Evaluation of Efficacy and Tolerance of Radical Radiotherapy and Radiochemotherapy in Treatment of Locally Advanced, Unresectable Rectal Cancer.

Background: A retrospective evaluation of tolerance and efficacy of two schemes of neoadjuvant treatment in patients (pts) with unresectable rectal cancer: radiochemotherapy (CRT) and radiotherapy (RT), including conventional and accelerated hyperfractionation. Material and Method: A total of 145 consecutive pts with unresectable, locally advanced rectal cancer. The schemes used are RT in 73 (50%) or CRT in 72 (50%). In CRT, 54 Gy in 1.8 Gy fractions was given with chemotherapy, In the RT group, conventional fractionation (CFRT) and hyperfractionated accelerated radiotherapy (HART). HART was introduced at first as an alternative to CFRT, after radiobiological studies suggesting a therapeutic gain of hyperfractionation in other cancers, and second to administer relatively high dose needed in unresectable cancer, which is not feasible in hypofractionation because of critical organs sensitivity to high fraction doses (fd). HART was an alternative option in pts with medical contraindications to chemotherapy and to shorten overall treatment time with greater radiobiological effectiveness than CFRT. Results: Objective response (OR) in the RT and CRT group was 60% versus 75%. Resection rate (RR) in RT and CRT: 37% versus 65%. Tumor mobility and laparotomy-based unresectability were significant factors for OR. Performance status (PS), tumor mobility, and neoadjuvant treatment method were significant for RR.

Ultrahypofractionated CyberKnifeTM based stereotactic radiotherapy versus conventional radiotherapy in patients with prostate cancer - acute toxicity evaluation in two phase II prospective studies.

Our purpose was to compare the acute toxicity of ultrahypofractionated CyberKnifeTM based stereotactic radiotherapy (SBRT Arm) and conventional radiotherapy (EBRT Arm) in prostate cancer patients. Two-hundred-sixteen men with prostate cancer were enrolled in our prospective studies. One-hundred and nine were irradiated using CyberKnife to total dose of 36,25 Gy in 5 fractions. One-hundred and seven were irradiated conventionally to total dose of 76 Gy in 38 fractions. Mean age of patients was 69. Acute genitourinary (GU) and gastrointestinal (GI) adverse-events were collected. The maximal acute toxicity EORTC/RTOG score was assumed. A total of 41%, 44%, 12% and 3% of patients presented grade 0, 1, 2 and 3 acute genitourinary toxicity in SBRT arm, respectively. A total of 21%, 33%, 43% and 3% of patients demonstrated acute grade 0, 1, 2 and 3 genitourinary toxicity in EBRT arm. A significant difference between number of patients with grade 2 GU toxicity was observed (p-0.000) and between patients without any toxicity (p-0.0017).A significant difference in frequency of acute GI toxicity between both groups was observed, too. 71% vs. 44% had no toxicity (p-0.0001), and 3% vs. 18% (p-0.0004) presented grade 2 GI toxicity in SBRT and EBRT arms respectively.The acute toxicity rates of fractionated stereotactic radiotherapy is lower compared to conventional irradiation.

The efficacy of stereotactic radiotherapy for metastases from renal cell carcinoma.

