Postoperative pneumoperitoneum after colorectal surgery: Expectant vs surgical management.

Postoperative pneumoperitoneum poses a clinical dilemma. Depending on the cause, its management includes a spectrum from simple observation and supportive care to surgical exploration. The aim of this paper is to present four clinical cases and propose an algorithm for the management of postoperative pneumoperitoneum based on available literature.

Is it time to lower the recommended screening age for colorectal cancer?

Background: Overall, colorectal cancer (CRC) incidence in the US has decreased over the last 30 years, yet it has increased in patients younger than 50. Cancers in this population are more aggressive and advanced at diagnosis. Our goal was to determine if screening should begin at a younger age.

The use of silver nylon in preventing surgical site infections following colon and rectal surgery.

Background: Patients who undergo colorectal surgery have up to a 30% chance of developing a surgical site infection postoperatively. Silverlon is a silver nylon dressing designed to prevent surgical site infections, but only anecdotal evidence has previously supported its efficacy.

Objective: The aim of this study was to evaluate the effect of silver nylon dressings in patients undergoing colorectal surgery.

Laparoscopic-assisted transvaginal approach for sigmoidectomy and rectocolpopexy.

Background And Objectives: Laparoscopic-assisted colonic resection has been well described for multiple surgical indications. This typically requires an abdominal incision for specimen removal that is associated with the majority of postoperative pain. We describe the first laparoscopic-assisted transvaginal approach for sigmoidectomy and rectocolpopexy for the treatment of rectal prolapse.

Slow transit constipation: a review of a colonic functional disorder.

Constipation is a common gastrointestinal complaint that can cause significant physical and psychosocial problems. It has been categorized as slow transit constipation, normal transit constipation, and obstructed defecation. Both the definition and pathophysiology of constipation are unclear, but attempts to describe each of the three types have been made.

Sclerosing epithelioid fibrosarcoma of the cecum: a radiation-associated tumor in a previously unreported site.

Data from the nuclear reactor explosion in Chernobyl and the atomic bomb detonations in Hiroshima and Nagasaki demonstrated an association between ionizing radiation and tumoriogenesis. There is a significant association between external beam radiation and radiation-induced sarcoma. Sclerosing epithelioid fibrosarcoma is a rare form of malignant fibrosarcoma that is low grade and indolent with distinct immunohistopathologic characteristics that usually occurs in the soft tissues of the extremities.

Venous identity is lost but arterial identity is not gained during vein graft adaptation.

Objectives: Ephrin ligands and Eph receptors are signaling molecules that are differentially expressed on arteries and veins during development. We examined whether Eph-B4, a venous marker, and Ephrin-B2, an arterial marker, are regulated during vein graft adaptation in humans and aged rats.

Methods And Results: Eph-B4 transcripts and immunodetectable protein are downregulated in endothelial and smooth muscle cells of patent vein grafts in both humans and in aged rats, whereas Ephrin-B2 transcripts and protein are not strongly induced.

Assessing risk factors for adverse outcomes in emergent colorectal surgery.

Background: A variety of factors influence the increased morbidity and mortality seen in patients undergoing emergent colon surgery. Understanding comorbid conditions and variations in preoperative laboratory values that effect both morbidity and mortality can influence clinical decision making.

Methods: During a 5-year period 185 patients underwent colon surgery at the Veterans Administration Hospital in West Haven, CT.

Sustained orbital shear stress stimulates smooth muscle cell proliferation via the extracellular signal-regulated protein kinase 1/2 pathway.

Objective: Nonlaminar shear stress stimulates smooth muscle cell (SMC) proliferation and migration in vivo, especially after an endothelial-denuding injury. To determine whether sustained shear stress directly stimulates SMC proliferation in vitro, the effect of orbital shear stress on SMC proliferation, phenotype, and extracellular signal-regulated protein kinase 1/2 (ERK1/2) phosphorylation was examined.

Methods: Bovine SMCs were exposed to orbital shear stress (210 rpm) for up to 10 days, with and without the ERK1/2 upstream pathway inhibitor PD98059 (10 microM) or the p38 pathway inhibitor SB203580 (10 microM).

Safety of carotid endarterectomy in 2,443 elderly patients: lessons from nonagenarians--are we pushing the limit?

Background: Elderly patients are a rapidly expanding segment of the population. Recent studies suggest that octogenarians have mortality and morbidity after carotid endarterectomy (CEA) similar to that in their younger cohort. Outcomes of CEA performed in nonagenarians have not been commonly reported; this study seeks to determine the safety of CEA in nonagenarians in general practice.

Improved outcomes of carotid endarterectomy: the critical role of vascular surgeons.

Improved outcomes after carotid endarterectomy (CEA) have been related to preoperative, intraoperative, and postoperative patient and procedural variables. Outcomes after CEA have also been related to other factors that are not clearly related to the patient or the procedure, such as performance of the procedure in high volume hospitals, by high volume surgeons, and by surgeons specializing in vascular surgery. These overlapping surrogate markers of "quality" have been widely quoted and may be used by external parties to limit access to vascular care; however, these markers have unclear significance when examined systematically.