Abstract: PURPOSE AND METHODS: Vascular endothelial growth factor (VEGF) overexpression has been associated with advanced stage and poor survival in several cancers. Additionally, endoglin was proposed as a marker of neovascularization in solid malignancies. The aim of this study was to evaluate the association between the VEGF and endoglin expression in colorectal carcinoma patients, as well as to correlate the VEGF and endoglin expression with standard parameters, to define their potential prognostic role. VEGF and endoglin expression were evaluated in 99 unrelated patients with colorectal cancer using immunohistochemistry. RESULTS: Vascular endothelial growth factor and endoglobin expression were positively interrelated. No significant correlation of VEGF and endoglin expression with clinicopathological parameters was observed in our cases. The Kaplan-Meier survival curves have demonstrated a clear association of cancer-specific overall survival with high VEGF, as well as high endoglin expression. CONCLUSION: Our results support that VEGF and endoglin act as two valuable indicators of prognosis.
Abstract: BACKROUND: Sigmoid colon cancer metachronous metastases commonly occur in the liver and lungs with sporadic reports also to the spleen, stomach, thyroid gland, abdominal wall and upper urinary tract. This is a rare case of metachronous metastases invading the mesorectum and the abdominal wall. CASE PRESENTATION: A 72-year-old female underwent sigmoidectomy for stage I (T2N0 M0) sigmoid colon cancer in May 2008. In June 2009, an abdominal computed tomography scan revealed a tumor 2 cm in size at the lower anterior mesorectum and a second mass 2 cm in size at the anterior abdominal wall midline. Total colonoscopy showed no mucosal lesion. The serum carcinoembryonic antigen level was normal. A biopsy of the mesorectum tumor showed similar histologic characteristics with the primary tumor. Since no other site of recurrence was identified, an abdominoperineal resection was attempted. During the operation and after the removal of the incision recurrence, sinus bradycardia and signs of myocardial ischemia were noticed. A loop transverse colostomy was immediately perfomed and the operation was terminated. Postoperative cardiologic examination revealed an acute myocardium infract. Chemo-radiation of the mesorectum tumor and re-evaluation for surgical excision was decided. CONCLUSION: Metachronous metastasis of the mesorectum from sigmoid colon cancer is extremely rare. Although patterns of lymphatic spread from rectal cancer to sigmoid colon have recently been demonstrated, there is no evidence of metachronous mesorectum invasion from sigmoid colon cancer. This could be the issue for future trials.
Abstract: The purpose of this study was to evaluate the added role of a chemotherapeutic in transarterial chemoembolization (TACE) of intermediate-stage hepatocellular carcinoma (HCC). The issue is of major importance since, as suggested by recent evidence, hypoxia or incomplete devascularization of the tumor is a potent stimulator of angiogenesis, and there are not many papers supplying level one evidence confirming the value of a chemotherapeutic. The hypothesis was that since drug-eluting bead (DEB)-TACE is standardized and reproducible, a comparison with bland TACE can readily reveal the potential value of the chemotherapeutic. Two groups were randomized in this prospective study: group A (n = 41) was treated with doxorubicin DEB-TACE, and group B (n = 43) with bland embolization. Patients were randomized for tumor diameter. Patients were embolized at set time intervals (2 months), with a maximum of three embolizations. Tumor response was evaluated using the EASL criteria and alpha-fetoprotein levels. At 6 months a complete response was seen in 11 patients (26.8%) in the DEB-TACE group and in 6 patients (14%) in the bland embolization group; a partial response was achieved in 19 patients (46.3%) and 18 (41.9%) patients in the DEB-TACE and bland embolization groups, respectively. Recurrences at 9 and 12 months were higher for bland embolization (78.3% vs. 45.7%) at 12 months. Time to progression (TTP) was longer for the DEB-TACE group (42.4 +/- 9.5 and 36.2 +/- 9.0 weeks), at a statistically significant level (p = 0.008). In conclusion, DEB-TACE presents a better local response, fewer recurrences, and a longer TTP than bland embolization with BeadBlock. However, survival benefit and bland embolization with smaller particles must be addressed in future papers to better assess the clinical value.
