A comparative study of the efficacy of endovenous laser treatment of the incompetent great saphenous under general anesthesia with external air cooling with and without tumescent anesthesia.

BACKGROUND: This clinical study reports our experience with endovenous laser treatment (ELT) in which external air cooling is used without classic tumescent anesthesia. METHODS: Two hundred thirty-two patients underwent ELT under general sedation. In group A (n = 192), ELT was performed with air cooling but without the concurrent use of tumescent anesthesia. In group B (n = 40), patients were treated using the traditional tumescent technique. The parameters were similar for both groups: 980-nm diode laser, power of 15 W, and pulse duration of 1 second. The laser fiber and catheter were manually withdrawn in 3-mm increments. Ultrasound was performed to reevaluate vein closure at the end of surgery and 2 and 8 weeks and 1 year after. During follow-up, complications such as burns, dyschromia, pain, and dysesthesia, as well as time used for surgery were recorded. RESULTS: A 96% closure rate was obtained in groups A and B at 2 and 8 weeks. This rate remained stable 1 year after the ELT procedure. Except for a higher percentage of ecchymoses in group B (55%) than in group A (0%) (p < 0.001), no significant differences were observed for complications. With external air cooling, ELT took 17.5 minutes to perform for the whole leg, compared with 38.5 minutes when using tumescent anesthesia (p < 0.05). CONCLUSION: ELT surgery for the great saphenous vein can be safely performed using the air cooling method and is as efficacious as ELT done with tumescent anesthesia but takes significantly less time to perform.

Obesity-related genes variability in Czech patients with sporadic colorectal cancer: preliminary results.

BACKGROUND: Genetic variability in obesity-related genes and the resulting phenotypes are being recognized as major risk factors for colorectal cancer and/or severity of the disease. MATERIALS AND METHODS: A total of 102 patients (aged 68 +/- 10.2 years, 79 men and 23 women) and 101 age-matched (68.1 +/- 5.4 years old) individuals without colorectal cancer, 59 men and 42 women, were recruited. All the individuals were genotyped for the following subset of polymorphisms in obesity-related genes: angiotensinogen gene (M235T and -6A/G), in IL-6 gene (-174 G/C and -596 A/G), in leptin gene (-2548 A/G), and polymorphism Gln223Arg within the leptin receptor (LEPR) gene. RESULTS: A significant increase in frequency of double heterozygote genotype (MTAG) of both angiotensinogen polymorphisms in males with colorectal cancer was observed when compared to control men [odds ratio (OR) = 3.77, P (corr) = 0.001]. A marginally significant difference in genotype distribution of -174 G/C IL-6 polymorphism between the patients in stage I-II compared to patients in III-IV was found (P (g) = 0.05, P (a) = 0.173). The GG genotype of -174 G/C IL-6 polymorphism in the patients in stage III-IV carries an increased risk compared to those in stage I-II (OR = 2.83, P (corr) = 0.06). Similarly, a difference in genotype distribution of Gln223Arg in LEPR gene between the patients staged I-II compared to III-IV was observed (P (g) = 0.05). The AA genotype was shown to be risky for the patients staged III-IV (OR = 3.35, P (corr) = 0.06). CONCLUSIONS: The investigated single nucleotide polymorphisms within the genes encoding for obesity-related genes were observed to be associated both with clinical manifestation of colorectal cancer and with severity of the disease. Thus, we suggest that defined genetic variability in the genes might become DNA markers for colorectal cancer in the future.

Acute mesenteric ischemia.

BACKGROUND/AIMS: Acute mesenteric ischemia (AMI) is a serious disease in old age with low incidence but with a very high mortality rate (60-70%). The etiology is either primary (embolism or thrombosis of mesenteric arteries or veins, non-occlusive mesenteric ischemia) or secondary (mechanical obstruction such as intestinal volvulus, intussusception, tumor-caused compression). Independent of the origin of the illness, the clinical-pathological picture is the same: intestinal ischemia with subsequent necrosis. The aim of this study was to ascertain which underlying conditions lead to increased probability of development of acute mesenteric ischemia. METHODS: Two hundred and fifteen patients with a primary form of AMI were treated in the years 1991-2007, in the 1st Clinic of Surgery in Brno, Czech Republic and in the Department of General Surgery, Derer's University Hospital in Bratislava, Slovak Republic; the results of the treatment have been statistically evaluated. CONCLUSION: The probability of arterial mesenteric ischemia development rises significantly (p < 0.05) in patients with a history of atrial fibrillation and/or myocardial infarction. This probability is also significantly higher in smokers with symptoms of hypertension and clinical signs of abdominal angina (p < 0.05).

Acute necrotizing pancreatitis: intra-abdominal vacuum sealing after necrosectomy.

BACKGROUND: Cases of acute pancreatitis with infected pancreatic necrosis warrant consideration of surgical interventions designed to achieve the goal of pancreatic debridement and drainage. Notable experience with the use of vacuum assisted closure for abdominal wall defects was an assumption for its peripancreatic application after debridement in septic patients with infected pancreatic necrosis confirmed by radiological evidence of gas or results of fine needle aspiration. The goal of this study was to evaluate our own experience with this new therapeutic technique. METHODS: This study is a multi-center retrospective analysis and comparison of 2 groups of patients with severe sepsis and a proven pancreatic source of infection. Group A consisted of 67 patients, 42 men and 25 women with ages ranging from 19-90 years (mean 48.0), who were treated surgically between 2002 and 2006 using a combination of laparostomy, multiple irrigations and abdominal drainage. Group B consisted of 39 patients, 28 men and 11 women aged from 18-87 years (mean 51.8), who were treated between 2002 and 2006 using the former techniques with the addition of an intra-abdominal vacuum assisted negative pressure therapy system. RESULTS: The number of repeat laparotomies with debridement of the open abdominal wound in general anesthesia in group A ranged from 5-18 over 10-33 days (median 21) of surgical treatment period. The number of repeat laparotomies in group B decreased to 3-9 and the surgical treatment period decreased to 9-29 days (median 16). Seventeen patients (25.4%) in group A died because of severe sepsis and multiple organ failure, compared to 7 patients (17.9%) in group B. CONCLUSION: Authors confirmed significant reduction of morbidity and mortality with the use of the intra-abdominal vacuum assisted system in the treatment of localized pancreatic source of sepsis.