Management of Colorectal Cancer Patients Undergoing a Colonic Stenting: A Multidisciplinary Team Approach.

Colonic stent procedure is one of the best therapeutic medical interventions for managing a colorectal cancer patient with large bowel obstruction. This is a retrospective study that evaluated data from the past 10 years; it examined the epidemiological and clinical data of patients with colorectal cancer undergoing a colonic stent procedure. In addition, this study prospectively evaluated the nurse's roles during a colonic stent procedure, and at the same time, it explored the patient's satisfaction with the procedure at the Hospital Universitario Central de Asturias (Spain). The results revealed that for the last 10 years, a total of 102 patients underwent a colonic stent procedure. Male patients outnumbered female patients by 2:1. The palliative group consisted of patients with multiple cancer metastases, elderly patients, and patients with other comorbidities, whereas the preoperative group comprised those patients with fewer comorbidities and no multiple cancer metastases. Survival time in the palliative group was 3 months without any aggressive treatment, whereas patients with a favorable condition and fit for surgery after a colonic stent procedure had a survival time of 28 months. In the prospective study, nurses implemented care in terms of a multidisciplinary team approach of safety culture that included patient safety, equipment safety, and environment and procedure safety. Therefore, the level of patient satisfaction was high. In conclusion, management of a colorectal cancer patient undergoing colonic stenting performed at the Hospital Universitario Central de Asturias has high technical and clinical success, and it is a quality procedure that includes a multidisciplinary team approach.

Outcome and prognostic factors of morbidity and mortality in perforated sigmoid diverticulitis.

The aim of this study was to assess the outcomes after treatment of patients with this condition and to identify prognostic factors of morbidity and mortality. From 1986 to 2005, the charts of 114 consecutive patients who were treated for perforated sigmoid diverticulitis were retrospectively reviewed. Thirty-three patients (28.9%) were treated conservatively, and 81 (71.1%) underwent surgery. Postoperative major morbidity and mortality rates were 35.8% and 6.2%, respectively. Age > 70 years, female sex, associated diseases, low serum albumin level, high American Society of Anesthesiologists class, and Mannheim Peritonitis Index score of 21 or more were factors linked with a poor outcome. Perforated diverticulitis carries substantial morbidity and occasional mortality. To achieve improvements in outcomes, the surgical procedure should be chosen on the basis of the presence of prognostic factors. Moreover, intensive treatment after surgery in patients with risk factors is recommended.

Presentation, management and outcome of acute sigmoid diverticulitis requiring hospitalization.

AIM: This study was conducted to assess the presentation, management, and outcomes of patients with acute sigmoid diverticulitis requiring hospitalization. METHODS: From 1986 to 2005, the medical records of 265 patients treated for acute sigmoid diverticulitis requiring hospitalization were retrospectively analyzed. Data were collected with regard to patient's demographics, clinical characteristics, presentations of acute diverticulitis, treatment, morbidity, and mortality. RESULTS: Only 47 patients (17.7%) had a previous diverticulitis episode. Of the 265 patients, 166 (62.6%) were managed without operation, and 99 (37.4%) underwent surgery. Overall and major morbidity in the whole series were 30.2 (80/265) and 15.5% (40/265), respectively; whereas among the patients with surgical management, were 72.7 (72/99), and 35.3% (35/99), respectively. Overall and postoperative mortality rates were 2.6 (7/265) and 6.1% (6/99), respectively. Older age, steroid use, perforation, and co-morbidities were significantly associated with unfavorable outcomes. CONCLUSIONS: It was concluded that surgery for acute sigmoid diverticulitis requiring hospitalization carries important morbidity and mortality. To achieve improvements in outcome, a selective therapeutic approach should be considered, choosing the best surgical procedure for each complication of diverticular disease.

Emergency surgery for complicated colorectal carcinoma: a comparison of older and younger patients.

The outcomes after emergency surgery for complicated colorectal cancer of 54 patients >70 years of age (group 1) and 53 patients < or =70 years of age (group 2) treated between 1991 and 2002 were compared. Forty-two patients had obstructions in group 1 and 41 patients had obstructions in group 2. Twelve patients had perforations in each group. Significantly higher ASA grading and APACHE II scores were seen in group 1. The overall and major morbidity and mortality rates in groups 1 and 2 were 81.5% and 58.5% (P = 0.009), 42.6% and 24.6% (P = 0.04), and 27.8% and 1.9% (P = 0.000), respectively. It was concluded that the outcome in older patients who underwent emergency surgery for complicated colorectal carcinoma was poor compared with that of younger patients. Careful preoperative assessment of the patient's general condition and intensive treatment after surgery in those with a poor physical status are recommended.

