The European experience with vascular injuries.

The rich and diverse heritage of the management of vascular injuries in the 45 independent European countries prevents the authors from revealing a uniform picture of the European experience, but some trends are clearly emerging. In countries with a low incidence of penetrating trauma and increasing use of interventional vascular procedures, the proportion of iatrogenic vascular trauma exceeds 40% of all vascular injuries, whereas on other parts of the continent, armed conflicts are still a major cause of vascular trauma. National vascular registries, mostly in the Scandinavian countries, produce useful, nationwide data about vascular trauma and its management but suffer still from inadequate data collection. Despite a relatively low incidence of vascular trauma in most European countries, the results are satisfactory, probably in most cases because of active and early management by surgeons on call, whether with vascular training or not, treating all kinds of vascular surgical emergencies. In some countries, attempts at developing a trauma and emergency surgical specialty, including expertise in the management of vascular injuries, are on their way.

Latent adenocarcinoma of the colon discovered during or after laparoscopic cholecystectomy.

BACKGROUND: The wide acceptance of laparoscopic cholecystectomy has resulted in the performance of increased numbers of cholecystectomies, hence increasing the number of patients discovered with concomitant malignancy or other pathological states. PATIENTS AND METHODS: A total of 3751 patients who underwent laparoscopic cholecystectomy between January 1995 and December 2000 were included in this study. Nine cases of coexisting malignant colonic neoplasm were discovered. All of these patients but one underwent therapeutic resection. RESULTS: The survival rate of these nine patients was the same as that of 62 consecutive colonic cancer patients who were treated in our department over the same period. The rate of postoperative complications in the study group was higher than in the control group (21 % vs. 9.5 %). The hospital stay in these patients was also greater (17 days vs. 10 days). CONCLUSION: The rate of incidental discovery of colorectal carcinomas during laparoscopic cholecystectomy in our department was 0.24 %. These patients had higher complication rates and a longer hospital stay.