Abstract: ABSTRACT: INTRODUCTION: Lower Spigelian hernia is a very rare entity. The clinical findings are similar to those of inguinal hernias and in many cases may be misdiagnosed. In the literature, only a few references to this entity have been reported in children. To the best of our knowledge, this is the first case report of a lower Spigelian hernia in a child who presented with an acute painful scrotum. CASE PRESENTATION: We discuss the case of a 6-year-old Greek boy who presented to our emergency department complaining of severe pain in the left inguinal area and scrotum. The acute painful swelling started suddenly, without any obvious cause. The initial diagnosis was incarcerated inguinal hernia which was reduced with difficulty. Five days later, the patient still experienced mild pain during palpation and he was operated on. During the operation, a large lower Spigelian hernia was revealed and reconstructed. CONCLUSION: Although Spigelian hernias are rare in children and difficult to diagnose, physicians should be aware of them and include them in the differential diagnosis.
Abstract: Angiogenesis plays an important role in growth, progression, and metastasis of tumors. The most important regulator of angiogenesis is vascular endothelial growth factor (VEGF). VEGF expression has been associated with advance stage and poor survival of several cancers. In the present study we evaluated the association of functional polymorphisms in the VEGF gene with colorectal cancer development, prognosis, and survival. Three hundred twelve consecutive patients with surgically treated colorectal adenocarcinoma were enrolled in the present study. The genomic DNA was extracted from paraffin-embedded tissue and five VEGF (-2578C>A, -1154G>A, -634G>C, -460T>C, and +936C>T) gene polymorphisms were determined using a polymerase chain reaction-restriction fragment length polymorphism assay. VEGF -2578C>A, -1154G>A, -634G>C, -460T>C, and +936C>T genotype and allele frequencies were similar among patients and controls. There was a trend showing carriers of the -2578A and +936T alleles more frequent among patients with CRC, but these differences did not reach statistical significance. Furthermore, no correlation was found between all these variants and tumor characteristics like size, histological grading, positive regional lymph node metastases or tumor stage. However, the -2578AA, -634CC, and +936TT genotypes found to be related with a significantly lower overall survival in our study. In conclusion, VEGF gene polymorphisms were found to be an independent prognostic marker for Greek CRC patients.
Abstract: A case is reported of a young man, who was presented with abdominal pain and an inflammatory abdominal mass resulting from intestinal perforation by a wooden spike. Thorough surgical exploration of the abdominal cavity didn't reveal the perforation site. An inflammatory mass in small bowel mesentery was excised and the cavity drained. The patient had an uneventful recovery. In cases of intestinal perforation by wooden spikes the site of perforation may not be identified. Healing of the opening after the passage of the spike is the possible mechanism. The outcome of these patients even without finding the opening is favorable.
Abstract: Acute appendicitis is the most common cause of the right lower quadrant acute abdominal pain in children. Some other conditions including cecal epiploica appendix torsion, can simulate acute abdomen. Epiploica appendix torsion usually occurs in the sigmoid colon and rarely in the cecum of adult males. In children, this entity is extremely rare and may represent a diagnostic and therapeutic dilemma. We report a case of an 8-year-old Greek girl, presented with signs and symptoms mimicking acute abdomen. Our patient is the younger one among the other four with cecal epiploica appendix torsion that had been reported in the literature.
Abstract: INTRODUCTION: Adenosquamous carcinoma of the pancreas is a rare variant of exocrine pancreatic tumor. This type of tumor is extremely rare as only few similar cases have been described in the literature. CASE PRESENTATION: We present a case of a 72 years old male patient who was admitted to the hospital complaining of epigastric pain and jaundice. Pancreatic carcinoma of the head was diagnosed and a pylorus preserving pancreaticoduodenectomy was performed. CONCLUSION: This type of cancer is a very aggressive tumor followed by a dismisal prognosis. Multimodality therapy seems to be a reasonable approach but more studies are needed, to propose the most effective treatment.
Abstract: Abstract Backround: Fistula formation between the sigmoid colon and an ovarian cyst as a result of diverticular disease is uncommon. We report a case of colo-ovarian cyst fistula presenting with recurrent urinary tract infections. Case report: An 87-year-old female with known diverticular disease complained of recurrent urinary tract infections and a fecal vaginal discharge. At laparotomy she was found to have a fistula from a sigmoid diverticulum into a left ovarian cyst that communicated through the left fallopian tube into the uterus and vagina. There was no other communication of the small or large bowel with the urogenital system. A loop transverse colostomy and left salpingo-oophorectomy were performed. The patient had an uneventful recovery. Conclusion: Vaginal discharge can result from a complicated colo-ovarian cyst.
