Laparoscopic vs. open colectomy in cancer patients: long-term complications, quality of life, and survival

PURPOSE

This study was designed to evaluate long-term complications, quality of life, and survival rate in a series of colorectal cancer patients randomized to laparoscopic or open surgery.

METHODS

A total of 391 patients with colorectal cancer were randomly assigned to laparoscopic (n = 190) or open (n = 201) resection. Long-term follow-up was performed every six months by office visits. Quality of life was assessed at 12, 24, and 48 months after surgery by a modified version of Short Form 36 Health Survey questionnaire. All patients were analyzed on an intention-to-treat basis.

RESULTS

Eight (4.2 percent) laparoscopic group patients needed conversion to open surgery. Overall long-term morbidity rate was 6.8 percent (13/190) in the laparoscopic vs. 14.9 percent (30/201) in the open group (P = 0.018). Overall quality of life was significantly better in the laparoscopic group in the first 12 months after surgery, whereas at 24 months, patients of the laparoscopic group reported a significant advantage only in social functioning. No difference was found in both overall and disease-free survival rates by comparing laparoscopic vs. open group.

CONCLUSIONS

Laparoscopic colorectal resection was associated with a lower incidence of long-term complications and a better quality of life in the first 12 months after surgery compared with open surgery. No difference between groups was found in overall and disease-free survival rates.

Laparoscopic colorectal surgery modifies risk factors for postoperative morbidity

PURPOSE

The aim of this study was to evaluate whether laparoscopic colorectal surgery can modify the risk factors for the occurrence of postoperative morbidity.

METHODS

A total of 384 consecutive patients with colorectal disease were randomized to laparoscopic resection (n = 190) or open resection (n = 194). On admission, demographics, comorbidity, and nutritional status were recorded. Operative variables, patient outcome, and length of stay were also recorded. Postoperative complications were registered by four members of staff not involved in the study.

RESULTS

The overall morbidity rate was 27.1 percent, with the rate in the laparoscopic group (18.7 percent) being less than that in the open group (31.5 percent; P = 0.003). Patients who underwent laparoscopic resection had a faster recovery of bowel function (P = 0.0001) and a shorter length of stay (P = 0.0001). In the whole cohort of patients, multivariate analysis identified open surgery (P = 0.003), duration of surgery (P = 0.01), and homologous blood transfusion (P = 0.01) as risk factors for postoperative morbidity. In the open group, blood loss (P = 0.01), homologous blood transfusion (P = 0.01), duration of surgery (P = 0.009), weight loss (P = 0.06), and age (P = 0.08) were related to postoperative morbidity. In the laparoscopic group the only risk factor identified was duration of surgery (P = 0.005).

CONCLUSION

In the laparoscopic group, both postoperative morbidity and length of stay were significantly reduced and most risk factors for postoperative morbidity disappeared.

Glial cell line-derived neurotrophic factor induces histologic and functional protection of rod photoreceptors in the rd/rd mouse

PURPOSE

To evaluate the neuroprotective potential of glial cell line-derived neurotrophic factor (GDNF) in the retinal degeneration (rd/rd) mouse model of human retinitis pigmentosa.

METHODS

Subretinal injections of GDNF were made into rd/rd mice at 13 and 17 days of age and electroretinograms (ERGs) recorded at 22 days. Control mice received saline vehicle injections or underwent no procedure. At 23 days of age, retinas from treated and control mice were fixed and processed for wholemount immunohistochemistry using an anti-rod opsin antibody, and rod numbers were estimated using an unbiased stereological systematic random approach. Subsequent to counting, immunolabeled retinas were re-embedded and sectioned in a transverse plane and the numbers of rods recalculated.

RESULTS

Although ERGs could not be recorded from sham-operation or nonsurgical rd/rd mice at 22 days of age, detectable responses (both a- and b-waves) were observed in 4 of 10 GDNF-treated mice. Stereological assessment of immunolabeled rods at 23 days showed that control rd/rd retinas contained 41,880+/-3,890 (mean +/- SEM; n = 6), phosphate-buffered saline (PBS)-injected retinas contained 61,165+/-4,932 (n = 10; P < 0.001 versus control retinas) and GDNF-injected retinas contained 89,232+/-8,033 (n = 10; P < 0.001 versus control retinas, P < 0.002 versus PBS). This increase in rod numbers after GDNF treatment was confirmed by cell counts obtained from frozen sections.

CONCLUSIONS

GDNF exerts both histologic and functional neuroprotective effects on rod photoreceptors in the rd/rd mouse. Thus rescue was demonstrated in an animal model of inherited retinal degeneration in which the gene defect was located within the rods themselves, similar to most forms of human retinitis pigmentosa. GDNF represents a candidate neurotrophic factor for palliating some forms of hereditary human blindness.

