ABSTRACT
The optimal delay in the start of chemotherapy following rectal cancer surgery has not yet been identified. However, postponed adjuvant therapy has been proven to be connected with a significant survival detriment. We aimed to investigate whether the time to initiation of adjuvant treatment can be influenced by the application of minimally invasive surgery rather than traditional open surgery. By comprehensively evaluating the available inherent literature, several factors appear to be associated with delayed postoperative chemotherapy. Some of them are strictly related to surgical short-term outcomes. Laparoscopy results in shortened length of hospital stay, reduced surgical morbidity and lower rate of wound infection compared to conventional surgery. Probably due to such advantages, the application of minimally-invasive surgery to treat rectal malignancies seems to impact favorably the possibility to start adjuvant chemotherapy within an adequate timeframe following surgical resection, with potential improvement in patient survival.
Subject(s)
Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Colorectal Neoplasms/drug therapy , Colorectal Neoplasms/surgery , Laparoscopy , Chemotherapy, Adjuvant/methods , Colorectal Neoplasms/mortality , Humans , Laparoscopy/methods , Minimally Invasive Surgical Procedures/methods , Postoperative Care/methods , Randomized Controlled Trials as Topic , Risk Factors , Survival Analysis , Time Factors , Treatment OutcomeABSTRACT
BACKGROUND: Laparoscopic appendectomy is widely performed by surgical residents, but its changing indications and outcomes have been poorly investigated. The aim of this study was to examine whether a difference exists in indications and outcomes between laparoscopic appendectomies performed by residents and those performed by experienced surgeons. METHODS: Between 1999 and 2007, 218 laparoscopic appendectomies were performed and recorded. Data were analyzed to compare operations performed by residents with those by experienced surgeons in terms of indications for surgery and severity of disease. Moreover, laparoscopic appendectomies were thoroughly compared regarding outcomes and complications. RESULTS: The residents had fewer conversions with laparoscopic appendectomy (8% vs 17%, P=0.04), and similar complication rates (12% vs 13%, P=0.16), compared with experienced surgeons. The median operating time was also comparable (67 minutes vs 60 minutes, P=0.23). However, patients operated on by residents had more emergencies (86% vs 70%, P=0.009), included more foreigners (27% vs 15%, P=0.03), and had intermediate to severe diseases, (81 vs 52%, P<0.001) than patients did operated on by experienced surgeons. CONCLUSIONS: Surgical residents performed more emergency laparoscopic appendectomies on foreign patients suffering from intermediate to severe diseases compared with experienced surgeons, with comparable surgical outcomes and lower conversion rates.
Subject(s)
Appendectomy/methods , Clinical Competence , Internship and Residency , Laparoscopy/methods , Adolescent , Adult , Aged , Aged, 80 and over , Chi-Square Distribution , Female , Humans , Male , Middle Aged , Postoperative Complications , Statistics, Nonparametric , Treatment OutcomeABSTRACT
Nanocomposites based on isotactic polypropylene/ethylene propylene rubber (iPP/EPR) were prepared adding different amounts of montmorillonite and maleated polypropylene. The structure and morphology of the samples were characterized by small angle X-ray scattering, wide angle X-ray diffraction, electronic and optical microscopy and differential scanning calorimetry, iPP showed a polymorphic behavior. Clay disrupted the ordered crystallization of iPP and had a key role in shaping the distribution of iPP and EPR phases: larger filler contents brought about smaller, less coalesced and more homogeneous rubber domains. Clay distributed itself only in the continuous phase and not in the rubber domains. Tactoids persisted on the surface of the sample, while delamination proceeded to a greater degree in the bulk of the materials. Melt flow rate, impact strength, flexural and tensile properties, were also measured and a structure-property correlation was sought. Clay produced its most significant effect on physical-mechanical properties by controlling the size of rubber domains in the heterophasic matrix. This allowed to obtain nanocomposites with increased stiffness and impact strength, a remarkable achievement for polymer layered-silica nanocomposites that usually suffer the drawback of being stiffer than the unfilled matrix, but at the same time with a lower resistance to impact. A beneficial effect of clay on thermal stability was also observed.
Subject(s)
Bentonite/chemistry , Crystallization/methods , Nanostructures/chemistry , Nanostructures/ultrastructure , Polyethylene/chemistry , Polypropylenes/chemistry , Rubber/chemistry , Elasticity , Hardness , Macromolecular Substances/chemistry , Materials Testing , Molecular Conformation , Nanotechnology/methods , Particle Size , Surface Properties , Tensile Strength , Transition TemperatureABSTRACT
Objetivo: Relatar casos que mostram a eficácia do uso exclusivo da pentoxifilina por via oral no tratamento da surdez súbita de etiologia näo definida. Método: Dez casos de surdez súbita sem etiologia conhecida foram tratados exclusivamente com pentoxifilina 400 mg via oral (1200mg/dia). Quatro eram do sexo feminino e seis do sexo masculino com idade média entre 40 e 70 anos. Resultados: As audiometrias seriadas demonstraram diferentes respostas individuais, com melhora audiométrica de todos os casos. Conclusäo: A surdez súbita pode ser tratada ambulatorialmente, com economia, segurança e bons resultados.
