Short-term outcomes after complete mesocolic excision compared with 'conventional' colonic cancer surgery

BACKGROUND

Complete mesocolic excision (CME) seems to be associated with improved oncological outcomes compared with 'conventional' surgery, but there is a potential for higher morbidity.

METHODS

Data for patients after elective resection at the four centres in the Capital Region of Denmark (June 2008 to December 2013) were retrieved from the Danish Colorectal Cancer Group database and medical charts. Approval from a Danish ethics committee was not required (retrospective study).

RESULTS

Some 529 patients who underwent CME surgery at one centre were compared with 1701 patients undergoing 'conventional' resection at the other three hospitals. Laparoscopic CME was performed in 258 (48·8 per cent) and laparoscopic 'conventional' resection in 1172 (68·9 per cent). More extended right colectomy procedures were done in the CME group (17·4 versus 3·6 per cent). The 90-day mortality rate in the CME group was 6·2 per cent versus 4·9 per cent in the 'conventional' group (P = 0·219), with a propensity score-adjusted logistic regression odds ratio (OR) of 1·22 (95 per cent c.i. 0·79 to 1·87). Laparoscopic surgery was associated with a lower risk of mortality at 90 days (OR 0·63, 0·42 to 0·95). Intraoperative injury to other organs was more common in CME operations (9·1 per cent versus 3·6 per cent for 'conventional' resection; P < 0·001), including more splenic (3·2 versus 1·2 per cent; P = 0·004) and superior mesenteric vein (1·7 versus 0·2 per cent; P < 0·001) injuries. Rates of sepsis with vasopressor requirement (6·6 versus 3·2 per cent; P = 0·001) and postoperative respiratory failure (8·1 versus 3·4 per cent; P < 0·001) were higher in the CME group.

CONCLUSION

CME is associated with more intraoperative organ injuries and severe non-surgical complications than 'conventional' resection for colonic cancer.

Young people who sexually abuse: a historical perspective and future directions

This article presents a historical overview of research on sexually abusive youth. The evolution of the field over the past 30 years is discussed-from the initial development of treatment interventions to contemporary efforts of professionals to move from traditional, adult-oriented interventions toward developmentally sensitive assessment strategies and practice models. Focus is on two critical areas: risk assessment and trauma-informed care. The article reviews contemporary research on risk assessment tools, stressing the need for validated tools that can accurately assess youth and follow changes in risk over time. Etiological models for understanding effects of trauma (Trauma Outcome Process Assessment and Family Lovemap) are presented. Discussed are new ecologically based therapy models for working with sexually abusive youth that approach the youth holistically and are attuned to youths' needs, including providing interventions to address effects of past trauma.

Victim and victimizer: the role of traumatic experiences as risk factors for sexually abusive behavior

The Victim to Victimizer paradigm purports to explain the connection between being a victim of sexual abuse and becoming a perpetrator, attributing sexually abusive behavior to a predictable cycle of cognitive distortions and self-destructive and/or abusive behaviors. Integration of two ecological models, Trauma Outcome Process Assessment and Family Lovemap provides a more comprehensive explanation of salient contributors to sexually abusive behavior in youth (i.e., trauma). A case example illustrates the parallel Trauma Outcome Process in a victim, and the victim's perpetrator, identifying protective factors beneficial for trauma recovery.

Paradigm shift: implementing MEGA, a new tool proposed to define and assess sexually abusive dynamics in youth ages 19 and under

Previous definitions of sexually abusive behavior in children and adolescents were deficient in failing to (1) highlight salient neuropsychological elements and antisocial behaviors that may contribute to a youth's functioning; (2) discriminate among possible types of coercion (e.g., manipulation, threats, physical force, and use of weapons); and (3) include predatory elements of sexual abuse against strangers or casual acquaintances. This article discusses a new comprehensive assessment tool that assists in defining sexually abusive youth. This tool, the Multiplex Empirically Guided Inventory of Ecological Aggregates for Assessing Sexually Abusive Children and Adolescents (Ages 19 and under) (MEGA; Miccio-Fonseca, 2006b), encompasses neuropsychological elements, coercive aspects, and predatory elements as essential factors to consider in comprehensive assessments of sexually abusive youth.

Differentiating youth who sexually abuse: applying a multidimensional framework when assessing and treating subtypes

Recent empirical research has shown that children with sexual behavior problems and adolescents who offend sexually are diverse populations consisting of several subtypes (Hall, Mathews, & Pearce, 2002; Pithers, Gray, Busconi, & Houchens, 1998; Worling, 2001). This article reviews the descriptive and empirical research related to identifying subtypes of children with sexual behavior problems and adolescents who offend sexually. Examples of clinically and empirically derived typologies are presented. The author discusses how data from the empirically derived typologies can be incorporated within a multidimensional assessment framework based on the Trauma Outcome Process model (Burton, Rasmussen, Bradshaw, Christopherson, & Huke, 1998; Rasmussen, Burton, & Christopherson, 1992; Rasmussen, 1999, 2001, 2002). The application of this framework in assessing and treating children with sexual behavior problems and adolescents who offend sexually is described.

