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BACKGROUND: Complete mesocolic excision (CME) seems to be associated with improved oncological outcomes compared with 'conventional' surgery, but there is a potential for higher morbidity. METHODS: Data for patients after elective resection at the four centres in the Capital Region of Denmark (June 2008 to December 2013) were retrieved from the Danish Colorectal Cancer Group database and medical charts. Approval from a Danish ethics committee was not required (retrospective study). RESULTS: Some 529 patients who underwent CME surgery at one centre were compared with 1701 patients undergoing 'conventional' resection at the other three hospitals. Laparoscopic CME was performed in 258 (48·8 per cent) and laparoscopic 'conventional' resection in 1172 (68·9 per cent). More extended right colectomy procedures were done in the CME group (17·4 versus 3·6 per cent). The 90-day mortality rate in the CME group was 6·2 per cent versus 4·9 per cent in the 'conventional' group (P = 0·219), with a propensity score-adjusted logistic regression odds ratio (OR) of 1·22 (95 per cent c.i. 0·79 to 1·87). Laparoscopic surgery was associated with a lower risk of mortality at 90 days (OR 0·63, 0·42 to 0·95). Intraoperative injury to other organs was more common in CME operations (9·1 per cent versus 3·6 per cent for 'conventional' resection; P < 0·001), including more splenic (3·2 versus 1·2 per cent; P = 0·004) and superior mesenteric vein (1·7 versus 0·2 per cent; P < 0·001) injuries. Rates of sepsis with vasopressor requirement (6·6 versus 3·2 per cent; P = 0·001) and postoperative respiratory failure (8·1 versus 3·4 per cent; P < 0·001) were higher in the CME group. CONCLUSION: CME is associated with more intraoperative organ injuries and severe non-surgical complications than 'conventional' resection for colonic cancer.

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BACKGROUND: Left ventricular hypertrophy is associated with adverse outcomes, including death, during cardiac surgery. This may be facilitated by an increased oxygen demand and diastolic dysfunction. Levosimendan augments haemodynamics without further oxygen consumption and improves echocardiographic indices of diastolic dysfunction. This study aimed to describe the haemodynamic effects of short-term pre- and intra-operative levosimendan infusion including advanced echocardiographic measures of diastolic and systolic heart function. METHODS: The study was randomised, double-blinded and placebo-controlled performed at a single-centre university hospital. Patients with left ventricular hypertrophy and ejection fraction > 45% scheduled for single procedure aortic valve replacement were included and randomised to infusion of either levosimendan 0.1 µg/kg/min or placebo from 4 h before anaesthesia to the end of surgery. Outcome measures were echocardiographic indices of left ventricular diastolic function: E/e' (primary endpoint), e', e'/a' and indices of systolic function: longitudinal strain, ejection fraction and s'. Patients were followed until 6 months after surgery. In addition, invasive haemodynamic measures were obtained perioperatively. RESULTS: The trial was prematurely terminated due to an overall high incidence of post-operative atrial fibrillation (15/20, P = 0.002) after inclusion of 20 patients. The relative decrease in perioperative cardiac index was lower (P = 0.016) in the levosimendan group. There was no difference in E/e', and similar results were found for all measures of systolic function. CONCLUSION: Short-term levosimendan caused a transient relative increase in cardiac index, but no effect was seen on the first post-operative day and up to 6 months post-operatively with indices of systolic and diastolic heart function.

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This article presents intervention strategies based on the Trauma Outcome Process, an integrated treatment model for guiding clinical practice with children with sexually abusive behavior problems. The steps for completing a comprehensive assessment are reviewed, and strategies are presented to help clinicians create a therapeutic alliance and increase these children's self-awareness of their thoughts, feelings, and body sensations. Treatment techniques based on an integrated approach combining cognitive-behavioral and expressive therapy approaches are described. These exercises help children accept responsibility for sexually inappropriate behavior and select adaptive responses for coping with the effects of traumatic experiences.

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This recidivism study retrospectively examined the juvenile court case records of 170 first-time juvenile sexual offenders in a 5-year observation period. Cox regression, a model of event history analysis, was used to test hypotheses and to build multivariate competing risk models predictive of criminal recidivism. The multivariate analyses found that nonsexual offense recidivism was significantly (p < .01) associated with (a) prior nonsexual offenses and (b) failure to complete treatment. Sexual offense recidivism was significantly associated with larger numbers of female victims, but results were inconclusive due to the small size (n = 13) of the sexual reoffending sample.

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Two cases of Marfan's syndrome with acute dissection in relation to labour are presented. One patient died of aortic rupture while the other was electively operated. The haemodynamic changes during pregnancy and labour can have catastrophic consequences. The Marfan patient must be well informed before pregnancy and carefully monitored during pregnancy and the peripartum period. Serial echocardiographic studies evaluating aortic root size and aortic valve function are essential. In case of severe cardiovascular manifestation the pregnancy should be interrupted.

