Is surgical quality more important than radicality? Long-term outcomes of stage I-III colon cancer (SAKK 40/00).

Background: To prospectively determine the influence of variations of surgical radicality and surgical quality on long-term outcome in patients with stage I-III colon cancer.

Methods: From a prospective multicenter cohort study including 1040 patients undergoing surgery for colorectal cancer from 09/2001 to 06/2005 in nine Swiss and one German hospital, 423 patients with stage I-III colon cancer were selected and analyzed. Surgeons and pathologists filled in standardized forms prospectively assessing items of oncosurgical radicality and quality.

Intraoperative esophageal washout reduces free intraluminal tumor cells during resection of carcinomas of the esophagus and cardia.

Objective: Intraluminally shed viable tumor cells might contribute to anastomotic recurrence in cancer of the esophagus and the cardia. The study aimed to establish a method of esophageal washout and, hence, to reduce intraluminal cancer cells before esophageal anastomosis.

Methods: Forty-eight consecutive patients with esophago-gastric resection for histologically proven cancer of the esophagus or the cardia were included in a prospective, interventional study.

Performance of the American Heart Association/American College of Cardiology/Heart Rhythm Society versus European Society of Cardiology guideline criteria for hospital admission of patients with syncope.

Background: Current American College of Cardiology/American Heart Association/Heart Rhythm Society (ACC/AHA/HRS) and European Society of Cardiology (ESC) guidelines recommend different strategies to avoid low-yield admissions in patients with syncope.

Objective: The purpose of this study was to directly compare the safety and efficacy of applying admission criteria of both guidelines to patients presenting with syncope to the emergency department in 2 multicenter studies.

Methods: The international BASEL IX (BAsel Syncope EvaLuation) study (median age 71 years) and the U.

Early standardized clinical judgement for syncope diagnosis in the emergency department.

Background: The diagnosis of cardiac syncope remains a challenge in the emergency department (ED).

Objective: Assessing the diagnostic accuracy of the early standardized clinical judgement (ESCJ) including a standardized syncope-specific case report form (CRF) in comparison with a recommended multivariable diagnostic score.

Methods: In a prospective international observational multicentre study, diagnostic accuracy for cardiac syncope of ESCJ by the ED physician amongst patients ≥ 40 years presenting with syncope to the ED was directly compared with that of the Evaluation of Guidelines in Syncope Study (EGSYS) diagnostic score.

B-Type Natriuretic Peptides and Cardiac Troponins for Diagnosis and Risk-Stratification of Syncope.

Background: The utility of BNP (B-type natriuretic peptide), NT-proBNP (N-terminal proBNP), and hs-cTn (high-sensitivity cardiac troponin) concentrations for diagnosis and risk-stratification of syncope is incompletely understood.

Methods: We evaluated the diagnostic and prognostic accuracy of BNP, NT-proBNP, hs-cTnT, and hs-cTnI concentrations, alone and against those of clinical assessments, in patients >45-years old presenting with syncope to the emergency department in a prospective diagnostic multicenter study. BNP, NT-proBNP, hs-cTnT and hs-cTnI concentrations were measured in a blinded fashion.

Prospective validation of prognostic and diagnostic syncope scores in the emergency department.

Background: Various scores have been derived for the assessment of syncope patients in the emergency department (ED) but stay inconsistently validated. We aim to compare their performance to the one of a common, easy-to-use CHADS score.

Methods: We prospectively enrolled patients ≥ 40 years old presenting with syncope to the ED in a multicenter study.

Circadian, weekly, seasonal, and temperature-dependent patterns of syncope aetiology in patients at increased risk of cardiac syncope.

Aims: It is unknown whether cardiac syncope, and possibly also other syncope aetiologies exhibit circadian, weekly, seasonal, and temperature-dependent patterns.

Methods And Results: We prospectively recorded the exact time, date, and outside temperature of syncope of patients >40 years old presenting with syncope to the emergency department in a diagnostic multicentre study. Two independent cardiologists/emergency physicians adjudicated the final diagnosis based on all information becoming available during clinical work-up including 1-year follow-up.

