Laparoscopy was documented safe, with similar morbidity rates and long-term results comparing with open surgery. Laparoscopy provided better functional short-term results comparing with the midline approach, but only small differences with respect to the transverse incision approach.
Objectives
Lung ultrasound (LUS) holds the promise of an accurate, radiation‐free, and affordable diagnostic and monitoring tool in coronavirus disease 2019 (COVID‐19) pneumonia. We sought to evaluate the usefulness of LUS in the diagnosis of patients with respiratory distress and suspicion of interstitial severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) pneumonia, in comparison to other imaging modalities.
Methods
This was a multicenter, retrospective study. LUS was performed, on Emergency Department (ED) arrival of patients presenting for possible COVID‐19 evaluation, by trained emergency physicians, before undergoing conventional radiologic examination or while waiting for the report. Scans were performed using longitudinal transducer orientation of the lung regions. CXR was interpreted by radiologists staffing ED radiology. Subjects were divided into two group based on molecular test results. LUS findings were compared to COVID test results, nonlaboratory data, and other imaging for each patient. Categorical variables were expressed as percentages and continuous variables as median ± standard error.
Results
A total of 479 patients were enrolled, 87% diagnosed with SARS‐CoV‐2 by molecular testing. COVID positive and COVID negative patients differed with respect to sex, presence of fever, and white blood cells count. Most common findings on lung point of care ultrasound (POCUS) for COVID‐positive patients were B‐lines, irregular pleural lines, and small consolidation. Normal chest X‐ray was found in 17.89% of cases.
Conclusions
This 479 patient cohort, with COVID‐19, found LUS to be noninferior to chest X‐ray (CXR) for diagnostic accuracy. In this study, COVID‐positive patients are most likely to show B lines and sub‐pleural consolidations on LUS examination.
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Purpose: The surgical treatment of advanced low rectal cancer remains controversial. Extended lymphadenectomy (EL) is the preferred option in the East, especially in Japan, while neoadjuvant radiotherapy is the treatment of choice in the West. This review was undertaken to review available evidence supporting each of the therapies.Methods: All studies looking at EL were included in this review. A comprehensive search was conducted as per PRISMA guidelines. Primary outcome was defined as 5-year overall survival, with secondary outcomes including 3-year overall survival, 3- and 5-year disease-free survival, length of operation, and number of complications.Results: Thirty-one studies met the inclusion criteria. There was no significant publication bias. There was statistically significant difference in 5-year survival for patient who underwent EL (odds ratio, 1.34; 95 confidence interval, 0.09–0.5; P=0.006). There were no differences noted in secondary outcomes except for length of the operations.Conclusion: There is evidence supporting EL in rectal cancer; however, it is difficult to interpret and not easily transferable to a Western population. Further research is necessary on this important topic.
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