Factores predictivos de malignidad en microcalcificaciones de mama sin lesiones asociadas / Predictive factors for malignancy in breast microcalcifications without associated lesions

Introducción. El cribado mamográfico de cáncer de mama permite la detección y el tratamiento temprano de los carcinomas no palpables. Las microcalcificaciones son un hallazgo mamográfico muy importante para la detección de muchos de estos procesos, pero también están presentes en enfermedad benigna de la mama. En este estudio se analizan los factores clínicos y radiológicos que tienen valor predictivo de malignidad. Material y métodos. Se han recogido retrospectivamente 133 casos de biopsias abiertas realizadas a pacientes con hallazgo mamográfico de microcalcificaciones sin lesión asociada. Las características clínicas y radiológicas se correlacionaron con los hallazgos histológicos. Resultados. El 28,6% de las lesiones analizadas fueron malignas, y entre ellas el 65,8% fueron carcinomas ductales in situ. Un 23,1% de los carcinomas infiltrantes presentaron adenopatías positivas. Ningún factor clínico tuvo valor predictivo de malignidad. En el estudio univariante, los factores radiológicos que presentaron significación estadística fueron: el tipo morfológico, según la clasificación de Le Gal, la irregularidad en el tamaño, la irregularidad en la densidad, el número de microcalcificaciones por grupo, el diámetro de la lesión y la presencia de más de un foco de microcalcificaciones. En el estudio multivariante, los factores con valor predictivo independiente fueron: la irregularidad en la densidad, la concentración ≥ 10 microcalcificaciones por grupo, la presencia de más de un foco de microcalcificaciones y el diámetro de la lesión ≥ 10mm. Conclusiones. Aunque ningún factor clínico fue relevante en la predicción de malignidad, las características radiológicas de las microcalcificaciones fueron determinantes en la indicación de una biopsia (AU)

Introduction. Screening mammography allows the early detection and treatment of nonpalpable carcinomas. Microcalcifications are highly important for the detection of many of these malignancies but are also present in benign breast disease. In the present study we analyzed the radiologic and clinical factors associated with malignancy. Material and methods. We retrospectively reviewed 133 patients who underwent open biopsy after a mammographic finding of microcalcifications without an associated lesion. Clinical and radiologic characteristics were correlated with histologic findings. Results. A total of 28.6% of the lesions analyzed were malignant. Of these, 65.8% were ductal carcinoma in situ. Among invasive carcinomas, 23.1% presented lymph node metastasis. No clinical criterion was significant for malignancy. On univariate analysis six radiologic criteria were significant: morphologic type (Le Gal's classification), irregularity of size, irregularity of density, number of microcalcifications per cluster, diameter of the lesion, and the presence of more than one cluster. On multivariate analysis the factors with independent predictive value were: irregularity of density, ≥ 10 microcalcifications per cluster, the presence of more than one cluster, and diameter of the cluster ≥ 10 mm. Conclusions: Although none of the clinical factors analyzed was predictive for malignancy, the radiological characteristics of microcalcifications were determining factors in the indication for biopsy (AU)

Obstructing colorectal carcinoma: outcome and risk factors for morbidity and mortality.

BACKGROUND/AIMS: Emergency surgery for colorectal cancer is widely thought to be associated with high morbidity and mortality. The aim of this study was to assess the operative results of patients who had emergency operations for obstructing colorectal cancer. Clinical factors that might influence the outcome were also evaluated. PATIENTS AND METHODS: This is a retrospective study including 83 patients who underwent emergency operations for completely obstructing colorectal cancers from 1991 to 2002. Demographic, clinical, and pathological variables were examined. Their influence on major morbidity and mortality was assessed using univariate and multivariate analyses. RESULTS: The overall and major morbidity rate was 67.5 and 32.5%, respectively. Mortality was 10.8%. Univariate analysis showed that high ASA class and perioperative blood transfusion were significantly associated with major complication, whereas older age and high APACHE II were linked to mortality. Independent risk factors for major morbidity were perioperative blood transfusion and high ASA class. The only independent predictor of postoperative death was high APACHE II score. CONCLUSIONS: Emergency surgery for obstructing colorectal carcinoma carries a negative impact on outcome. Patients with risk factors should undergo safe and least risky procedures. Moreover, their presence might help in selecting patients for intensive treatment after surgery.

Presentation, treatment, and multivariate analysis of risk factors for obstructive and perforative colorectal carcinoma.

BACKGROUND: It is known that emergency surgery for colorectal cancer is associated with high morbidity and mortality. The aim of this study was to assess the presentation, treatment, and outcome of patients with complicated colorectal cancer. Risk factors for morbidity and mortality were also evaluated. METHODS: From 1991 to 2002, the medical records of 107 consecutive patients undergoing emergency surgery for obstructing or perforating colorectal carcinoma were retrospectively reviewed. Information regarding patient and tumor characteristics, treatment, and outcome was recorded. Risk factors were assessed by multivariate analysis. RESULTS: Eighty-three patients (78%) had complete obstruction and 24 (22%) had perforation. Overall and major complications occurred in 70% and 34%, respectively. The mortality rate was 15%. Independent risk factors for major morbidity were perioperative blood transfusion and high American Society of Anesthesiologists (ASA) class, whereas those for mortality were older age and high Acute Physiology and Chronic Health Evaluation II (APACHE II) score. CONCLUSIONS: Emergency surgery for complicated colorectal carcinoma carries high rates of morbidity and mortality. To achieve improvements in outcome, intensive treatment after surgery in patients with risk factors is recommended.