Prohormones in the Early Diagnosis of Cardiac Syncope.

Background: The early detection of cardiac syncope is challenging. We aimed to evaluate the diagnostic value of 4 novel prohormones, quantifying different neurohumoral pathways, possibly involved in the pathophysiological features of cardiac syncope: midregional-pro-A-type natriuretic peptide (MRproANP), C-terminal proendothelin 1, copeptin, and midregional-proadrenomedullin.

Methods And Results: We prospectively enrolled unselected patients presenting with syncope to the emergency department (ED) in a diagnostic multicenter study.

Prospective multicenter registration study of colorectal cancer: significant variations in radicality and oncosurgical quality-Swiss Group for Clinical Cancer Research Protocol SAKK 40/00.

Purpose: This study aimed to investigate in a multicenter cohort study the radicality of colorectal cancer resections, to assess the oncosurgical quality of colorectal specimens, and to compare the performance between centers.

Methods: One German and nine Swiss hospitals agreed to prospectively register all patients with primary colorectal cancer resected between September 2001 and June 2005. The median number of eligible patients with one primary tumor included per center was 95 (range 12-204).

Lateral lung hernia following a low-energy trauma without bony injuries: A case report.

Introduction: Lateral lung hernias are rare, and a herniation of the lung is only reported in the context of high-energy trauma. The predilection site for lung hernias is the anterior thorax.

Presentation Of Case: We present the case of a 82-year-old male, who was admitted with dry cough, shortness of breath and breath-dependent left-sided chest pain after a fall.

Large ovarian cystadenofibroma causing large bowel obstruction in a patient with Klippel-Feil syndrome-A case report.

Introduction: Ovarian cystadenofibromas (CAF) are epithelial tumors, which are fairly rare, mainly benign and asymptomatic. The Klippel-Feil syndrome (KFS) is a rare congenital anomaly which combines osseous and visceral development disorders. While bowel obstruction is a common complication in advanced ovarian cancer this condition is rarely described in cystic lesions such as CAF.

Residents' performance in open versus laparoscopic bench-model cholecystectomy in a hands-on surgical course.

Introduction: Laparoscopy has become the gold standard for many abdominal procedures. Among young surgeons, experience in laparoscopic surgery increasingly outweighs experience in open surgery. This study was conducted to compare residents' performance in laparoscopic versus open bench-model task.

Physician's first clinical impression of emergency department patients with nonspecific complaints is associated with morbidity and mortality.

The association between the physician's first clinical impression of a patient with nonspecific complaints and morbidity and mortality is unknown. The aim was to evaluate the association of the physician's first clinical impression with acute morbidity and mortality. We conducted a prospective observational study with a 30-day follow-up.

Mandatory resection of strangulation marks in small bowel obstruction?

Background: No evidence is available on how to treat intraoperatively detected band-shaped strangulation marks of the bowel wall originating from an adhesive band or hernia ring. The authors prefer to resect these hazardous strangulation marks to avoid secondary small bowel perforation. This retrospective study investigated the prevalence of intraoperatively unrecognized ulceration and transmural necrosis at the site of the strangulation marks.

Transanal endoscopic microsurgery (TEM) facilitated by video-assistance and anal insertion of a single-incision laparoscopic surgery (SILS(®))-port: preliminary experience.

Objective: Transanal endoscopic microsurgery (TEM) is an established method for the resection of benign and early malignant rectal lesions. Very recently, TEM via an anally inserted single incision laparoscopic surgery (SILS(®))-port has been proposed to overcome remaining obstacles of the classical TEM equipment.

Methods: Nine patients with a total of 12 benign or early stage malignant rectal polyps were operated using the SILS(®)-port for TEM.

The Tibetan herbal formula Padma Digestin in functional dyspepsia: an open-label study.

Background: The etiology of functional dyspepsia (FD) is multi-factorial. Its prevalence is high and it considerably impairs the patients' quality of life. The treatment options are limited.