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This paper presents a retrospective analysis of the fluid balance during the first 12 hours after laparotomy in 60 consecutive patients. The analysis showed that the majority of patients received greater volumes of crystalloid infusions than recommended, and that the actual number of blood transfusions given did in many circumstances not comply with the available guidelines. Perioperative fluid therapy is an area that needs increased attention since overhydration may contribute to cardiopulmonary morbidity. Perioperative fluid therapy regimens should be evaluated in future prospective, controlled, randomized trials.

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An unusual tumor in the descending colon with human chorionic gonadotropin-beta (HCG-beta) production and histological features of a "glassy cell" carcinoma is presented. Glassy cell carcinoma has been described in the uterus and fallopian tubes as well as the cervix, but in these locations the tumor is not HCG-beta producing. Glassy cell carcinomas have been described in some cases as having glandular and squamous differentiation as well as marked cellular pleomorphism. The tumors are generally associated with a poor prognosis.

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BACKGROUND: The mechanism of post-traumatic immunosuppression is still not known in detail. However, histamine released during trauma and major surgery may play a significant role in the process. Previously, we showed that the histamine-2 receptor antagonist (H2RA), ranitidine, reduced trauma-induced suppression of certain immunological parameters. STUDY DESIGN: The effect of perioperative ranitidine on postoperative change in plasma interleukin-6 (IL-6) and serum C-reactive protein (CRP) levels was assessed in 23 women undergoing elective abdominal hysterectomy. The patients were randomized to receive intravenous ranitidine, 100 mg twice a day from skin incision, for two days, followed by oral ranitidine, 150 mg twice a day, for a further three days, or no ranitidine. Interleukin-6 and CRP were analyzed in plasma and serum, respectively, drawn preoperatively and six, 24, 48, and 120 hours after skin incision. RESULTS: Routine blood analyses, clinical data (except age), duration of surgery, anesthesia, antibiotic prophylaxis, blood loss, and perioperative blood transfusion were similar in the two groups. Interleukin-6 levels were significantly increased in all patients and without difference between the ranitidine-treated and non-ranitidine-treated patients after six, 24, and 48 hours compared to preoperative levels, respectively. C-reactive protein levels were also significantly increased in all patients after 24, 48, and 120 hours, respectively; however, at 48 hours, CRP was significantly reduced in ranitidine-treated patients compared with non-ranitidine-treated patients (p = 0.02). CONCLUSIONS: These results suggest that histamine-2 receptor activation mechanisms may not be involved in postoperative IL-6 synthesis. However, the reduced CRP level in ranitidine-treated patients suggests that H2RAs modulate IL-6 signal transduction in hepatic cells.

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The analgesic efficacy of inguinal funicular block with 10 ml carbocaine 1% as a supplement to local infiltration analgesia of the vas deferens was investigated in patients undergoing vasectomy. Pain/discomfort during vasectomy and on the first and third day postoperatively were investigated using a questionnaire. Fifty-seven male patients scheduled for legal sterilization were randomized and allocated in a double-blinded manner to receive the 10 ml carbocaine 1% in the right or left side and 10 ml isotonic NaCl in the contralateral side, the patient then being his own control. There was significantly less intraoperative pain on the side of the active inguinal funicular block (p < 0.0001), but no significant differences were found at the first and third postoperative day (p = 1.16-1.19). Inguinal funicular block can be recommended as a supplement to the usual use of local infiltration analgesia of the vas deferens.

PIP: Vasectomy is performed routinely under local anesthesia without major complications. The most frequently used method is local infiltration analgesia (LIA) of the vas deferens at the site of the resection. During the period of August 1992 - February 1993, all men who were referred for vasectomy at the Frederikssund Hospital were solicited to participate in the study. The analgesic efficacy of inguinal funicular block (FB) with 10 ml carbocaine 1% as a supplement to LIA of the vas deferens was investigated. Pain and discomfort during vasectomy and on the first and third day postoperatively were investigated using a questionnaire. 57 healthy male patients scheduled for legal sterilization were randomized in a double blind manner to receive 10 ml carbocaine 1% in the right or left side and 10 ml isotonic NaCl in the contralateral side, the patient thereby serving as his own control. Six patients were excluded for inadequate answers to the questionnaire (5) or reoperation for bleeding (1) which could not be related to administration of analgesia. 42 (82%) of 51 patients had pain during the operation; 39 (76%) on the first day after the operation; and 29 (57%) on the third day postoperatively. The therapeutic effect with active FB as a supplement to LIA in the scrotal skin was 73% (p 0.0001). There was significantly less intraoperative pain on the side of the active inguinal funicular block (p 0.0001), but no significant differences were found at the first and third postoperative day (p=1.16-1.19). With active FB on the left side, the localization of pain was exclusively scrotal in 14% (3/12) and both abdominal and scrotal in 86% (18/21). With active FB on the right side, pain distribution was scrotal in 52% (11/21) and abdominal/scrotal in 48% (10/21). Inguinal funicular block can be recommended as a supplement to the routine use of local infiltration analgesia of the vas deferens.

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