Influence of gender, ASA physical status, the location of a tumor and stage of the disease on the survival rate in patients with rectal cancer after surgery.

BACKGROUND: There are limited data describing different factors that influence survival rate of patients with rectal cancer. AIMS: Our aim was to determine the influence of patient gender, American Society of Anesthesiologists (ASA) physical status, the location of the tumor and stage of the disease on the patient survival rates after excision of rectal cancer. SETTINGS AND DESIGN: We included 385 patients who were operated between 2004 and 2014 in the University Clinical Center Maribor. The patients were treated due to rectal adenocarcinoma. We assessed survival rates according to gender, ASA physical status, the location of the tumor and stage of the disease with different statistical methods. SUBJECTS AND METHODS: To find the extent of correlation between factors and survival rate, we used means and medians, Log Rank test, Breslow test and Tarone-Ware test. RESULTS: According to patient gender, survival rate did not differ significantly (P > 0.05), however ASA physical status (P < 0.05), location of the tumor (P < 0.05) and stage of the disease (P < 0.05) significantly affected the survival rates. CONCLUSIONS: Our study showed that gender does not have a significant impact on survival rate as oposed to ASA physical status, the location of the tumor and stage of the disease.

[ETIOLOGY OF PROSTATE CANCER].

Prostate cancer is now recognized as one of the most important medical problems in male population. Epigenetic regulation of gene expression by promoter methylation and histone acetylation, proinflammatory enzyme cyclooxygenase-2 and somatic mutations in a variety of genes with diverse biological functions has been implicated in prostate cancer development and progression.

Abdominal pain and two x-rays: spot the difference.

We present two patients with air found in the right upper quadrant on standard abdominal x-ray. One was diagnosed with pneumobilia and underwent elective surgery for a bilioenteric fistula. The other was diagnosed with portal vein gas and underwent an emergency exploratory laparotomy at which a superior mesenteric artery embolism was found. The differential diagnostic criteria for pneumobilia and portal vein gas are described. If portal venous gas is found on x-ray in patients with abdominal pain, it is recommended that management is aggressive, meaning an emergency exploratory laparotomy, because mortality in such cases is approximately 75%.

Synchronous celiac axis and superior mesenteric artery embolism.

We present a case of combined celiac axis and superior mesenteric artery embolism in a 70-year-old patient that was examined in emergency department for atrial fibrillation and diffuse abdominal pain. Standard abdominal x-ray showed air in the portal vein. CT scan with contrast showed air in the lumen of the stomach and small intestine, bowel distension with wall thickening, and a free gallstone in the abdominal cavity. Massive embolism of both celiac axis and superior mesenteric artery was seen after contrast administration. On laparotomy, complete necrosis of the liver, spleen, stomach and small intestine was found. Gallbladder was gangrenous and perforated, and the gallstone had migrated into the abdominal cavity. We found free air that crackled on palpation of the veins of the gastric surface. The patient,s condition was incurable and she died of multiple organ failure a few hours after surgery. Acute visceral thromboembolism should always be excluded first if a combination of atrial fibrillation and abdominal pain exists. Determining the serum levels of d-dimers and lactate, combined with CT scan with contrast administration can, in most cases, confirm the diagnosis and lead to faster surgical intervention. It is crucial to act early on clinical suspicion and not to wait for the development of hard evidence.

Advantages of new materials in fascia transversalis reinforcement for inguinal hernia repair.

PURPOSE: We investigated whether new absorbable materials can be used in the treatment of inguinal hernia with the same efficacy as the traditionally used polypropylene. METHODS: We compared local tissue inflammation and fibrous reaction, postoperative complications (bleeding, wound haematoma, wound infection) and postoperative recovery time (time of mobilisation) in rats (Fischer strain) after implantation of a polypropylene mesh (PPM) (Prolene, Ethicon, Bracknell, UK) or a dual component fibrin mesh (DCFM) (Tachosil, Nycomed, Marlow, UK), between the muscle layer and the fascia transversalis defect. We further compared direct hernia repair methods using Lichtenstein's operation in humans after implantation of either PPM or DCFM for fascia transversalis reinforcement regarding postoperative pain and complications, time needed for patient mobilisation, and recurrence. RESULTS: The results show that implantation of DCFM in rats resulted in milder inflammatory response and thicker fibrous tissue formation. Patients implanted with DCFM had significantly lower postoperative pain scores on a visual-analogue scale and lower analgesic use. The overall incidence of postoperative complications was significantly reduced with the use of DCFM. The incidence of recurrence after 24-month follow-up was the same in both groups. CONCLUSION: This study has shown that DCFM has the same short-term efficacy in hernia treatment as the standard PPM, with a reduction in postoperative pain and analgesic use, and a decrease in overall postoperative complications. In the rat model, DCFM resulted in milder inflammatory response and thicker fibrous plate than the PPM. Further biomechanical testing and longer follow-up is necessary, but initial results are promising.