PubMed · 14799686
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G T HARDING. 1951. Irritable colon.. https://doi.org/10.1016/0002-9610(51)90180-8
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"Fast-track"-surgery -- also called "fast-track"-rehabilitation -- is an interdisciplinary, multimodal concept to accelerate postoperative reconvalescence and reduce general morbidity. "Fast-track"-rehabilitation focuses on preoperative patient education, atraumatic and minimal-invasive access to the operative field, optimized anesthesia under normovolemia and prevention of intraoperative hypoxia and hypothermia, effective analgetic therapy without high systemic doses of opioids, enforced postoperative patient mobilisation, early postoperative oral feeding, and avoidance of tubes and drains. "Fast-track"-rehabilitation plans have been published for numerous operative procedures in general-, visceral-, vascular- and thoracic surgery, as well for orthopaedic, urological and gynaecological operations. Until today, "fast-track"-rehabilitation was evaluated most thoroughly in elective colonic surgery. Here, the multimodal regime decreased general morbidity from 20 - 30 % to below 10 %, while postoperative hospital stay was reduced from 10 - 15 to 2 - 5 days. "Fast-track"-rehabilitation for major surgery should be evaluated in randomised, controlled trials.
There is an important need for a high-specificity approach to colorectal cancer. Approximately 50% of colorectal tumors contain K-ras gene mutations, which occur as an early step in carcinogenesis. K-ras mutations were detectable not only in tumors but also in microscopically normal colorectal mucosa close to carcinomas in some patients with colorectal cancer. This is the first systematic analysis of K-ras mutations in normal colonic mucosa at multiple consistently-selected locations. A total of 480 normal colonic mucosal samples were obtained from 80 subjects, including 65 patients with sporadic colorectal cancer and 15 controls in whom a colorectal neoplasm was ruled out endoscopically. Normal mucosal samples were obtained at multiple consistently-selected locations using biopsy forceps during colonoscopy. Mutant allele-specific amplification (MASA)-PCR was performed; this could detect a K-ras mutation in normal colonic mucosa even though it was only sparsely present. The K-ras mutation was found in histologically normal mucosa from colorectal cancer patients (20 of 65 cases; 41 of 390 loci) by MASA-PCR, especially frequent (51%; 19 of 37 cases) when the tumor showed a K-ras mutation. In contrast, no mutation was found in normal mucosa from 15 controls (90 loci). K-ras mutation in normal mucosa showed a significant association with the presence of colorectal cancer (p = 0.008). The specificity of the MASA-PCR method for colorectal neoplasms was thus 100%. We conclude that detection of K-ras mutations in normal colonic mucosa might serve as a high-specificity approach to colorectal cancer.
The transverse colon is an exceptional location of intestinal duplication. Perforated duplications are rarely described in neonates. Meconium peritonitis (MP) can originate from prenatal perforated intestinal duplication. The authors report a case of a baby girl with prenatal diagnosis of MP. Rapid worsening of clinical aspects at birth and the presence of a pneumoperitoneum on systematic abdominal plain radiographs led to urgent surgery on the 1st day of life. Laparotomy showed a perforated necrotizing tubular duplication of the transverse colon. Removal of the duplication followed by limited segmental colonic resection and double colostomy were carried out. Follow-up was uneventful.