The influence of bowel preparation on postoperative complications in surgical treatment of colorectal cancer

Introduction Colorectal cancer is the most common gastrointestinal cancer treated by departments and surgical clinics in Poland. Currently, the biggest challenge of surgery is to reduce the number of leaks in the bowel anastomoses and postoperative wound infections to a minimum. Objective Whether bowel preparation before surgery affects the early results of treatment? Methods The study was retrospective and included patients operated electively on one surgical center due to colorectal and rectal cancer in years 2013-2018. Patients who underwent surgery were divided into two groups in the study. The first was 109 patients with mechanical bowel irrigation. The second group of 118 patients, in addition to mechanical bowel preparation, received an oral antibiotic. Results The studied groups did not differ significantly in terms of traits that could affect the results of treatment within 30 days of surgery. Postoperative mortality was 0,9% and 0,85%. Complications: leakage of the bowel anastomosis 1,8% and 1,7%, postoperative obstruction 3,7% and 5,0%, wound dehiscence 2,75% and 0,85%, infection of the surgical site 13,8% and 3,4% respectively in the first and second group of patients. Conclusion 1. Mechanical bowel preparation in combination with the oral supply of antibiotic significantly reduces the frequency of surgical site infection compared to the mechanical rinsing itself. 2. Type of preparation of the intestine before the surgery does not significantly affect postoperative mortality and other complications, including anastomotic leak, but may be important for the frequency of postoperative wound dehiscence.

Preferences of patients with inflammatory bowel disease for receiving specialized health services using technology: the role of Internet and other sources of medical information

INTRODUCTION

It is notable that patients with inflammatory bowel disease (IBD) have insufficient knowledge about their disease and are willing to be more involved in their treatment. Nowadays medical information is easily available and health-related topics state the third most frequent reason for using the Internet. Therefore, patient's health-related self-awareness and willingness to take part in medical decisions have improved. The possibility of choice of specialized health services may have a positive effect on patient's satisfaction. The aim of the study was to characterize the extent of Internet use for health information among a representative sample of IBD patients and to examine the effects that Internet and other sources of information about specialized health services have on patients' choices of a doctor and hospital department.

MATERIALS AND METHODS

In total, 135 IBD patients admitted to the Department of General and Colorectal Surgery at Medical University of Lodz were asked to complete an anonymous questionnaire. Only 123 fully completed questionnaires were included for analysis. The study group involved 68 women and 55 men.

RESULTS

A total of 85.4% IBD patients used Internet in order to gather medical information about their disease. Age of those patients was significantly lower than of those patients who did not use Internet. The most reliable source of information about physicians was Internet. Opinions and recommendations gathered from the Internet have a notable influence on patients' preference of hospital department and attending physician.

CONCLUSIONS

A majority of patients used Internet as a source of medical information related to IBD. Opinions obtained from the Internet seem to be the most reliable regarding attending physicians treating IBD patients.

Comparison of Two Different Modes of Active Recovery on Muscles Performance after Fatiguing Exercise in Mountain Canoeist and Football Players

Background

The aim of this study is to assess if the application of different methods of active recovery (working the same or different muscle groups from those which were active during fatiguing exercise) results in significant differences in muscle performance and if the efficiency of the active recovery method is dependent upon the specific sport activity (training loads).

Design

A parallel group non-blinded trial with repeated measurements.

Methods

Thirteen mountain canoeists and twelve football players participated in this study. Measurements of the bioelectrical activity, torque, work and power of the vastus lateralis oblique, vastus medialis oblique, and rectus femoris muscles were performed during isokinetic tests at a velocity of 90°/s.

Results

Active legs recovery in both groups was effective in reducing fatigue from evaluated muscles, where a significant decrease in fatigue index was observed. The muscles peak torque, work and power parameters did not change significantly after both modes of active recovery, but in both groups significant decrease was seen after passive recovery.

Conclusions

We suggest that 20 minutes of post-exercise active recovery involving the same muscles that were active during the fatiguing exercise is more effective in fatigue recovery than active exercise using the muscles that were not involved in the exercise. Active arm exercises were less effective in both groups which indicates a lack of a relationship between the different training regimens and the part of the body which is principally used during training.

[Colopleural fistula complicating laparotomy for perforated gastric ulcer]

Colopleural fistula is a very rare clinical problem which was described barely in a few articles. Common causes of this kind of fistula are strangulated diaphragm hernias and neoplasms of the splenic flexure of the colon. We report a case of 58 years old male with colopleural fistula. Symptoms of left sided pyo and pneumothorax appeared two weeks after laparotomy for perforated peptic gastric ulcer. Chest tube was inserted and antibiotics was used. The pyothorax was evacuated almost entirely. Left sided recurrent purulent thoracic wall fistulas complicated the latter two and a half year course. Finnaly the reccurence of left sided pyothorax leaded to surgical treatment. During thoracotomy decortication and resection of cirrhotic lover lobe of the left lung was performed. In the postoperative course faecal fluid appeared in the left pleural cavity. The patient was transfer to The Surgical Department where fistula between colon and pleural cavity was confirmed by colonoscopy. During laparotomy fistula between splenic flexure of the colon penetrating through diaphragm was confirmed and excised. The patient was cured. On the basis of reviewed literature we discuss possible pathological mechanisms of creating colopleural fistula, diagnostic workup and treatment. We conclude that colonoscopic examination may be helpful in diagnosis and localization of fistula site when radiological examination fails. Colopleural fistula course may lasts with few symptoms for years.