AIM:To perform a review of patients with colorectal cancer to a community hospital and to compare the risk-adjusted survival between patients managed in general surgical units versus a colorectal unit. METHODS:The stu...AIM:To perform a review of patients with colorectal cancer to a community hospital and to compare the risk-adjusted survival between patients managed in general surgical units versus a colorectal unit. METHODS:The study evaluated all patients with colorectal cancer referred to either general surgical units or a colorectal unit from 1/1996 to 6/2001.These results were compared to a historical control group treated within general surgical units at the same hospital from 1/1989 to 12/1994.A Kaplan- Meier survival analysis compared the overall survivals (all- cause mortality) between the groups.A Cox proportional hazards model was used to determine the influence of a number of independent variables on survival.These variables included age,ASA score,disease stage,emergency surgery, adjuvant chemotherapy and/or radiotherapy,disease location,and surgical unit. RESULTS:There were 974 patients involved in this study. There were no significant differences in the demographic details for thethree groups.Patients in the colorectal group were more likely to have rectal cancer and Stage Ⅰ cancers, and less likely to have Stage Ⅱ cancers.Patients treated in the colorectal group had a significantly higher overall 5-year survival when compared with the general surgical group and the historical control group (56 % versus 45 % and 40 % respectively,P<0.01).Survival regression analysis identified age,ASA score,disease stage,adjuvant chemotherapy,and treatment in a colorectal unit (Hazards ratio:0.67;95 % CI:0.53 to 0.84,P =0.0005),as significant independent predictors of survival. CONCLUSION:The results suggest that there may be a survival advantage for patients with colon and rectal cancers being treated within a specialist colorectal surgical unit.展开更多
BACKGROUND Upper gastrointestinal fishbone microperforations are rare and not commonly reported in medical literature.Despite the increasing use of computer tomography(CT)imaging and the employment of the Alvardo crit...BACKGROUND Upper gastrointestinal fishbone microperforations are rare and not commonly reported in medical literature.Despite the increasing use of computer tomography(CT)imaging and the employment of the Alvardo criteria,misdiagnosis of acute appendicitis can still occur.We report the rare case of an elderly Chinese gentleman who had a fish-bone induced microperforation of the duodenum that closely mimicked the symptoms of acute appendicitis.CASE SUMMARY This 79-year-old man presented with migratory lower abdominal pain that localized at his periumbilical region and right lower quadrant.He had associated pyrexia,general malaise and was noted to have an elevated white cell count.CT investigations initially revealed a distended appendix which was resected laparoscopically but showed no obvious signs of gross inflammation.The patient then deteriorated clinically and had increased oxygen requirements immediately after the surgery.This prompted further investigations.A further review of his CT scan revealed a fine fishbone microperforation in the distal duodenum associated with retroperitoneal abscess formation and seepage extending into the right lower quadrant.He was then started on broad spectrum intravenous antibiotics and subsequently underwent a laparotomy 12 h later to manage the obscure aetiology and to drain the abscess.The post-operative course was uneventful and he was discharged 11 d later including a 2-d stay in the intensive care unit.CONCLUSION This case offers an insight into a potential mimic of acute appendicitis and the diagnostic difficulties experienced in such presentations.展开更多
Our fascination with the nature of the human person has been a consistent driving force behind a variety of academic disciplines. This is especially evident within the domain of philosophy in general and within the mo...Our fascination with the nature of the human person has been a consistent driving force behind a variety of academic disciplines. This is especially evident within the domain of philosophy in general and within the more specialized areas of philosophy of mind and action in particular. Two issues that have been a mainstay throughout the history of philosophy can be encapsulated in the following two questions： what is the nature of mind （consciousness） and how does the mind causally interact with the world （agency）？展开更多
文摘AIM:To perform a review of patients with colorectal cancer to a community hospital and to compare the risk-adjusted survival between patients managed in general surgical units versus a colorectal unit. METHODS:The study evaluated all patients with colorectal cancer referred to either general surgical units or a colorectal unit from 1/1996 to 6/2001.These results were compared to a historical control group treated within general surgical units at the same hospital from 1/1989 to 12/1994.A Kaplan- Meier survival analysis compared the overall survivals (all- cause mortality) between the groups.A Cox proportional hazards model was used to determine the influence of a number of independent variables on survival.These variables included age,ASA score,disease stage,emergency surgery, adjuvant chemotherapy and/or radiotherapy,disease location,and surgical unit. RESULTS:There were 974 patients involved in this study. There were no significant differences in the demographic details for thethree groups.Patients in the colorectal group were more likely to have rectal cancer and Stage Ⅰ cancers, and less likely to have Stage Ⅱ cancers.Patients treated in the colorectal group had a significantly higher overall 5-year survival when compared with the general surgical group and the historical control group (56 % versus 45 % and 40 % respectively,P<0.01).Survival regression analysis identified age,ASA score,disease stage,adjuvant chemotherapy,and treatment in a colorectal unit (Hazards ratio:0.67;95 % CI:0.53 to 0.84,P =0.0005),as significant independent predictors of survival. CONCLUSION:The results suggest that there may be a survival advantage for patients with colon and rectal cancers being treated within a specialist colorectal surgical unit.
文摘BACKGROUND Upper gastrointestinal fishbone microperforations are rare and not commonly reported in medical literature.Despite the increasing use of computer tomography(CT)imaging and the employment of the Alvardo criteria,misdiagnosis of acute appendicitis can still occur.We report the rare case of an elderly Chinese gentleman who had a fish-bone induced microperforation of the duodenum that closely mimicked the symptoms of acute appendicitis.CASE SUMMARY This 79-year-old man presented with migratory lower abdominal pain that localized at his periumbilical region and right lower quadrant.He had associated pyrexia,general malaise and was noted to have an elevated white cell count.CT investigations initially revealed a distended appendix which was resected laparoscopically but showed no obvious signs of gross inflammation.The patient then deteriorated clinically and had increased oxygen requirements immediately after the surgery.This prompted further investigations.A further review of his CT scan revealed a fine fishbone microperforation in the distal duodenum associated with retroperitoneal abscess formation and seepage extending into the right lower quadrant.He was then started on broad spectrum intravenous antibiotics and subsequently underwent a laparotomy 12 h later to manage the obscure aetiology and to drain the abscess.The post-operative course was uneventful and he was discharged 11 d later including a 2-d stay in the intensive care unit.CONCLUSION This case offers an insight into a potential mimic of acute appendicitis and the diagnostic difficulties experienced in such presentations.
文摘Our fascination with the nature of the human person has been a consistent driving force behind a variety of academic disciplines. This is especially evident within the domain of philosophy in general and within the more specialized areas of philosophy of mind and action in particular. Two issues that have been a mainstay throughout the history of philosophy can be encapsulated in the following two questions： what is the nature of mind （consciousness） and how does the mind causally interact with the world （agency）？
