Rectal Cancer Treatment and Survival – Comparison of Two 5 – Year Time Intervals

In last two decades there was a huge step forward concerning rectal cancer treatment. The aim of our study was comparison of two time intervals regarding the methods of treatment and results of radical rectal cancer surgery. 407 patients operated on for rectal cancer were included in study. Those were patients with elective radical resection of solitary rectal tumor who survived first month after the operation. Patients were divided in two groups regarding the time of operation. In group one were patients operated on between 1996 and 2000 and in group two patients operated on between 2001 and 2005. We compared our results in both intervals with special interest about type of operation considering localization of the tumor, local recurrence and cancer related survival. Significant differences were found between two groups. There were more sphincter saving operations in second group, less local recurrences and better survival than in first group. This study observed significant improvements at recurrence rates and total survival for patients operated on rectal cancer

Dolgoročni rezultati po anatomski korekciji D-transpozicije velikih arterij – izkušnja enega centra

Izhodišča: Anatomska korekcija (ASO) je zdravljenje izbire za D-transpozicijo velikih arterij (D-TGA). Namen raziskave je bil oceniti dolgoročno uspešnost anatomske kirurške korekcije. Metode: Delno retrospektivno smo pregledali dokumentacijo ali ponovno ocenili zdravstveno stanje 38 bolnikov (30 moških, 8 žensk) v času tranzicije mladostnikov v odraslo dobo (starost ob zadnjem kliničnem pregledu 17,1 ± 1,4 let), ki so bili rojeni od leta 2000 do leta 2005 z D-TGA in so imeli ASO. Ocenili smo: funkcijski razred po NYHA, spremembe, ki so ostale, na neoaorti in neoaortni zaklopki, neopulmonalni zaklopki in pljučnih arterijah, funkcijo desnega in levega prekata, telesno zmogljivost in znake ishemije miokarda. Rezultati: Nihče v skupini ni umrl (interval zaupanja (0,00-0,09). 32 bolnikov (84,2 %) je bilo v NYHA I, 6 bolnikov (15,7 %) je bilo v NYHA II. Pri 83,3 % bolnikov se je bulbus aorte razširil (20,9 ± 2,8 mm/m2, max. 27,7 mm/m2). Pri 27 bolnikih (90 %) je bila prisotna regurgitacija neoaortne zaklopke. Med skupinami brez, z blago ali zmerno neoaortno regurgitacijo ni bilo razlik v širini bulbusa, normaliziranih na telesno površino (p = 0,6). Regurgitacija neopulmonalne zaklopke je bila prisotna pri 58,1 % bolnikov. Zaradi obstrukcije v iztoku iz desnega prekata je bila potrebna ponovna operacija v enem primeru in perkutana dilatacija neopulmonalne zaklopke v enem primeru. Zaradi zapletov na koronarnih arterijah je bil potreben le en kirurški poseg zaradi miokardnega infarkta med naporom. Zaključek: Pozni rezultati po anatomski korekciji D-TGA so dobri in primerljivi z večjimi centri. Nihče ni umrl, večina bolnikov je bila brez simptomov, z normalno sistolično funkcijo obeh prekatov in z normalno telesno zmogljivostjo. Ponovne operacije in perkutani posegi so bili dokaj redki, toda dolgoročno uspešni

Colorectal cancer

Pojavnost raka širokega črevesa in danke (RŠČD) v Sloveniji narašča, še posebej izrazito po 50. letu starosti. Prekanceroza RŠČD je adenomatozni polip, nastanek raka je posledica nakopičenih prirojenih in pridobljenih genetskih sprememb. Zaradi vse večje izgube krvi z blatom se rak najpogosteje klinično izrazi z normocitno normohromno anemijo, pogoste se tudi spremembe ritma odvajanja blata in spremembe debeline izločenega blata. Posebno ogrožene skupine prebivalstva je treba redno spremljati. Najučinkovitejša oblika zdravljenja bolnikov z RŠČD je radikalni operativni kirurški poseg. Pri kirurškem zdravljenju RŠČD so že dolgo uveljavljene klasične odprte operacije, v zadnjem desetletju pa postajajo vse pomembnejši laparoskopski kirurški posegi. Dosedanji rezultati večine prospektivnih in retrospektivnih primerjalnih raziskav kažejo, da laparoskopska operacija v primerjavi s konvencionalno kirurgijo debelega črevesa in danke ne kaže razlik glede pojava ponovitve in dolgoročnega preživetja. Med druge oblike zdravljenja spadata še pred- oziroma pooperacijsko onkološko zdravljenje: kemoterapija in radioterapija

