No abstract

Mild perioperative hypothermia suppressed mitogen-induced activation of lymphocytes and reduced the production of certain cytokines, IL-1beta and IL-2, and in this way may contribute to the immune alterations observed in the perioperative period.

To examine the effect of patient's age and the location of diverticular disease on the course of the acute disease we retrospectively collected demographic data, symptoms, laboratory findings, imaging techniques, type of treatment (conservative vs. surgical), early and late complications, and follow-up data on 119 patients with acute diverticulitis (74 women, 45 men; mean age 64+/-14 years; follow-up 7-102 months, median 40). Patients were divided by their age into two groups (42 aged 60 years or younger, 77 aged over 60) and on the location of their disease (108 to the left of the middle transverse, 11 to the right). Lower abdominal pain, abdominal tenderness, and fever were the most common complaints (70-97%). In the younger patients we found a significantly greater preponderance in the right colon (P = 0.02) than in older patients. Abdominal abscesses and fistulas were more common in right-sided diverticulitis (P = 0.01). Patients with right-sided colon diverticulitis were treated surgically (82%) and on an emergency basis more often than patients with left-side colon diverticulitis (25%; P = 0.001). Older patients treated conservatively suffered more than younger patients (61% and 33% respectively; P = 0.04) from recurrent abdominal pain but not from recurrent, confirmed diverticulitis. Patients with right-sided diverticulitis treated conservatively suffered more from recurrent diverticulitis episodes than patients with left-sided diverticulitis (P = 0.05). Younger patients thus do not have a more aggressive form of diverticulitis than older patients. Patients with acute diverticulitis in the right colon are likely to be operated earlier and for mistaken diagnoses than patients with left-sided diverticulitis.

Spontaneous perforation of the small intestine in the newborn is rare. In most cases the etiology is unknown. Three cases of perforation in preterm newborn infants are described. The clinical diagnosis was necrotizing enterocolitis (NEC), and an urgent laparotomy was performed. The histologic examination was compatible with the diagnosis of a congenital defect of the intestinal musculature. All three infants survived.

Right hemicolectomy is the treatment of choice for adenocarcinoma of the appendix.

The efficiency of magnetic resonance imaging (MRI) and that of transrectal ultrasound (TRUS) were compared in preoperative staging of 15 patients with rectal cancer and in postoperative follow-up of 12 patients. Thirteen of the 15 patients evaluated for preoperative staging were operated on. Preoperative staging and pathologic finding were identical in 11 patients (84.6 percent) examined by TRUS and in 10 patients (76.9 percent) examined by MRI. Recurrent cancer was detected in 3 of 12 patients in the follow-up group. MRI was able to diagnose correctly 10 of 12 patients (83.2 percent), one patient was misdiagnosed, and in one patient the MRI could not distinguish between fibrous tissue and recurrent cancer. TRUS diagnosed correctly only 5 of 12 patients (41.6 percent). One was falsely diagnosed, and, in 6 patients (50 percent), this examination could not differentiate between fibrous tissue and recurrent tumor. According to our results, both MRI and TRUS have a place in the preoperative staging of patients with rectal cancer. The main differences between the two methods were in the differential diagnoses of fibrous tissue and recurrent cancer. MRI being more specific in detection of recurrence.

No abstract

A comparative study of preoperative evaluation of rectal cancer is presented. Sixty-eight patients with rectal cancer were examined digitally and by computerized tomography and transrectal ultrasound. Preoperative staging was compared with pathologic findings at surgery. Digital examination and transrectal ultrasound were accurate in 82.8 and 76.2 percent, respectively and were superior to CT, which was accurate in 65.5 percent of cases for assessment of rectal wall invasion. All three modes play a role in preoperative assessment, but digital examination and rectal ultrasound appear to be more effective.