The role of primary tumor resection (PTR) in synchronous patients with metastatic colorectal cancer (mCRC) who had unresectable metastases and few or absent symptoms of their primary tumor is unclear. Studying subgroups with low postoperative mortality may identify patients who potentially benefit from PTR.OBJECTIVE To determine the difference in 60-day mortality between patients randomized to systemic treatment only vs PTR followed by systemic treatment, and to explore risk factors associated with 60-day mortality.DESIGN, SETTING, AND PARTICIPANTS CAIRO4 is a randomized phase 3 trial initiated in 2012 in which patients with mCRC were randomized to systemic treatment only or PTR followed by systemic treatment with palliative intent. This multicenter study was conducted by the Danish and Dutch Colorectal Cancer Group in general and academic hospitals in Denmark and the Netherlands. Patients included between August 2012 and December 2019 with histologically proven colorectal cancer, unresectable metastases, and a primary tumor with few or absent symptoms were eligible.INTERVENTIONS Systemic treatment, consisting of fluoropyrimidine-based chemotherapy with bevacizumab vs PTR followed by fluoropyrimidine-based chemotherapy with bevacizumab. MAIN OUTCOMES AND MEASURESThe aim of the current analysis was to compare 60-day mortality rates in both treatment arms. A secondary aim was the identification of risk factors for 60-day mortality in the treatment arms. These aims were not predefined in the study protocol.RESULTS A total of 196 patients were included in the intention-to-treat analysis (112 [57%] men; median [IQR] age, 65 [59-70] years). Sixty-day mortality was 3% (95% CI, 1%-9%) in the systemic treatment arm and 11% (95% CI, 6%-19%) in the PTR arm (P = .03). In a per-protocol analysis, 60-day mortality was 2% (95% CI, 1%-7%) vs 10% (95% CI, 5%-18%; P = .048). Patients with elevated serum levels of lactate dehydrogenase, aspartate aminotransferase, alanine aminotransferase, and/or neutrophils who were randomized to PTR had a significantly higher 60-day mortality than patients without these characteristics.CONCLUSIONS AND RELEVANCE Patients with mCRC who were randomized to PTR followed by systemic treatment had a higher 60-day mortality than patients randomized to systemic treatment. Especially patients randomized to the PTR arm with elevated serum levels of lactate dehydrogenase, neutrophils, aspartate aminotransferase, and/or alanine aminotransferase were at high risk of postoperative mortality. Final study results on overall survival have to be awaited.

Objective To evaluate whether post-operative blood lossResults The post-operative blood loss correlated significantly with the per-operative loss (P=0.047) and the in patients with benign prostatic hyperplasia, undergoing transurethral resection of the prostate (TURP), weight of resected tissue (P=0.029). There was a highly significant correlation between the area under depends on in situ fibrinolysis in urine, and to determine the relative contributions of the urokinase and the curve of FbDP in the urine and the post-operative blood loss (P<0.005), while there was no significant tissue-type plasminogen activator systems. Patients and methods TURP was performed in 24 men positive correlation between the PA concentration or activity in the urine and post-operative blood loss. (median age 68.5 years, range 52-78) and the weight of resected tissue, the operative and post-operativeThere was a significant correlation between the urinary t-PA activity and the amount of FbDP in the blood loss determined. The concentrations of the urokinase-(u-PA) and tissue-type plasminogen actiurine (P=0.047), and a significant correlation between the weight of resected tissue and the amount vator (t-PA)-related fibrinolysis in their urine was followed using sensitive and specific assays, and the of FbDP in the urine (P=0.014). Conclusion The post-operative blood loss after TURP is changes related to post-operative blood loss. Measurements of the urinary concentrations of free significantly related to an increase of the urinary fibrinolytic activity and the enhanced fibrinolytic t-PA activity, t-PA antigen, free u-PA activity, u-PA antigen and fibrin degradation products (FbDP) were activity is probably caused by t-PA. Keywords In situ fibrinolysis, blood loss, transurethral determined and the area under the curve for each of these quantities correlated with the post-operative prostatic resection blood loss.antifibrinolytic drugs on post-operative blood loss [6][7][8][9].

OBJECTIVE Earlier reports have shown different effects of levothyroxlne in the prevention of recurrence of non-toxic goltre after operation. These studies have been either retrospectlve or of short-term follow-up. This study was designed to evaluate the efficacy of long-term Eitroxln treatment (levothyroxlne 0.1 mg daily) In the prevention of Postsperatlve recurrence of non-toxic goitre. DESIGN Randomized prospective non-placebo controlled Study with 9 years follow-up. Group A (11-40) received levothyroxine and group B (11=60) did not. PATIENTS One hundred patients consecutively operated for non-toxic goitre. All cllnlcaily and biochemically 8 U -W o l d and none taklng any thyrold andlor antithyroid medication. MEASUREMENTS T3, T4, TSH, thyroid antibodies (mlcro-Somallthyroglobulln). welght and neck circumference Were measured and thyroid palpation were done preoperatlvely, 3 and 12 months after surgery and thereafter Yearly up to 9 years. RESULTS Sixty-nine patients completed 9 years follow-UP. lncldence of recurrence In group A YS group B was 14.5 "8 21.8% (P

Objective To evaluate whether the activation of the increase in systemic t-PA activity and t-PA antigen, coinciding with a significant drop in PAI activity. Postextrinsic tissue-type plasminogen activator-related fibrinolysis is implicated in the blood loss in patients operatively, PAI activity and PAI-1 antigen increased. The formation of plasmin was indicated by a fall in with benign prostatic hyperplasia, undergoing transurethral prostatic resection (TURP).the plasma concentration of Plg activity and Plgantigen and a 2 -AP but which increased significantly Patients and methods TURP was performed in 24 men and the operative and post-operative blood loss deterat the end of the study period. Increased systemic fibrinolytic activity was further confirmed by a marked mined. The activation of the tissue-type plasminogen activator-related fibrinolysis was followed using new increase in fibrin d-dimer and FbDP. There was no correlation between the AUC in the operative period sensitive and specific assays, and the changes related to the blood loss. Measurements of the plasma concenof any of the fibrinolytic variables and the measured blood loss. In the post-operative period, t-PA antigen trations of free tissue-type plasminogen activator (t-PA) activity, tissue-type plasminogen activator (t-PA) anti-(P=0.004), PAI activity (P=0.043), PAI-1 antigen (P=0.016) and a 2 -AP (P=0.047) all correlated with gen, plasminogen activator inhibitor (PAI) activity, plasminogen activator inhibitor 1 (PAI-1) antigen, the post-operative blood loss, while there was no correlation between fibrin d-dimer or FbDP and plasminogen (Plg) activity, plasminogen (Plg) antigen, a 2 -antiplasmin (a 2 -AP), d-dimer and fibrin degradation blood loss. Conclusion The fibrinolytic system is activated during products (FbDP) were all determined and the area under the curve (AUC) for each of these quantities and after TURP, but the increased activity is not of pathophysiological importance for the blood loss. correlated with the blood loss. Results TURP was followed by a marked activation of Keywords Fibrinolysis, blood loss, transurethral prostatic resection the fibrinolytic system. There was an immediate [9][10][11][12]. Only a few have attempted to ascertain whether

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