The contribution of follow-up programs in the reduction of mortality of rectal cancer recurrences.

AIM: The aim of this study is to investigate whether patients, who have undergone curative surgery for rectal cancer and present with recurrence of the disease, could have a better chance of radical reoperation and increased survival if they were diagnosed earlier due to a screening program, when they were still asymptomatic, than those who were not followed up and their recurrence is discovered by its symptoms. METHODS: 113 patients, 52 men and 61 women (mean age 64.19 years, SD 10.76), who presented recurrence of the disease after radical resection for rectal carcinoma were evaluated in a follow-up period of 5 years. 53 of them (46.9%, group I) were asymptomatic and their recurrence was detected in a routine follow-up examination. The remaining 60 patients (53.1%, group II) were not followed up regularly and the recurrence was diagnosed by the development of symptoms. RESULTS: The two groups were comparable with regard to patients' sex, type of operation, postoperative morbidity, tumor stage, histologic differentiation, size of primary tumors, the distance from the anal ring and distal margin. There was no difference in the disease-free period between the two groups (17.3 +/- (SD) 9.9 months in group I versus 20.3 +/- (SD) 14.4 months in group II, p = 0.1). 24 out of 53 patients in group I (45.2%) and 24 out of 60 patients in group II (40%) underwent surgery for their recurrence, but only in 8 and 9 cases, respectively, could the operation be considered as curative. The mean postrecurrence survival was 13.14 +/- (SD) 23.8 months for group I and 10.97 +/- (SD) 18.03 months for group II (p = 0.113). There was no difference in survival between the two groups after surgical treatment of the recurrence (p = 0.14). CONCLUSIONS: Our data show that if we exclude the palliative treatment of symptoms such as hemorrhage or obstruction, only a small percentage of patients with recurrent colorectal cancer will benefit from the treatment and achieve an increased survival, which is independent of the postoperative follow-up program.

Rubber band ligation of symptomatic internal hemorrhoids: results of 500 cases.

BACKGROUND/AIM: In this prospective study the results of rubber band ligation (RBL) of symptomatic hemorrhoids in 500 consecutive patients with 2nd (255 cases), 3rd (218 cases) and 4th degree (27 cases) hemorrhoids are presented. METHODS: The patients' symptoms were hemorrhage in 142 cases (28.4%), prolapse in 33 cases (6.6%) and both hemorrhage and prolapse in 325 cases (65%). Sixteen patients with hemorrhoids had liver cirrhosis and portal hypertension. RBL was performed using the St Marks' applicator (Seward) on an outpatient basis. Multiple ligations in two (259 cases) or three (190 cases) sessions were undertaken in 449 patients (89.8%), while a single ligation was done in 51 cases (10.2%). RESULTS: Successful results were achieved in 440 cases (88%) in a 24-month follow-up. A total of 94 patients (18.8%) had complications which required no hospitalization. Pain and hemorrhage were the most frequent complications. RBL proved to be safe in 16 patients with coagulation disorders due to liver cirrhosis. Two years after RBL, symptomatic recurrence was 11.9% (53/445) with repeat RBL or surgery in 9.2% (41/445). CONCLUSIONS: RBL is a useful, safe and successful method for treating symptomatic 2nd and 3rd degree hemorrhoids, which can be applied successfully in selected cases with 4th degree hemorrhoids, but with an increased rate of recurrence and additional treatment requirements. Also, RBL seems to be safe in patients with liver cirrhosis and portal hypertension.

Factors that influence the effectiveness of surgical gowns in the operating theatre.

OBJECTIVE: To compare the barrier function, comfort, and protection afforded by nine types of surgical gowns during use and to identify factors that may influence their effectiveness. DESIGN: Prospective randomised study. SETTING: Teaching hospital, Greece. MATERIAL: 4 Types of disposable single layer gowns, 1 reusable cloth gown, and 4 types of disposable reinforced gowns used during 250 major operations by the surgeon and first assistant (total n = 500). INTERVENTIONS: Direct observation by specially trained nurse and questionnaire to surgeons. MAIN OUTCOME MEASURES: Contamination of the outside of the gown, blood strike through, safety, and comfort. RESULTS: Half of all gowns became contaminated on the outside. The mean total rate of strike through was 90% in reusable gowns (528/586 areas contaminated), 11% in disposable single layer gowns (95/855 areas contaminated), and 3% in disposable reinforced gowns (42/1407 areas contaminated). There were differences in strike through among the disposable gowns depending on the material and design, the reinforced gowns consistently showing less strike through than the single layer ones. The areas most vulnerable to strike through were the cuff, forearm, thigh, chest, and abdomen. From 80% to 99% of surgeons felt comfortable and protected wearing disposable gowns, but only 0 to 4% of surgeons felt comfortable and safe with reusable gowns. CONCLUSIONS: Reusable cloth gowns have a high strike through rate and were rejected by most surgeons. Reinforced disposable gowns provided better protection. The highest strike through was at the cuffs, forearms, and thighs, and this requires new designs for surgical gowns.

Laparoscopic resection of a large right adrenal gland cyst.

A case of a benign cyst of the right adrenal gland resected laparoscopically is presented. The approach was through the right subcostal space mobilizing the right lobe of the liver and the right colonic flexure. The procedure was of 75 min duration and was uneventful. The patient was discharged the 3rd postoperative day free of postoperative pain. The advantages and disadvantages of this new modality for the treatment of adrenal gland cysts are discussed.

Surgical common trunk training in Europe.

There are wide variations of surgical common trunk training programmes among European countries. Variations are also found in entry criteria to training programmes, in training evaluation methods and final certification, and also in accreditation of training institutions. Finally manpower control should be applied to secure production of an adequate number of competent surgeons and consequently high quality of health care.