Laparoscopic versus open resection in locally advanced rectal cancers: a propensity matched analysis of oncological and short-term outcomes

AIM

The aim was to compare oncological and short-term outcomes between open and laparoscopic surgery in locally advanced rectal cancers.

METHODS

It is a retrospective analysis conducted in a high volume tertiary centre. Matching was carried out for nine variables, including preoperative factors, neoadjuvant treatment and sphincter preservation.

RESULTS

Both the open and laparoscopic surgery arms had 239 patients each. The distributions of pretreatment MRI T3, T4, circumferential resection margin (CRM) positive tumours, neoadjuvant long-course chemoradiation and sphincter preservation were 80.3%, 13.6%, 50%, 89% and 56.4% respectively. The mean number of nodes harvested (12.9 vs. 12.7, P = 0.716), pathological CRM positivity (6.3% in open vs. 5.4% in laparoscopic, P = 0.697) and distal resection margins were similar. The mean blood loss was higher in open surgeries (910 ml vs. 349 ml, P < 0.001). Anastomotic leaks and Clavien-Dindo Grade 3-4 complications were higher in the open arm than in the laparoscopy arm (5.9% vs. 1.7%, P = 0.024, and 12.5% vs. 6.7%, P = 0.015 respectively). The median postoperative hospital stay was significantly shorter in the laparoscopy arm (7 vs. 6, P = 0.015). In CRM positive and threatened cases, the measured outcomes were similar between the two groups except for blood loss which was significantly higher in the open surgery (872 vs. 379, P = 0.000).

CONCLUSIONS

In high volume centres, in the hands of experienced colorectal surgeons, laparoscopic rectal surgery is oncologically safe in locally advanced rectal cancers and has lesser morbidity and shorter hospital stay than open surgery. In CRM positive and threatened cases the laparoscopic surgery showed less blood loss compared to open surgery, while other outcome measures were similar to open surgery.

Morphology and innervation of brachioradialis and flexor carpi radialis and their utility in tendon transfer surgeries: A Cadaveric Study

INTRODUCTION

The Brachioradialis (BR) muscle flap is easy to harvest, provides a stable coverage to the cubital fossa as it is well vascularized. The BR andflexor carpi radialis (FCR) tendons are utilized in tendon transfer to restore the normal hand function. Therefore, the present study describes the morphology of the muscle bellies and the tendons of BR and FCR along with their pattern of innervation.

MATERIALS AND METHODS

The study was carried out on 27 upper limbs of formalin-fixed, adult human cadavers. Length and width of the bellies of BR and FCR were measured. The number of motor branches and their distances from the bi-epicondylar line was measured.

RESULTS

The mean lengths of BR and FCR bellies were 21.22±2.18cm and 16.15±2.39cm, and the lengths of their tendons were, 12.67±1.13cm and 12.48±1.72cm respectively. BR received a single motor branch in 19 upper limbs. However, FCR received single motor branch in 25 limbs as a common trunk. One upper limb received three motor branches to BR, and two upper limbs received two motor branches to FCR. The most proximal and distal branches to the BR were ranged between 6.3-2.2cm proximal to the bi-epicondylar line. Those to the FCR were ranged between 3.5-6.9cm distal to the bi-epicondylar line.

CONCLUSION

The motor branches to the BR and FCR are variable in their origin, and the knowledge of such variations is essential for identifying them while performing selective neurotomy surgeries.

Femoral Neck Anteversion and Neck Shaft Angles: Determination and their Clinical Implications in Fetuses of Different Gestational Ages

Precise anatomical assessment of femoral neck anteversion (FNA) and the neck shaft angles (NSA) would be essential in diagnosing the pathological conditions involving hip joint and its ligaments. The present study was undertaken on 48 fetal femurs to calculate the NSA and FNA in fetuses digitally. End on images of upper end of the femurs were taken for the estimation of FNA and a photograph in a perpendicular plane was taken to calculate the NSA. Microsoft Paint software was used to mark the points and Image J software was used to calculate the angles digitally. The FNA ranged from 17.08º to 33.97 º on right and 17.32 º to 45.08 º on left. The NSA ranged from 139.33 º to 124.91 º on right and 143.98 º to 123.8 º on left. Unpaired t test showed the FNA and NSA of femur did not vary significantly during the third trimester.