Abstract: ABSTRACT: We report the case of a 3-yr-old boy who presented an acute right hydrocele. A rapid scrotal swelling under tension developed the first hours and the child complained for discomfort especially during palpation of the scrotum. Three days later, surgical exploration revealed an incomplete torsion of a communicated and pedunculated peritoneal sac arising from the tunica vaginalis testis.The present case report represents the eleventh report of torsion of processus vaginalis saccular protrusion in the literature, being unique due to painless hematocele.
Abstract: INTRODUCTION: Crohn's disease (CD) can affect any part of the alimentary tract from the mouth to the anus, with most common site being the terminal ileum. CASE PRESENTATION: A child suffering from undiagnosed Crohn disease (CD), presented with an acute abdominal obstruction due to a large pseudopolyp in the jejunoileal area. At laparotomy, a jejunoileal segment of 45 cm, containing multiple areas of damage to the small intestine, was excised and a primary end - to - end anastomosis was performed. CONCLUSION: The coexistence of an intestinal pseudopolyp with undiagnosed Crohn's disease may be the cause of acute abdominal obstruction in children.
Abstract: BACKGROUND: Periampullary diverticula (PAD) are found in 9% to 32% of patients who undergo an ERCP. Published studies confer conflicting results regarding the true impact of PAD on the technical success and complications of ERCP. OBJECTIVE: The aim of the study was to investigate and compare success rate, difficulty at cannulation, and complications between patients with and without PAD, as well as to identify independent factors that influence the difficulty at cannulation. DESIGN: A prospective study. SETTING: Tzaneio General Hospital. PATIENTS: A total of 601 consecutive patients who underwent an ERCP were divided into 2 groups according to the presence (group A, 117 patients) or absence (group B, 484 patients) of PAD. Patients with undetectable papilla were excluded from the study cohort. The incidence of undetectable papilla was 8.3% in patients with duodenal diverticula and 0.9% in patients without duodenal diverticula (P = .000). RESULTS: Successful cannulation was achieved in up to 94.9% and 94.8% in groups A and B, respectively. The effort and difficulty at attempting this goal was different between the groups (43.5% vs 59.1%, P = .003), because patients without PAD were subjected to more vigorous attempts or even the pre-cut technique to attain a cholangiogram. There was no significant difference between the groups in the complication rate either in total or in any particular patient. Multivariate logistic regression analysis showed 3 of the variables, namely choledocholithiasis, abnormal papilla, and the presence of diverticula, remained significant, and all of them presented with odds ratios indicating an easier cannulation attempt. LIMITATION: A nonrandomized study. CONCLUSIONS: The finding of a periampullary diverticulum during an ERCP should not be considered an obstacle to a successful cannulation and, furthermore, may be an indicator of an easier cannulation attempt, provided that the papilla can be found with confidence. Concerns about increased complications are not substantiated in this study.
Abstract: ABSTRACT: Carcinoids are the most common tumours of the appendix. These tumours show prevalence in white children. The clinical presentation of the appendiceal carcinoids is similar to that of acute appendicitis, although in many cases the tumour is diagnosed incidentally during an operation. The diagnosis should be confirmed histologically. The prognosis in patients with local disease is excellent. In small lesions isolated appendicectomy is considered as the most appropriate treatment, while in larger lesions right colectomy should be performed. We report a case of a carcinoid tumour in the tip of the appendix of a thirteen year old girl which was diagnosed intraoperatively. The patient received isolated appendicectomy due to the small size of the lesion. Ten years after the operation there is no evidence of recurrence or metastases, and the patient is considered free of disease.
Abstract: INTRODUCTION: The combination of Carboplatin and Paclitaxel is considered the standard of care as initial chemotherapy for Advanced Ovarian Cancer (AOC). We compared this regimen with the combination of Cisplatin, Paclitaxel and Doxorubicin. PATIENTS AND METHODS: Patients with AOC were randomised to either six courses of Paclitaxel 175mg/m(2) plus Carboplatin 7AUC or Paclitaxel at the same dose plus Cisplatin 75mg/m(2) plus Doxorubicin 40mg/m(2). RESULTS: Analysis was performed on 451 patients. The treatment groups were well balanced with regard to patient and disease characteristics. Performance status (PS) was better in the anthracycline arm. In terms of severe toxicity, the only significant difference between the two groups was the development of febrile neutropaenia in the anthracycline arm. Overall response rate was similar in both groups. With a median follow-up of 57.5 months, a marginal significance towards improved Progression-Free Survival (PFS) was noted in favour of the anthracycline arm, whilst there was no difference in overall survival. In multivariate analysis the hazard of disease progression at any time was significantly decreased by 25.5% for patients of the anthracycline arm. CONCLUSION: The combination of Cisplatin, Paclitaxel and Doxorubicin demonstrates a marginal PFS improvement, but no additional survival benefit when compared with the standard Carboplatin/Paclitaxel regimen.
