Psychological stress impairs the inflammatory response and matrix degradation processes in the wound immediately following surgery. This finding generalizes previous laboratory research to surgical patients and expands the known influence of stress to connective tissue matrix remodelling processes. These results suggest that in clinical practice, interventions to reduce the patient's psychological stress level may improve wound repair and recovery following surgery.
In a prospective study of 402 colorectal cancer patients, 133 patients (46 men and 87 women) presented with right colon cancer. There was no significant difference between men and women in right colon cancer incidence. Common presenting features were abdominal pain, weight loss, and anemia. Ninety-one patients underwent resection with curative intent. There were significantly fewer Dukes' A tumors in the right colon cancer series (P less than 0.05). Significantly more women in the right colon cancer group were over 70 years old (P less than 0.05). The findings of peritoneal metastases and poorly differentiated lesions at initial surgery also were associated significantly with women who had right colon cancer (P less than 0.05). This study confirms previous reports of more advanced tumors in the right colon. The need for age, sex, and subsite differences to be taken into account when assessing treatment outcomes or survival is emphasized.
In a retrospective case control review we determined the cholecystectomy frequency of 479 index cases of colonic carcinoma and 479 age, sex, and admission date matched controls. The frequency distribution patterns of cholecystectomy with reference to subsite specific cancer of the large bowel were determined. The cholecystectomy frequency in patients with proximal colonic cancer was higher than those in whom cancer was present in areas other than the proximal colon (12.3 per cent vs. 6.6 per cent, P less than 0.02). There was a gradient of previous cholecystectomy history from the proximal colon to the rectum. The overall frequency of previous cholecystectomy in the index cases was 8.1 per cent while that in the matched control was 5.4 per cent. The difference was not statistically significant. However, the cholecystectomy frequency of the proximal colonic cancer subgroup was significantly higher than its matched control group (12.3 per cent vs. 4.6 per cent, P less than 0.02). The difference was greater in females with proximal colonic cancer compared with their matched controls (14.3 per cent vs. 3.6 per cent, P less than 0.02). Our data supported the hypothesis that either (1) altered bile salt metabolism after cholecystectomy may increase colonic cancer formation, or (2) gallbladder disease and colonic cancer may share common etiologic factors.
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