Our purpose was to evaluate the efficacy of stereotactic radiotherapy (SRT) for intracranial and extracranial metastases in patients with renal cell carcinoma. The retrospective analysis of 85 patients (151 tumors) treated with SRT was performed. SRT was the sole treatment in 35% of tumors, the other 65% had received additional treatment such as surgery, palliative radiotherapy, immunotherapy or chemotherapy. In 60% and 40% of patients SRT was delivered to brain and extracranial lesions, respectively. The assessment of the efficacy of SRT was based on a radiological imaging (Computed Tomography or Magnetic Resonance Imaging) and estimation of Local Control (LC) as well as Overall Survival (OS). Single fraction was used for 104 tumors and fractionated treatment for 47 tumors. The crude LC for evaluable lesions was 81%, stratified by tumor location: brain LC=94%, extracranial tumors LC=70% (p=0.049). The median OS was 9.4 months; 1-year and 2-year OS were 40% and 29%, respectively. The additional treatment did not lead to a better local response (p=0,543), but resulted in a benefit in OS (7 vs 13 months, p=0,01). A positive relationship between the biologically effective dose (BED) and local response was noted, but the BED was influenced by a tumor volume (R=-0,38; p<0,00001). The presence of multi-organ metastases reduced the OS rate (8.7 vs 19.1 months; p=0,01). The interval between the diagnosis of the metastasis and its treatment with SRT was inversely related to OS (P=0.0001). SRT results in a good local response, which is more beneficial for brain than extracranial lesions. The local efficacy of the SRT depends on the radiation dose. Multidisciplinary treatment and earlier application of SRT improves the prognosis of patients.

Acute toxicity of robotic ultrahypofractionated radiotherapy CyberKnifeTM in prostate cancer patients.

Our purpose was to evaluate the toxicity of CyberKnifeTM based fractionated stereotactic radiotherapy (FSRT) in prostate cancer patients. One-hunred-thirty-two men with low (62) and intermediate (70) prostate cancer were enrolled in our prospective study. Mean age was 69. Total dose of 36,25 Gy in 5 fractions was prescribed. Image guided FSRT was performed on CyberKnife. Minimum follow-up ranged from 3 to 28 months. EORTC/RTOG scale was used to evaluate toxicity. A total of 47%, 10% and 2% of patients presented grade 1, 2 and 3 acute genitourinary toxicity, respectively. In 25% and 3% of patients, respectively, grade 1 and 2 acute gastrointestinal toxicity was observed. No significant association between acute grade ≥ 2 toxicity and clinical factors: age, androgen deprivation therapy or infections were found. Neither CTV nor PTV volumes had significant impact on acute grade ≥ 2 toxicity. Late toxicity was assessed in 104 patients. In 16% and 1% of patients late GU toxicity in grade 1 and 2, respectively, was presented. Late GI toxicity grade 1, 2 and 3 occurred in 8%, 3% and 1% of patients, respectively. The acute toxicity rates of fractionated stereotactic radiotherapy are low. Early data suggest also low late toxicity rates.

Daily image-guidance in prostate cancer radiotherapy - implications for treatment margins.

UNLABELLED: Our purpose was to evaluate interfractional organ and patient movement during radiotherapy of prostate cancer and to calculate the necessary CTV to PTV margins. Fifty patients irradiated between 2009 and 2011were included into the prospective study. The 2D-2D KV system combined with the intraprostatic fiducial marker were used for daily position verification. Based on the 8629 measurements of isocentre displacement an interfractional motion of pelvis and prostate was evaluated. The CTV to PTV margins were calculated. Margins of 0.7 cm (AP), 1 cm (SI) and 0.35 cm (LR) are necessary when only bony based IGRT is performed. Margins of 1.0 cm, 1.8 cm and 0.5 cm in AP, SI and LR directions respectively are necessary in case of no IGRT.There was no clinically relevant changes in patient/target mobility throughout the whole treatment. The IGRT is essential for state of art radiotherapy of prostate cancer. Necessary CTV to PTV margins are much bigger in case of no IGRT performed. Changing of margins size throughout regular treatment is not necessary. KEYWORDS: IGRT, prostate cancer, fiducial marker.

Application of spectroscopic techniques: ICP-OES, LA-ICP-MS and chemometric methods for studying the relationships between trace elements in clinical samples from patients with atherosclerosis obliterans.