[Predictive factors for malignancy in breast microcalcifications without associated lesions]. / Factores predictivos de malignidad en microcalcificaciones de mama sin lesiones asociadas.

INTRODUCTION: Screening mammography allows the early detection and treatment of nonpalpable carcinomas. Microcalcifications are highly important for the detection of many of these malignancies but are also present in benign breast disease. In the present study we analyzed the radiologic and clinical factors associated with malignancy. MATERIAL AND METHODS: We retrospectively reviewed 133 patients who underwent open biopsy after a mammographic finding of microcalcifications without an associated lesion. Clinical and radiologic characteristics were correlated with histologic findings. RESULTS: A total of 28.6% of the lesions analyzed were malignant. Of these, 65.8% were ductal carcinoma in situ. Among invasive carcinomas, 23.1% presented lymph node metastasis. No clinical criterion was significant for malignancy. On univariate analysis six radiologic criteria were significant: morphologic type (Le Gal's classification), irregularity of size, irregularity of density, number of microcalcifications per cluster, diameter of the lesion, and the presence of more than one cluster. On multivariate analysis the factors with independent predictive value were: irregularity of density, > or = 10 microcalcifications per cluster, the presence of more than one cluster, and diameter of the cluster > or = 10 mm. CONCLUSIONS: Although none of the clinical factors analyzed was predictive for malignancy, the radiological characteristics of microcalcifications were determining factors in the indication for biopsy.

Hernias externas incarceradas en pacientes octogenarios / Incarcerated external hernias in octogenarian patient

Objetivo. Estudiar la presentación y evolución clínica de pacientes octogenarios intervenidos de urgencia por hernia externa y, además, tratar de identificar los factores que pudieran tener algún efecto en su curso evolutivo. Pacientes y método. Se ha revisado retrospectivamente a 60 pacientes de 80 años o más intervenidos de urgencia por hernia externa incarcerada, entre enero de 1992 y diciembre de 2001. Se estudió el tipo de hernia, las características de la presentación clínica, el grado ASA, el tipo de anestesia, los métodos quirúrgicos, las complicaciones y la mortalidad. Se realizó también un análisis univariable para determinar los factores clínicos con una posible influencia en la evolución clínica. Resultados. Hubo 16 varones (26,7 por ciento) y 44 mujeres (73,3 por ciento). Un total de 32 casos fueron hernias crurales, 15 inguinales, 7 umbilicales y 6 eventraciones. Veintiséis enfermos (43,3 por ciento) acudieron al hospital con incarceración herniaria de más de 48 h de evolución. En 47 pacientes (78,3 por ciento) se observaron enfermedades asociadas significativas. Veintiocho casos (46,7 por ciento) fueron ASA II, 29 ASA III (48,3 por ciento) y 3 ASA IV (5 por ciento). En 36 pacientes (60 por ciento) se usó anestesia general y en 24, raquianestesia. Los métodos quirúrgicos más utilizados fueron las técnicas preperitoneal y de McVay. En 33 enfermos (55 por ciento) se objetivó estrangulación y en 17 (28,3 por ciento) fue necesaria una resección intestinal. Las tasas de morbilidad global y mayor y de mortalidad fueron del 58,3, 18,3 y 8,3 por ciento, respectivamente. La hospitalización tardía y un grado ASA alto fueron factores significativamente asociados con morbilidad y mortalidad. Conclusiones. Para disminuir la elevada morbimortalidad en estos pacientes, la cirugía electiva precoz debería ser la estrategia terapéutica adecuada (AU)

Emergency hernia repairs in elderly patients.

The aim of this study was to determine the clinical presentation, morbidity, and mortality and to identify the factors that might affect the outcome of emergency repair in elderly patients. A study of 143 patients (> 65 years old) who underwent emergency surgical repair for incarcerated external hernias during the period 1992-2001 was done. Fifty patients (35%) presented after 48 hours of symptoms onset. Coexisting diseases were found in 104 cases (77.7%). Bowel resection was required in 25 patients (17.5%). Overall morbidity was 46.2%, and major complications were seen in 17 cases (11.9%). Mortality was observed in seven patients (4.9%). Longer duration of symptoms, delayed hospitalization, concomitant illness, and high American Society of Anesthesiologists scores were significant factors linked with unfavorable outcome. To avoid the increased risks of emergency hernia repairs in the elderly, priority admission and early elective surgery should be used.