42 research outputs found
A study investigating the perfusion of colorectal anastomoses using fluorescence angiography: results of the FLAG randomized trial
No full textRECTAL CANCER INCIDENCE IN ARKHANGELSK REGION: TRENDS AND SHORT-TERM PROGNOSIS BY THE DATA OF THE ARKHANGELSK REGIONAL CANCER REGISTRY
No full textIntroduction. More than 1 million new cases of rectal cancer (RC) are annually detected worldwide, and together with colon cancer this tumor is the 4th most frequent cause of cancer death.Objective: To analyze short-term prognosis of RC incidence for certain population subgroups in the Arkhangelsk region, Russia.Material and methods. The data on all primary RC cases in the Arkhangelsk region in the time period from 2000 to 2015 were selected. Crude (whole population) and age-standardized incidence rates were calculated depending on gender and place of residence (urban or rural). The ARIMA model (autoregressive integrated moving average) was chosen to analyze the variations of the time series and to estimate prognosis. To transform the series to a stationary form and to reduce dispersion, the first or second differences of their values and the natural logarithms were taken. The incidence values for the period 2016–2018 were predicted on stationary series of RC incidence from 2000 to 2015.Results. Crude and age-standardized RC incidence rates in Arkhangelsk region increased from 14.4 and 11.4 in 2000 to 23.5 and 15.1 per 100,000 in 2015. Age-standardized RC incidence rates for males, females, urban and rural populations increased from 14.8, 10.1, 9.3 and 15.1 to 20.3, 12.6, 12.3 and 20.4 per 100, 000, respectively. Actual values of incidence rates among all population, male/female and rural/urban population in 2015 were within the confidence interval of the prognosis. The constructed prognosis model assumes an increase in the RC incidence among all population groups, which may cause the detection of 279 new cases by 2018; i.e. 16 cases (6%) more than in 2015.Conclusion. The incidence rates of RC have been steadily increasing in all population groups, and the rate of growth depends only partly on the population ageing. The number of new patients is expected to increase by 6 % in 2018
POSTOPERATIVE DELIRIUM: MODERN ASPECTS OF DIAGNOSIS, PREVENTION AND THERAPY
No full textDelirium is an acute change in mental status in the form of disorientation in time and space, loss of attention and disruption of sleep/wake patterns. From the psychopathological point of view, delirium is a qualitative disorder of consciousness with concomitant disorders of perception (illusions and hallucinations). Postoperative delirium (POD) is one of the postoperative complications that occur in patients of any age, including children. As a rule, POD develops within 5-7 days after the surgery. The frequency of its occurrence varies in different age groups. Nowadays more than 230 million surgeries are performed annually in the world, and the frequency of POD depends on the type of surgical operations, age of a patient and a number of risk factors. The effects of POD include cognitive disorders, prolonged hospitalization, increased mortality, leading to a significant increase in healthcare costs. The implementation of the protocol on the diagnosis and therapy of delirium, based on modern recommendations, can improve the clinical outcome
ЗАБОЛЕВАЕМОСТЬ РАКОМ ПРЯМОЙ КИШКИ В АРХАНГЕЛЬСКОЙ ОБЛАСТИ: ТРЕНДЫ И КРАТКОСРОЧНЫЙ ПРОГНОЗ (ПО ДАННЫМ ОБЛАСТНОГО КАНЦЕР-РЕГИСТРА)
No full textIntroduction. More than 1 million new cases of rectal cancer (RC) are annually detected worldwide, and together with colon cancer this tumor is the 4th most frequent cause of cancer death.Objective: To analyze short-term prognosis of RC incidence for certain population subgroups in the Arkhangelsk region, Russia.Material and methods. The data on all primary RC cases in the Arkhangelsk region in the time period from 2000 to 2015 were selected. Crude (whole population) and age-standardized incidence rates were calculated depending on gender and place of residence (urban or rural). The ARIMA model (autoregressive integrated moving average) was chosen to analyze the variations of the time series and to estimate prognosis. To transform the series to a stationary form and to reduce dispersion, the first or second differences of their values and the natural logarithms were taken. The incidence values for the period 2016–2018 were predicted on stationary series of RC incidence from 2000 to 2015.Results. Crude and age-standardized RC incidence rates in Arkhangelsk region increased from 14.4 and 11.4 in 2000 to 23.5 and 15.1 per 100,000 in 2015. Age-standardized RC incidence rates for males, females, urban and rural populations increased from 14.8, 10.1, 9.3 and 15.1 to 20.3, 12.6, 12.3 and 20.4 per 100, 000, respectively. Actual values of incidence rates among all population, male/female and rural/urban population in 2015 were within the confidence interval of the prognosis. The constructed prognosis model assumes an increase in the RC incidence among all population groups, which may cause the detection of 279 new cases by 2018; i.e. 16 cases (6%) more than in 2015.Conclusion. The incidence rates of RC have been steadily increasing in all population groups, and the rate of growth depends only partly on the population ageing. The number of new patients is expected to increase by 6 % in 2018.Ежегодно в мире выявляется более 1 000 000 новых случаев рака прямой кишки (РПК), вместе с раком ободочной кишки эта опухоль является четвертой по частоте причиной онкологической смертности.