The study was aimed to evaluate the influence of the vascular disease, atherosclerotic obliterans (AO), on the location and concentration of elements in the arterial wall and serum. Use of a modern method for studying element's concentration and distribution in samples of clinical material, i.e. laser ablation inductively coupled plasma mass spectrometry, is presented. Elements are not equally distributed between the inner (intima) and the outer (media + adventitia) layer of the arterial wall. Among the studied elements, calcium was found to have an unquestionable role in the calcification of the wall. Increased concentration of calcium found in the inner part of the atherosclerotic arterial wall and in the plaque, as compared to the control arterial wall samples, demonstrates the unquestionable role of this element in the calcification of the wall observed in AO. Applied chemometric methods were useful for demonstrating the differences in the element's concentration in blood serum and the arterial wall samples between AO and the control group.

Patients' radiation doses during the implantation of stents in carotid, renal, iliac, femoral and popliteal arteries.

OBJECTIVES AND DESIGN: The aim of the study was to document the radiation doses to patients during the implantation of stents in various arteries and to discuss potential reasons for prolongation of radiological procedures. MATERIALS AND METHODS: Measurements of air kerma (Gy) and dose-area product (Gy cm²) (DAP) were carried out simultaneously on a sample of 345 patients, who underwent different interventional radiological procedures involving angioplasty with stenting of 73 carotid (21.5%), 22 renal (6.5%), 160 iliac (45%), 63 femoral (18.6%) and 27 popliteal (7.9%) arteries. RESULTS: The highest mean air kerma values for fluoroscopy and exposure were found for renal angioplasty (340 and 420 mGy, respectively). With regard to total DAP values, the highest were obtained for renal (148 Gy cm²) and iliac/The Inter-Society Consensus for Management of Peripheral Arterial Disease (TASC) II C (199 Gy cm²) stent implantation. The lowest values were for carotid (53 Gy cm²), iliac/TASC II A (6.3 Gy cm²) and femoral/TASC II A (53 Gy cm²) arteries. For 3.5% of the patients, the air kerma was between 1 and 1.5 Gy and for 1.5%, it was between 1.5 and 2 Gy. CONCLUSIONS: In procedures performed on the arteries of the lower limbs, a significantly higher dose was received by patients with TASC II C lesions. With regard to the number of stents implanted, the total DAP value was 50% higher for simultaneous three-stent implantation than for one or two stents.

IL-6, TNF-alpha, IL-1-beta arterial wall expression is independent of serum concentration in patients sustaining primary or secondary open vascular reconstructions.

AIM: The aim of this study was to assess morphological and immunohistochemical differences in arterial wall inflammation during primary and secondary vascular reconstructions. METHODS: Forty patients with lower extremities ischemia underwent vascular reconstruction: Group I included patients undergoing primary vascular reconstruction with 25 minor arterial reconstructive procedures; Group II included patients undergoing secondary reconstruction due to limb ischemia after at least 12 months since first operation (15). Immunohistochemical expression of IL-1-BETA,IL-6,and TNF-alpha in arterial wall was correlated with serum concentration. RESULTS: No differences were observed in IL-1-beta, IL-6, TNF-alpha expression among groups (P=0.06, P=0.13, P=0.9). Cytokines expression was not accompanied by the growth of its serum concentrations (P=0.8, P=0.9). IL-6 serum concentration depended on the degree of limb ischemia and was very high in case of critical limb ischemia (P=0.006). Arterial morphology was comparable among the groups. CONCLUSION: IL-6, IL-1-BETA, TNF-alpha expression in the arterial wall is comparable in primary and secondary lesions. Serum concentrations of IL-6, IL-1-BETA, TNF-alpha are independent of its arterial wall expression.

The influence of elastic components of the venous wall on the biomechanical properties of different veins used for arterial reconstruction.