In situ atomic force microscopy tip-induced deformations and Raman spectroscopy characterization of single-wall carbon nanotubes

In this work, an atomic force microscope (AFM) is combined with a confocal Raman spectroscopy setup to follow in situ the evolution of the G-band feature of isolated single-wall carbon nanotubes (SWNTs) under transverse deformation. The SWNTs are pressed by a gold AFM tip against the substrate where they are sitting. From eight deformed SWNTs, five exhibit an overall decrease in the Raman signal intensity, while three exhibit vibrational changes related to the circumferential symmetry breaking. Our results reveal chirality dependent effects, which are averaged out in SWNT bundle measurements, including a previously elusive mode symmetry breaking that is here explored using molecular dynamics calculations.

Long-term monitoring and proposed diffuse pollution control of a tropical reservoir

This paper presents the results of 30 years of water quality monitoring in a tropical water supply reservoir (Vargem das Flores, Brazil). This water body is subjected to eutrophication problems caused by point sources (discharge of untreated sewage) and diffuse pollution (agricultural use in the drainage basin). Emphasis is given here on the estimation of nutrient loads and on the study of the N/P ratio in the water body. In spite of the prevalence of high N/P values, there is a clear trend in the dominance of cyanobacteria in the phytoplankton, which contradicts results from research in temperate aquatic environments. Some restoration measures for Vargem das Flores Reservoir are currently being implemented: construction of wastewater treatment plants, control of recreational activities, erosion control by hydroseeding and use of natural wetlands. Finally some management strategies in order to prevent algae input in the water abstraction system are discussed. Examples of these techniques are the installation of plastic barriers and the construction of an air curtain device.

Digital image processing measurement of the upper eyelid contour in Graves disease and congenital blepharoptosis

OBJECTIVE

This study used image processing techniques to quantify the upper eyelid contour of patients with Graves upper eyelid retraction and congenital blepharoptosis.

DESIGN

The study design was a cross-sectional study.

PARTICIPANTS

A total of 29 patients with Graves disease, 22 patients with congenital blepharoptosis, and 50 patients with no history of eye disease participated.

INTERVENTION

The images of the palpebral fissure of all participants were transferred to a personal computer and processed with NIH Image 1.55 software.

MAIN OUTCOME MEASURES

The following parameters were analyzed: the curvature of the upper eyelid contour, the position of the contour peak relative to the midline, and the ratio between the temporal and nasal upper quadrant areas of the palpebral fissure.

RESULTS

All upper eyelid contours could be fitted with second-degree polynomial functions. The mean temporal/nasal area ratio was 1.33 mm in patients with Graves disease, 0.92 mm in patients with blepharoptosis, and 1.04 mm in control subjects. The peak of the upper eyelid contour was found to be lateral to the midline in control subjects (1.05 mm) and in patients with Graves disease (2.09 mm). In patients with blepharoptosis, the peak was 0.69 mm medial to the midline. Overall, the distance between the midpupil and the upper eyelid margin was correlated with several factors: the degree of curvature, the position of the peak of the eyelid contour, and the temporal/nasal area ratio.

CONCLUSIONS

In Graves eyelid retraction, the curvature of the upper eyelid is enhanced, the peak of the contour is displaced laterally, and the temporal upper quadrant area is increased. Conversely, in congenital blepharoptosis, the eyelid is almost flat, the peak of the contour is displaced medially, and the upper quadrant area is diminished. The lateral segment of the upper eyelid is more involved than the nasal segment in both Graves upper eyelid retraction and congenital blepharoptosis.