Late anastomotic leakages in rectal surgery: a wake-up call about their impact on long-term results.

OBJECTIVE: To assess the impact of the incidence of late anastomotic dehiscences, defined as those occurring after the 60th post-operative day, in the final results of rectal cancer treatment. METHODS: A retrospective analysis was performed reviewing all anastomotic leakages (AL) recorded in a prospective rectal cancer database, from November 2006 to December 2015. RESULTS: The analysis included 395 (71.5%) colo-rectal anastomosis performed in 552 patients undergoing rectal cancer surgery. Overall 32 (8.1%). AL were identified: 25 (78%) early and 7 (22%) late. Late AL compared to early AL were significantly associated with: higher ASA score (p = 0.021), higher CLS score (p = 0.005), lower rectal tumours (p = 0.014), neo-adjuvant radio-chemotherapy (p = 0.028), presence of ileostomy (p = 0.013), early hospital discharge (p = 0.048) and with the need for definitive stoma creation (p = 0.003). CONCLUSIONS: Late AL can represent up to 22% of all AL; with significant long-term implications such as an increase of the requirement of definitive stoma or chronic pelvic sepsis. This findings could modify the long-term outcomes in rectal cancer published. In our experience, the late AL do not represent a distinct clinical process compared to early forms, with exception of the chronological criteria.

OBJETIVO: Valorar el impacto de la incidencia de dehiscencias anastomóticas tardías, definidas como las aparecidas después del día 60 del posoperatorio, en los resultados finales del tratamiento del cáncer de recto. MÉTODO: Estudio retrospectivo de todas las dehiscencias anastomóticas recogidas a largo plazo en un registro prospectivo de cáncer de recto entre noviembre de 2006 y diciembre de 2015. RESULTADOS: Se realizaron 395 anastomosis colorrectales en 552 pacientes con cáncer de recto (71.5%) y se diagnosticaron 32 dehiscencias anastomóticas (8.1%): 25 precoces (78%) y 7 tardías (22%). Las tardías se diferenciaron de las precoces por presentarse en pacientes con mayor puntuación ASA (p = 0.021), mayor puntuación predictiva CLS (p = 0.005), tumores más bajos (p = 0.014), neoadyuvancia (p = 0.028), ileostomía (p = 0.013), menos tiempo de estancia posoperatoria (p = 0.048) y mayor necesidad de estomas definitivos (p = 0.003). CONCLUSIONES: Las dehiscencias anastomóticas tardías pueden suponer el 22% de las dehiscencias totales y se acompañan de un aumento de estomas definitivos y de sepsis pélvica crónica que podrían empeorar los estándares publicados en cáncer de recto. En nuestra experiencia no son diferentes de las formas precoces salvo en su cronología.

Stroke Incidence and Survival in Ludwigshafen am Rhein, Germany: the Ludwigshafen Stroke Study (LuSSt).

BACKGROUND AND PURPOSE: Considerable locoregional differences in stroke incidence exist even within countries. Based on data from a statewide stroke care quality monitoring project, we hypothesized a high stroke incidence mainly among younger age groups in the industrial city of Ludwigshafen am Rhein, Germany. To test this hypothesis and to provide data on stroke incidence and case-fatality rates, a population-based stroke register was initiated. METHODS: The Ludwigshafen Stroke Study is a prospective ongoing population-based stroke register among the 167 906 inhabitants of Ludwigshafen am Rhein. Starting on January 1, 2006, standard definitions and multiple overlapping methods of case ascertainment were used to identify all patients with incident stroke or transient ischemic attack. RESULTS: In 2006 and 2007, 1231 cases with stroke or transient ischemic attack including 725 patients with first-ever stroke were identified. The crude annual incidence rate per 1000 for first-ever stroke was 2.16 (95% CI 2.10 to 2.32). After age adjustment to the European population, incidence for first-ever stroke was 1.46 (95% CI 1.35 to 1.57; men: 1.63; 95% CI 1.46 to 1.81; women: 1.29; 95% CI 1.15 to 1.43). Crude annual incidence rates per 1000 were 1.86 for ischemic stroke, 0.19 for intracerebral hemorrhage, 0.05 for subarachnoid hemorrhage, and 0.05 for undetermined stroke. Case-fatality rates for first-ever stroke were 13.6%, 16.4%, and 23.2% at Days 28, 90, and 365, respectively. CONCLUSIONS: High crude incidence rates in our study reflect the rising burden of stroke in our aging population. Age-adjusted incidence rates were somewhat higher than those reported by recent studies from Western Europe, mainly due to higher incidence in subjects <65 years.

Effect of surface roughness, porosity, and a resorbable calcium phosphate coating on osseointegration of titanium in a minipig model.

The aim of this study was to compare the osseointegration of four different implant surfaces in the Göttingen minipig femur model. They were prepared by glasspearlblasting (A), sandblasting (B) and titaniumplasma spraying (C and D). Surface D received additionally an electrochemically deposited layer of a resorbable calcium phosphate (CaP) layer, made mainly of brushite. Sample size was n = 20 per group. Implants were placed in the intertrochanteric and intercondylar sites of both femora. After 12 weeks, implant anchorage was measured by the pull-out test and histomorphometry measurements were carried out at the bone-implant interface. Implant anchorage was 0.7 +/- 0.3 MPa for surface A, 3.2 +/- 0.6 MPa for surface B, 6.5 +/- 1.5 MPa for surface C and 7.3 +/- 1.9 MPa for surface D. The differences between surfaces were statistically significant, with exception of C and D. The stiffness of the bone-implant interface showed no statistically significant difference between surfaces. After pull-out, surface A and B showed nearly no bone spots, while on surfaces C and D bone remains were found. Bone-implant contact was 1.9 +/- 1.1% for surface A, 10.5 +/- 3.6% for surface B, 22.4 +/- 4.5% for surface C and 48.8 +/- 4.5% for surface D. The differences were statistically significant. Implant location, intertrochanteric and intercondylar, did not affect the data. In this minipig model, rougher surfaces showed better osseointegration. After 12 weeks of healing, the resorbable CaP layer enhanced significantly the bone-implant contact but not the level of anchorage. The findings also suggest that the pull-out test should be critically evaluated to determine the shear strength between bone and porous surfaces.