Prevalence and clinical implications of diverticulosis of the vermiform appendix.

Objective: The epidemiology and the aetiology of inflammatory diseases of the vermiform appendix remain poorly understood. The prevalence of appendiceal diverticulosis and diverticulitis in patients undergoing appendectomy for suspected acute appendicitis was investigated.

Methods: A retrospective study was completed on patients who underwent appendectomy for suspected acute appendicitis.

Hyponatremia is a specific marker of perforation in sigmoid diverticulitis or appendicitis in patients older than 50 years.

Introduction. This study aimed to evaluate symptoms and signs, inflammation markers, electrolytes, and ECG signs of increased vagal tone as markers of colon perforation in sigmoid diverticulitis or appendicitis. Methods.

Implantation of a stent graft in the right pulmonary artery enables radical resection of a central endothelial sarcoma of the left pulmonary artery.

In a patient with a huge endothelial sarcoma of the left pulmonary artery, we report successful implantation of a stent graft in the right pulmonary artery, including the pulmonary arterial trunk. This preoperative measure enabled a safe and radical left-sided pneumonectomy, including the tumor and the central parts of the left pulmonary artery. No major blood loss occurred, and neither use of a heart-lung machine nor cardiopulmonary bypass was necessary.

Venous small bowel infarction: intraoperative laser Doppler flowmetry discriminates critical blood supply and spares bowel length.

Introduction. In mesenteric infarction due to arterial occlusion, laser Doppler flowmetry and spectrometry are known reliable noninvasive methods for measuring microvascular blood flow and oxygen utilisation. Case Presentation.

Subtotal colectomy for malignant left-sided colon obstruction is associated with a lower anastomotic leak rate than segmental colectomy.

Aim: To compare subtotal colectomy to segmental colectomy for malignant left-sided colonic obstruction.

Patients And Methods: Obstruction was defined by failure to trespass a colonic stenosis during endoscopy, by truncation of the contrast column during contrast enema, by severe colonic dilatation (cecum >10 cm, transverse colon >8 cm, descending colon >6 cm) or by serosal tears. From 53 consecutive patients treated for malignant left-sided colon obstruction at our surgical department from July 2002 to July 2010, 19 patients had subtotal colectomy and 30 patients had segmental colectomy.

Oncological short-term effects and adverse events of MRI-guided selective neoadjuvant radiochemotherapy for rectal cancer.

Aim: To investigate the oncological short-term effects and acute side-effects of magnetic resonance imaging (MRI)-guided selective neoadjuvant radiochemotherapy (nRCT) for rectal cancer.

Patients And Methods: In a prospective multicenter cohort study of 230 patients with rectal cancer stage II or III, nRCT was applied in the following situations (n=96) only: cT4 tumors, cT3 tumors of the distal rectum or tumors leaving a circumferential resection margin (CRM) of ≤1 mm between the tumor and the mesorectal fascia (mrCRM+). Pre-therapeutical tumor stage and involvement of mesorectal fascia were assessed by MRI and were compared with the pathological findings of the rectal specimens.

Timing of rectosigmoid resection for diverticular disease: the patient's view.

Aim: The study aimed to determine the patient's view on the timing of elective resection for sigmoid diverticulitis.

Method: A questionnaire was answered by 162 (69%) of 236 consecutive patients who had a resection of the rectosigmoid for diverticulitis from July 2002 to August 2005. Patients (n=45) having resection at or after the first inflammatory attack were excluded, leaving 117 eligible for analysis.

Ischemic colitis: clinical presentation, localization in relation to risk factors, and long-term results.

Background: Ischemic colitis is commonly thought to occur most often in the left hemicolon close to the splenic flexure owing to insufficient blood supply near Griffith's point. This study investigates the colorectal localization pattern, the risk factors, and the long-term outcome of histologically proven ischemic colitis.

Methods: Between 1996 and 2004, a total of 49 patients with a median age of 69 years (range 26-94 years) with colonoscopically assessed and histologically proven ischemic colitis were identified on behalf of the pathology database.