimetric lesions, water enema computed tomography had a low sensitivity estimated at 6%, specificity at 89.9%, positive predictive value at 91.9% and NPV at 27.7%
Conclusion: water enema computed tomography has proven to be a valuable and non-invasive method indicated as a first-line examination in case of colonic symptoms in the elderly to diagnose supracentimetric lesions
ABSTRACT
In recent years, multidisciplinary therapeutic management of rectal cancer has evolved. This progress had interest radio and chemotherapy. Aim: To describe the main spots of the progress in the therapeutic strategies of the disease, surgical techniques and standardization of these techniques, particularly regarding locoregional extension in the mesorectum. Literature review. Treatment of rectal cancer is multidisciplinary. On the surgical field, excision of the mesorectum [total mesorectal excision [TME]] has reduced local recurrence and the genitourinary sequelae. Meanwhile, chemoradiotherapy has become important. The standard now is to indicate to T3 T4 N+ tumors to decrease local recurrence without improving survival, however. Advances in the management of rectal cancer with both imaging progress and therapeutic modalities have improved the prognosis and survival of this cancer
ABSTRACT
Feasibility and advantages of laparoscopic approach in performed duodenal ulcer have no longer to be demonstrated. Laparoscopic suture and peritoneal cleaning expose to a conversion rate between 10 and 23%. However less than laparotomy, morbidity of this approach is not absent. This study aim to analyze factors exposing to conversion after laparoscopic approach of perforred duodenal ulcer. We also aim to define the morbidity of this approach and predictive factors of this morbidity. Retrospective descriptive study was conducted referring all cases of perforated duodenal ulcer treated laparoscopically over a period of ten years, running from January 2000 to December 2010. All patients were operated by laparoscopy with or without conversion. We have noted conversion factors. A statistical analysis with logistic regression was performed whenever we have sought to identify independent risk factors for conversion verified as statistically significant in univariante. The significance level was set at 5%. Analytic univariant and multivariant study was performed to analyze morbidity factors. 290 patients were included. The median age was 34ans.T he intervention was conducted completely laparoscopically in 91.4% of cases. The conversion rate was 8.6%. It was selected as a risk factor for conversion: age> 32 years, a known ulcer, progressive pain, renal function failure, a difficult peritoneal lavage and having a chronic ulcer. Postoperative morbidity was 5.1%. Three independent risk factors of surgical complications were selected: renal failure, age> 45 years, and a chronic ulcer appearance. Laparoscopic treatment of perforred duodenal ulcer expose to a conversion risk. Morbidity is certainly less than laparotomy and a better Knowledge of predictif's morbidity factors become necessary for a better management of this disease