Same-day surgery ileostomy closure?

Loop ileostomy is a common procedure for temporary fecal diversion. Length of stay for ileostomy closure in many series is 3 to 6 days. There is, however, increasing pressure on surgeons to discharge patients as soon as possible. With attention to surgical details and careful perioperative management, it is possible to perform ileostomy closure as a same-day-discharge operation. This technique was used to treat six patients who needed ileostomy closure. All patients were discharged the day after or the day of the surgical intervention. There was no morbidity. Loop ileostomy and same-day ileostomy closure are cost-effective procedures for temporary fecal diversion.

Multifactorial analysis of local recurrences in rectal cancer, including DNA ploidy studies: a predictive model.

DNA ploidy studies were performed in 188 patients operated on for rectal cancer. In order to define different risk groups of patients, a stepwise logistic regression was carried out in 138 patients who underwent abdominal "curative" resections. Thirty-seven variables were analyzed. Although several variables were significant, only three improved the prognostic value: (1) more than three positive lymph nodes (p = 0.0007); (2) macroscopic local tumor invasion (p = 0.01); and (3) DNA ploidy (p = 0.03). Standardized discriminant coefficients were used to obtain a model and format for predicting local recurrences. This is the first time that a predictive model for rectal cancer, using DNA ploidy as a variable, is reported. Based on calculated discriminant values (DV), patients can be divided into three subgroups: (1) low risk for local recurrences (DV < -1.9, n = 56)--local recurrences were observed in two patients (3.6%); (2) moderate risk (DV between -1.9 and -0.6, n = 55)--local recurrences occurred in nine patients (16.4%); and (3) high risk (DV > -0.6, n = 27)--local recurrences occurred in 14 patients (51.8%). This predictive model for local recurrences has much better prognostic value than Dukes' staging (p < 0.0001).

Prognostic value of positive lymph nodes in rectal cancer.

Abdominal "curative" resections for rectal cancer in 109 patients with positive lymph nodes were prospectively studied. The best subdivision of patients for predicting outcome was into 1-3 and greater than 3 positive lymph node groups. Comparison with patients with greater than 3 positive lymph nodes demonstrated that patients with 1-3 positive nodes had less local (35.0 percent vs. 13.0 percent; P = 0.007) and less distant recurrence (45.0 percent vs. 26.0 percent; P = 0.04) and had much better crude five-year survival (58.2 percent vs. 17.0 percent; P less than 0.0001). For predicting postsurgical outcome in patients with positive lymph nodes, the results justify subdividing patients into the following two prognostic subgroups: 1) those with 1-3 involved lymph nodes and 2) those with metastatic tumor in four or more lymph nodes.

Palliation for rectal cancer. Resection? Anastomosis?

There is no agreement regarding the proper management of patients with advanced carcinoma of the rectum. We performed a study to clarify whether palliative resection with or without primary anastomosis is worthwhile and safe. Among 679 patients managed for cancer of the rectum, 125 were considered incurable and underwent palliative procedures. High and low anterior resections were performed in nine and 57 cases, respectively, abdominoperineal resection in 26, Hartmann's procedure in three, simple diverting colostomy in 17, and transanal excision in 13. The overall postoperative mortality rate was 0.8%. Postoperative morbidity was 18% in abdominal operations and none in local excisions. Among patients treated by abdominal resections, only one required subsequent reoperation for colonic obstruction secondary to local recurrence. The median survival was 6.4 months for patients treated by diverting colostomy, 14.8 months for abdominally resected cases, and 14.7 months for transanal excisions. We conclude that palliative resection, often with primary anastomosis or local transanal excision, can be done safely in patients with incurable rectal cancer. We believe this approach improves the quality of the remaining life for these patients.

Mastery of verb tense markers by normal and learning-disabled children.

Sixty learning-disabled children with a mean age of 7-11 and 60 children in regular classes with a mean age of 7-10 were given a tense marker test to elicit future, present, and past tense markers for 50 verbs organized into 10 categories based on the operation required to form the past tense. Results indicated that both normal and learning-disabled children had achieved control of future, present, and /-d/ and /-t/ past tense markers. Neither group has mastered the /-ed/ nor seven categories of irregular past tense markers. Children in regular classes showed significantly higher correct responses across 10 categories of past tense items. Analysis of error patterns indicated that learning disabled children used a different pattern of responses and a different set of rules to mark past tense. This study shows the need for data on the linguistic status of normally developing children above the age of seven, if we are to make any inferences about the performance of children whose development is deviate.