Colorectal cancer - prevention and screening

Rak debelega črevesa in danke je drugi najpogostejši vzrok smrti zaradi raka v Sloveniji, njegova incidenca je v zadnjih desetletjih v porastu. Po epidemioloških podatkih iz leta 2001 je incidenca pri moških 64/100.000 prebivalcev, pri ženskah 48/100.000 prebivalcev. Kljub temu, da se relativno 5-letno preživetje bolnikov s to boleznijo daljša, jih še vedno največ odkrijemo, ko je bolezen že v napredovalem stadiju in je prognoza slabša. Rak debelega črevesa in danke je ozdravljiva bolezen, če ga ugotovimo in kirurško odstranimo v zgodnji razvojni stopnji. S presejalnimi testi: preiskavo blata na prikrito krvavitev (hematest) in endoskopijo spodnje prebavne cevi lahko zaznamo in zdravimo premaligne spremembe sluznice in zgodnje oblike raka. Ta oblika maligne bolezni bi lahko bila tretja v Sloveniji, za rakom materničnega vratu in dojke, pri kateri bi bilo smiselno uvesti sekundarno preventivo in tako zmanjšati pojavnost in smrtnost. V prispevku avtorju predstavljajo in razpravljajo o izsledkih študij o preprečevanju raka debelega črevesa in danke, o najpogosteje uporabljanih presejalnih metodah, a tudi o nekaterih, ki se še razvijajo. Predlagajo nekatere možnosti ukrepanja v Sloveniji, ki naj bi jih udejanili.Background. Colorectal cancer is the second most common cause of cancer death in Slovenija and its incidence in the last decades is rising. According to the epidemiological data from 2001, the incidence in male is 64/100,000 in female 48/100,000. Even though the relative five-year survival of the patients with this disease is rising, the majority of them are discovered in the advanced stage of the disease with poor prognosis. Conclusions. If diagnosed and surgically removed in its early stage, colorectal cancer is a curable disease. Using screening tests, such as fecal occult blood test and endoscopy of the lower gastrointestinal tract, we can detect and treat premalignant lesions and early stages of colorectal cancer. In Slovenia, colorectal cancer could be the third malignant disease, after uterine cervix and breast cancer where secondary prevention should be introduced in order to reduce its incidence and mortality. In the following article the authors present and discuss the results of studies made on the prevention of colorectal cancer and the most commonly used screening methods, as well as some of the methods that are still being evaluated. They suggest measures that should be taken in Slovenia against this disease

Gangrenous appendicitis presenting as acute abdominal pain in a patient on automated peritoneal dialysis: a case report

<p>Abstract</p> <p>Introduction</p> <p>Presentations of abdominal pain in patients on peritoneal dialysis deserve maximal attention and careful differential diagnosis on admittance to medical care. In this case report a gangrenous appendicitis in a patient on automated peritoneal dialysis is presented.</p> <p>Case presentation</p> <p>We report the case of a 38-year-old Caucasian man with end-stage renal disease who was on automated peritoneal dialysis and developed acute abdominal pain and cloudy peritoneal dialysate. Negative microbiological cultures of the peritoneal dialysis fluid and an abdominal ultrasonography misleadingly led to a diagnosis of culture negative peritonitis. It was decided to remove the peritoneal catheter but the clinical situation of the patient did not improve. An explorative laparotomy was then carried out; diffuse peritonitis and gangrenous appendicitis were found. An appendectomy was performed. Myocardial infarction and sepsis developed, and the outcome was fatal.</p> <p>Conclusion</p> <p>A peritoneal dialysis patient with abdominal pain that persists for more than 48 hours after the usual antibiotic protocol for peritoneal dialysis-related peritonitis should immediately alert the physician to the possibility of peritonitis caused by intra-abdominal pathology. Not only peritoneal catheter removal is indicated in patients whose clinical features worsen or fail to resolve with the established intra-peritoneal antibiotic therapy but, after 72 hours, an early laparoscopy should be done and in a case of correct indication (intra-abdominal pathology) an early explorative laparotomy.</p