Surgery for local recurrence of rectal carcinoma

PURPOSE: This study was designed to evaluate results, especially mortality and morbidity, of surgical resection with curative intent for patients with a l

The composition of serous fluid after axillary dissection

Objective: To analyse the composition of the serous fluid formed after axillary dissection Design: Descriptive study Setting: University hospital and teaching hospital, The Netherlands Subjects: 16 patients whose axillas were dissected as part of a modified radical mastectomy for stage I or II breast cancer. Main outcome measures: Chemical and cellular composition of axillary drainage fluid on the first, fifth, and tenth postoperative days compared with the same constituents in blood and with reported data on the composition of peripheral lymph. Results and conclusion: On the first postoperative day the drainage fluid contained blood contents and a high concentration of creatine phosphokinase (CPK). After day one it changed to a peripheral lymph-like fluid but containing different cells, more protein, and no fibrinogen, making coagulation impossible. The reduction in the fluid production must be caused by other wound healing processes, such as formation of scars and connective tissue

Assessment of insertion techniques and complication rates of dual lumen central venous catheters in patients with hematological malignancies

One hundred and twenty-three dual lumen silicone rubber central venous catheters were inserted into 101 patients with hematological malignancies undergoing intensive treatment. There was a perioperative complication rate of 13%. Open and closed techniques for inserting the catheter were compared. The operating time needed for introducing the catheter by the closed technique (average, 51 minutes) was significantly shorter (p< 0.001) than the time needed for the open technique (70 minutes), whereas complication rates were equal in both techniques. On average, the catheters functioned for 149 days. Complications leading to removal were observed in 29.3% of patients, most of which were catheter-related infections (20.4%). Thromboembolic complications leading to removal were less frequent (4.1%) and appeared significantly earlier (p<0.001). These data indicate that introduction of the catheter by direct puncture of the subclavian vein is a quick and safe technique, and that this type of catheter is suitable for long-term use, both for infusion and for blood sampling

The pedicled omentoplasty and split skin graft (POSSG) for reconstruction of large chest wall defects. A validity study of 34 patients

The aim of this study was to evaluate retrospectively the results of pedicled omentoplasty and split skin graft (POSSG) in reconstructing (full thickness) chest wall defects, and to define its role as a palliative procedure for local symptom control. Thirty-four patients with recurrent breast cancer (n = 25), radiation-induced necrosis (n = 5) or sarcoma (n = 4) of the chest wall were selected for the study. All patients underwent curative or palliative chest wall resection with reconstruction by pedicled omentoplasty and split skin graft (POSSG), between 1986 and 1994. Reconstructive outcome, complications, local tumour and symptom control following surgery was measured. The most common complication was shown to be partial necrosis of the omental flap (35%), followed by respiratory problems (26%), facial hernia (26%) and thoracic wound problems (15%), which were mostly treated in a conservative way (68%). The 3-year local tumour-free interval after POSSG in patients curatively treated for breast cancer is 16%. Seventy per cent of the patients who underwent palliative resection had longstanding relief of local pain, bleeding or foetor due to local tumour growth. It can be concluded that large (full thickness) chest wall defects after resection of local recurrence, primary malignancy or osteoradionecrosis of the chest wall can successfully be reconstructed by POSSG. Chest wall resection in patients treated with palliative intention is effective in local symptom control

Detection of liver metastases from colorectal carcinoma: Is there a place for routine computed tomography arteriography?

Background. A prospective evaluation of the liver by preoperative ultrasonography, conventional computed tomography (CT), and continuous CT angiography (CCTA) was performed in 60 patients with primary or secondary colorectal carcinoma. Methods. The standards of reference were palpation of the liver and intraoperative ultrasonography. The imaging techniques were assessed independently of each other. Results. In 37 patients 105 liver metastases were identified; 23 patients had no metastases. CCTA had a high sensitivity of 94% (99 lesions identified) in contrast to ultrasonography (48%) and conventional CT (52%). The superiority of CCTA was also manifest in lesions less than 1 cm in diameter. However, the high sensitivity was accompanied by a high false-positive rate, particularly because of variations in the perfusion of normal liver parenchyma. Overall, CCTA had the highest accuracy (74%) compared with ultrasonography and CT (both 57%). The data indicate that preoperative ultrasonography and conventional CT have low sensitivity in the detection of liver metastases. Conclusions. Although CCTA seems to be superior to other preoperative imaging techniques, the too low specificity will hamper its routine application in patients with hepatic metastases from colorectal carcinoma

