ABSTRACT
BACKGROUND: The role of carbon dioxide (CO2) in the pathogenesis of tumor recurrence after laparoscopy remains controversial. Using a new rat model, we studied the effect of different CO2 flow rates on the dispersal of free cancer cells. METHODS: A novel model of desufflation without trocar was developed, and 55 Fischer rats were randomized into three flow groups: group A (rapid, 0.67 l/min; n = 20), group B (slow, 0.44 l/min; n = 20), and group C (gasless, n = 15). We vented CO2 via a portless surgical valve that filtered cells. After the abdominal wall had been suspended to create space, half of the animals in each group (nonrecovery) received 7.5 x 10(6) immunolabeled rat colon cancer cells (RCC2) intraperitoneally, whereas the other half (recovery) received 7.5 x l0(6) viable RCC2 before insufflation or gasless laparoscopy. Nonrecovery animals were killed after 20 l of insufflation. Parietal peritoneal and port-site specimens were examined for RCC2 by fluorescence microscopy (FM) and flow cytometry (FC). The recovery animals were killed at 4 weeks for evidence of wound recurrence. RESULTS: Nine of 10 nonrecovery animals in A had RCC2 on FM or FC, as compared with 2 animals in each of the nonrecovery groups B and C (p = 0.018, Fisher's exact test). Two of the nine animals in group A also had RCC2 in their portless valves. Two recovery (A) animals developed wound recurrence as compared with none in the other groups (p = 0.315). CONCLUSION: In this model, rapid CO2 flow dispersed free cancer cells into the peritoneal cavity, but not into the port sites, thus supporting a role for CO2 in the intraperitoneal dispersal of free cancer cells, but not in wound recurrence.
Subject(s)
Abdominal Neoplasms/surgery , Laparoscopy/adverse effects , Neoplasm Recurrence, Local/etiology , Neoplasm Seeding , Peritoneal Neoplasms/etiology , Peritoneal Neoplasms/pathology , Animals , Carbon Dioxide/adverse effects , Cell Survival , Colonic Neoplasms/therapy , Disease Models, Animal , Male , Neoplasm Transplantation , Pilot Projects , Punctures/adverse effects , Rats , Rats, Inbred F344Subject(s)
Cholecystectomy, Laparoscopic/methods , Cholecystitis/surgery , Acute Disease , Fibrosis , HumansSubject(s)
Disinfectants , Disinfection , Disposable Equipment , Glutaral , Laparoscopes , Surgical Instruments , Humans , PlasticsSubject(s)
Hernia, Inguinal/complications , Peritonitis/complications , Aged , Female , Groin , Humans , Male , Suppuration/etiologySubject(s)
Patient Admission , Surgical Procedures, Operative , Adolescent , Adult , Aged , Humans , London , Middle Aged , Surgical Procedures, Operative/economics , Waiting ListsSubject(s)
Colitis, Ulcerative , Seasons , Adolescent , Adult , Female , Humans , Male , Middle Aged , Prospective StudiesABSTRACT
A system was implemented using a commercial database management program and a microcomputer for computerising references from journals and other sources. In addition to the citation, the user can enter the address of the institution where the study was carried out, a description of the article and of the work, key words, and an abstract. References are added, edited, searched for, displayed on screen, typed on paper, or sent to a text file, using selection criteria entered by the user. When a search is performed the printout will include the abstract of each paper, similar to that obtained from larger bibliographic services. The computer also writes requests for reprints. This program now holds over 30 000 references and has been in use for over three years. Such a system is beneficial for personal study, for writing books, articles, and theses, and for use by institutions, departments, and small libraries.
Subject(s)
Bibliographies as Topic , Computers , Information Systems/organization & administration , Microcomputers , Humans , SoftwareABSTRACT
In a 12-month period from 1 January to 31 December 1982, 1064 patients were admitted under the care of one consultant general surgeon. Of these, 485 came through the Accident and Emergency (A & E) Department; details of their management are presented. All the data were collected prospectively, stored on microcomputer discs and later analysed. The surgical cases provided adequate material for training but the planning of curricula did not allow all the A & E trainees to be adequately exposed to it. Head injuries accounted for nearly one-third of the emergency workload and were well managed, but more children with this diagnosis were admitted than was necessary. About one-quarter of the investigations performed did not contribute usefully to management; adequate discussion between the laboratories and clinicians and the laying-down of written guidelines may reduce the number of unnecessary investigations. A system which enables casualty officers to follow up the patients whom they admit will help trainees to confirm or refute their initial diagnostic impressions, and should be encouraged. A knowledge of the number, type and outcome of treatment of general surgical cases passing through the A & E Department is important in planning curricula and also for allocating resources.
