Laparoscopic colectomy for transverse colon carcinoma: a surgical challenge but oncologically feasible.

AIM: The aim of the study was to assess the safety and feasibility of laparoscopic surgery for transverse colon cancer and to compare the clinicopathological outcome with that of conventional open surgery. METHOD: From March 1998 to December 2009, 1253 patients with colorectal tumours were operated on, 564 laparoscopically. There were 154 cases of transverse colon cancer, 86 of which were included in the study. Details were collected on age, sex, body mass index (BMI), operation time, blood loss, time to first flatus, time to resume a liquid diet, postoperative length of hospital stay, complications, TNM stage, tumour size, distal resection margin, proximal resection margin, number of nodes harvested and surgical procedure. Laparoscopic and open surgical removal was compared. RESULTS: No significant differences were found between laparoscopic and conventional groups in age, sex, BMI, operation time or postoperative length of hospital stay. The mean blood loss during the operations was significantly less in the laparoscopic group (105.9 ± 140.9 ml vs 305.7 ± 325.3 ml; P = 0.05). The time to the first flatus was shorter (2.1 ± 0.3 days vs 3.8 ± 3.0 days; P = 0.043) and diet was started earlier (3.1 ± 1.4 days vs 3.4 ± 1.5 days) in the laparoscopic group. No significant differences in tumour size, proximal resection margin or number of lymph nodes were observed. The mean distal resection margin was not statistically different (10.3 ± 4.5 cm vs 8.8 ± 4.9 cm). At a mean follow up of 33 ± 2.3 months, nonport-site metastases occurred in eight patients and locoregional recurrence occurred in three, with no significant difference between the groups. The 3-year cumulative overall survival rate was 78%, and the disease-free survival rate was 69%. CONCLUSION: There was no difference in the outcome of laparoscopic and open surgery for transverse colon cancer, including the cancer-specific outcome.

Initial surgical experience in laparoscopic total mesorectal excision for middle and lower third rectal cancer: short-term results

INTRODUCTION: Total mesorectal excision (TME) of the rectum has been advocated as the gold standard surgical treatment of middle and lower third rectal cancer. Laparoscopy has gained acceptance among surgeons in the treatment of colon malignancies, while scepticism exists about laparoscopic TME in terms of safety and its oncological adequacy. OBJECTIVE: To evaluate the impact of laparoscopic TME on surgical and oncological outcome in a group of consecutive unselected patients. METHODS: One hundred and thirty-two patients with middle or inferior rectal cancer were admitted to our unit and underwent TME from December 1998 to February 2008. Eighty-nine patients were approached with laparoscopy. Patients staged cT3/4 cTxN+ or uTxN+ were submitted to neoadjuvant treatment. Postoperative complications and oncological outcomes were registered. RESULTS: In the laparoscopic group 80 anterior resections (including 4 intersphincteric resections and manual colo- anal anastomosis) and 9 abdominal-perineal resections were performed. 33.3% of patients were enrolled in "long-course" neoadjuvant chemo-radiotherapy (partial and complete response rates 88.2% and 11.8%, respectively). Protective lateral ileostomy was performed in 72% of patients. Mean operative time was 254.3+/-38.3 min and mean blood loss was 215+/-180 ml. Conversion rate was 12.7%. Morbidity rate was 39.3% without mortality. The rate of anastomotic leaks was 13.48%, reoperation rate 13.48%, recovery rate 3.1+/-1.4 days and hospital stay 10.4+/-4.6 days. Concerning adequacy of oncologic resection, mean distance of the tumour from the anal verge was 4.3+/-2.2 cm. Nodal sampling of 12.4+/-4.8 were obtained. Six patients (6/89, 6.74%) had a R1 margin: 3 distal and 3 circumferential. Median follow-up was 29 months and local recurrence rate was 5.79%. Four-year cumulative overall survival was 78% and disease-free survival was 63% (Kaplan-Meier method). CONCLUSIONS: Laparoscopic approach for rectal tumour is a technically demanding procedure, but it is oncologically safe (AU)

The decade 1989-1998 in Spanish psychology: an analysis of development of professional psychology in Spain.

In this paper, an overview of the evolution and current situation of professional psychology in Spain is offered. From a historical viewpoint, since the seventies, the profession of psychologist in Spain has advanced significantly in both quality and quantity. There are many different reasons for this development, although in this paper, we highlight two: the introduction of the Psychology Degree and the development of a professional identity due to the influence of an organization such as the "Colegio Oficial de Psicólogos" [COP--Official College of Psychologists, also denominated The Spanish Psychological Association]. Our description of the current situation is based on the analysis of the results of 6,765 surveys out of the approximately 28,000 that were sent to members of the professional College. In general, these results reveal a profession predominantly practiced by young women (mean age 36 years), working preferably in the clinical area, whose theoretical orientation is mainly behavioral, located for the most part in urban areas, and chiefly working in private practice. The main current professional psychology fields in our country will be analyzed in detail, according to the following criteria: type of center where the professional works, intervention areas, and training required for professional practice. Some final reflections about the defense of our profession are commented upon, proposing training and accreditation strategies as the best way to face increasing problems about the entry of unqualified people into the profession.

[Ribavirin in the treatment of bronchiolitis caused by syncytial respiratory virus]. / Ribavirina como tratamiento de la bronquiolitis por virus respiratorio sincitial.

OBJECTIVE: The aim of this study was to evaluate ribavirin therapy for acute bronchiolitis caused by viral syncytial respiratory infection. PATIENTS AND METHODS: Ninety-seven patients with acute bronchiolitis in which respiratory syncytial virus was identified by direct immunofluorescence and admitted to the hospital between October 1990 and May 1995 were studied. Data pertaining to age, sex, weight, respiratory frequency at admission, respiratory frequency on the fourth day, day in which respiratory ausculation was normal, day in which there were no thoracic retractions, number of days that the infants needed oxygen, duration of hospital stay, and whether or not they were treated with ribavirin were collected retrospectively. RESULTS: At admission there were no statistically significant differences in patients treated or not with ribavirin or in age, sex or weight, but the respiratory frequency was higher in those patients treated with ribavirin than in those who were not. The number of days of oxygen therapy was statistically different between these groups, with infants treated with ribavirin requiring oxygen for 2.7 days and the nontreated group requiring 1.7 days. However, we think that this difference is not clinically relevant. CONCLUSIONS: We did not find any difference of clinical relevance between patients treated or not with ribavirin.

[Use of microwaves for enhancing or restoring antigens before immunohistochemical staining]. / Utilisation des micro-ondes pour aviver ou restaurer les antigènes avant la réaction immunohistochimique.

In the proposed protocol, the slides are deparaffinized, rehydrated, placed in 0.01 M, pH 6 citrate buffer and irradiated 3 x 5 minutes in a microwave oven (power output = 650 Watts) before immunostaining. This enables a positive staining for some antibodies and an enhancement of staining intensity for most antibodies.