ESTES guidelines: acute mesenteric ischaemia.

PURPOSE: Acute mesenteric ischaemia (AMI) accounts for about 1:1000 acute hospital admissions. Untreated, AMI will cause mesenteric infarction, intestinal necrosis, an overwhelming inflammatory response and death. Early intervention can halt and reverse this process leading to a full recovery, but the diagnosis of AMI is difficult and failure to recognize AMI before intestinal necrosis has developed is responsible for the high mortality of the disease. Early diagnosis and prompt treatment are the goals of modern therapy, but there are no randomized controlled trials to guide treatment and the published literature contains a high ratio of reviews to original data. Much of that data comes from case reports and often small, retrospective series with no clearly defined treatment criteria. METHODS: A study group of the European Society for Trauma and Emergency Surgery (ESTES) was formed in 2013 with the aim of developing guidelines for the management of AMI. A comprehensive literature search was performed using the Medical Subject Heading (MeSH) thesaurus keywords "mesenteric ischaemia", "bowel ischaemia" and "bowel infarction". The bibliographies of relevant articles were screened for additional publications. After an initial systematic review of the literature by the whole group, a steering group formulated questions using a modified Delphi process. The evidence was then reviewed to answer these questions, and recommendations formulated and agreed by the whole group. RESULTS: The resultant recommendations are presented in this paper. CONCLUSIONS: The aim of these guidelines is to provide recommendations for practice that will lead to improved outcomes for patients.

Combination of serum carcino-embryonic antigen and C-reactive protein--a useful test in preoperative staging of colorectal cancer.

The value of the simultaneous estimation of serum carcino-embryonic antigen (CEA) and C-reactive protein (CRP) concentrations in staging patients with colorectal neoplasias was evaluated. The study included 95 patients with benign or malignant epithelial tumors of colon and rectum. The simultaneous negative values of CEA and CRP were able to exclude stage D tumors with a specificity of 92.6% (P less than 0.001). Simultaneously positive values of CEA and CRP were able to diagnose stage C or D tumors with a specificity of 92.1% (P less than 0.001). It is concluded that the combination of CEA and CRP tests can substantially contribute to the preoperative staging and assessment of the extent of colorectal cancer.