Current changes in the management and outcome of patients with curable colorectal cancer.

Background: Major changes in the evaluation and treatment of curable colorectal cancer (CRC) have emerged in the last two decades. These changes have led to better patient outcome overtime.

Objectives: To evaluate the impact of these changes as reflected in the difference in long-term outcome of a consecutive group of recently laparoscopically operated curable CRC patients and a consecutive group of patients operated 20 years earlier in the same department.

[Anal mucinous adenocarcinoma arising in long standing fistula-in-ano].

Perianal mucinous adenocarcinoma is an unusual but well described malignancy constituting approximately 3 to 11% of all anal carcinoma. The pathology is thought to develop from one of three types, the distal part of the rectum, the mucin-secreting columnar epithelium of the anal glands, and from chronic fistula-in-ano. The association of carcinoma with anal fistula may manifest itself in several ways: a fistula may be associated with cancer elsewhere in the colon; cancer may present as a fistula; or cancer may develop in anal fistula.

[Gossypiboma?].

Although not a rare finding in medicine and particularly in surgery, only few know what "gossypiboma" actually means. The author briefly describes a patient found to have a neglicted, missed, surgical gauze in his abdominal cavity and explains the origin of the terms.

Bauhin's ileocecal valve syndrome-a rare cause for small-bowel obstruction: report of a case.

Benign ileocecal valve hypertrophy is a rare cause for intestinal obstruction. We describe a 51-year-old female with clinical and imaging presentation of chronic small-bowel obstruction. The patient was operated on, and a limited thickening of the ileocecal bowel wall causing intestinal obstruction was found.

First 100 cases with Doppler-guided hemorrhoidal artery ligation.

Purpose: This study was designed to examine the benefits of a Doppler-guided hemorrhoidal artery ligation technique in terms of surgical outcome, functional recovery, and postoperative pain.

Methods: Using local, regional, or general anesthesia, 100 patients with symptomatic Grades II or III hemorrhoids underwent sonographic identification and suture ligation of six to eight terminal branches of the superior rectal artery above the dentate line. Visual Analog Scales were used for postoperative pain scoring.

[Unfinished surgery].

Appendicitis after appendectomy is rare and most often is due to incomplete appendectomy-stump appendicitis. Prophylactic appendectomy is rarely conducted as opposed to incidental appendectomy. The author focuses on the possibility of such an event by using an anecdotal case report and imagination.

Laparoscopic surgery may be associated with severe pain and high analgesia requirements in the immediate postoperative period.

Objective: To assess the immediate (0-4 hours) postoperative pain level in patients after laparoscopy and laparotomy whose analgesic requirement in the Post-Anesthesia Care Unit (PACU) exceeds standard morphine therapy.

Background Data: Clinical observation has raised the suspicion that laparoscopic surgery may be associated with more intense immediate postoperative pain than expected.

Methods: This prospective study assessed the 24-hour pain intensity and analgesia requirements in patients who underwent similar abdominal surgery via laparoscopy or laparotomy under standardized general anesthesia and whose pain in the PACU was resistant to 120 microg/kg intravenous morphine.

[Review articles--to write, to read or to throw away?].

The author comments on the value of review articles, narrative and systematic, to both the reader and to the writer. Based on personal experience he advocates the publication of reviews in the local medical journal for greater impact. Review articles should not be underrated by academic institutions as they often serve as the major source of continued education to the general practitioner and to the non-academic-affiliated specialist.

Treatment of pilonidal sinus disease using fibrin glue as a sealant.

Background: Complete excision is the preferred treatment for pilonidal sinus disease. We describe a new technique of excision and tension-free primary closure of pilonidal sinus disease, combined with application of fibrin glue in order to obliterate the dead space and to promote wound healing.

Methods: A curved incision of the carried out, 2-3 cm lateral to the opening of the sinus, done under general or spinal anesthesia, and a thick flap was created by undercutting the medial edge and advancing it across the midline.

[Proctalgia Fugax--what's new over the last 100 years?].

Proctalgia Fugax is a benign, self-limiting disease characterized by episodes of intense pain in the anorectal area occurring at infrequent intervals. It is common, but most suffers do not seek medical advice. Although its classical symptomatology was describe more than a century ago, the etiology is unclear.

[Stapled hemorrhoidectomy--early experience in 30 patients].

Introduction: We report the early results of 30 patients treated by stapled hemorrhoidectomy.

Patients And Methods: Thirty patients with symptomatic grade 2-4 hemorrhoids were treated by stapled hemorrhoidectomy. The procedure was performed with a 33 mm diameter automatic hemorrhoidal circular stapler.

Free perforation in Crohn's disease.

Background: Free bowel perforation is one of the indications for emergency surgery in Crohn's disease. It is generally accepted that 1-3% of patients with Crohn's disease will present with a free perforation initially or eventually in their disease course.

Objectives: To evaluate the incidence and treatment results of free perforation in patients with Crohn's disease and, based on our experience, to suggest recommendations.

[Repair of anorectal fistulas using fibrin glue tissue adhesive--preliminary experience in 15 patients].

Purpose: The goal of this study was to evaluate whether commercially produced fibrin sealant can be used for the treatment of complex anorectal fistulae.

Methods: Fibrin glue was used for patients with primary and recurrent ano-rectal fistulae, but patients with Crohn's disease or AIDS were excluded. The procedure was performed under anesthesia in the operating room.

Isolated rib fractures in elderly patients: mortality and morbidity.

Objectives: To describe the management, morbidity and mortality seen with isolated rib fractures in elderly patients and assess the need for hospitalization.

Design: A case series.

Setting: A tertiary care centre in Tel Aviv.

The new technology of combined transmission and emission tomography in evaluation of endocrine neoplasms.

Unlabelled: The clinical value of a novel technology of combined transmission and emission tomography (TET) was assessed in patients with endocrine tumors.

Methods: TET technology, which combines simultaneous acquisition of SPECT and CT images, using the same imaging device, allows correct fusion of images of both modalities. TET was performed on 27 patients with known or suspected endocrine tumors.

Survival of colorectal carcinoma in the elderly. A prospective study of colorectal carcinoma and a five-year follow-up.

Purpose: Colorectal carcinoma in elderly patients has become a more common problem in the last decade. There are some physicians who tend to offer a less definitive treatment for these patients because of their chronologic age. The purpose of this study was to evaluate the long-term survival of elderly patients (> 70) who underwent surgery for colorectal carcinoma in comparison with a younger group of patients with the same disease.