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Dose surgical sub-specialization influence survival in patients with colorectal cancer?

World Journal of Gastroenterology 2003年第5期9卷 961-964页

作者： Cameron Platell Daniel Lim Nazreen Tajudeen Karen Wong Department of Surgery University of Western AustraliaFremantle HospitalAustralia

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/*** 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 *** 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 *** in the colorectal group were more likely to have rectal cancer and Stage Ⅰ cancers, and less likely to have Stage Ⅱ *** 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.

关键词： Adult Aged Aged, 80 and over Colorectal Neoplasms Colorectal Surgery Comparative Study Female hospitals, Community hospitals, teaching Humans Male Middle Aged Surgery Survival Rate Treatment Outcome Western Australia

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Epidemiology and outcome of Crohn's disease in a teaching hospital in Riyadh

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World Journal of Gastroenterology 2004年第9期10卷 1341-1344页

作者： Abdullah S.AI-Ghamdi Ibrahim A.AI-Mofleh Rashed S.AIRashed Saleh M.AI-Amri Abdulrahman M.Aljebreen Reda EI-Badawi Arthur C.Isnani Gastroenterology Division Department of Medicine (38)King Khalid University HospitalRiyadhKingdom of Saudi Arabia King Khalid University Hospital College of Medicine and Research Center (74)PO Box 2925RiyadhKingdom of Saudi Arabia

AIM: To know the epidemiology and outcome of Crohn's disease at King Khalid University Hospital, Riyadh, Saudi Arabia and to compare the results from other world ***: A retrospective analysis of patients seen for 20 years (between 1983 and 2002). Individual case records were reviewed with regard to history, clinical, findings from colonoscopy, biopsies, small bowel enema, computerized tomography scan, treatment and ***: Seventy-seven patients with Crohn's disease were revisited, 13% presented the disease in the first 10 years and 87% over the last 10 years. Thirty-three patients (42.9%) were males and 44 (57.1%) were females. Age ranged from 11-70 years (mean of 25.3+11.3 years). Ninety-two (92%) were Saudi. The mean duration of symptoms was 26+34.7 mo. The mean annual incidence of the disease over the first 10 years was 0.32:100 000 and 1.66:100 000 over the last 10 years with a total mean annual incidence of 0.94:100 000 over the last 20 years. The chief clinical features included abdominal pain, diarrhea, weight loss,anorexia, rectal bleeding and palpable mass. Colonoscopic findings were abnormal in 58 patients (76%) showing mostly ulcerations and inflammation of the colon. Eighty nine percent of patients showed nonspecific inflammation with chronic inflammatory cells and half of these patients revealed the presence of granulomas and granulations on bowel biopsies. Similarly, 69 (89%) of small bowel enema results revealed ulcerations (49%), narrowing of the bowel lumen (42%), mucosal thickening (35%) and cobblestone appearance (35%). CT scan showed abnormality in 68 (88%) of patients with features of thickened loops (66%) and lymphadenopathy (37%). Seventy-eight percent of patients had small and large bowel disease, 16% had small bowel involvement and only 6% had colitis alone. Of the total 55 (71%) patients treated with steroids at some point in their disease history, a satisfactory response to therapy was seen in 28 patients (51%) w

关键词： hospitals, teaching Adolescent Adult Aged Child Comparative Study Crohn Disease Female Humans Male Middle Aged Retrospective Studies Saudi Arabia Treatment Outcome

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