[Circumferential resection margin in the modern treatment of rectal cancer]. / Cirkumferencný resekcný okraj v modernej liecbe karcinómu rekta.

INTRODUCTION: In the last decades, the assessment of circumferential resection margin (CRM) has gained enormous importance in the management of patients with rectal carcinoma, not only in predicting the prognosis, but also in precise cancer staging, in multimodal treatment indications and in quality assessment of provided care. METHODS: The authors present a review article containing CRM definition, describing the technique of CRM assessment, the effect of CRM status on the prognosis and quality of provided therapy. CRM assessment in the context of a multidisciplinary team is especially emphasised. The aspect of CRM has to be considered by the radiologist during cancer staging, the surgeon in the course of the operation, the pathologist during precise macroscopic and histopathological specimen evaluation, and the oncologist when deciding on neoadjuvant/adjuvant therapy administration. CONCLUSION: CRM nowadays represents a fundamental aspect in modern treatment of patients with rectal carcinoma. The introduction of CRM assessment into clinical practice has lead to more precise staging, better multimodal therapy indications, more precise surgical technique (total mesorectal excision), an increased rate of sphincter-saving resections, lowered local recurrence rates and improved patient survival.

Radiofrequency-assisted liver resection: short-term results in a single institution.

OBJECTIVES: The main goal of the study was to evaluate the effectiveness and safety of radiofrequency-assisted liver resection. BACKGROUND: Liver resection is the "gold standard" for patients with resectable liver tumors. In the past years, the role of radiofrequency in liver surgery has been expanded from simple tumor ablation to its use in the technique of radiofrequency-assisted liver resection. METHODS: Patients with primary or secondary liver tumors, who underwent radiofrequency-assisted liver resection have been included into the prospective study. The acquired data underwent statistical analysis and were compared with the published results of liver resections. RESULTS: Between January 1, 2007 and September 30, 2009, 53 patients underwent radiofrequency-assisted liver resection. Seventy-six tumours were resected with the mean diameter of 38±19 mm. Mean peroperative blood loss was 170.8±285.4 mL and transfusions were needed postoperatively in 9.4 % cases. The mean hospital stay was 10.6±7.2 days. Postoperative complications were noted in 16.9 % patients; postoperative mortality was 1.9 %. CONCLUSION: The radiofrequency-assisted liver resection represents a safe and effective way of hepatic parenchyma transaction and to hepatobiliary surgeon it offers a new way of effective transection of liver parenchyma (Tab. 2, Ref. 23).

Telemedicine in urgent neurosurgery.

The transportation of patients, the speed of stating the diagnosis and fast commencement of adequate treatment are the most problematic moments. We see the solution to this problem in the shortening of time between accident and admission of the patient at the neurosurgical center. We would like to underline that no matter how important is the connection between the hospitals, it represents only one technical aspect of communication. The software module for fast, comfortable and safe transmission of data was developed by experts of f. West Trend Encore Inc. in cooperation with the medical expert group and in our region it is referred to as ER-Slovakia, with the access to Internet. Our experience has proved definitely that the time between the accident and the admission of the patient at the neurosurgical center can be shortened. According to our experiences the time of 6-8 hours, could be possibly reduced into 2-2.5 hours. The process of mailing the request for consultation with picture documentation to and receiving a qualified evaluation from a distant center takes about 10-15 minutes. From September 1, 1999 to December 31, 2000 we have 244 consultations among the hospitals and the neurocenter. We have focused our consultation on acceleration of the correct diagnosis statement, early commencement of sufficient treatment and at last but not at least, on providing of qualified evaluation of treatment by the specialized center. On the basis of consultations, a conservative way of treatment was used in 100 patients, further diagnostic evaluation was necessary in 32 patients, and 77 patients were hospitalized in the neurosurgical center. 47 patients of the given number (19% of total number), needed an urgent transportation to different hospitals were they were subdued to operations. (Tab. 2, Fig. 1, Ref. 6.)