Transanal endoscopic microsurgery for T1 and T2 rectal cancers: a meta-analysis and meta-regression analysis of outcomes.

The objective of this study is to assess transanal endoscopic microsurgery (TEM) as a surgical strategy for stage I rectal cancer. The literature lacks level I and level II evidence of the oncologic competence of TEM. Three randomized controlled, one prospective, and seven retrospective comparative studies were evaluated. End-points included perioperative outcomes, margin involvement, disease-free and overall survival, and recurrence. The number of patients with major (odds ratio (OR) = 0.24, 95% confidence interval (CI) 0.07-0.91) and overall postoperative complications (OR = 0.16, 95% CI 0.06-0.38) were significantly lower in TEM. The disease-free survival was higher in standard resection (SR) group compared with TEM (OR = 0.46, 95% CI 0.24-0.88). The number of patients with positive margins were less in the SR group (OR = 6.49, 95% CI 1.49-24.91), which was associated with lower local recurrence (OR = 4.92, 95% CI 1.81-13.41) and overall recurrence rate (OR = 2.03, 95% CI 1.15-3.57). No survival advantage was observed in favor of either procedure. TEM had lower rate of positive margins and longer disease-free survival when compared with transanal excision (TAE). TEM seems to be superior to SR concerning morbidity whilst less effective in obtaining negative surgical margins, and it is associated with higher local and overall recurrence. No survival advantage was observed in favor of either procedure. Unfavorable tumor preoperative histology does not seem to influence the selection between TEM and SR. TEM is more effective than TAE in obtaining negative surgical margins and shows a greater disease-free survival.

Selective beta blockade improves the outcome of cardiopulmonary resuscitation in a swine model of cardiac arrest.

BACKGROUND AND OBJECTIVES: Epinephrine has been the mainstay drug of choice for cardiac resuscitation for more than 30 years. Its vasopressor effects favoring initial resuscitation point to its beta-adrenergic action. However, its beta-adrenergic actions may have detrimental effects. The aim of the present experimental study was to evaluate the efficiency of coadministration of Esmolol, an ultra-short-acting beta-blocker, and of epinephrine in a swine model of cardiac arrest. MATERIALS AND METHODS: Fourteen pigs (19 +/- 2 Kg) were anesthetized and instrumented. Ventricular Fibrillation (VF) was produced electrically. After induction of VF, the animals were left untreated for 5 minutes. Animals were randomized into two groups, control and study group. Six animals were used in the control group, and 8 in the study group. The control group received 10 ml of normal saline via a peripheral vein, while the study group received 0.4 mg/kg Esmolol in 10 ml dilution. Epinephrine was administered to all animals after the first unsuccessful defibrillation set, and all animals received standardized Advanced Life Support. RESULTS: Seven animals (87.5%) restored cardiac rhythm compatible with a pulse in the Esmolol group, compared to 2 animals (33.3%) in the control group (p = 0.018). The average time until restoration of circulation was 16 +/- 3.2 minutes in our control group and 12.8 +/- 1.4 minutes in Esmolol group (p = 0.059). Coronary perfusion pressure (CPP) was significantly higher in the Esmolol group. CONCLUSIONS: Esmolol improves significantly the outcome of cardiopulmonary resuscitation and the average time of restoration of circulation, while in the proposed dosage does not alter the CPP at the beginning of CPR. However, it augments CPP from the sixth minute of CPR and afterwards.

Resuscitation outcomes comparing year 2000 with year 2005 ALS guidelines in a pig model of cardiac arrest.

BACKGROUND: Ventricular fibrillation remains the leading cause of death in western societies. International organizations publish guidelines to follow in case of cardiac arrest. The aim of the present study is to assess whether the newly published guidelines record similar resuscitation success with the 2000 Advanced Life Support Guidelines on Resuscitation in a swine model of cardiac arrest. METHODS AND RESULTS: Nineteen landrace/large white pigs were used. Ventricular fibrillation was induced with the use of a transvenous pacing wire inserted into the right ventricle. The animals were randomized into two groups. In Group A, 10 animals were resuscitated using the 2000 guidelines, whereas in Group B, 9 animals were resuscitated using the 2005 guidelines. Both algorithms recorded similar successful resuscitation rates, as 60% of the animals in Group A and 44.5% in Group B were successfully resuscitated. However, animals in Group A restored a rhythm, compatible with a pulse, quicker than those in Group B (p=0.002). Coronary perfusion pressure (CPP) was not adversely affected by three defibrillation attempts in Group A. CONCLUSIONS: Both algorithms' resulted in comparable resuscitation success, however, guidelines 2000 resulted in faster resuscitation times. These preliminary results merit further investigation.