OBJECTIVE: To evaluate the relationship between the biomechanical properties and the structure of elastic components in different veins used for vascular reconstruction. DESIGN: In vitro experimental study. MATERIAL AND METHODS: Groups of 30 samples of incompetent saphenous veins (rSV), competent saphenous veins (cSV) and femoral veins (FVs) were compared following immunohistochemical staining for the presence of collagen types I, III and IV and elastin. The percentage area of transverse section of veins occupied by each type of collagen and elastin was measured using a computer-image-analysis system connected to a microscope. For all three groups of veins, the storage modulus, E', and the loss modulus, E'', were measured with a mechanical analyser, DMA-242, and changes in the function of temperature and frequency, and duration of exposure to the applied force were determined. RESULTS: The rSV showed the highest percentage share of collagen I and the lowest percentage share of collagen IV. These samples also showed the greatest expression of elastin and the highest elastin to collagen ratio. The rSV were also found to have the highest E' and E'', and during the long-term exposure achieved maximum stiffness in the least time as compared to cSV and FV. CONCLUSION: The histological structure directly influences the biomechanical properties of venous wall with rSV showing least compliance and cSV the greatest compliance.

Morphological and mechanical changes in juxtarenal aortic segment and aneurysm before and after open surgical repair of abdominal aortic aneurysms.

OBJECTIVE: The aim of study was to assess how the ultrastructure of the wall of aortic aneurysms, sac and neck influences aortic wall distensibility and proximal dilatation 2 years after open repair. METHODS: Biopsies for electron microscopy were taken from aneurysmal sac and neck of 30 patients. Patients were assessed by computed tomography (CT) and ultrasound for aneurysm diameter and distensibility (M-mode ultrasonography). RESULTS: Postoperative CT of the aortic stump distinguished two groups. Group I (n = 11) with little enlargement, median 1 mm (1-3 mm) and group II (n = 19) with significant aortic enlargement, median 5.2 mm (4-12 mm). In group II, changes in elastic fibres in the aneurysm neck were comparable to, but as extreme as in the aneurysm sac. For group I, the distensibility of the aneurysmal sac was significantly lower than in the neck or at the renal arteries. For group II, the distensibility in both the neck and sac was significantly lower than at the juxtarenal segment (p = 0.01). The biopsies of group II patients showed the extensive degeneration of normal architecture, which was associated with altered wall distensibility in both the aneurysmal neck and sac. CONCLUSIONS: Disorganisation and destruction of normal aortic architecture at the ultrastructural level are associated with decreasing aortic distensibility. Low aortic neck distensibility is associated with proximal aortic dilatation at 2 years postoperatively.

Dose-area product to patients during stent-graft treatment of thoracic and abdominal aortic aneurysms.

This article is the first investigation that studies patient doses (air kerma and DAP) during digital subtraction angiography (DSA) for stent-graft treatment of both thoracic (TAAs) and abdominal (AAAs) aortic aneurysms. Fluoroscopy and exposure time, air kerma and dose-area product (DAP) were analyzed from 100 patients. In 41% of the analyzed patients total air kerma was between 1-2 Gy and for 7% exceeded 2 Gy. Median DAP values for fluoroscopy were 87.6 (TAAs) and 142.2 (AAAs) (Gy cm2) and for exposure 364.7 and 238.7 (Gy cm2), respectively. A 10-min prolongation of treatment causes about 83 Gy cm increase of DAP for fluoroscopy and 390 Gy cm for each 1 s of exposure. A good correlation between DAP and examination times was found for both exposure (r = 0.78) and fluoroscopy (r = 0.7). Moreover, sex was found to be a differential factor for DAP: DAP values for females were about 25% lower for both clinical procedures. For this kind of treatment the radiation doses were obtained for patients. Total air kerma in this kind of treatment for TAAs might be high and can even reach 4 Gy.

Acute and late toxicity in radical radiotherapy for bladder cancer.

