ABSTRACT
A 68-year-old female presented with acute abdominal discomfort in the left lower quadrant and a painful left leg. Her medical history only revealed an eating disorder. Physical examination was insignificant. Diagnostic imaging showed an obturator hernia; subsequently, a laparotomy was performed. An obturator hernia, also known as little old ladies' disease, is associated with abdominal pain and a painful leg.
Subject(s)
Cachexia/complications , Hernia, Obturator/complications , Herniorrhaphy/methods , Pain/etiology , Aged , Female , Hernia, Obturator/diagnosis , Humans , Laparotomy , Leg , Pain/diagnosisABSTRACT
BACKGROUND: Video-assisted thoracoscopic surgery (VATS) lobectomy and stereotactic ablative radiotherapy (SABR) are both used for early-stage non-small-cell lung cancer. We carried out a propensity score-matched analysis to compare locoregional control (LRC). PATIENTS AND METHODS: VATS lobectomy data from six hospitals were retrospectively accessed; SABR data were obtained from a single institution database. Patients were matched using propensity scores based on cTNM stage, age, gender, Charlson comorbidity score, lung function and performance score. Eighty-six VATS and 527 SABR patients were matched blinded to outcome (1:1 ratio, caliper distance 0.025). Locoregional failure was defined as recurrence in/adjacent to the planning target volume/surgical margins, ipsilateral hilum or mediastinum. Recurrences were either biopsy-confirmed or had to be PET-positive and reviewed by a tumor board. RESULTS: The matched cohort consisted of 64 SABR and 64 VATS patients with the median follow-up of 30 and 16 months, respectively. Post-SABR LRC rates were superior at 1 and 3 years (96.8% and 93.3% versus 86.9% and 82.6%, respectively, P = 0.04). Distant recurrences and overall survival (OS) were not significantly different. CONCLUSION: This retrospective analysis found a superior LRC after SABR compared with VATS lobectomy, but OS did not differ. Our findings support the need to compare both treatments in a randomized, controlled trial.
Subject(s)
Carcinoma, Non-Small-Cell Lung/surgery , Catheter Ablation/methods , Lung Neoplasms/surgery , Pneumonectomy/methods , Propensity Score , Thoracic Surgery, Video-Assisted/methods , Aged , Aged, 80 and over , Carcinoma, Non-Small-Cell Lung/pathology , Cohort Studies , Female , Follow-Up Studies , Humans , Lung Neoplasms/pathology , Male , Middle Aged , Neoplasm Staging , Retrospective Studies , Treatment OutcomeABSTRACT
Acute pancreatitis remains a disease with high morbidity and mortality. Acute pancreatitis can be subdivided in acute interstitial pancreatitis and necrotising pancreatitis, largely compatible with clinically mild and severe pancreatitis. This diagnosis is made on the basis of patient history, physical examination, laboratory parameters, contrast CT scan and, occasionally, endoscopic retrograde cholangiopancreatography. Prognosis on admission can be established using a scoring system such as the modified Glasgow score, the Ranson score and the 'Acute physiology and chronic health evaluation'--(APACHE)-II-score. The treatment of acute pancreatitis is primarily conservative. Indications for surgical intervention are: progressive sepsis despite maximum conservative management, an established infection of (peri)pancreatic necrosis, peripancreatic abscess and perforation of stomach, small intestine or colon. The purpose of an operation is to remove necrotic tissue, achieve adequate drainage of the necrotic area or to treat a perforation. The Groningen and Utrecht University Hospitals have collaborated to develop a protocol to standardise the diagnostic approach, management, timing and choice of surgical intervention, as well as to prospectively investigate the effect of such a strategy in patients with acute pancreatitis.
Subject(s)
Abdominal Pain/etiology , Pancreas/surgery , Pancreatitis/diagnosis , Pancreatitis/therapy , Acute Disease , Algorithms , Cholangiopancreatography, Endoscopic Retrograde , Diagnosis, Differential , Humans , Pancreatic Function Tests , Pancreatitis/complications , Pancreatitis, Acute Necrotizing/complications , Pancreatitis, Acute Necrotizing/diagnosis , Severity of Illness IndexABSTRACT
BACKGROUND: Medical peri-operative consultation plays an important role in the practice of the internist. It represents 13-33% of the total consultation done by the internist. The value of preoperative consultation by the internist is still unclear and the place of the consultations is under discussion. METHODS: Consecutive medical consultations--by internist-intensivists from the surgical ICU--of 408 patients in the department of Surgery of the University Hospital Groningen were retrospectively analyzed, with specific attention to the consultation request, the consultation report and the outcome of the consultation. RESULTS: The main problems were cardiac (34%) or pulmonary (20%). In 78% well defined questions about the patients were asked and in 29% of the preoperative requests, the requesting surgeon asked specific advice about diagnosis and management. In 49% the requesting physician asked for an 'evaluation' of the patients. Of all consultations 271 (67%) were preoperative consultations. In 12% the findings of the preoperative consultation had a significant impact on the course of the patient, whereas in 7% of the preoperative requests the operation was postponed. The consulting internist recommended in 2% to cancel the operation for this admission, which was shared by the surgeon and anesthesiologist. In 10% of all cases new diseases or processes were diagnosed, or were found not to be treated adequately before consultation, so the diagnosis or management was changed. CONCLUSIONS: Our data show that (semi-) elective consultations by internists at the department of Surgery, on indication of the surgeon, changes the course of a significant percentage of patients. (See Editorials p. 1 and p. 4).
