Postoperatieve morbiditeit en tumorregressie na neoadjuvante chemoradiatie gevolgd door rectumresectie bij locally advanced rectumcarcinoom

Background: In patients with locally advanced rectal cancer treated with neoadjuvant chemoradiation followed by rectal resection, postoperative morbidity is a significant clinical problem. Pathologic complete tumour response seems to be associated with the best prognosis in the long-term. Little is known about the factors that are associated with postoperative complications and pathologic complete response. Aim of this retrospective study was to identify and describe these factors. Methods: 99 consecutive patients with locally advanced rectal cancer who underwent neoadjuvant chemoradiation (50 Gy and capecitabine) followed by surgery at Medisch Spectrum Twente between 01-2007 and 05-2012 were identified. Postoperative complications (within 6 months) were graded according to the Clavien-Dindo classification. Pathologic tumour response was categorized as complete response or no/partial response. Results: Postoperative complications occurred in 68 patients (69%) and grade 3-5 complications in 25 patients (25%). The 30-day mortality was 1% (n=1) and the 90-day mortality was 2% (n=2). A lower mean age (p=0.02) and a pre- or postoperative blood transfusion (p<0.01) independently predicted complications. Blood transfusion (p=0.01) and ypT0-1 stage (p=0.04) were independent predictors of grade 3-5 complications. Complete response rate was 22% (n=22). There were no independent clinical factors predicting complete response. Conclusions: Neoadjuvant chemoradiation followed by rectal surgery is associated with a significant postoperative complication rate, but minimal postoperative mortality. A complete response rate of 22% can be achieved.

Brain Abscess after Transanal Hemorrhoidal Dearterialization: A Case Report

A relatively new therapy in the treatment of hemorrhoids is transanal hemorrhoidal dearterialization (THD). We report a case of brain abscess caused by Streptococcus milleri following THD. Although a brain abscess after drainage of a perianal abscess has been described in the literature, no report exists of a brain abscess following treatment of hemorrhoids. A healthy 51-year-old man with hemorrhoids underwent THD. Two weeks later he presented with a headache, bradyphrenia, flattened behavior and a left hemiplegia. No perianal complaint and/or perianal abscess was present. A contrast CT scan of the cerebrum showed a right temporoparieto-occipital abscess, with edema and compression of the surrounding tissue and lateral ventricles. MRI showed an abscess with leakage in the right lateral ventricle. Treatment with dexamethasone and intravenous antibiotics was started. Because of progression of symptoms, 3 weeks later ventriculoscopy was performed and the abscess was drained. Culture of the punctuate showed S. milleri. Because of developing hydrocephalus 3 days after ventriculoscopy, first an external ventricle drain and later a ventriculoperitoneal drain was placed. Hereafter the hemiplegia and cognitive disorders improved. This case report describes a severe complication following treatment of hemorrhoids with THD which until now, to our knowledge, has never been described in the literature

In-line quantification of peroxidase-catalyzed cross-linking of a-lactalbumin in a microreactor

Horseradish peroxidase can induce the oxidative cross-linking of proteins through the radicalization of tyrosine residues and subsequent formation of dityrosine bonds. The dityrosine bond absorbs light at 318 nm which can be used to monitor in-line the peroxidase-catalyzed cross-linking of proteins in a microfluidic system. In this study calcium-depleted a-lactalbumin is used as model protein. To quantify the progress of the reaction, the absorbance increase at 318 nm was monitored in-line and compared with the amount of reacted monomeric a-lactalbumin as determined with size-exclusion chromatography (SEC) at various residence times. The increase in absorbance at 318 nm shows a logarithmic relation with the extent of reacted monomer. The logarithmic relation can be explained using a reaction model describing minimum and maximum formation of dityrosine cross-links to reacted monomer. Since the size distribution of reaction products was found to be reproducible, the absorbance increase at 318 nm can be used as a fast in-line screening method for the peroxidase-mediated cross-linking of protein

The association between preoperative body composition and aerobic fitness in patients scheduled for colorectal surgery

Aim Although cardiopulmonary exercise testing (CPET) is considered the gold standard, a preoperative abdominal CT scan might also provide information concerning preoperative aerobic fitness for risk assessment. This study aimed to investigate the association between preoperative CT-scan-derived body composition variables and preoperative CPET variables of aerobic fitness in colorectal surgery. Method In this retrospective cohort study, CT images at level L3 were analysed for skeletal muscle mass, skeletal muscle radiation attenuation, visceral adipose tissue (VAT) mass and subcutaneous adipose tissue mass. Regression analyses were performed to investigate the relation between CT-scan-derived body composition variables, CPET-derived aerobic fitness and other preoperative patient-related variables. Logistic regression analysis was performed to predict a preoperative anaerobic threshold (AT) <= 11.1 ml/kg/min as cut-off for having a high risk for postoperative complications. Results Data from 78 patients (45 men; mean [SD] age 74.5 [6.4 years]) were analysed. A correlation coefficient of 0.55 was observed between absolute AT and skeletal muscle mass index. Absolute AT (R-2 of 51.1%) was lower in patients with a lower skeletal muscle mass index, together with higher age, lower body mass and higher American Society of Anesthesiologists (ASA) score. Higher ASA score (odds ratio 5.64; P = 0.033) and higher VAT mass (odds ratio 1.02; P = 0.036) were associated with an increased risk of an AT <= 11.1 ml/kg/min. Conclusion Body composition variables from the preoperative CT scan were moderately associated with preoperative CPET-derived aerobic fitness. Higher ASA score and higher VAT mass were associated with an increased risk of an AT <= 11.1 ml/kg/min