levoleucovorin and Emergencies

Endoscopic self-expanding metal stent (SEMS) placement as a bridge to surgery is an option for acute malignant colonic obstruction. There is ongoing debate regarding the superiority and oncological safety of SEMS placement compared with emergency surgery. This retrospective study aimed to compare outcomes of these treatment approaches.. Patients were identified from cohorts treated between 2005 and 2012 in two teaching hospitals, of which one used emergency surgery only in patients with large bowel obstruction, whereas the other attempted SEMS placement. Only patients treated with curative intent were included.. The study included 59 patients in whom SEMS placement was attempted and 51 who underwent surgery alone. The successful primary anastomosis rate was higher in the SEMS group than in the surgery-alone group among patients with left-sided obstruction (30 of 43 versus 10 of 34 respectively; P = 0.001), whereas stoma formation was less common (11 of 43 versus 23 of 34; P < 0.001). Such differences were not apparent in patients with right-sided obstruction. Secondary stoma rates were comparable between treatment approaches (left-sided: 11 of 43 versus 13 of 34, P = 0.322; right-sided: 1 of 16 versus 1 of 17, P = 1.000). There were no significant differences in morbidity, mortality, recurrence or survival.. Endoscopic SEMS placement increased the primary anastomosis rate in patients with left-sided large bowel obstruction.

Topics: Aged; Anastomosis, Surgical; Antineoplastic Combined Chemotherapy Protocols; Colonic Diseases; Colorectal Neoplasms; Emergencies; Female; Fluorouracil; Humans; Intestinal Obstruction; Leucovorin; Male; Neoplasm Recurrence, Local; Organoplatinum Compounds; Retrospective Studies; Stents; Treatment Outcome

A 70-year-old woman underwent emergent clipping surgery for subarachnoid hemorrhage under general anesthesia. Her laboratory data showed thrombocytopenia (4.0 x 10(4) microl(-1)). She had taken prednisolone (3 mg x day(-1)) and methotrexate (MTX) (10 mg x week(-1)) for rheumatoid arthritis for the last 10 years. Anesthesia was induced with remifentanil as well as propofol, maintained with remifentanil and sevoflurane in oxygen. The operation was performed uneventfully without platelet transfusion. Since the cause of thrombocytopenia was suspected to be MTX, we started rescue therapy by calcium folinate postoperatively. Platelet count was normalized two days later (11.6 x 10(4) microl(-1)). One month after the operation, she was discharged uneventfully.

Topics: Aged; Anesthesia, General; Arthritis, Rheumatoid; Emergencies; Female; Humans; Immunosuppressive Agents; Intracranial Aneurysm; Leucovorin; Methotrexate; Piperidines; Platelet Transfusion; Postoperative Care; Propofol; Remifentanil; Subarachnoid Hemorrhage; Thrombocytopenia; Treatment Outcome; Vascular Surgical Procedures

To analyze short term results and to report survival rates in a series of patients after palliative emergency treatment for obstructive left sided colorectal cancer (CRC) with unresectable synchronous metastases.. From 2004 to 2008, 55 patients were included. Palliative management consisted of stenting to recover bowel patency and starting chemotherapy. Indications for surgery were perforation or failure of stenting. Early failure occurred when decompression after insertion was unsuccessful and late failure when obstruction occurred after successful decompression. Morbidity and mortality were analyzed for stenting and surgery and survival for resected and non-resected patients.. Stenting was scheduled in 49 patients.Morbidity and mortality occurred in 5 and 3 patients respectively. Early failure occurred in 4 patients and late failure in 11 patients. Surgery was indicated in 6 patients for peritonitis at diagnosis and in 11 patients for complications (1 case) or stenting failure (10 cases). Of the 17 operated patients, 12 cases were resected and 5 cases were not. Mortality occurred in 1 case. Resected patients received first-line (12 cases) and second-line (5 cases) systemic chemotherapy based on FOLFIRI or FOLFOX while stented and non-resected patients were similarly treated in 37 cases and 12 cases respectively. Overall survival at 2 years was 39.3% in resected patients and 1% in stented and non-resected patients (p = 0.008).. Stenting in palliative stage IV obstructive CRC patients may be less successful as previously thought. Prospective studies are needed to define the role of palliative resection.

Topics: Adult; Aged; Aged, 80 and over; Antineoplastic Combined Chemotherapy Protocols; Camptothecin; Colorectal Neoplasms; Colostomy; Comorbidity; Emergencies; Female; Fluorouracil; Humans; Intestinal Obstruction; Kaplan-Meier Estimate; Length of Stay; Leucovorin; Logistic Models; Male; Middle Aged; Neoplasm Staging; Organoplatinum Compounds; Palliative Care; Quality of Life; Retrospective Studies; Stents; Treatment Outcome

Topics: Accidents, Home; Aspartate Aminotransferases; Child, Preschool; Emergencies; Humans; L-Lactate Dehydrogenase; Leucovorin; Male; Methotrexate; Poisoning; Time Factors