Цель исследования – анализ временных рядов и кратковременный прогноз заболеваемости раком прямой кишки у отдельных групп населения Архангельской области (АО).Материал и методы. Отобраны данные обо всех первичных случаях РПК в АО в 2000–15 гг. Рассчитаны грубые (вся популяция) и стандартизованные по мировому возрастному стандарту показатели (СВП) заболеваемости в зависимости от пола и района проживания (город или сельская местность). Для анализа вариаций использованных временных рядов и прогноза выбрана статистическая интегрированная модель авторегрессии скользящего среднего (ARIMA, autoregressive integrated moving average). Для приведения рядов к стационарному виду и уменьшения их дисперсии были взяты первые или вторые разности их значений и натуральные логарифмы. На стационарных рядах заболеваемости РПК в 2000–15 гг. построены модели и спрогнозированы значения для проверки точности прогноза. Построен прогноз для изучаемых уровней заболеваемости на период 2016–18 гг.Результаты. Грубые и стандартизованные по возрасту показатели заболеваемости РПК в АО возросли с 14,4 и 11,4 в 2000 г. до 23,5 и 15,1 на 100 000 населения в 2015 г. Соответствующие СВП для мужского, женского, городского, сельского населения возросли с 14,8; 10,1; 9,3 и 15,1 до 20,3; 12,6; 12,3 и 20,4 на 100 000 населения. Фактические значения уровней заболеваемости всего населения, мужского/женского и сельского/городского населения в 2015 г. находились в доверительном интервале прогноза. Построенная модель прогноза предполагает повышение уровней заболеваемости РПК во всех группах населения, что может привести к выявлению 279 новых случаев в 2018 г., или на 16 (6 %) больше, чем в 2015 г.Заключение. Показатели заболеваемости неуклонно повышались во всех анализируемых подгруппах, этот рост лишь частично связан со старением населения. Количество пациентов, нуждающихся в специальном лечении, в 2018 г. возрастет на 6 %
Диагностическая ценность применения номограмм в прогнозировании возникновения несостоятельности колоректального анастомоза (обзор литературы)
No full textThe anastomosis leakage is one of the most terrible complications of rectal cancer surgery. The anastomosis leakage rate after low anterior resection may exceed 20 %. The anastomosis leakage increases postoperative mortality, length of hospitalization, requires the formation of a temporary or permanent colostomy, which impairs the quality of life of patients. In recent years, some authors have suggested using a nomogram, a prognostic algorithm in the form of a graphic image showing the probability of a certain outcome individually for each patient. This review presents literature data on the use of nomograms in predicting the occurrence of colorectal anastomosis leakage after rectal cancer surgery.Несостоятельность анастомоза — одно из самых грозных осложнений в хирургии рака прямой кишки, частота которого при выполнении низких передних резекций может превышать 20 %. Возникновение несостоятельности анастомоза приводит к увеличению послеоперационной летальности, длительности госпитализации, требует формирования временной или постоянной колостомы, что значительно ухудшает качество жизни пациентов. В последние годы некоторые авторы предлагают использовать номограмму — прогностический алгоритм в виде графического изображения, показывающего вероятность определенного исхода индивидуально для каждого пациента. В данном обзоре литературы представлен мировой опыт применения номограмм в прогнозировании возникновения несостоятельности колоректального анастомоза у больных раком прямой кишки
Waist circumference and waist/hip ratio are better predictive risk factors for mortality and morbidity after colorectal surgery than body mass index and body surface area
No full textObjectives: To determine whether body fat distribution, measured by waist circumference (WC) and waist/hip ratio (WHR), is a better predictor of mortality and morbidity after colorectal surgery than body mass index (BMI) or body surface area (BSA).
Background: Obesity measured by BMI is not a consistent risk factor for postoperative mortality and morbidity after abdominal surgery. Studies in metabolic and cardiovascular diseases have shown WC and WHR to be better outcome predictors than BMI.
Methods: A prospective multicenter international study was conducted among patients undergoing elective colorectal surgery. The WHR, BMI, and BSA were derived from body weight, height, and waist and hip circumferences measured preoperatively. Uni- and multivariate analyses were performed to identify risk factors for postoperative outcomes.
Results: A total of 1349 patients (754 men) from 38 centers in 11 countries were included. Increasing WHR significantly increased the risk of conversion [odds ratio (OR) = 15.7, relative risk (RR) = 4.1], intraoperative complications (OR = 11.0, RR = 3.2), postoperative surgical complications (OR = 7.7, RR = 2.0), medical complications (OR = 13.2, RR = 2.5), anastomotic leak (OR = 13.7, RR = 3.3), reoperations (OR = 13.3, RR = 2.9), and death (OR = 653.1, RR = 21.8). Both BMI (OR = 39.5, RR = 1.1) and BSA
(OR = 4.9, RR = 3.1) were associated with an increased risk of abdominal wound complication. In multivariate analysis, the WHR predicted intraoperative complications, conversion, medical complications, and reinterventions, whereas BMI was a risk factor only for abdominal wall complications; BSA did not reach significance for any outcome.