Abstract: ABSTRACT: We report an unusual case of an 11-year-old Greek girl with complicated acute appendicitis. The pelvic plastron that had been formatted secondary to appendix perforation was mimicking appendiceal intussusception in the preoperative ultrasound and computed tomography images. Although acute complicated appendicitis and appendiceal intussusception may represent possible causes of acute abdomen no similar cases have reported in the literature.
Abstract: Totally Implantable Central Venous Access Devices (Intraports) are commonly used in cancer patients to administer chemotherapy or parenteral nutrition. These devices are placed by Seldinger technique. We report an unusual case of intraport catheter rupture before the use of the device. The ruptured part of the catheter migrated into the left pulmonary vein via right ventricle. The ruptured part was removed by means of interventional radiology before causing any problems to the patient. All the reported ruptures of port catheters refer to port devices that had been used to administer chemotherapy, fluids, or parenteral nutrition. The unique feature of this case is that the catheter had not been used at all. It is of great interest also the removal of the broken part from the pulmonary vein.
Abstract: BACKGROUND: Nitric oxide (NO) is an important signal molecule in many types of cells and tissues. Efficiently balanced NO production was noted to play an important role in the healing of burns. However, the exact pathophysiological role of NO in burns and its potent relation with clinical and laboratory parameters has not been elucidated. METHODS: A cohort of 23 burn patients followed for 5 days were enrolled. NO, antioxidant capacity (AC), NO synthase (NOS) activity and xanthine oxidase (XO) activity were indirectly determined by fluorophotometer. Multiple regression against total burn surface area (TBSA), age, weight, height, proximity of septic episode, hemoglobin, white blood cells, percent of neutrophils, platelets, glucose, urea, potassium, sodium and albumin was performed. RESULTS: Elevation of NO, XO and AC levels is observed from day 2 (p<0.00001), day 4 (p=0.005) and day 6 (p=0.036), respectively. At the end of follow-up period (day 6), NO production was found to independently correlate with TBSA, glucose levels and percent of neutrophils (p=0.0004), AC with age, hemoglobin and glucose levels (p=0.012), and NOS with proximity of septic episode and glucose levels (p=0.027). CONCLUSIONS: NO production exerts its prophylactic effect from the first 24h after burn, and is independently correlated with severe injury, enhanced neutrophil motivation and augmented glucose levels, thus possibly representing a response to stress. This need might trigger induction of XO and salvage of antioxidants, as suggested by their rise at a later stage. These data underline that an effort to compromise stress and to administer antioxidants could be a priority in the treatment of these patients.
Abstract: We present a rare case of primary spleen Echinococcus cyst with rupture evidence due to trauma. The cyst presented with an echogenic pattern at ultrasound examination but subsequent CT study revealed calcification of the cyst wall and signs of rupture. Serological tests were positive for echinococcus and eosinophilia defined. Volume changes of hydatid cyst were not discernible in the imaging studies despite evidence of rupture. Both imaging methods may suggest the diagnosis unless typical diagnostic features are present. Hydatid disease was confirmed histologically on the specimen after surgical excision of the cyst.
Abstract: Malignant gastrointestinal stromal tumor (GIST) consists a rare neoplasm, developing in small intestine and stomach. The presenting manifastations include weakness, weight loss, nausea, melena and anaemia. The present case refers to a 65 years old female patient with a GIST of the ampulla of Vater presenting with obstructive jaundice. Diagnosis was achieved pre-operatively by biopsies collected through diagnostic ERCP. The tumour was locally excised, with preservation of the ampulla. The histological analysis suggested low grade GIST positive for both CD 117 (c-kit) and CD34. Two years after the surgery the patient remains free of disease. Malignant GIST of the ampulla of the Vater is extremely rare as only few similar cases have been described in the literature. This is the first time a GIST being presented as obstructive jaundice ever reported. Despite the unavailability of EUS-FNA, the diagnosis was set preoperatively and the tumor was resected.
