Adel S. Al-Jurf

Resection of the liver for colorectal carcinoma metastases. A multi-institutional study of long-term survivors.

In this review of a collected series of patients undergoing hepatic resection for colorectal metastases, 100 patients were found to have survived greater than five years from the time of resection. Of these 100 long-term survivors, 71 remain disease-free through the last follow-up, 19 recurred prior to five years, and ten recurred after five years. Patient characteristics that may have contributed to survival were examined. Procedures performed included five trisegmentectomies, 32 lobectomies, 16 left lateral segmentectomies, and 45 wedge resections. The margin of resection was recorded in 27 patients, one of whom had a positive margin, nine of whom had a less than or equal to 1-cm margin, and 17 of whom had a greater than 1-cm margin. Eighty-one patients had a solitary metastasis to the liver, 11 patients had two metastases, one patient had three metastases, and four patients had four metastases. Thirty patients had Stage C primary carcinoma, 40 had Stage B primary carcinoma, and one had Stage A primarycarcinoma. The disease-free interval from the time of colon resection to the time of liver resection was less than one year in 65 patients, and greater than one year in 34 patients. Three patients had bilobar metastases. Four of the patients had extrahepatic disease resected simultaneously with the liver resection. Though several contraindications to hepatic resection have been proposed in the past, five-year survival has been found in patients with extrahepatic disease resected simultaneously, patients with bilobar metastases, patients with multiple metastases, and patients with positive margins. Five-year disease-free survivors are also present in each of these subsets. It is concluded that five-year survival is possible in the presence of reported contraindications to resection, and therefore that the decision to resect the liver must be individualized.

Uncommon features of giant colonic diverticula

Two patients with giant colonic diverticula were operated upon within one week. Uncommon features of this rare condition were observed in both patients: 1) the diverticulum was located outside the sigmoid colon, 2) smooth-muscle fibers and ganglion cells were present in the wall of the diverticulum, and 3) free perforation into the peritoneal cavity was the presenting symptom. Barium enema in one patient showed no communication between the diverticulum and the colonic lumen, despite evidence of such communication on histologic examination. Both patients were successfully treated by simple excision of the diverticulum without colonic resection.

Magnesium balance and distribution during total parenteral nutrition: effect of calcium additives.

Homeostatic alterations and derangements in magnesium (and phosphate) metabolism may occur during total parenteral nutrition (TPN) and may be influenced by the amounts of calcium supplied daily. We tested these possibilities in previously fasted or nonfasted animals receiving TPN with variable amounts of calcium. Large calcium additives (90 mg/d) produced hypomagnesemia in nonfasted animals and increased the degree of hypomagnesemia observed in some of the fasted groups. Bone and muscle magnesium were occasionally altered, by high-calcium additives. Urine magnesium was increased, metabolism may have been dependent upon the amount of calcium added and magnesium supplied in TPN. Some of the derangements may have been dependent upon the state of fasting (and resultant phosphate-depletion syndrome).