Preoperative evaluation of stage I and stage II non-small cell lung cancer.

The appropriate preoperative evaluation for occult metastasis in patients with potentially resectable lung cancer remains controversial. The records of 265 patients with stage I and II non-small cell lung cancers who underwent resection with curative intent were reviewed to determine if there was a survival benefit of negative preoperative scanning to detect metastases. A minimum of 5 years of follow-up was possible for all long-term survivors. Patients having preoperative bone scans, brain imaging, and abdominal imaging had no increased survival over those without such evaluation (using Kaplan-Meier survival curves). Additionally, no difference was found in the time to first recurrence between these groups, and the site of recurrence was independent of a negative preoperative scan for that location. These data, using patient outcome as the basis of our conclusion, support a policy of reserving expensive preoperative metastatic evaluations only for those patients with clinical evidence of metastatic disease.

Altruism and task participation in the elderly.

The purpose of this study was to investigate altruism as a factor in task participation among the elderly. The question was whether elderly persons are more likely to participate in an activity designed to help or benefit others than in an activity with no such altruistic purpose. Four groups of persons living in a home for the aged (N = 130) were invited to participate in a cookie-decorating activity. The invitations for two of the groups stated that the cookies would be a gift for a local preschool, and the invitations for the other two groups did not. Significantly more individuals (n = 25) chose to participate when the product of the activity was to be a gift for preschool children than when no altruism was involved (n = 14). Implications for occupational therapy practice and research are discussed.

Effects of donor position on harvested lung quality.

Potential lung donors are frequently maintained in one position for prolonged periods of time prior to harvest. This study was designed to determine if the effects of gravity induced by maintaining an animal model in the supine position for 24 hr would have adverse effects on the harvested lung. Group 1 pigs were anesthetized, instrumented, mechanically ventilated, and the lungs harvested within 90 min. Group 2 pigs were anesthetized, instrumented, and mechanically ventilated in an identical manner then maintained in the same dorsal-spinal recumbency position for 24 hrs. Hemodynamic and respiratory parameters were stable and not statistically different between the two groups for the baseline and 1 hr time period measurements. There were no significant differences between the two groups for shunt fractions, wet/dry ratios, blood flow distribution, or flush solution distribution. We conclude that in anesthetized pigs there is no evidence that routine repositioning protocols improve blood flow distribution, shunting, or dependent edema.

Defining the role of laparoscopic-assisted sigmoid colectomy for diverticulitis.

PURPOSE: The purpose of this study was to evaluate the safety and efficacy of laparoscopic-assisted sigmoid colectomy for the treatment of diverticulitis. METHODS: The Norfolk Surgical Group Laparoscopic Surgery Registry identified all patients undergoing laparoscopic colon and rectal surgery. Retrospective chart review was performed for all patients undergoing elective sigmoid resection for a final diagnosis of diverticulitis and minimum follow-up of 12 months. Demographic data, indications for surgery, operative data, conversion rate, reason for conversion, complications, postoperative course (days to flatus and regular diet), and length of stay were identified. A telephone survey determined the incidence of recurrent diverticulitis. Statistical analysis was performed to evaluate the frequency of conversion over time, to determine risk factors for conversion, and to compare the laparoscopic-assisted and conversion groups with regard to postoperative days to flatus, regular diet, and discharge. RESULTS: From June 1992 to September 1997, elective laparoscopic-assisted sigmoid colectomy was attempted in 69 patients. Uncomplicated recurrent diverticulitis was the most common indication for surgery, occurring in 51 of 69 patients (75 percent). No deaths occurred. Complications were identified in seven patients (10.1 percent) including one wound infection and one incarcerated port-site hernia with small bowel obstruction. There were no anastomotic leaks or major septic complications. Conversion to laparotomy occurred in 18 of 69 patients (26 percent). Uncomplicated, recurrent diverticulitis was associated with conversion in 7 of 51 patients (14 percent), whereas complicated diverticulitis required conversion in 11 of 18 patients (61 percent). Logistic regression identified fistula and abscess as predictors of conversion (P = 0.0009). Comparison of the laparoscopic-assisted sigmoid colectomy group with the conversion group revealed that postoperative days to regular diet were 3.5 and 5.2 (P = 0.0004), respectively, and lengths of stay were 4.2 and 6.4 days (P < 0.0001), respectively. No difference was noted with regard to operative time or postoperative complications. Median follow-up was 48 (range, 13-76) months, and a single recurrence of diverticulitis has been identified. CONCLUSIONS: Laparoscopic-assisted sigmoid colectomy for diverticulitis can be safely performed. Conversion appears to be associated with complicated diverticulitis (fistula or abscess), which may be better approached by laparotomy. Short-term follow-up indicates that recurrence is rare and suggests that laparoscopic-assisted sigmoid colectomy achieves adequate resection. Laparoscopic-assisted sigmoid colectomy offers benefits of decreased ileus and length of stay and may represent the procedure of choice for elective resection for uncomplicated sigmoid diverticulitis.