Colonoscopy-Assisted Laparoscopic Wedge Resection for the Treatment of Suspected T1 Colon Cancer.

BACKGROUND: Local en bloc resection of pT1 colon cancer has been gaining acceptance during the last few years. In the absence of histological risk factors, the risk of lymph-node metastases (LNM) is negligible and does not outweigh the morbidity and mortality of an oncologic resection. Colonoscopy-assisted laparoscopic wedge resection (CAL-WR) has proved to be an effective and safe technique for removing complex benign polyps. The role of CAL-WR for the primary resection of suspected T1 colon cancer has to be established. METHODS: This retrospective study aimed to determine the radicality and safety of CAL-WR as a local en bloc resection technique for a suspected T1 colon cancer. Therefore, the study identified patients in whom high-grade dysplasia or a T1 colon carcinoma was suspected based on histology and/or macroscopic assessment, requiring an en bloc resection. RESULTS: The study analyzed 57 patients who underwent CAL-WR for a suspected macroscopic polyp or polyps with biopsy-proven high-grade dysplasia or T1 colon carcinoma. For 27 of these 57 patients, a pT1 colon carcinoma was diagnosed at pathologic examination after CAL-WR. Histological risk factors for LNM were present in three cases, and 70% showed deep submucosal invasion (Sm2/Sm3). For patients with pT1 colon carcinoma, an overall R0-resection rate of 88.9% was achieved. A minor complication was noted in one patient (1.8%). CONCLUSIONS: The CAL-WR procedure is an effective and safe technique for suspected high-grade dysplasia or T1-colon carcinoma. It may fill the gap for tumors that are macroscopic suspected for deep submucosal invasion, providing more patients an organ-preserving treatment option.

A study to determine a practical method for weight estimation of deceased persons.

BACKGROUND: Body weight is an important parameter for estimating the postmortem interval (PMI) at a crime scene. However, a challenge arises at crime scenes when a weight scale for measuring the total body weight is unavailable. Anthropometry-based models to estimate body weight have been developed in previous studies. This study aims to determine the accuracy of body weight estimations by practitioners, test the anthropometry-based models for applicability to deceased individuals, and examine a potential new method based on applying heel weight. METHODS: A prospective study was conducted at the Isala Hospital in the Netherlands. During the study period, deceased people that were admitted to the hospital mortuary were included consecutively. The body weight of deceased persons estimated by practitioners was compared to the actual body weight. Anthropometric measurements were taken and used to perform eight sex dependant anthropometry-based models, with accuracy for the actual body weight calculated using RMSE values. A Pearson's correlation test was used to determine the correlation between heel weight and total body weight. RESULTS: During the study period, a total of 100 cases, 56 males and 44 females, were included. Overall, only 33.3 % of practitioners' estimations were within 5 % of the actual measured weight. The model based on abdominal and thigh circumference performed best for weight estimation in males and the models based on mid-arm circumference, abdominal circumference, calf circumference and, in one model, subscapular skinfold performed best in females. A Pearson's correlation test revealed a weak positive correlation between weight of the heel and total body weight (Pearson's correlation coefficient: 0.214). DISCUSSION: Estimations of underweight or obese patients posed a challenge for weight estimation. Especially in these cases, study results showed that anthropometry-based models have potential for daily practice. However, additional research is required to assess the reliability of the best performing models before implementation in forensic casework. The correlation between the weight of the heel and body weight was low, therefore implementation of the current method is not recommended, and further research is required.

[Retrospective study of 20 years of post-mortem examination of young adults]. / De meerwaarde van postmortaal onderzoek.

OBJECTIVE: This study is designed to gain insight into the cause of death in deceased young adults, by analyzing autopsies and other post-mortem examinations including their contribution into finding the cause of death DESIGN: Retrospective cohort study. METHOD: Included were adults aged between 18-45 years old who underwent a clinical autopsy at the Isala Klinieken in Zwolle between January 2000 and October 2022. Included patients had a natural cause of deaths and were divided into two categories: expected and unexpected deaths. For each patient the post-mortem examination and their contribution to diagnose the cause of death were determined, among other things. Collected data was processed in a database and analyzed. RESULTS: Between January 2000 and October 2022, 212 autopsies were performed in the 18-45 age group. Of these 212 patients, 54 (25,5%) were expected deaths and 158 (74,5%) unexpected deaths. 116 patients had an unknown cause of death (7 expected vs. 109 unexpected). After post-mortem examination, this number has decreased to 15 deaths (expected 0 vs. unexpected 15). This is a reduction form 54,7% to 7,1%. Of the 96 presumed diagnoses/causes of death for autopsy, 16 (16,7%) cases were reclassified as Goldman score 1 discrepancies. CONCLUSION: Performing post-mortem examinations contributes to reducing the number of unknown causes of death. Post-mortem examinations also provide knowledge about illnesses, the clinical course of syndromes and the actual cause of death in (young) adults, even when mortality is expected.

Missed injuries in trauma patients: the value of a diagnostic thoracotomy or thoracoscopy during surgical stabilisation of rib fractures.

PURPOSE: Over the last decade Surgical Stabilisation of Rib Fractures (SSFR) gained popularity in our hospital. With increased numbers, we noted that frequently injuries were missed during primary/secondary survey and radiological imaging that were found during the surgical procedure. With this observation, the research question was formulated: What is the value of diagnostics thoracotomy or thoracoscopy during surgical stabilisation of rib fractures? METHODS: In a single-centre, retrospective study between February 2010 and December 2019, trauma patients who underwent Surgical Stabilisation of Rib Fractures (SSFR) and an inspection thoracotomy were included. All radiological injuries were compared with intraoperative findings. Missed injuries that were discovered during the surgical procedure that were not analysed during primary/secondary survey or on radiological imaging were recorded and retrospectively analysed by an independent radiologist. RESULTS: Fifty-one patients were included. Eight patients had additional injuries; all had a diaphragmatic rupture, one patient had an additional stomach laceration, and another patient had a significant lung laceration in need of surgical repair. On a CT scan there are 7 signs of predictive value for a diaphragmatic rupture. Only 13 out of the total of 56 diaphragm rupture CT signs were confirmed on the primary CT scans of the eight patients with diaphragmatic injuries; therefore, still 77% of signs could not be confirmed by initial radiological findings. CONCLUSION: With the recent shift towards surgical stabilisation of rib fractures, an inspection thoracoscopy or thoracotomy during SSFR should be considered to minimise the incidence of missed intrathoracic injuries requiring early or late surgical treatment.