By Neil Hyman, Konstantin Umanskiy
This multi-authored ebook comprises short chapters dedicated to one or particular questions or judgements in colon and rectal surgical procedure which are tricky or arguable. it's a present and well timed reference resource for working towards surgeons, surgeons in education, and educators that describes the instructed excellent technique, instead of known care, in chosen medical situations.
Just just like the different volumes during this sequence, the chapters in Difficult judgements in Colorectal Surgery adhere to a selected structure. This method presents uniformity to the shows, making it attainable to spot helpful fabric at a glance.
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Additional resources for Difficult Decisions in Colorectal Surgery
It is most easily identified by examining the 95 % confidence interval (CI) around the difference in effect; the larger the interval the less precise the estimate . Examine the absolute and not the relative difference as the latter will inflate any observed effect. Use a theoretic test: if the true value was equal to the upper or lower 95 % CI and if this result would change the course of action, then consider the results imprecise and downgrade the evidence . Be suspicious when the effect is large, yet both the sample size and the number of events are small even if the CIs are narrow; in other words, relatively few patients with relatively few incidents should call a large magnitude of effect into question.
The purpose of this chapter is to compare the results of medical and surgical treatment for symptomatic PF in CD patients. While there are numerous studies looking at the results of either medical or surgical treatment, little high quality comparative data exists and evidence based comparisons are challenging at best. Not all fistulas in patients with CD are the same and both fistula characteristics and patient factors are integral in determining the best therapy. It is important to know whether there is active mucosal disease in the rectum, whether or not the patient is concurrently receiving medical therapy for luminal disease, the history of medication use and any adverse reactions, previous surgical treatment, and level of continence.
N Engl J Med. 1999;340:1398–405. Sands BE, Anderson FH, Bernstein CN, et al. Infliximab maintenance therapy for fistulizing Crohn’s disease. N Engl J Med. 2004;350:876–85. Human anti-tumor necrosis factor monoclonal antibody (adalimumab) in Crohn’s disease: the CLASSIC-1 trial. Gastroenterology. 2006;130:323–32. Sandborn WJ, Rutgeets P, Enns R, et al. Adalimumab induction therapy for Crohn disease previously treated with infliximab: a randomized trial. Ann Intern Med. 2007;146:829–38. Adalimumab for maintenance of clinical response and remission in patients with Crohn’s disease: the CHARM trial.
Difficult Decisions in Colorectal Surgery by Neil Hyman, Konstantin Umanskiy