treatment on the metastatic rate in patients with rectal carcinoids. year metastasis free survival rates for those patients presenting without metastatic 2 Department of Medical Informatics, The Unidisease were 100% for patients with tumors õ 1 cm (n Å 16), 73% for those with versity of Texas M. D. Anderson Cancer Center, tumors 1-2 cm (n Å 8), and 25% for those with tumors ú 2 cm (n Å 4) (P Å 0.04 Houston, Texas.comparing õ1 cm with 1-2 cm and P Å 0.05 comparing 1-2 cm with ú2 cm); tumor size data were not available for 3 patients. The 5-year metastasis free survival rate for patients presenting without metastatic disease with typical histology (n Å 20), regardless of size, was 100%, compared with 50% for patients with tumors with atypical histology (n Å 11) (P Å 0.001). Nine patients underwent extensive surgery for rectal carcinoid tumors but no survival benefit was demonstrated. that are 1 -2 cm is unpredictable. 1,5 Reports indicate that carcinoid tumors 1 -2 cm are associated with a 10 -20% incidence of metastaAddress for reprints: Lee M. Ellis, M.D., Departsis. 1,6,7 The identification of factors that predict aggressive tumor be- The objectives of the current study were to determine 1) the natural history of rectal carcinoid tumors, 2) whether specific histo-
CONCLUSIONS.
Gout is characterized by high serum uric acid (SUA) levels and arthritis. It is associated with obesity and metabolic syndrome. Bariatric surgery has been associated with decreased SUA levels and overall gout incidence. This meta-analysis aims to summarize the current evidence on bariatric surgery, gout and SUA levels. A literature review was performed on papers published from 2000 up till December 2018.Original studies investigating the impact of bariatric surgery on SUA levels or gout incidence were evaluated. Twenty studies with a total of 5,233 patients were analysed. Majority (n=14) had a follow-up duration of at least 12 months. The mean preoperative body mass index (BMI) was 45.2kg m −2 . The mean preoperative SUA level was 6.5mg dL −1 . Subgroup analysis demonstrated a mean decrease in SUA levels (−0.73mg dL −1 ) from the third postoperative month onwards, which was sustained until the third postoperative year (−1.91mg dL −1 ). There was a rise in SUA levels in the first post-operative month. Meta-regression analyses demonstrated a proportionate linear relationship between the change in BMI and SUA levels. Postbariatric surgery weight loss is associated with reduced SUA levels and decreased incidence of gout attacks. However, this is only evident from the third postoperative month onwards.
Introduction. The aim of this study was to compare the outcomes between laparoscopic and open omental patch repair (LOPR versus OR) in patients with similar presentation of perforated peptic ulcer (PPU). The secondary aim was to evaluate the outcomes according to the severity of peritonitis. Methods. All patients who underwent omental patch repair at two university-affiliated institutes between January 2010 and December 2014 were reviewed. Matched cohort between LOPR and OR groups was achieved by only including patients that had ulcer perforation <2 cm in size and symptoms occurring <48 hours. Outcome measures were defined in accordance with length of stay (LOS), postoperative complications, and mortality. Results. 148 patients met the predefined inclusion criteria with LOPR performed in 40 patients. Outcome measures consistently support laparoscopic approach but only length of hospital stay (LOS) achieved statistical significance (LOPR 4 days versus OR 5 days, p < 0.01). In a subgroup analysis of patients with MPI score >21, LOPR is also shown to benefit, particularly resulting in significant shorter LOS (4 days versus 11 days, p < 0.01). Conclusion. LOPR offers improved short-term outcomes in patients who present within 48 hours and with perforation size <2 cm. LOPR also proved to be more beneficial in high MPI cases.
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