AIMS: To evaluate the incidence, severity and kinetics of acute and late toxicity from bladder and bowels in patients with bladder cancer treated with radical radiotherapy. MATERIALS AND METHODS: The retrospective analysis was based on 487 patients with T2, T3 bladder cancer, treated with radiotherapy between 1975 and 1995. The pelvis was irradiated electively in 303 patients; in the remaining patients, the bladder alone was treated. The mean total radiation dose to the bladder was 65.5 Gy. Various schedules of protracted, conventional and accelerated radiotherapy were used. The influence of selected factors on maximum acute toxicity and late toxicity was assessed. The kinetics of acute toxicity was also evaluated. The median follow-up was 76 months. RESULTS: Seven patients did not complete treatment due to excessive acute toxicity. The incidence of grade >or=3 acute bladder and bowel toxicity was 5 and 3%, respectively. The actuarial, 5-year incidence of grade >or=3 late bladder and bowel toxicity was 12 and 3%, respectively. The most important factors influencing acute toxicity were: T-stage (P=0.004) for the bladder and pelvic irradiation (P=0.044) and dose intensity (P=0.000) for the bowels. The latency of both early bladder and bowel toxicity was correlated with dose intensity. The most important factor influencing late bladder toxicity was acute toxicity score (P=0.000). Late bowel toxicity was also influenced by acute bowel toxicity (P=0.04). CONCLUSIONS: The severity of acute bowel toxicity is related to pelvic irradiation and dose intensity. The severity of acute bladder toxicity depends on T-stage. The increase in dose intensity is associated with shorter latency to maximum acute bladder and bowel toxicity. The severity of acute bladder and bowel toxicity influences the risk of late effects from those organs.

The importance of ceruloplasmin oxidase activity in patients with chronic lower limb atherosclerotic ischemia.

AIM: Inflammatory reactions accompanying ischemia increase the cytokine synthesis what leads to the increase in serum ceruloplasmin (Cp) concentration and activity. The aim of the study was to evaluate the association between serum Cp oxidase concentration and activity and the grade of lower extremity ischemia. Moreover, the correlation of Cp concentration and activity with the levels of interleukin 6 (IL-6), C-reacting protein (CRP), and a-1-acid glycoprotein (AGP) in serum was studied. METHODS: Two groups of patients were examined: 15 patients with moderate (MI) and 32 patients with critical ischemia (CI) of the lower extremities. Cp oxidase activity was measured spectrophotometrically, after incubation with o-dianisidine. The concentration of IL-6 was measured with the ELISA method, and Cp, CRP and AGP concentration by rocket immunoelectrophoresis. RESULTS: Significant increase in Cp oxidase concentration and activity was observed in patients with critical limb ischemia (median: 164.8 U/L), especially in patients with necrotic changes (median: 216.6 U/L). Cp oxidase activity was dependent on its concentration in patients with critical limb ischemia with necrotic changes (r=0.56; P<0.01). In patients with critical limb ischemia, the increase in Cp concentration and activity correlated significantly with CRP concentration (r=0.46; P=0.0007) (r=0.62; P=0.0001), respectively. CONCLUSION: Concentration and the oxidase activity of Cp depend of the degree of lower extremity ischemia and correlates with the major markers of inflammation, such as CRP. Critical limb ischemia induces the inflammatory reaction triggering the increase in IL-6 and of acute phase protein production. These processes lead to the increase in Cp oxidase activity dependent of Cp and CRP concentration.

Laparoscopic removal of renal cysts in patients with ADPKD as an alternative method of treatment and patient preparation for kidney transplantation: preliminary results.

