Evaluation and comparison of the clinical, surgical and pathological TNM staging of colorectal cancer.

BACKGROUND/AIMS: The aim of our study was to compare the results of clinical, surgical and pathological staging of colorectal cancer. METHODOLOGY: 660 patients with colorectal carcinoma were included in the study. The results of the clinical, surgical and pathological staging were compared. RESULTS: Clinical T values were identical with the surgical in 75.15%, and with the pathological in 74.54% respectively. Surgical T values were identical with the clinical in 78.48%. In 67.27% of the cases the clinical evaluation of N value was identical with the surgical one. Clinical evaluation was identical with the pathological result in 60.60% of the cases. Surgical diagnosis of the lymph node metastasis matched the pathological finding in 76.66%. Regarding the M value, the coincidence of the diagnoses was as follows: clinical versus pathological 72.72%, surgical versus pathological 90.90%. Clinical and surgical TNM stages were by 79.09% in accordance. By decision of total TNM stage the clinical-pathological staging showed worse (76.06%), while surgical-pathological showed significantly better (88.48%) matching. CONCLUSIONS: Based on our results we can state that in a quarter of all colorectal cancer cases the extent of the primary tumor could not have been established correctly. The lymph node involvement was well defined in just over half of the cases only. The M values were accurately stated in about three quarters of the cases. High grade of conformity of clinical, surgical and pathological staging can result in better treatment-planning, short- and long-term survival, and higher quality of life.

Comparison of early and 1-year follow-up results of conventional hemorrhoidectomy and hemorrhoid artery ligation: a randomized study.

BACKGROUND AND AIMS: Doppler-guided hemorrhoid artery ligation is a new approach for treating hemorrhoids. Early and 1-year follow-up results of the procedure are presented and compared with those of closed scissors hemorrhoidectomy in a prospective randomized study. PATIENTS AND METHODS: Sixty consecutively recruited patients were randomized into two groups: group A ( n=30) was treated with standardized closed scissors hemorrhoidectomy and group B ( n=30) with Doppler-guided hemorrhoid artery ligation. The follow-up period was 11.7+/-4.6 months. RESULTS: The average need for minor analgesics was 11.7+/-12.6 doses in group A and 2.9+/-7.7 in group B. Patients in group A spent 62.9+/-29.0 hours in hospital postoperatively and those in group B 19.8+/-41.8 hours. Return to normal daily activities took 24.9+/-24.5 days in group A and 3.0+/-5.5 days in group B. Neither the disappearance (26 vs. 25 patients) nor the recurrence of preoperative symptoms (5 vs. 6 patients) differed significantly between the two groups. CONCLUSION: Both procedures were effective in treating hemorrhoids. The 1-year results of Doppler-guided hemorrhoid artery ligation do not differ from those of closed scissors hemorrhoidectomy. Doppler-guided hemorrhoid artery ligation seems to be ideal for 1-day surgery, and it fulfills the requirements of minimally invasive surgery.

[The first clinical experiences in Hungary with a new effective antibiotic (linezolid) effective against Gram-positive infections]. / Multirezisztens Gram-pozitív kórokozók ellen hatékony, új antibiotikummal (linezolid) szerzett elsó magyarországi tapasztalatok.

INTRODUCTION: The occurrence of gram-positive infections caused by multiresistant organisms has increased significantly in general, particularly among the surgical patients, and only a few effective antibiotics are available. A new and effective, synthetic antibiotic, against gram-positives is the oxazolidinon group, that electively inhibits bacterial protein synthesis in the early phase. Linezolid, the first member of this group to be used in clinical practice is the linezolid was studied. AIMS: The purpose of this study was to evaluate the effectiveness and safety of linezolid in the gram-positive infections of surgical patients. METHODS: A 3rd phase, clinical trial was conducted at the Semmelweis University Ist Surgical Department in the period of 1999-2001. Twenty-one patients with gram-positive infections were enrolled to this study. The mean of age was 57 years. Patients were selected for linezolid treatment in whom the conventional anti-gram-positive antibiotic therapy caused difficulties. RESULTS: Sixteen patients out of 21 recovered, one patient was cured clinically, but not microbiologically, and one case showed microbiological cure with clinical failure. In one case the methicillin resistant Staphylococcus aureus carriership was cured. Two cases had a fatal outcome. The causes of death were mediastinitis plus pneumonia in one case, and diffuse peritonitis with renal insufficiency in the other. Withdrawal from the study occurred in one case, due to drug intolerance. CONCLUSIONS: The linezolid administration proved to be safe and effective even in those cases, in which either hypacusis or decreased renal function persisted, or oral intake was advantagous. Contraindication of linezolid therapy did not occur. Few side effects were observed. If the infection was polymicrobial, the linezolid could be combined with other antibiotics. Further investigations are mandatory to evaluate the role of linezolid in the treatment of methicillin resistant Staphylococcus aureus carriership.