The risk of a colorectal adenoma containing APF can be estimated only by a complex model taking into account several adenoma and patient characteristics. Size, histological type, location and age are independent risk factors for APF in colorectal adenomas. As a considerable percentage of adenomas with diameter < 0.5 cm contain high-grade dysplasia, the clinical conclusion from our study is that all adenomas, including those with diameter < 0.5 cm, should be removed whenever possible.

2 ), undergoing elective gastroplasty for the induction of weight loss, were examined for hemostatic, metabolic, and inflammatory parameters at baseline and 14 Ϯ 5 months postoperatively. Results: Weight loss significantly reduced circulating plasma TF (314 Ϯ 181 vs. 235 Ϯ 113 pg/mL, p ϭ 0.04), coagulation factor VII (130 Ϯ 22% vs. 113 Ϯ 19%, p ϭ 0.023), and prothrombin fragment F1.2 (2.4 Ϯ 3.4 vs. 1.14 Ϯ 1.1 nM, p ϭ 0.04) and normalized glucose metabolism in 50% of obese patients preoperatively classified as diabetic or of impaired glucose tolerance. The postoperative decrease in plasma TF correlated with the decrease of F1.2 (r ϭ 0.56; p ϭ 0.005), a marker of in vivo thrombin formation. In subgroup analysis stratified by preoperative glucose tolerance, baseline circulating TF (402.6 Ϯ 141.6 vs. 176.2 Ϯ 58.2, p Ͻ 0.001) and TF decrease after gastroplasty (⌬TF: 164.7 Ϯ 51.4 vs. Ϫ81 Ϯ 31 pg/mL, p ϭ 0.02) were significantly higher in obese patients with impaired glucose tolerance than in patients with normal glucose tolerance. Discussion: Procoagulant TF is significantly reduced with weight loss and may contribute to a reduction in cardiovascular risk associated with obesity.

Colonic perforation is an abdominal emergency with high morbidity and mortality. This retrospective study was performed to evaluate the prognostic relevance of several factors and to characterize patients at high risk. One hundred and twelve patients (61 women, 51 men) were treated for colonic perforation from 1979 to 1992. Diverticulitis [65 patients (58%)] and carcinoma [24 patients (21%)] were the commonest pathology. In 62 cases (55%) perforation was found to be covered; 50 (45%) times it was free. 34 (30%) patients had diffuse peritonitis. Resection with primary anastomosis was performed 43 times (7 times with a protective colostomy). Resection without restoration of the intestinal continuity was carried out 53 times (including 49 Hartmann operations). Suture with drainage was performed 16 times mainly after iatrogenic perforation (8 times with a colostomy). The overall mortality was 19.6% (22 patients). The prognostic importance of various factors was investigated by univariate analysis (Wilcoxon and Chi-square test) and stepwise logistic regression including sex, age, underlying disease, localization and type of perforation, degree of peritonitis, pre- or postoperative organ failure, surgical procedure, reoperation, sepsis and the Mannheimer Peritonitis Index (MPI) score. Age over 65 years (relative risk 4.6, P = 0.0089), organ failure (relative risk 40, P = 0.001) and MPI (relative risk for an increase of 10 points 2.72, P = 0.001) proved to be the only risk factors of significance. The patient's course is determined by the septic state, while the underlying pathology and degree of peritonitis did not significantly influence survival.

The final place of LSG in bariatric surgery is still unclear, but our results and those of others show that LSG can be a viable alternative to established procedures.

A cumulative effect of malignancy and sepsis may be responsible for the high postoperative mortality in malignant perforation. Patients with perforated cancers represent the highest risk group in colonic perforation.

The majority of patients with colorectal cancer have increased fecal concentration of calprotectin. One single fecal spot seems to be sufficient for determination of the calprotectin level. Measurement of fecal calprotectin may possibly become of value as a marker for colorectal cancer, although calprotectin, similar to fecal occult blood (FOB) tests, is a non-specific test for colorectal pathology, also being elevated in inflammatory bowel diseases. Further investigation of its specificity is therefore needed.

Background: Outcome assessment after surgical treatment of intra-abdominal infections and pancreatic necrosis has concentrated on postoperative complications and survival, while long-term results have received little attention. Objectives: To evaluate hospital costs and long-term outcome for patients undergoing open treatment of intraabdominal infection or pancreatic necrosis and to determine whether results justify costs.

Background: While patients’ needs for adequate preoperative information are generally recognized, data evaluating the effectiveness of the consultation before laparoscopic cholecystectomy have not been published until today. This prospective study was performed to investigate the success of preoperative information. Methods: A combination of oral and written information was given to all patients in two interviews. Information concentrated on indications for surgery, operative procedures, and risks. Patients were asked to answer questionnaires 5 days after the operation. Results: From January 1996 to January 1997, 200 patients were interviewed. Ninety-seven percent indicated to wish detailed information. Eighty-four percent indicated a high level of satisfaction with the presented information. While the levels of knowledge concerning indications for surgery and procedures were satisfactory in 85 and 51% respectively, only 30% were able to name at least one risk factor of laparoscopic cholecystectomy. Conclusion: This study demonstrated that patients’ evaluation of their surgical knowledge and the process by which it was communicated to them did not correspond to their ability to recall this information after surgery.