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Oliveira do Hospital, Portugal

Brown S.R.,Surgery
Cochrane database of systematic reviews (Online) | Year: 2010

Although conventional colonoscopy is the most sensitive test available for the investigation of the colorectum for polyps, there are data that raise concerns about its sensitivity. Chromoscopy may be one way of enhancing the ability for colonoscopy to detect polyps particularly diminutive flat lesions that may be otherwise difficult to detect. To determine whether the use of chromoscopy enhances detection of polyps and neoplasia during endoscopic examination of the colon and rectum. MEDLINE, EMBASE and the Cochrane Library databases were searched (April 2010) along with a hand search of abstracts from relevant meetings. Search terms included randomised trials containing combinations of the following: 'chromoscopy' 'colonoscopy' 'dye-spray' 'chromo-endoscopy' 'indigo-carmine' 'magnifying endoscopy'. All prospective randomised trials comparing chromoscopic with conventional endoscopic examination of the lower gastrointestinal tract were included. Patients with inflammatory bowel disease or polyposis syndromes were excluded. Two reviewers assessed the methodological quality of potentially eligible trials and independently extracted data from the included trials. Outcome measures included the detection of polyps (neoplastic and non-neoplastic), the detection of diminutive lesions, the number of patients with multiple neoplastic lesions and the extubation time. Five trials were included in this update, and although there were some methodological drawbacks and differences in study design, combining the results showed a significant difference in favour of chromoscopy for all detection outcomes. In particular, chromoscopy is likely to yield significantly more patients with at least one neoplastic lesion (OR 1.67 (CI 1.29-2.15)) and significantly more patients with three or more neoplastic lesions (OR 2.55 (CI 1.49-4.36)). Not surprisingly the withdrawal times were significantly slower for the chromoscopy group. There appears to be strong evidence that chromoscopy enhances the detection of neoplasia in the colon and rectum. Patients with neoplastic polyps, particularly those with multiple polyps, are at increased risk of developing colorectal cancer. Such lesions, which presumably would be missed with conventional colonoscopy, could contribute to the interval cancer numbers on any surveillance programme.

Cina C.S.,Surgery
Journal of Vascular Surgery | Year: 2010

Endovascular repair is an established modality of treatment for abdominal aortic aneurysms. It is therefore reasonable to expect its application to other less common aneurysmal conditions, including isolated iliac and popliteal artery aneurysms (PAA). There are, however, essential differences between aortic aneurysms and peripheral aneurysms: smaller arterial caliber, mobility of the arterial segment, associated occlusive disease, and devices that have not been specifically designed for peripheral applications. Due to these differences, results obtained in abdominal aortic aneurysms cannot be extrapolated to peripheral aneurysms. The attraction of the endovascular repair for PAA is its minimally invasive nature. The literature, however, provides only case reports, case series and small cohorts, and one small randomized, controlled trial. A cumulative summary of these studies provides the clinician with information upon which to base the choice of treatment on a specific patient. Endovascular repair for PAA with suitable anatomy and good run-off can be considered safe, and medium term results appear comparable with those of open repair. © 2010 Society for Vascular Surgery.

This small study in Essex has shown that MSF is seen as a tool with the potential to identify learning needs and help participants change their behaviour. However, while it is seen as a tool with potential it has not been shown to have significant educational impact on established GPs. Trainees have been able to take advantage of a clear-cut system; a well-researched and designed tool and an opportunity to discuss findings, educational needs and plans with another doctor who has observed their work. Even so, the process does not appear to be good at identifying and encouraging changes in clinical behaviour. This suggests that the nMRCGP tool may need to be revised. Established GPs will need to develop a trusted tool and a recognised pathway to encourage them to make best use of the MSF process.

Schwartz A.J.,Surgery
Journal of Arthroplasty | Year: 2012

The purpose of this multicenter study is to determine the utility of the erythrocyte sedimentation rate, C-reactive protein, and synovial fluid white blood cell (WBC) count and differential for evaluating periprosthetic joint infection (PJI) in patients with a failed unicompartmental knee arthroplasty (UKA). A total of 259 patients undergoing revision of a failed UKA were reviewed; 28 (10.8%) met the study criteria for PJI. The optimal cutoff values were 27 mm/h for the erythrocyte sedimentation rate, 14 mg/L for the C-reactive protein, 6200/. μL for the synovial fluid WBC count, and 60% for the differential. These tests are useful for diagnosing PJI after UKA with optimal cutoff values that are similar to those used for total knee arthroplasty; however, the optimal synovial WBC count was found to be somewhat higher, which may be related to the unresurfaced compartments. In addition, we found that nearly half of patients had suboptimal evaluation for PJI. © 2012 Elsevier Inc..

Jones K.I.,University of Oxford | Doleman B.,Surgery | Scott S.,Surgery | Lund J.N.,University of Nottingham | Williams J.P.,University of Nottingham
Colorectal Disease | Year: 2015

Aim: Radiologically assessed muscle mass has been suggested as a surrogate marker of functional status and frailty and may predict patients at risk of postoperative complications. We hypothesize that sarcopenia negatively impacts on postoperative recovery and is predictive of complications. Method: One hundred patients undergoing elective resection for colorectal carcinoma were included in this study. Lean muscle mass was estimated by measuring the cross-sectional area of the psoas muscle at the level of the third lumbar vertebra identified on a preoperative CT scan, normalizing for patient height. Perioperative morbidity was scored according to the Clavien-Dindo classification. All statistical data analyses were carried out using the Statistical Package for the Social Sciences (SPSS) version 20.0. Results: Fifteen per cent of patients were identified as sarcopenic. There were no deaths in the study group. Sarcopenia was associated with a significantly increased risk of developing major complications (Grade 3 or greater, OR = 5.41, 95% CI: 1.45-20.15, P = 0.01). Sarcopenia did not predict length of stay, critical care dependency or time to mobilization. Conclusion: Sarcopenia, as a marker of frailty, is an important risk factor in surgical patients but difficult to estimate using bedside testing. CT scans, performed for preoperative staging, provide an opportunity to quantify lean muscle mass without additional cost or exposure to radiation and eliminate the inconvenience of further investigations. © 2015 The Association of Coloproctology of Great Britain and Ireland.

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