Outcome of large-bowel perforation in patients with colorectal cancer.

PURPOSE: Perforation of the colon is seldom associated with malignant disease. Operative mortality varies widely in published studies and little is known about patterns of failure and long-term outcome. An observational study was undertaken to assess the outcome of colorectal cancer complicated by perforation. METHOD: We reviewed a series of 83 consecutive patients treated during a 14-year period at one institution. RESULTS: Fifty-four (65 percent) patients had perforation of the tumor itself, and 29 (35 percent) had diastatic perforation proximal to an obstructing tumor. Twenty-six (31.5 percent) patients had metastatic disease at laparotomy. Primary resection of the diseased segment was performed in 47 (87 percent) patients with perforation of the tumor itself and in 21 (72.4 percent) patients with diastatic perforation proximal to an obstructing tumor. However, only 57 patients (39 (72.2 percent) with perforation of the tumor itself; 18 (62 percent) with diastatic perforation proximal to an obstructing tumor; P = not significant) were potentially cured. Operative mortality was 16.7 and 48.3 percent, respectively (P < 0.01) and correlated significantly with Hinchey's stage (P < 0.001) and advanced disease (P = 0.023). At a mean follow-up of 43 (median 31) months, 21 (46 percent) of the 46 potentially cured survivors were alive. The local recurrence rate was 22.9 percent in patients with perforation of the tumor itself and 18.2 percent in patients with diastatic perforation proximal to an obstructing tumor (P = not significant). Peritoneal seeding occurred in 17 and 0 percent (P = not significant); the mean disease-free interval was 33.9 and 49.9 months (P = not significant); and five-year cumulative disease-related survival probability was 0.51 and 0.90 (P = 0.049), respectively. CONCLUSIONS: Diastatic perforation proximal to an obstructing tumor is associated with higher operative mortality and better cancer-related survival than a tumor perforating through the bowel wall. Early diagnosis in diastatic perforation and aggressive management of sepsis associated with radical surgical resection is recommended.

[Epidemiology of severe thoracic trauma at a multiregional urban hospital. Analysis of 5 years]. / Epidemiologia del trauma toracico grave in un Ospedale urbano multizonale. Analisi di 5 anni.

The authors re-examined 198 cases of severe chest trauma presented in their hospital in 1983-1987. They analyse the clinical conditions, the diagnostic and therapeutic procedures, the results and complications and evaluate each patient according to the ISS code to compare them with the literature data, for the dead patients they classify the lesions according to the autoptic examinations. They confirm in this the validity of the ISS that can be well correlated with: mortality, length of survival and length of hospitalisation, they indicate important prognostic factors such as: age, association with extra thoracic lesions and number of intrathoracic lesions. Plotting the mortality in function of the time, they stress the need for an expert team in the first hours after trauma to manage such patients.

[Surgical therapy of perforated duodenal ulcers: suture versus highly selective vagotomy. Immediate and remote results (case series from 1978 to 1990)]. / Terapia chirurgica delle ulcere duodenali perforate: rafia versus vagotomia superselettiva. Risultati immediati e a distanza (casistica dal 1978 al 1990).

The aim of this study was to compare the results of high selective vagotomy and simple suture in the treatment of perforated duodenal ulcer. Among 150 patients admitted in our institute from 1978 to 1990, 96 were treated with simple suture while 54 underwent high-selective vagotomy (42 with pyloroplasty). In our study with high-selective vagotomy we had no surgical mortality and low morbidity. The overall clinical results according to the Visick evaluation, were recorded as excellent or good, in 90.9% cases in the group of patients treated with high-selective vagotomy versus 40% in the group with simple suture, after a similar period of follow-up. The recurrence of ulcers after high-selective vagotomy was of 6%, compared with 32.6% in simple suture patients. The results of high-selective vagotomy performed for perforated duodenal ulcers were compared with those of a group of duodenal ulcers not complicated treated with high-selective vagotomy too; the better results of this last group may be due to higher technical difficulties in presence of peritonitis. High selective vagotomy is therefore a safe procedure in the management of perforated duodenal ulcer, and moreover obtains good long-term results in the control of peptic disease.