BACKGROUND: The most frequent genetic disease of the kidneys occurring in 1 of 1000 inhabitants is autosomal-dominant polycystic kidney disease (ADPKD). Growing renal cysts compress the kidney resulting in damage to parenchyma and functional disorders. Around 10% of these patients are dialyzed due to terminal renal insufficiency. With the advent of laparoscopic techniques, the idea of laparoscopic excision of cysts seemed a tempting alternative to nephrectomy. We assessed the preliminary results of laparoscopic treatment of polycystic kidneys compared with open nephrectomy for patients with ADPKD. MATERIALS AND METHODS: Thirty ADPKD patients were treated between 2000 and 2004. Eleven procedures in five men and six women of mean age 51 years included laparoscopic cyst excisions. In the remaining 19 patients (six men and 13 women) of mean age 54 years, nephrectomy was done. Indications for surgery included pain due to compression by large cysts and cyst contamination. Patients after nephrectomy were prepared for renal transplantation when necessary. RESULTS: Laparoscopic polycyst removal produced better effects than nephrectomy. Mean operative time was significantly shorter (86 minutes for cyst removal vs 108 minutes for nephrectomy; P < .05). Postoperative pain measured with the VAS scale was reduced in patients after laparoscopy. Hospital stay was shorter (5 vs 9 days), as well as time to recovery. Other benefits of laparoscopic cyst removal included maintained urination in the patient and no need for erythropoietin substitution, as well as reduced risk of cyst contamination. When eligible for renal transplantation, patients after laparoscopic polycyst removal have smaller kidneys that do not interfere with the graft and the risk of infection during immunosuppression seems lower. CONCLUSION: Although larger series of patients are required in patients with ADPKD, laparoscopic polycyst removal seemed superior to early nephrectomy.

Serum magnesium, copper and zinc concentration changes in lower limb ischemia and postoperative treatment.

A prolonged state of ischemia of the lower limbs may affect the balance of some metal ion concentrations in blood. Ischemia of a critical degree, surgery and complicated postoperative periods invoke an inflammatory response, increased production of interleukin-6 (IL-6) and acute phase proteins (APhP) as a response to tissue destruction. The aim of the present study was to investigate the modification of Mg, Cu and Zn concentrations in the serum of patients with atherosclerosis obliterans (AO) before surgery and during the postoperative treatment, and the effect of chronic ischemia of the lower limbs on the relationship between the elements. The group studied consisted of 54 men with chronic ischemia of the lower limbs due to AO. The mean value of serum Mg concentration in men with AO was found to be significantly lower, and that of Cu to be higher, in comparison with the control group. In critical ischemia, the mean serum Cu concentration and the ratio Cu/Zn were found higher than in moderate ischemia. The postoperative treatment results in changes in Cu and Zn concentrations in the AO group that are inversely related to the levels before surgery.

Long-term outcome, adhesions, and quality of life after laparoscopic and open surgical therapies for acute abdomen: follow-up of a prospective trial.

BACKGROUND: The objective of this study was to determine the long-term outcome of laparoscopic and open therapies for acute abdomen, and to assess the patients postoperative quality of life, with special attention to adhesions. METHODS: A follow-up study was conducted from June through December 2001 of a case-control trial of laparoscopic and open surgical treatment in patients with acute abdomen. Mean (median) duration of follow-up was 35.9 months (32.5) for the laparoscopic group (L) and 40.7 months (38.5) for the open group (O). A total of 284 (92%) of the original 310 study patients (108 L and 202 O) were contacted. Twenty-eight (9%) were confirmed to be dead. From the remaining 256 patients (131 men and 125 women, mean age [+/- SD] 38.9 +/- 19.9 years), we enrolled 153(67 L and 91 O) in the follow-up. The main outcome measures were frequency of relapse requiring treatment, frequency of reoperations, incidence of adhesion ileus and incisional hernia, distant morbidity and mortality, satisfaction with therapy, and Gastrointestinal Quality of Life Index (GQLI) scores. RESULTS: The morbidity and mortality rates, readmission rates, incisional hernia rates, and scores for long-term quality of life were the same in both groups. The reoperation rate was significantly higher among L patients, but there were significantly fewer episodes of adhesion ileus in this group. Patient satisfaction was 85% in the L group and 73% in the O group (p = NS). CONCLUSIONS: The laparoscopic treatment of patients with acute abdomen offers an outcome comparable to that achieved with the open approach. There were fewer episodes of adhesion ileus in laparoscopic patients. Consequently, the operative treatment of acute abdomen patients by laparoscopy can be recommended.

