Laparoscopic colorectal surgery and cancer

Review article of the actual level of knowledge about laparoscopic colorectal surgery and laparoscopic-assisted procedures. At present time laparoscopy for the cure of colorectal neoplasia should only be performed within prospective randomized trials. In the meantime it is perfectly appropriate to perform laparoscopy for palliation of metastatic disease. Patients with benign colorectal neoplasms can achieve better outcome if treated by laparoscopy rather than laparotomy. Other areas in which laparoscopy may be useful include enterolysis and possibly, treatment of rectal prolapse. Laparoscopy can be appropriately applied for the treatment of terminal ileal Crohn's disease, sigmoid diverticulitis, reversal of Hartmann's pouches and the construction of stomas.     

Laparoscopic versus open surgery for colorectal cancer

There are three basic roles of laparoscopic surgery for patients with colorectal cancer. First, although infrequently needed prior to therapy, diagnostic or staging laparoscopy may be valuable in certain colorectal cancer patients. Second, the laparoscopic approach may offer several attractive features for the palliative management of patients with incurable colorectal cancer. Finally, although this issue is the most controversial, there are theoretic but unproved advantages of using laparoscopic techniques for curative colorectal cancer therapy. The concerted efforts of surgical oncologists and their colleagues must prove this theory in well constructed trials.     

Laparoscopic anti-reflux surgery--report of experiences from Germany

This is a report on a questionnaire in Germany reflecting the activity in antireflux surgery, both in open and laparoscopic modifications in the time period of 1990 through 1995. It serves as an overview of the acceptance of diagnostic workup, indication, applied techniques, and different antireflux procedures. In a total of 104 representative hospitals, 2,036 patients were operated during this time. Almost 80% of the hospitals provide antireflux surgery in the open technique and only 1/3 of the hospitals have experience in the laparoscopic technique. There is a total rise in antireflux surgery during the last 5 years, since the number of laparoscopic antireflux operations rises constantly with a total amount of open operations of about 250 cases per year. In open surgery the most favourite technique is the Nissen-Rossetti procedure, while in laparoscopic technique the choice for the original Nissen, the Nissen-Rossetti, or the floppy Nissen technique is divided in almost equal parts.     

Ambulatory surgery. Laparoscopic surgery

Laparoscopic surgery procedures have increased over the past decade and newer uses are being investigated. The major reasons for increased use of laparoscopic procedures include decreased pain, smaller incisions, and decreased length of hospital stay. Although the cost of hospital stay is decreased, there are increased costs associated with longer surgery time, increased anesthesia time, and additional equipment. Other drawbacks to the procedure are miniaturized instruments, decreased field of vision, inability to palpate tissue and organs directly, and necessary hand-eye coordination.     

Indications for laparoscopic colorectal surgery. Results from the Medical Centre Alkmaar, The Netherlands

The Boyden chamber method showed that the invasiveness to reconstituted blood vessel endothelium of metastatic gynecologic cancer cell lines of the uterine cervix (MS751 and ME-180), endometrium (AN3 CA), and ovary (SK-OV-3 and PA-1) was significantly higher than of primary cancer cell lines of the cervix (HeLa and C-33 A), endometrium (Ishikawa, HEC-1-A and HHUA), and ovary (MCAS and Caov-3), and that the invasiveness was inhibited by estradiol or progestin in the metastatic cells but not in the primary cells. These results suggest that metastatic cancer cells by themselves increase the potential of blood vessel invasion, which can be inhibited by estrogen and progestin administration.     

Laparoscopic cholecystectomy--analysis of the first 100 operations

Laparoscopic cholecystectomy is a surgical method of removing the gallbladder through four small incisions on the abdominal wall using laparoscopic technique with specially designed equipment and instruments. The method is characterized with the following: reduced operative trauma and postoperative pain, shorter hospital stay, quicker recovery and better cosmetic effect. This method is in surgical practice in the last 10 years, whereas in General Hospital in Senta, in the surgical department it was introduced in June 1995. In the period June 16, 1995-March 1, 1996 one hundred patients underwent laparoscopic cholecystectomy. The median age of patients was 48 years; 79% were females and 21% were males. There was no operative mortality. Four (4%) mild complications occurred. Conversion was performed in only one patient (1%). The average operation time was 54 minutes, while the postoperative hospital stay was 2.3 days.     