Integrating cognitive-behavioral and expressive therapy interventions:applying the trauma outcome process in treating children with sexually abusive behavior problems

This article presents intervention strategies based on the Trauma Outcome Process, an integrated treatment model for guiding clinical practice with children with sexually abusive behavior problems. The steps for completing a comprehensive assessment are reviewed, and strategies are presented to help clinicians create a therapeutic alliance and increase these children's self-awareness of their thoughts, feelings, and body sensations. Treatment techniques based on an integrated approach combining cognitive-behavioral and expressive therapy approaches are described. These exercises help children accept responsibility for sexually inappropriate behavior and select adaptive responses for coping with the effects of traumatic experiences.

Factors related to recidivism among juvenile sexual offenders

This recidivism study retrospectively examined the juvenile court case records of 170 first-time juvenile sexual offenders in a 5-year observation period. Cox regression, a model of event history analysis, was used to test hypotheses and to build multivariate competing risk models predictive of criminal recidivism. The multivariate analyses found that nonsexual offense recidivism was significantly (p < .01) associated with (a) prior nonsexual offenses and (b) failure to complete treatment. Sexual offense recidivism was significantly associated with larger numbers of female victims, but results were inconclusive due to the small size (n = 13) of the sexual reoffending sample.

[Marfan syndrome and pregnancy]

Two cases of Marfan's syndrome with acute dissection in relation to labour are presented. One patient died of aortic rupture while the other was electively operated. The haemodynamic changes during pregnancy and labour can have catastrophic consequences. The Marfan patient must be well informed before pregnancy and carefully monitored during pregnancy and the peripartum period. Serial echocardiographic studies evaluating aortic root size and aortic valve function are essential. In case of severe cardiovascular manifestation the pregnancy should be interrupted.

[Perioperative fluid therapy. A quality control study]

This paper presents a retrospective analysis of the fluid balance during the first 12 hours after laparotomy in 60 consecutive patients. The analysis showed that the majority of patients received greater volumes of crystalloid infusions than recommended, and that the actual number of blood transfusions given did in many circumstances not comply with the available guidelines. Perioperative fluid therapy is an area that needs increased attention since overhydration may contribute to cardiopulmonary morbidity. Perioperative fluid therapy regimens should be evaluated in future prospective, controlled, randomized trials.

Glassy cell carcinoma of the colon with human chorionic gonadotropin-production. A case report with immunohistochemical and ultrastructural analysis

An unusual tumor in the descending colon with human chorionic gonadotropin-beta (HCG-beta) production and histological features of a "glassy cell" carcinoma is presented. Glassy cell carcinoma has been described in the uterus and fallopian tubes as well as the cervix, but in these locations the tumor is not HCG-beta producing. Glassy cell carcinomas have been described in some cases as having glandular and squamous differentiation as well as marked cellular pleomorphism. The tumors are generally associated with a poor prognosis.

Ranitidine reduces postoperative interleukin-6 induced C-reactive protein synthesis

BACKGROUND

The mechanism of post-traumatic immunosuppression is still not known in detail. However, histamine released during trauma and major surgery may play a significant role in the process. Previously, we showed that the histamine-2 receptor antagonist (H2RA), ranitidine, reduced trauma-induced suppression of certain immunological parameters.

STUDY DESIGN

The effect of perioperative ranitidine on postoperative change in plasma interleukin-6 (IL-6) and serum C-reactive protein (CRP) levels was assessed in 23 women undergoing elective abdominal hysterectomy. The patients were randomized to receive intravenous ranitidine, 100 mg twice a day from skin incision, for two days, followed by oral ranitidine, 150 mg twice a day, for a further three days, or no ranitidine. Interleukin-6 and CRP were analyzed in plasma and serum, respectively, drawn preoperatively and six, 24, 48, and 120 hours after skin incision.

RESULTS

Routine blood analyses, clinical data (except age), duration of surgery, anesthesia, antibiotic prophylaxis, blood loss, and perioperative blood transfusion were similar in the two groups. Interleukin-6 levels were significantly increased in all patients and without difference between the ranitidine-treated and non-ranitidine-treated patients after six, 24, and 48 hours compared to preoperative levels, respectively. C-reactive protein levels were also significantly increased in all patients after 24, 48, and 120 hours, respectively; however, at 48 hours, CRP was significantly reduced in ranitidine-treated patients compared with non-ranitidine-treated patients (p = 0.02).

CONCLUSIONS

These results suggest that histamine-2 receptor activation mechanisms may not be involved in postoperative IL-6 synthesis. However, the reduced CRP level in ranitidine-treated patients suggests that H2RAs modulate IL-6 signal transduction in hepatic cells.

[Inguinal funicular block in vasectomy]

The analgesic efficacy of inguinal funicular block with 10 ml carbocaine 1% as a supplement to local infiltration analgesia of the vas deferens was investigated in patients undergoing vasectomy. Pain/discomfort during vasectomy and on the first and third day postoperatively were investigated using a questionnaire. Fifty-seven male patients scheduled for legal sterilization were randomized and allocated in a double-blinded manner to receive the 10 ml carbocaine 1% in the right or left side and 10 ml isotonic NaCl in the contralateral side, the patient then being his own control. There was significantly less intraoperative pain on the side of the active inguinal funicular block (p < 0.0001), but no significant differences were found at the first and third postoperative day (p = 1.16-1.19). Inguinal funicular block can be recommended as a supplement to the usual use of local infiltration analgesia of the vas deferens.