ABSTRACT
Hepatic metastases due to colorectal carcinoma have often been felt to preclude pulmonary metastasectomy. With the recent advances in surgical options, should patients with both liver and lung metastases be considered for surgical resection? The current study reviews the impact of such aggressive management on disease-free and overall survival (OS). The clinical course of 63 patients presenting with colorectal metastasis to the lung alone (group 1, n = 45) or combined hepatic and lung metastases (group 2, n = 18) were reviewed. All patients underwent complete resection of their lung metastases. Surgical control of hepatic tumor burden was achieved by tumor ablation, intra-arterial therapy, and/or resection. All patients in group 1 and group 2 were available for a mean follow-up of 27 and 24 months, respectively. The presence of hepatic metastases, the resectability of hepatic tumor burden, and the disease-free interval after pulmonary metastasectomy did not significantly influence survival. These findings demonstrate that aggressive surgical management of pulmonary metastases in the presence of liver metastases offers a similar benefit as compared to patients with pulmonary metastases alone. Therefore, hepatic metastatic disease does not preclude an attempt at pulmonary metastasectomy if hepatic metastases can be resected or remains responsive to therapy. Such an approach achieves comparable OS and mean survival when compared to pulmonary metastasectomy alone.
Subject(s)
Colorectal Neoplasms/mortality , Colorectal Neoplasms/pathology , Liver Neoplasms/secondary , Lung Neoplasms/secondary , Lung Neoplasms/surgery , Thoracotomy , Comorbidity , Female , Humans , Life Tables , Liver Neoplasms/epidemiology , Lung Neoplasms/epidemiology , Male , Middle Aged , Thoracic Surgery, Video-AssistedABSTRACT
OBJECTIVE: To determine whether neonatal fat mass, which may be a better estimate of fetal overgrowth, is correlated with maternal fasting, preprandial and/or postprandial glucose values in women with gestational diabetes mellitus (GDM). STUDY DESIGN: Women with GDM and no other medical or obstetric problems, and their infants, were the subjects of this study. Portable reflectance meters were used by all participants for self-monitoring of blood glucose levels. Average fasting, preprandial, 2-h postprandial and bedtime glucose values were determined for each subject. Neonatal body composition was obtained by total body electric conductivity and/or anthropometric measurements within 48 h after delivery. RESULTS: Eighteen women with their infants participated in this study. The age (mean +/- SD) of the mothers was 28.0 +/- 5.7 years. Nine were treated with diet and nine with diet and insulin. An average of 40 fasting (84 +/- 13 mg/dl), 50 preprandial (87 +/- 14 mg/dl), 80 2-h postprandial (106 +/- 19 mg/dl) and 17 bedtime (104 +/- 19 mg/dl) glucose values were obtained from each subject. The average gestational age of the infants at birth was 38.3 +/- 1.3 weeks with a mean weight of 3,356 +/- 526 g. Three infants were > 4 kg and seven infants were > 90th centile for gestational age. The strongest correlation with neonatal fat mass was maternal fasting glucose level (r = 0.71, p < 0.01). Neonatal fat mass was not found to be significantly correlated with any other mean glucose value. Additionally, the infant's per cent body fat (r = 0.71, p < 0.01), sum of skinfold thicknesses (r = 0.70, p < 0.01), fat-free mass (r = 0.50, p < 0.05), and weight (r = 0.61, p < 0.01) were also found to be correlated with maternal fasting glucose level. No other maternal glucose measurements were correlated with either birth weight or estimates of fat free mass. CONCLUSION: Maternal fasting glucose levels correlated best with neonatal fat mass and other estimates of neonatal body composition.
Subject(s)
Birth Weight/physiology , Blood Glucose Self-Monitoring , Body Composition/physiology , Diabetes, Gestational/blood , Infant, Newborn/growth & development , Adult , Diabetes, Gestational/physiopathology , Diabetes, Gestational/therapy , Diet, Diabetic , Fasting , Female , Humans , Hypoglycemic Agents/therapeutic use , Insulin/therapeutic use , Linear Models , Postprandial Period , Pregnancy , Pregnancy Outcome , Regression Analysis , Time FactorsABSTRACT
Postoperative femoral neuropathy is an uncommon complication of abdominal surgery. We present four cases occurring after colectomy at our institution and discuss the diagnosis and treatment.
Subject(s)
Adenocarcinoma/surgery , Colectomy , Diverticulitis, Colonic/surgery , Femoral Neuropathy/etiology , Postoperative Complications/etiology , Rectal Neoplasms/surgery , Aged , Female , Femoral Neuropathy/diagnosis , Humans , Male , Middle Aged , Postoperative Complications/diagnosis , Risk FactorsABSTRACT
Peliosis is a rare condition in which blood-filled cysts occupy the parenchyma of solid organs. It most commonly involves the liver or liver and spleen, but isolated cases of splenic peliosis have been documented. Spontaneous splenic hemorrhage from splenic peliosis has been reported in the literature only 6 times. We present the seventh known case of spontaneous hemorrhage from a peliotic spleen in an otherwise healthy man.