Laparoscopic anti-reflux surgery--report of experiences in Austria]

In Austria neither the open nor the laparoscopic fundoplication can be described as a routine operation. The number of laparoscopic operations is increasing year by year, the indication for surgery is more determined by radiological than by functional diagnostic tools. In our own patients the complication rate in 196 laparoscopic operations is 6%, regarding symptoms of reflux and dysphagia. Dysphagia was found only in cases with 360 degrees fundoplication, whereas recurrent reflux occurred in 270 degrees hemifundoplications (Toupet). The mortality rate following laparoscopic fundoplications was zero, morbidity below 10%.     

The learning curve for laparoscopic colorectal surgery. Preliminary results from a prospective analysis of 1194 laparoscopic-assisted colectomies

BACKGROUND: Laparoscopic-assisted colectomy is an emerging technology for patients with cancer, polyps, inflammation, and other types of pathologic conditions. While previous studies have shown better outcomes for laparoscopic cholecystectomies when surgeons perform more procedures, there is no information on the relationship between surgeon volume and outcomes for laparoscopic-assisted colectomy. OBJECTIVE: To evaluate whether better clinical outcomes are found for surgeons who perform higher numbers of laparoscopic-assisted colectomies and whether such a relationship, if it exists, applies to both intraoperative and postoperative outcomes. DESIGN: Analysis of a data set of 1194 patients, operated on by 114 surgeons, from a prospective registry sponsored by the American Society of Colon and Rectal Surgeons, from May 1991 to October 1994. MAIN OUTCOME MEASURES: Completion rate, intraoperative and postoperative complications, and length of hospital stay. RESULTS: In 75% of cases, surgery was completed laparoscopically, with no difference between high-volume surgeons (> or = 40 cases) and low-volume surgeons. Length of stay (average, 6 days) did not vary according to surgeon volume. Postoperative complications occurred in 15% of cases, with a significantly lower rate for high-volume surgeons (10% vs 19%; P < .001). Intraoperative complications occurred in 5% of cases, with a nonsignificant trend toward a lower rate for high-volume surgeons (3.7% vs 6.3%). A multivariate regression analysis, adjusting for type of disease (cancer vs inflammation vs polyps) and for level of difficulty of the procedure (high vs low) showed that for high-volume surgeons there is a lower probability of both intraoperative complications (adjusted odds ratio, 0.56; 95% confidence interval, 0.32-0.97; P = .04) and postoperative complications (adjusted odds ratio, 0.48; 95% confidence interval, 0.34-0.68; P < .001). CONCLUSIONS: There is a learning curve for laparoscopic-assisted colectomy with respect to intraoperative and postoperative outcomes. As with other laparoscopic procedures, surgeons who perform higher volumes of laparoscopic-assisted colectomy have lower rates of intraoperative and postoperative complications.     

Conventional heart surgery with the fast-track-method: experiences from a pilot study

Early release after cardiac surgery can be promoted by implementation of a standard protocol for accelerated perioperative and early postoperative care, with optimal education and support of the patient playing a key role. We report on our preliminary experience with 100 selected patients who underwent a "fast track" protocol following coronary artery bypass (n = 61), valve replacement or reconstruction (n = 34) or closure of an atrial septal defect (n = 5) between 1996 and 1998. Surgery was performed through a midline sternotomy using normothermic or mild hypothermic cardiopulmonary bypass. Patients undergoing cardiac surgery with less invasive techniques were excluded from this study. The following criteria had to be fulfilled for early hospital discharge: sinus rhythm, temperature below 37.5 degrees C, stable haematocrit around 0.30, uncomplicated wound healing and complete mobilisation including stair exercises. Mean duration of the operation was 137 +/- 24 minutes and mean intubation time was 4.5 +/- 3 hours. Mean duration of hospitalisation from the day of the operation was 4.9 +/- 2.1 days. There was no early or late mortality in this group of patients and only 2 patients had to be re-admitted on postoperative day 10 and 14 because of atrial fibrillation in one and a wound healing problem in the other. Accelerated recovery and early hospital discharge is highly attractive in selected patients; in helps to promote early cardiac rehabilitation and the costs of the procedure can be substantially reduced. According to our experience and the most recent literature, this approach does not expose patients to higher mortality or morbidity. In addition, fast-tracked patients have shown a higher level of satisfaction. Under optimal cooperation between surgery, anaesthesiology and intensive care unit, the fast-track protocol can be applied in approximately 30% of overall adult cardiac surgery patients.     