Conclusions: The WHR is predictive of adverse events after elective colorectal surgery. It should be used in routine clinical practice and in future risk-estimating systems.
Keywords: body mass index, body surface area, colorectal surgery, morbimortality, waist/hip rati
Применение магнитно-резонансной томографии у больных хроническим парапроктитом (предварительные результаты)
No full textAim. Investigation of possibilities of magnetic resonance imaging as a whole, as well as different modes of MR scanning (without intravenous contrast, with intravenous contrast, with the use of diffusion-weighted imaging) in the diagnosis of cryptogenic fistulas of the rectum.Materials and methods. In the study were included 50 patients with cryptogenic fistulas of the rectum (21 women and 29 men). All patients underwent magnetic resonance imaging of the pelvic organs.Results. The sensitivity of MRI in the diagnosis of the primary fistulas was 100%. With regard to secondary fistulas MRI sensitivity was 91.7%, specificity was 94.3%. The sensitivity of MRI in the diagnosis of chronic abscesses paraproctitis was 82.6%, specificity was 95.2%. The sensitivity of the method in the visualization of internal opening was 95.5%, specificity was 80.0%. The sensitivity of the method in the diagnosis of external openings was 91.7% and specificity was 100%. In the analysis of separates MR scanning mode we didn’t find statistically significant differences between them (p < 0.05). Conclusions. Magnetic resonance imaging has a high diagnostic efficacy in the diagnosis of cryptogenic perianal fistulas. We didn’t find statistically significant differences between MR scanning modes.Цель исследования: оценить возможности магнитно-резонансной томографии в целом, а также различных режимов МР-сканирования (без внутривенного контрастирования, с внутривенным контрастированием, с применением диффузионно-взвешенных изображений) в диагностике криптогенных свищей прямой кишки.Материал и методы. В исследование включено 50 пациентов с криптогенными свищами прямой кишки (21 (42,0%) женщина и 29 (58,0%) мужчин). Всем пациентам была выполнена магнитно-резонансная томография органов малого таза.Результаты. Чувствительность магнитно-резонансной томографии в диагностике основного свищевого хода составила 100%. В отношении добавочного свищевого хода чувствительность магнитно-резонансной томографии составила 91,7%, специфичность – 94,3%. Чувстви тельность магнитно-резонансной томографии в диагностике абсцессов при хроническом парапроктите составила 82,6%, специфичность – 95,2%, в визуализации внут реннего свищевого отверстия – 95,5 и 80,0% соответственно, в диагностике наружных свищевых отверстий – 91,7% и 100,0% соответственно. При анализе отдельных МР-режимов сканирования статистически значимых различий между ними выявлено не было (p < 0,05).Выводы. Магнитно-резонансная томография имеет высокую диагностическую эффективность в диагностике криптогенных свищей прямой кишки. Сравнение диагностической информативности отдельных режимов сканирования не выявило между ними статистически значимых различий
РЕЗУЛЬТАТЫ ЛЕЧЕНИЯ БОЛЬНЫХ С МЕСТНЫМИ РЕЦИДИВАМИ РАКА ОБОДОЧНОЙ КИШКИ
No full textAim: to improve the results of treatment of patients with local recurrence of colon cancer and evaluate effectiveness of the combined treatment.Materials and methods. From 1997 to 2012 in SRCC 71 consecutive patients underwent combined surgery for local recurrence of colon cancer. Of these patients 38 (53.5%) had surgical treatment with intraoperative intraperitoneal chemotherapy. Sixty-five (91.5%) patients had locally advanced recurrent tumor. Localization of local recurrence in patients who underwent combined operations, was as follows: in the area of colonic anastomosis - in 11 (15.5%) patients; in the bed of the removed tumor - in 19 (26.8%); in the area of colostomy - in 10 cases (14.1%); in the stump of distal colon after obstructive procedures - in 31 (43.6%) patients. Mean operative time was 270 ± 45 minutes and mean blood loss - 430 ± 80 ml.Results. Postoperative complications were observed in 6 (9.8%) of 61 patients. There was no mortality. Sixty-four (90.1%) patients were followed-up, 34 (53.1%) patients of which are currently alive with no signs of the relapse of the disease. Effectiveness of intraperitoneal chemotherapy was evaluated. Repeated local recurrence occurred in 5 (14.3%) of the 35 followed-up patients who underwent intraperitoneal chemotherapy, and in 6 (20.7%) of the 29 followed-up patients who received surgery alone (p = 0.2). Distant metastases were found in 9 (25.7%) and in 5 patients (17.2%) patients, respectively (p = 0.17), and peritoneal carcinomatosis in 1 (2.9%) and 4 (13.8%) cases, respectively (p = 0.09). Disease-free 5-year survival rate in patients who received intraperitoneal chemotherapy was 57.1%, and in patients received only surgical treatment - 48.3% (p = 0.15)
WAIST TO HIP RATIO BETTER PREDICTS ONCOLOGICAL SHORT - AND LONG-TERM OUT-COME AFTER RECTAL CANCER SURGERY THAN BODY MASS INDEX
No full textpeer reviewe