Retinitis pigmentosa: rod photoreceptor rescue by a calcium-channel blocker in the rd mouse

Retinitis pigmentosa is an inherited degenerative disease of photoreceptors leading to blindness. A well-characterized model for this disease is provided by the retinal degeneration mouse, in which the gene for the rod cGMP phosphodiesterase is mutated, as in some affected human families. We report that D-cis-diltiazem, a calcium-channel blocker that also acts at light-sensitive cGMP-gated channels, rescued photoreceptors and preserved visual function in the retinal degeneration mouse. The long record of diltiazem prescription in cardiology should facilitate the design of clinical trials for some forms of retinitis pigmentosa.

Cellular retinol-binding protein I is essential for vitamin A homeostasis

The gene encoding cellular retinol (ROL, vitA)-binding protein type I (CRBPI) has been inactivated. Mutant mice fed a vitA-enriched diet are healthy and fertile. They do not present any of the congenital abnormalities related to retinoic acid (RA) deficiency, indicating that CRBPI is not indispensable for RA synthesis. However, CRBPI deficiency results in an approximately 50% reduction of retinyl ester (RE) accumulation in hepatic stellate cells. This reduction is due to a decreased synthesis and a 6-fold faster turnover, which are not related to changes in the levels of RE metabolizing enzymes, but probably reflect an impaired delivery of ROL to lecithin:retinol acyltransferase. CRBPI-null mice fed a vitA-deficient diet for 5 months fully exhaust their RE stores. Thus, CRBPI is indispensable for efficient RE synthesis and storage, and its absence results in a waste of ROL that is asymptomatic in vitA-sufficient animals, but leads to a severe syndrome of vitA deficiency in animals fed a vitA-deficient diet.

Differential distribution of dystrophins in rat retina

PURPOSE

Duchenne muscular dystrophy is frequently associated with a reduced amplitude of b-wave under scotopic conditions in the electroretinogram. This suggests that the dystrophin gene-encoded proteins play a role in retinal neurotransmission. The abnormal neurotransmission has been attributed to altered expressions of C-terminal products of the dystrophin gene in the outer plexiform layer, where photoreceptor cells form synapses with secondary neurons. The present study was undertaken to determine the cellular distribution of each member of the dystrophin superfamily in rat retina.

METHODS

Examined in the study were the developmental pattern of dystrophins in rat retinae that exhibit inherited progressive photoreceptor degeneration; dystrophins messengers expression in the outer and the inner retina of normal rats, prepared by mechanical fractionation through the outer plexiform layer; and immunolocalization of dystrophin proteins and utrophin in normal and degenerated adult rat retinae, with several antibodies prepared against specific regions of the dystrophin superfamily.

RESULTS

The results showed that Dp260 is exclusively localized in photoreceptor cells; Dp140 seems to be present in perivascular astrocytes; the exon 78 spliced isoform of Dp71 and the unspliced form are located in Müller glial cells and in perivascular astrocytes, respectively. Müller glial cells also contain utrophin.

CONCLUSIONS

Although the role of these membrane cytoskeletal proteins remains to be elucidated in retina, the results support the hypothesis that b-wave reduction may be caused by molecular anomalies of C-terminal products of the dystrophin gene expressed in both neuron and glial cells.

Benefit of against-the-rule astigmatism to uncorrected near acuity

PURPOSE

To determine whether with-the-rule (WTR) or against-the-rule (ATR) astigmatism gives a better visual outcome after cataract and intraocular lens (IOL) implantation surgery by comparing the uncorrected distance and near visual acuities in eyes with low, simple, myopic residual astigmatism.

SETTING

S. Geraldo Eye Hospital, Federal University of Minas Gerais, Belo Horizonte, Brazil.

METHODS

Two groups of 10 eyes each, one with WTR and the other with ATR simple, myopic astigmatism, were studied after uneventful cataract and IOL implantation surgery. All patients had an uncorrected distance visual acuity of 20/40 or better. The negative cylinder ranged from 1.00 to 1.50 diopters (D). The uncorrected distance and near visual acuities of the two groups were compared.

RESULTS

There was no statistically significant between-group difference in uncorrected distance visual acuity. However, for uncorrected near, the difference between groups was highly statistically significant (P < .001). Patients with ATR astigmatism had much better uncorrected near acuity than those with WTR astigmatism.

CONCLUSION

In pseudophakia, low, simple, ATR myopic astigmatism is better than WTR astigmatism because it provides superior uncorrected near visual acuity.

Osteoid osteoma of the vertebral body. A case report

The authors describe a case of osteoid osteoma localised in the body of a lumbar vertebra. This rare localisation--the tenth case described in the literature--and its associated drug-dependency and serum positivity for HTL3 justify its addition to the literature. In addition to an accurate history, the diagnosis requires scintigraphy with Tc 99 and CT scan. The latter is needed so that a correct surgical approach may be planned.