Posttraumatic craniofacial reconstruction using combined resorbable and nonresorbable fixation systems.

The facial skeleton consists of high-stress-bearing buttresses and low-stress-bearing curved surfaces. The buttresses are like trusses made of beams, struts, and columns. They resist tensile, compressive, and shear loading. The thin, curved, planar surfaces provide for the support and partitioning of the soft tissue. The trusses are strong and one-dimensional whereas the planes are weak and two-dimensional. Ideally, strong one-dimensional fixation systems should be used for the former; weaker, two-dimensional systems should be used for the latter. The authors report their clinical experience of using such combined approaches to the treatment of facial fractures using rigid, titanium mini-plates and screws for the buttresses and polymeric resorbable meshes for the curved planes. For an 11-month period (August 2000 to June 2001), nine patients (7 males and 2 females) with a mean age of 33.7 years were treated in this fashion. The resorbable meshes were deployed for the reconstitution of the orbital walls and the anterior wall of the maxillary sinus. No enophthalmos, globe dystopia, or diplopia occurred during the short mean follow-up of 10 months (4-17 months). There were no infections or sterile abscess formations. This type of combined use of fixation systems appears to be safe and effective. More patients and more extensive follow-ups are obviously needed.

Free tissue transfer in pregnancy: guidelines for perioperative management.

A successful free tissue transfer of serratus anterior muscle, to provide coverage for an open ankle defect in a pregnant patient, is described. Microvascular surgery in the presence of a viable pregnancy demands considerations unique to this situation. Although rarely possible, an attempt should be made to plan surgery to coincide with the second trimester, to lessen the risk of anesthesia to the fetus. Maternal positioning, fluid balance, and aspiration precautions need to be critically addressed. Close perioperative monitoring by an obstetrician is essential. The condition of pregnancy results in a hypercoagulable state that may lead to an increased risk of anastomotic failure. The use of anticoagulants results in increased risk of bleeding, not only for the patient but also for the fetus, as well as risk of teratogenic effects. Closely monitored heparin is considered safe in pregnancy as is low-molecular-weight dextran and low-dose aspirin. Additional considerations include the use of narcotics and sedatives for comfort postoperatively, as well as antibiotic choices, if indicated.

Diagnostic laparoscopy for the acute abdomen and trauma.

BACKGROUND: We set out to investigate the potential benefits of routine diagnostic laparoscopy (DL) in cases of acute abdomen. METHODS: A prospective study of 120 DL in acute abdominal cases was performed in comparison with 310 similar acute abdominal cases treated without DL. The diagnostic accuracy, hospital stay, therapeutic delay, and convalescence time were then evaluated. RESULTS: DL established the indications for intervention in 96% of cases, yielded a diagnosis in 90%, and changed the treatment in 14%. The sensitivity achieved was 99.3%, specificity was 83.3%, and accuracy was 88.6%. There were two false positives, one false negative, and three results insufficient to make a diagnosis. Morbidity was one (0.8%), and mortality was one (0.8%). Seventy-nine patients (66%) were managed by laparoscopy and 24 by open interventions. The hospital stay in DL groups was shorter (median, 5 days vs 6 days in controls, p<0.0003), as was the effective treatment time (median, 5 days vs 6 days, p<0.0012). The convalescence time was also shorter in DL groups (median, 14 days vs 14 days, p<0.04). Therapeutic delay occurred in 16% of the control group cases, doubling the morbidity rate, increasing mortality by 50%, and prolonging hospital stay (median, 9 days vs 6 days, p>0.3 (NS). CONCLUSIONS: DL in the acute abdomen is a safe and accurate procedure that enables laparoscopic interventions and helps avoid nontherapeutic surgery. DL and appropriate treatment reduces hospital stay, therapeutic delay, and convalescence time.