Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract
-
J. Gastrointest. Surg. · Jul 2009
Acute abdominal pain in patients with systemic lupus erythematosus.
Patients with Systemic Lupus Erythematosus (SLE) that present with acute abdominal pain (AAP) represent a challenge for the general surgeon. The purpose of this study was to identify the major causes of AAP among these patients and to define the role of disease activity scores and the APACHE II score in identifying patients with an increased perioperative risk. ⋯ This is one of the largest series of AAP and SLE. Most common causes of AAP were pancreatitis and intestinal ischemia. APACHE II score in patients with intestinal ischemia was higher than those with serositis; further studies are needed to examine whether this score may help to differentiate these etiologies when CT findings are inconclusive. APACHE II score was the most important factor associated with mortality. Furthermore, a prompt diagnosis and an appropriate surgical management are essential in order to improve patient outcome.
-
J. Gastrointest. Surg. · Jul 2009
Comparative StudyA simple scoring system based on clinical features to predict locally advanced rectal cancers.
The purpose of this study was to identify clinical risk factors and establish a prediction scoring system for locally advanced rectal cancer. ⋯ Tumor size more than 2 cm, poor differentiation, and elevated serum CEA level are high-risk factors of locally advanced rectal cancer. A simple scoring system based on these three factors may be valuable to predict locally advanced rectal cancer.
-
J. Gastrointest. Surg. · Jul 2009
Comparative StudyIs liver resection justified in advanced hepatocellular carcinoma? Results of an observational study in 464 patients.
The role of liver resection in advanced hepatocellular carcinoma (multinodular or with macroscopic vascular involvement) is still controversial. The aim of this study is to evaluate the role of surgical resection compared to other therapeutic modalities in patients with advanced hepatocellular carcinoma (HCC). ⋯ The present study shows that the surgery can achieve good results in patients with single HCC and good liver function. Also, patients with multinodular HCCs (two to three nodules) could benefit from LR where survival is longer than after LAT or ST. In patients with more than three HCCs, LR have similar results of LAT. Macroscopic vascular invasion is a major prognostic factor, and the LR is justified in selected patients, where it can allow good long-term results compared to ST.
-
J. Gastrointest. Surg. · Jul 2009
CT scans and acute appendicitis: a five-year analysis from a rural teaching hospital.
Studies examining the relationship between computed tomography (CT) scans and appendiceal perforation have largely been conducted in urban centers. The present study sought to evaluate this relationship in a rural hospital. ⋯ Males undergoing CT scans are significantly more likely to have perforated appendicitis. A protocol-driven rational approach to CT evaluation of suspected appendicitis may lower perforation rates, especially in males.
-
J. Gastrointest. Surg. · Jul 2009
Comparative StudyNational trends and outcomes for the surgical therapy of ileocolonic Crohn's disease: a population-based analysis of laparoscopic vs. open approaches.
The laparoscopic approach to Crohn's disease has demonstrated benefits in several small series. We sought to examine its use and outcomes on a national level. ⋯ A variety of patient- and system-related factors influence the utilization of laparoscopy in Crohn's disease. Laparoscopic resection is associated with excellent short-term outcomes compared to open surgery.