Eye injuries during paintball games. The first Danish case with a summary of foreign experiences

Paintball shooting is played with increasing frequency in Denmark, and ocular injuries can cause serious damage. The first Danish case is presented and the literature is reviewed.     

Laparoscopic surgery and the systemic immune response

New York Online Access to Health (NOAH) is a Web site that provides accurate, timely, relevant, and unbiased full-text health information in both English and Spanish. A joint project of The City University of New York Office of Library Services, The New York Academy of Medicine Library, the Metropolitan New York Library Council, and The New York Public Library, NOAH brings consumer health information to the public in New York City and around the world via the Internet. NOAH is an example of a successful collaboration among different types of libraries (academic, public, medical society) and voluntary health agencies to use new technologies to reach a very broad public. This paper discusses the involvement of the library partners in terms of the management and funding of the site. Web site construction is described including how the information is gathered and organized. Future plans and funding issues for NOAH are considered in terms of the expected increase in the need for consumer health information. NOAH can be reached at: www.noah.cuny.edu.     

Follow up after potential curative surgery of colorectal cancer. Guidelines from the Norwegian Gastrointestinal Cancer Group

In Norway, about 2,800 cases of colorectal cancer are diagnosed every year. Two-thirds of the patients undergo potentially curative surgery and almost half of them develop local or distant metastases. The follow-up of colorectal cancer patients involves four strategies: Educating the patients about the disease, symptoms of relapse, and risk of hereditariness; Early diagnosis of relapse, to make curative re-surgery possible; Diagnosis of metachronous/synchronous cancer(s); Recording the results of current surgical techniques. The Norwegian Gastrointestinal Cancer Group recommend a four-year follow-up programme (every third month for two years and then twice a year) of colorectal cancer patients. It is suggested that patients treated with low anterior resection are followed regularly by means of rectoscopy and local examination (digital or by ultrasound) undertaken by specialist (surgeon or gastroenterologist). The others should be followed up mainly by general practitioners. Carcinoembryonic antigen (CEA)-monitoring is suggested every third month for two years, and then every sixth month. Colonoscopy is recommended at one and four year follow-up. Patients with normal CEA levels prior to surgery should be evaluated by ultrasound of the liver every sixth month for four years.     

Learning from the experiences of people with disabilities.

Comments on a paper by J. W. Jacobson et al (see record 1996-12698-001) on the history of facilitated communication. D. Biklen contends that the authors ignored by omission much data that make facilitated communication an example of the complexities of inquiry on human behavior. Examples of such data are provided on language, intelligence, the existence of apraxia-dyspraxia in autism, the uses and abuses of facilitated communication, and the testing of facilitated communication. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Lessons from the experiences of White antiracist activists.

What can the experiences of White antiracist activists teach psychologists about social justice training, practice, and advocacy? Not only have the perspectives of these individuals received little in the way of scholarly exploration, their activities are largely unknown to mainstream society. In this qualitative analysis, we studied the views, actions, turning points, and challenges reported by 18 adults whose self-reported antiracist activities ranged from organization and leadership to speaking out in everyday situations. Participants demonstrated a complex structural conceptualization of race and racism, and considered their antiracist activities to be rewarding and meaningful despite the interpersonal conflict that had accompanied them. The results of the analysis are tied to suggestions regarding the multicultural/social justice training of applied psychologists. (PsycINFO Database Record (c) 2010 APA, all rights reserved)