Goal-neglect links Stroop interference with working memory capacity

Relationships between Stroop interference and working memory capacity may reflect individual differences in resolving conflict, susceptibility to goal neglect, or both of these factors. We compared relationships between working memory capacity and three Stroop tasks: a classic, printed color-word Stroop task, a cross-modal Stroop, and a new version of cross-modal Stroop with a concurrent auditory monitoring component. Each of these tasks showed evidence of interference between the semantic meaning of the color word and the to-be-named color, suggesting these tasks each require resolution of interference. However, only Stroop interference in the print-based task with high proportions of congruent trials correlated significantly with working memory capacity. This evidence suggests that the relationships observed between Stroop interference and working memory capacity are primarily driven by individual differences in the propensity to actively maintain a goal. (C) 2012 Elsevier B.V. All rights reserved

Impact of composition and morphology on the optical properties of Si-NC/P3HT thin films processed from solution

Blends of Si nanocrystals (Si-NCs) and organic semiconductors are promising materials for new optical and electronic devices processed from solutions. Here, we study how the optical properties of composite films containing Si-NCs and the organic semiconductor poly(3-hexylthiophene) (P3HT) are influenced by the composition and morphology resulting from different solution-processing parameters and different solvents used dichlorobenzene vs. chloroform). The optical spectra of the hybrid films are described using a simple phenomenological model, with which we can discern the contribution of each material in the films to the optical properties. From this analysis, we obtain quantitative information about the composition and morphology of the hybrid nanostructured films, which otherwise would be obtained from more demanding microscopy and spectroscopy techniques. For the case of the Si-NC/P3HT blend, we find that in films deposited from dichlorobenzene solutions the Si-NCs contribute sizably to light absorption.This work was funded by FCT/I3N via the HybridSolar project, by the DFG via Teilprojekt B2 and by the European Union and the Ministry of Innovation, Science and Research of the German State of North Rhine-Westphalia in the framework of an Objective 2 Programme (European Regional Development Fund, ERDF). Funding is also acknowledged from the Portuguese Foundation for Science and Technology (FCT) through the Projects Nos. PTDC/FIS/112885/2009 and PEst-C/CTM/LA0025/2011 and via the Strategic Project LA 25:2011-2012

What is the appropriate timetable and exams density for tailored follow-up?

After completion of treatment for colorectal cancer, patients are offered a control program. This program can be split into aftercare and follow-up. Aftercare is meant to treat and to support the patient in the somatic and psychologic sequelae of the intensive treatment. In most cases, the patient has adopted to these consequences after 1 year. In this period, follow-up has already been started to detect recurrent disease in curatively treated patients. The rationale behind this scheduled follow-up is to detect asymptomatic recurrent disease as early as possible and by that increase the rate of curable recurrences followed by a better survival in a cost-effective way. Traditionally it consists of anamnesis, physical examination, blood tests, and imaging. Timing and duration has been debated for many years with endless discussions about the definition of minimal or intensive schedule, but guidelines all over the world have incorporated a kind of follow-up schedule in their national or institutional guidelines. However, evidence for a certain schedule of follow-up is based on old, often poor, designed studies with inclusion of the patients in the 1970s and 1980s of the last century, when surgery was suboptimal and the preoperative staging more or less missing. The subsequent meta-analyses have included all these old series and are the rationale of today’s practice. In general, the conclusion is that a kind of follow-up results in an improved survival, but it is not possible to determine the best combination of tests and the frequency

Acute-phase response patterns in isolated hepatic perfusion with tumour necrosis factor α (TNF-α) and melphalan in patients with colorectal liver metastases

Background. In this study, we have evaluated hepatotoxicity, secondary cytokine production and hepatic acute-phase response (APR) in patients who underwent isolated hepatic perfusion (IHP) with tumour necrosis factor (TNF) α and melphalan for irresectable colorectal liver metastases. Design. An extracorporeal veno-venous bypass was used to shunt blood from the lower body and intestines to the heart. Inflow catheters were placed in the hepatic artery and portal vein, and an outflow catheter in the inferior caval vein. The liver was perfused for 60 min with 0.4 mg of TNF-α plus 1 mg kg-1 melphalan (IHP(TM) group, n = 6) or 1 mg kg-1 melphalan (IHP(M) group, n = 3). The liver was washed with macrodex before restoring vascular continuity. Results. After the washout procedure, a TNF-α peak (169 ± 38 pg mL-1) was demons