ObjectiveThe aim of the study was to determine whether the introduction of the Enhanced Recovery after Surgery (ERAS) protocol in laparoscopic total mesorectal excision (TME) for rectal cancer offers additional advantages concerning postoperative hospital stay compared to laparoscopy and conventional care.MethodsA consecutive series of patients that underwent a laparoscopic TME for rectal cancer in a single institution between January 2004 and July 2009 were retrospectively included in this study. The ERAS protocol was introduced in this cohort in January 2007. The study cohort was divided in a conventional care group and an ERAS group. Both groups were compared for primary and secondary outcome measures. The primary outcome measure was postoperative length of hospital stay.ResultsSeventy-six patients were included: 43 in the ERAS group and 33 in the conventional care (control) group. Median hospital stay was 7 days (range 2–83 days) in the ERAS group and 10 days (range 4–74 days) in the control group (p = 0.04). Return of bowel function occurred on days 2 and 3 respectively (p < 0.001). There were no significant differences between both groups concerning postoperative complications, readmission rate and reoperations. Thirty-day mortality was absent in both groups.ConclusionThese results suggest that the introduction of the ERAS protocol in laparoscopic TME leads to a further reduction in length of hospital stay.

The postoperative length of stay was significantly reduced in the ERAS group without differences in patient outcome. It is suggested that these results are the effect of a combination of the ERAS protocol with laparoscopic colectomy.

Background and Aims:To evaluate wire-guided localization for nonpalpable breast cancer regarding procedure and surgery-related outcome in a nonteaching community hospital in the Netherlands.Material and Methods: A consecutive series of 117 patients who were treated with breastconserving surgery after wire-guided localization for nonpalpable breast cancer between January 2006 and December 2010 was retrospectively analyzed. The patients' digital records were reviewed for patient, radiological, histological, and surgical characteristics. In order to quantify the excess resected tissue, a calculated resection ratio was determined by dividing the total resection volume by the optimal resection volume. The optimal resection volume was defined as a spherical tumor volume with an added 1.0 cm margin. The total resection volume was defined as the corresponding ellipsoid.Results: There were no procedure-related complications. There were two postoperative hemorrhages. Margins were clear in 92.3% of the cases after the first surgical procedure. Eight (6.8%) patients required two operations and one (0.9%) patient required three operations in order to obtain negative margins. Breast conservation was possible in 113 (96.6%) patients. The median calculated resection ratio was 1.87 (range 0.47-14.92).Conclusions: This study proves that it is possible to obtain excellent results performing breast-conserving surgery for nonpalpable breast cancer regarding margin status, total amount of operations, and the ratio between tumor and resected tissue volume using wireguided localization as a localization tool.

The nose occupies a central position on the face, dictating, to a large extent, general facial aesthetics. There is no single model of ideal proportions of the face, or nose. Moreover, a slight facial asymmetry is considered an attractive trait. In practice, therefore, the concept of the normal range should be used instead of determining the 'ideal' values of parameters describing the proportions of the face and nose. The result of rhinoplasty should be an attractive nose, harmonious with the rest of the face and emphasizing the beauty of the eyes (Tardy, 1997). The most favourable evaluation of patient before rhinoplasty is based on the proportions of nose with the whole face. 2.1 Nose as an integral part of the face Examination of the patient prior to rhinoplasty should include assessment of all the facial components as complementary elements. Knowledge of normal proportions allows for accurate detection of deviations from existing standards and precise targeting of surgical correction in the establishment of an aesthetic shape of the nose, which is proportionate to the rest of the face. Leonardo da Vinci's facial model is split into three equal horizontal parts, bounded by the lines intersecting four topographic points: trichion (hairline in the midline), glabella, subnasale (nasal spine) and menton (lower edge of the chin) (Figure 1) (Gunter et al., 2007). The upper third is the least important in the estimation of the proportion of the nose and face. The nose is in the middle third of the face. The lower third of the face (between subnasale and menton) is further divided by a horizontal line intersecting the commissure of the lips (stomion) into two parts: 1/3 upper and 2/3 lower.

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