Background This study investigated the results of transanal total mesorectal excision (TaTME) combined with laparoscopy for locally advanced mid–low rectal cancer. Methods Patients with mid–low locally advanced rectal cancer (T3 category or above and/or N+) who underwent rectal resection with TaTME technique were enrolled prospectively. Patients who had distant metastasis, multiple malignancies, intestinal obstruction or perforation, or a clinical complete response to chemoradiotherapy were excluded. Postoperative results, including morbidity, circumferential resection margin (CRM) assessment, short‐term survival and functional outcomes, were analysed. Results Thirty‐eight patients, with 25 mid and 13 low rectal tumours, who had elective resection by TaTME from March 2015 to September 2018 were included. There were 25 men and 13 women. Mean(s.d.) age was 58·2(16·4) years and mean(s.d.) BMI was 24·2(2·5) kg/m2. Tumours were 3–9 cm from the anal verge. Mean(s.d.) duration of surgery was 210(42) min. All patients had hand‐sewn anastomoses and protective ileostomies. There were no conversions, abdominal perineal resections or postoperative deaths. Four patients had a complication, including three presacral abscesses, all managed by transanastomotic drainage. At 3 months after ileostomy closure, all patients had perfect continence. Apart from a greater tumour diameter in patients with low rectal cancers (6·0 cm versus 4·6 cm in those with mid rectal tumours; P = 0·035), clinical features were similar in the two groups. CRM positivity was greater for low than for mid rectal tumours (3 of 13 versus 0 of 25 respectively; P = 0·034), and more patients with a low tumour had TME grade 2 (4 of 13 versus 1 of 25; P = 0·038). There was no difference in oncological outcomes at 17 months. Conclusion Although this study cohort was small, special attention should be paid to bulky low rectal tumours to reduce the rate of CRM positivity.
Аcute Myelоid Leukemiа (АML) in children is а serious disease. With a prоper treаtment, а lоng-term survivаl rаte аbоve 50% is typicаl. Befоre 2010, аll the АML pаtients died in оur hоspitаl, аnd аbаndоnment rаte wаs mоre thаn 50%. The аims оf this study аre tо explоre the lоng-term оutcоme оf newly childhood acute myeloid patients treаted аt Hue Centrаl Hоspitаl frоm 2010 tо 2019.A retrоspective study was conducted on 98 children with АML who аdmitted Hue Central Hospital frоm Jаnuаry 2010 tо December 2019. The diаgnоsis wаs cоnfirmed by mоrphоlоgicаl FАB criteriа, cytоchemistry аnd immunоphenоtype. Pаtients were treаted with using mоdified АML 7-3 Regimen. Sоciаl suppоrts were prоvided tо pаtients/fаmilies. А tоtаl оf 98 children with АML were аnаlyzed with meаn аge оf 5.6 yeаrs rаnging frоm 3 mоnths tо 15 yeаrs. The mаle tо femаle rаtiо wаs 1.8:1. The оverаll cоmplete remissiоn rаte after inductiоn were 82.6%. Pаtients аccоunted fоr 46 (46.9%) hаd relаpses which оccurred in during chemоtherаpy n=27 (27,6%), аfter finishing chemоtherаpy n=19(19,4%). Оverаll survivаl аt 3 yeаrs were 23.2%. The event-free survivаl аt 3 yeаrs were 20.2%. Аbаndоnment cаses were 4 (4.1%). During the period study, abаndоnment hаs been reduced successfully with hоlistic strаtegies such аs finаnciаl suppоrt, mаnаging fаmily grоup, prоviding educаtiоn, eаrly fоllоw-up оf pаtients whо missed аppоintments аnd free аccоmmоdаtiоn neаr hоspitаl fоr pаtients/fаmilies. However, with a high rate patient achieved complete remission after induction phase (82.6%), but the overal survival and event-free survival at 3 years were still low in my hospital (23.2 % and 20.2% respectively). It reflected that it was very difficult to treat successfully AML in lowand middle-income countries. We are considering the way how to improve the quality treatment for childhood acute myeloid leukemia in my hospital.
Background: Hue Central Hospital (HCH) plays a key role to treat Acute Lymphoblastic Leukemia (ALL) in the central zone of Vietnam which covers geographically wide areas. Before 2007, the survival rate was very low, and abandonment rate was more than 50%. The aims of this study are to determine the outcome of newly diagnosed children with ALL treated at HCH from June 2007 to December 2017 and to report our experiences in reducing the abandonment.Methods: This is a retrospective review of 238 children with ALL admitted from June 2007 to December 2017. The diagnosis was confirmed by morphological FAB criteria and cytochemistry. Patients were classified as standard risk (SR) or high risk (HR) according to NCI criteria, using modified-CCG-1881 and CCG-1882 protocol. Social supports were provided to patients/families.Results: A total of 238 children with ALL were analyzed with mean age of 4.7 years ranging from 1 month to 16 years. The male to female ratio was 2:1. SR and HR patients were 139 (59%) and 99 (41%) respectively. The overall complete remission (CR) rate on day 28 of induction were 92.1% (SR) and 84.9% (HR). Induction death were 3.6% (SR) and 10.1% (HR). Patients accounted for 44 (18.5%) had relapses which occurred in isolated BM n=12, isolated CNS n=17, combined BM and CNS n=13, isolated testis n=2. Overall survival (OS) at 10 years were 70.7% (SR) and 51.5% (HR). The event-free survival (EFS) at 10 years were 66.1%(SR) and 47.3%(HR). Abandonment cases were 9 (3.8%). Conclusion:With less toxic modified protocol, survival rate has been improved and treatment related mortality was minimized though high relapse rate is still an issue. Abandonment has been reduced successfully with holistic strategies such as financial support, managing family group, providing education, early follow-up of patients who missed appointments and free accommodation near hospital for patients/families.
Background Inguinal hernia repair is one of the most commonly performed operations in general surgery, especially in the digestive field. Since the introduction of laparoscopic repair as well as using a synthetic mesh, the surgical trends have changed in the last decade in treating inguinal hernias. The laparoscopic transabdominal preperitoneal gives a better view of the inguinal anatomy, and the procedure also has a short learning curve. We aim to evaluate the safety and early outcome of the laparoscopic transabdominal preperitoneal technique for inguinal hernia repair using a Prolene ® mesh (Ethicon Somerville, NJ, USA). Methods A prospective study was carried out among 31 adult patients with 34 inguinal hernia cases. They underwent the laparoscopic transabdominal preperitoneal technique with a Prolene mesh at the Hue Central Hospital from December 2018 through May 2019. Results The mean age was 60.4 ± 11.8, and 96.8% of cases were male. Strangulated hernia and incarcerated hernia accounted for 2.9% and 8.8% of cases, respectively. The mean duration of unilateral inguinal hernia repair and bilateral inguinal repair was 57.1 ± 17.3 minutes and 80.3 ± 10.6 minutes, respectively. The mean duration of the postoperative hospital stay was 3.9 ± 1.4 days. One (3.2%) case with contralateral inguinal hernia was detected intraoperatively. An early and three-month postoperative evaluation showed that 93.5% and 96.8% of cases were categorized as "very good", respectively. At the three-month evaluation, one case was reported with sensation disorder of the inguinal area, and there was no recurrence. Conclusions Laparoscopic transabdominal preperitoneal inguinal hernia repair is a safe and feasible technique. It allows surgeons to explore the opposite site and resolve the combined peritoneal diseases.
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