Evaluation of the POSSUM scoring system in lung surgery. Physiological and Operative Severity Score for the enUmeration of Mortality and Morbidity.

The current study was designed to test the POSSUM (Physiological and Operative Severity Score for the enUmeration of Mortality and Morbidity) in a population of lung resection candidates, and to propose its use as an instrument of evaluation of surgical outcome and quality in thoracic surgery. 250 consecutive patients submitted to lung resection from 1993 through 1996 at our institution were prospectively evaluated. Two significant predictive models were than yielded by logistic regression analysis (model I: POSSUM alone; model II: Combining POSSUM Physiological Score with predicted postoperative FEV1 ) and compared with each other by means of ROC curves analysis. The study of the areas under the ROC curves showed that these models were equally predictive of postoperative complications (area of model I=0.66; area of model II=0.67). Both models showed no significant differences between predicted and observed morbidity (chi-square test p > 0.05). In particular, in model II there was perfect agreement between observed and predicted morbidity in the group of patients with a predicted morbidity above 60%. These results suggest that POSSUM may be appropriately used as a tool of surgical audit even in lung surgery.

[Traumatic lesions of the diaphragm]. / Lesioni traumatiche del diaframma.

The authors report their experience of 21 cases of post-traumatic hernias of the diaphragm. On the basis of the results obtained by discussion of etiologic, diagnostic and therapeutic patterns they make at the conclusion that the high mortality, associated with diaphragmatic hernias, can be reduced only with a short time of diagnosis and a prompt surgical treatment of the associated lesions.

[Emergency surgical treatment in cancer of the colon]. / Il trattamento chirurgico d'urgenza del cancro del colon.

The diagnostic delay which accompanies the colon-rectum neoplastic desease makes that complications are often the first signal. This work means to prove, according to our experience, that the incidence of these complications is high and that only in a few patients undergoing emergency treatment is possible a one-stage procedure with radical purpose. In our survey, since Genuary 1975 to December 1993, 473 patients (255 males and 218 females) affected of colon-rectum cancer were treated: among these 54 (11.5%) underwent emergency surgery. The neoplasm was located: in the rectosigmoid junction in 25 cases (46.3%) in the caecum or in the right colon in 10 cases (18.6%), in the left colon and in the hepatic flexure in 6 cases (11.1%), in splenic flexure in 4 cases (7.4%), and in the trasversum colon in 3 cases (5.5%). According to Astler & Coller classification 22 patients (40.8%) were C2, 17 (31.5%) were D, 11 (20.4%) were B2, 3 (5.5%) were A, and only 1 patient (1.8%) was C1. 16 patients (29.7%) underwent a one-stage procedure, 8 (14.9%) had a first stage with a colostomy added together with resective procedure, and 3 (5.5%) patients had a Hartmann procedure. In 27 (50%) patients was possible only a palliative procedure. Finally, 10 patients (18.5%) had post-operative complications such as anastomotic fistula, wound's leakage or subphrenic abscess, and 11 patients (20.4%) died for cardiac insufficiency, ARDS, renal failure or cerebral stroke.