In this study, we analyzed the Norwegian guidelines for systematic follow-up after curative colorectal cancer surgery in a large single institution. Three hundred fourteen consecutive unselected patients undergoing curative surgery for colorectal cancer between 1996 and 1999 were studied with regard to asymptomatic curable recurrence, compliance with the program, and cost. Follow-up included carcinoembryonic antigen (CEA) interval measurements, colonoscopy, ultrasonography of the liver, and radiography of the chest. In 194 (62%) of the patients, follow-up was conducted according to the Norwegian guidelines. Twenty-one patients (11%) were operated on for curable recurrence, and 18 patients (9%) were disease free after curative surgery for recurrence at evaluation. Four metachronous tumors (2%) were found. CEA interval measurement had to be made most frequently (534 tests needed) to detect one asymptomatic curable recurrence. Follow-up program did not influence cancer-specific survival. Overall compliance with the surveillance program was 66%, being lowest for colonoscopy (55%) and highest for ultrasonography of the liver (85%). The total program cost was 228,117 euro (US 280,994 dollars), translating into 20,530 euro (US 25,289 dollars) for one surviving patient after surgery for recurrence. The total diagnosis yield with regard to disease-free survival after surgery for recurrence was 9%. Compliance was moderate. Whether the continuing implementation of such program and cost are justified should be debated.

This article describes the use of a balloon catheter introduced via the femoral artery into the abdominal aorta without the use of fluoroscopy to stabilize six patients with life-threatening post-partum haemorrhage. The femoral artery was localized blindly or with the use of ultrasound. Immediate control of the bleeding was achieved in all patients, and the procedure was believed to be life saving for some patients. One patient with a narrow and fragile aorta had an aortic rupture necessitating surgical repair, which may have been caused by the balloon. In these six cases, the procedures were carried out by interventional radiologists. However, this procedure can also be performed by anaesthesiologists or surgeons who are trained in vascular access techniques.

Diagnostic accuracy of CEA in follow-up after curative surgery for CRC is influenced by the chosen cut-off value. A threefold increase of CEA may indicate recurrent disease. The value of serial measurement of CEA was limited.

BACKGROUND:Appropriate stratification tools for targeted surveillance after resection for colorectal cancer (CRC) are lacking. The objective of the current study was to investigate the effect of microsatellite instability (MSI) and DNA ploidy on surveillance after surgery.METHODS:The authors evaluated 186 consecutive, population‐based patients with stage I through III CRC who underwent surgery with curative intent and who entered a systematic surveillance program. MSI was analyzed with polymerase chain reaction for 5 known quasimonomorphic markers (BAT‐26, BAT‐25, NR‐21, NR‐24, and NR‐27), and DNA ploidy was analyzed with automated cytometry. Recurrence, recurrence‐free survival (RFS), and disease‐specific survival (DSS) were evaluated by univariate and multivariate statistical tests.RESULTS:Patients with MSI (20%) were significantly younger than patients without MSI (median age, 61 years vs 67 years; P = .016). Proximal location (adjusted odds ratio [AOR], 5.4; 95% confidence interval [95% CI], 2.1‐14.1 [P = .001]), large tumor size (≥5 cm: AOR, 3.5; 95% CI, 1.3–9.6 [P = .015]), and poor tumor differentiation (AOR, 6.6; 95% CI, 2–21.8 [P = .002]) were associated with MSI. MSI conveyed an increased risk for locoregional recurrence (OR, 2.9; 95% CI, 1.2–7 [P = .016]), with a trend toward a shorter time to recurrence (P = .060). Neither MSI status nor DNA ploidy predicted distant metastasis, RFS, or DSS. Lymph node status was the best predictor of distant spread (AOR, 3.9; 95% CI, 2–7.9 [P < .001]) and DSS (hazard ratio, 4.9; 95% CI, 2.6–9 [P < .001]).CONCLUSIONS:Patients who had microsatellite instable tumors were at increased risk for locoregional recurrence, whereas lymph node status was the best predictor of distant metastasis. Clinical surveillance and choice of modality (ie, endoscopy vs radiologic imaging) may be improved when patients are stratified according to these cancer features. Cancer 2009. © 2009 American Cancer Society.

All hospitals reported having a strategy for surveillance after surgery for colon and rectal cancer, but there was considerable variance in strategy. A scientific audit of the true level of compliance, effectiveness and cost-benefit is warranted at a national level.

BackgroundTo reduce the possibility of secondary deterioration of spinal injuries, it is desirable to maintain the spinal immobilisation that is applied in the prehospital setting throughout computed tomography (CT) scanning. A previous study found that metallic components within the inflation valve of the vacuum mattresses caused CT artefacts. The aim of our study was to investigate the effect of vacuum mattresses with plastic valves on CT artefacts, the radiation dose, and noise compared to a trauma transfer board and the spine boards currently used in our trauma system.MethodsWe scanned an anthropomorphic whole body phantom with different immobilisation devices on a 128-slice CT scanner using the standard polytrauma CT-protocol at our institution. The phantom was scanned without any immobilisation device and with three different vacuum mattresses, two spine boards, and one trauma transfer board. Two radiologists independently assessed the artefacts. Agreement between the two radiologists was measured using the kappa coefficient. The radiation dose and noise were assessed.ResultsOne spine board produced major artefacts due to its metal components. One of the vacuum mattresses resulted in artefacts that impaired clinical judgement. Otherwise, the artefacts predominantly did not impede clinical judgement and were mainly subtle. One of the vacuum mattresses resulted in no artefacts that affected clinical judgement. The overall inter-rater agreement was substantial (0.86, kappa 0.77). We did not observe any artefacts due to plastic valves. The mean CT radiation dose was slightly higher for two of the devices in the head series than that for the trauma transfer board, used as the standard in our system. Only marginal differences were noted for the other devices and series. Small differences in image noise were found between the devices.ConclusionsOur results indicate that it is feasible to maintain some vacuum mattresses with plastic valves on trauma patients during CT scanning. The tested mattresses did not result in a considerably increased radiation dose or artefacts that hampered clinical judgement. One of the tested vacuum mattresses produced no artefacts that hampered clinical judgement whatsoever.

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Three patients presented with swelling of the leg after surgical removal of the greater saphenous vein (GSV): two of them after stripping of the GSV for varicosity, and one after harvesting the GSV for coronary artery bypass graft (CABG) surgery. Lymphoscintigraphic examination of the affected leg revealed impaired lymphatic drainage. Two of the subjects showed an impaired lymphatic drainage in both legs, suggesting a pre-existing dysplastic lymphatic system. We discuss and review the cause of lymphedema after venous surgery.