Laparoscopic One-Stage vs Endoscopic Plus Laparoscopic Management of Common Bile Duct Stones – A Prospective Randomized Study

Improvements in diagnostic and operative approach to CBD stones associated with cholelithiasis allow the surgeon to treat in a single stage the disease through a laparoscopic approach, The AA report the results of a prospective randomised study comparing this approach to a a double stage endoscopic plus laparoscopic cholecistectomy in 124 patients. techniques and procedures are referred and the results are statistically analysed. the outcome of the two procedures were recorded as success or failure according to the complete clearance of the CB

Subtotal colectomy in the dimethylhydrazine-treated rat. A surgical model of colorectal cancer.

Abstract The effects of subtotal colectomy on the survival of rats with established colon cancer induced by 1,2-dimethylhydrazine (DMH) have been investigated in an attempt to assess whether it might provide a suitable model of surgical treatment of this disease. 40 female Wistar rats received a regimen of DMH injections (40 mg/kg body weight s.c. every 14 days for 10 weeks) known to produce colon cancer. An additional 10 rats received no DMH, serving as controls (group 1). After presenting with signs of colonic disease at 25 weeks, all DMH-treated rats had diagnostic colonoscopy under general anaesthesia, only those with visible neoplasms (n = 34) being included in the study. These were randomised into two groups: group 2 (n = 13) animals were unoperated controls while group 3 (n = 21) animals had a therapeutic subtotal colectomy with histological confirmation of cancer in the resected colon. The animals were observed until death, the postoperative survival and cause of death at necropsy being compared between groups. The results showed that overall survival (p less than 0.013) and survival from death due to colon cancer (p less than 0.001) were significantly increased in the colectomised group 3 animals compared to unoperated controls (group 2). While 91% of the unoperated controls died of colon cancer, only 8% of the colectomised group died of this cause (p less than 0.001), the remainder dying from unrelated causes, predominantly DMH-induced primary extracolonic cancers. Subtotal colectomy in rats with DMH-induced colon cancer reduces mortality from this disease, providing a suitable model of surgical treatment. However, the high incidence of DMH-induced extracolonic cancers may make the model unsuitable for studies of adjuvant therapy

Experimental colon carcinogenesis is facilitated by endogenous factors in the intestinal contents.

Abstract The theory that endogenous factors in the intestinal contents may be pathogenic during large bowel carcinogenesis was tested in the dimethylhydrazine (DMH)-induced rat colon cancer model. Thirty female Wistar rats, each serving as their own control, had a surgical transection of the proximal colon with reanastomosis to the rectum, thereby excluding part of the colon from faecal contact. All rats then received a course of DMH (40 mg/kg body wt/wk s.c. for 10 weeks) while fed on Vivonex. This diet was selected because it lacks known exogenous (dietary) cocarcinogens. It also produces mucosal atrophy in functioning (proximal) colon, to parallel the disuse atrophy induced in the defunctioned (distal) colon. Animals remained on the diet throughout the experiment and were killed when moribund or at 40 weeks. At necropsy, the anatomical distribution, number, size and histological type of colon tumours were compared between functioning and defunctioned colonic segments within the same animal. At autopsy, there were significantly fewer colon tumours in the defunctioned segment (P less than 0.005). Furthermore, there were significantly fewer carcinomas (P less than 0.005) and fewer tumours greater than 1 cm diameter (P less than 0.01) in this segment. The data indicate that endogenous factors in the intestinal contents facilitate chemically-induced colon carcinogenesis. Luminal nutrition may be implicated

Fast track vs. standard preparation in colo-rectal surgery

Prospective comparison of the surgical outcome after colorectal laparoscopic surgery between two groups managed with standard protocol and respectively with fast track surgery progra