RESUMO
BACKGROUND AND OBJECTIVES: Simple methods to identify colorectal cancer patients at risk of recurrence are needed. This study aimed to determine if neutrophil-to-lymphocyte ratio (NLR) predicts survival in colorectal cancer patients. METHODS: Two-hundred thirty patients diagnosed with colorectal cancer over a two-year period were identified from a prospectively maintained colorectal cancer database. NLR was calculated from pre-operative full blood counts. In the case of patients who did not undergo surgery, the full blood count from their out-patient visit was used. Known prognostic factors were recorded. Overall and cancer-specific survival were calculated. RESULTS: Pre-operative NLR greater than 5 correlated with overall and cancer-specific survival in univariate analyses. NLR was not independent of Dukes stage. CONCLUSIONS: Pre-operative NLR may represent a simple method of identifying colorectal cancer patients with a poor prognosis pre-operatively.
Assuntos
Neoplasias Colorretais/diagnóstico , Inflamação/sangue , Contagem de Leucócitos , Idoso , Idoso de 80 Anos ou mais , Neoplasias Colorretais/imunologia , Neoplasias Colorretais/mortalidade , Feminino , Humanos , Linfócitos , Masculino , Análise Multivariada , Neutrófilos , Valor Preditivo dos Testes , Prognóstico , Modelos de Riscos Proporcionais , Estudos Prospectivos , Sensibilidade e Especificidade , Taxa de Sobrevida , Reino Unido/epidemiologiaRESUMO
BACKGROUND: Bile duct clearance at open cholecystectomy had become normal surgical practice before the introduction of laparoscopic cholecystectomy. However, perceived technical difficulties have deterred many surgeons from treating common bile duct stones at the time of laparoscopic cholecystectomy. This has led to a reliance on preoperative clearance of ducts known to have stones and postoperative clearance of ducts found to have stones at operation or those that subsequently develop complications of retained stones. METHODS: The authors describe a series of 120 consecutive bile duct explorations carried out between April 1991 and February 1997 in a series of 1,237 laparoscopic cholecystectomies. RESULTS: Laparoscopic exploration and clearance of the bile ducts was achieved in 89% of cases in the whole series, and 97% success was attained in the last 60 cases, which also were associated with a decrease in operating time. CONCLUSIONS: We believe that for surgeons familiar with open common bile duct exploration and laparoscopic cholecystectomy, the next logical step is laparoscopic exploration of the common bile duct at the time of cholecystectomy, which is safe and readily mastered.
Assuntos
Colecistectomia Laparoscópica/métodos , Cálculos Biliares/cirurgia , Distribuição de Qui-Quadrado , Colangiopancreatografia Retrógrada Endoscópica , Feminino , Humanos , Masculino , Estatísticas não Paramétricas , Resultado do TratamentoRESUMO
The glove preferences of all the consultant surgeons and consultant orthopaedic surgeons in North West Thames were surveyed by questionnaire. Responses were received from 59 of 78 general surgeons and 47 of 55 orthopaedic surgeons. Twenty-two percent of general surgeons never double gloved compared with 4% of orthopaedic surgeons (P < 0.01). Seventy-three percent of general surgeons double gloved for 'high risk' patients compared with 17% of orthopaedic surgeons (P < 0.001). When double gloving the majority of surgeons (67%) used their normal sized glove inside and half a size larger on the outside.
Assuntos
Atitude do Pessoal de Saúde , Comportamento de Escolha , Luvas Cirúrgicas , Corpo Clínico Hospitalar/psicologia , Inglaterra , Cirurgia Geral , Humanos , Controle de Infecções/métodos , Ortopedia , Inquéritos e QuestionáriosRESUMO
The wound infection incidence during inpatient stay was compared with the post-discharge infection incidence for 1 month using audit data and a patient questionnaire. The true infection rate was found to be 20% compared with an apparent rate of 2.4% (P < 0.001). The study highlights the problems of postoperative monitoring in the context of shorter inpatient stays and fewer routine outpatient appointments.