Abstract: BACKGROUND: Malignant proliferating trichilemmal tumour is a rare skin tumour that originates from the root sheath of the hair and usually arises in the sun-exposed areas of elderly women. It mimicks poorly differential squamous cell carcinoma ant its biological behaviour is unpredictable, because rarely can produce distant metastases. CASE REPORT: The Authors report on a case of a 54-year-old female patients who proceeded with a cystic lesion in the scalp. The lesion was removed with wide excision. The histological examination of the lesion revealed a malignant proliferating trichilemmal tumour. Two years after the excison the patients is free of disease. DISCUSSION: Only few cases (about seventy) of malignant proliferating trichilemmal tumours have been reported in the Bibliography, in some of the patients with malignancy, the tumour produces distant metastases. In the reported case, although the high risk of distant metastasis, two years after the tumour resection the patient is free of disease, It is also reported a short review of the literature. CONCLUSIONS: Malignant proliferating trichilemmal tumours are rare malignant lesions that affect mainly older women. The appropriate treatment includes wide resection and dose postoperative follow-up of the patient to facilitate the early diagnosis of distant metastases.
Abstract: Fecal incontinence represent a complex and multifactorial disorder. Although the condition is widely accepted as belonging to the elderly, it is now becoming apparent that younger adults are also frequently affected. Its incidence is estimated at 2% of the general population, while in the elderly it may increase up to 60%. Despite the considerable advances that have been made in the evaluation of anorectal incontinence during the past decades, the cause of this entity still remains obscure. The patient's history, the physical examination, and specialized investigations are essential for the diagnosis and the selection of the appropriate treatment. In clinical practice the most useful tests are the anorectal manometry, the anal endosonography and the pudendal nerve latency. Complete functional and anatomical assessment of the anorectum, the anal sphincters, and the pelvic floor is mandatory in all patients with fecal incontinence for the appropriate diagnosis and identification of the cause, the type of incontinence and the selection of the appropriate treatment.
Abstract: A rare case of ectopic pancreas in the ampulla of Vater presented with obstructive jaundice. Ectopic pancreas is a common congenital disorder which is referred to as pancreatic rest. The incidence in autopsy series varies from 1 to 2% (range 0.55 to 13%). Most common site of ectopic pancreatic tissue is the stomach, although it can be found anywhere in the foregut and the proximal midgut. Ectopic pancreatic tissue in the ampulla of Vater is a very rare condition. Searching in the literature, using the terms "ectopic pancreas" and "Ampulla of Vater", we found only 10 records. The authors report on a rare case of a 69 years old female with ectopic pancreas in the ampulla of Vater, presented with painless obstructive jaundice, and the diagnostic and therapeutic strategy that followed.
Abstract: BACKGROUND: Gardner's syndrome can occasionally be complicated with intra-abdominal desmoid tumor. These tumors usually remain asymptomatic but can exhibit symptoms due to intestinal, vascular and ureteral compression and obstruction. CASE PRESENTATION: A rare case of a 41-year-old male patient with Gardner's syndrome complicated with intra-abdominal desmoid tumor, which first presented as acute abdomen, is presented. CONCLUSION: Extra-abdominal manifestations of Gardner's syndrome along with a palpable abdominal mass would raise suspicion for the presence of a desmoid tumor in the majority of cases. In life-threatening cases, surgical treatment should be considered as a palliative approach, though the extent of excision remains debatable.
Abstract: BACKGROUND: Actinomycosis is a rare inflammatory disease caused by an anaerobic bacterium that can rarely affect the large intestine. CASE PRESENTATION: We present a rare case of a cecum and ascending colon actinomycosis in a 72 years old woman, mimicking clinically a malignant inflammatory tumor of the right colon. The patient complained of right lower quadrant pain. Although our first thought was a peri-appendiceal abscess, CT scan suggested a right colon tumor. The patient underwent a right colectomy and the histological examination of the specimen revealed colon actinomycosis. CONCLUSIONS: Preoperative diagnosis in colon actinomycosis is difficult to achieve. Treatment of choice is antibiotics administration. A review of the possible pathogenesis and therapeutic modalities is also presented.
Abstract: BACKGROUND: Fournier's gangrene is a synergistic necrotic fasciitis or myositis of genitalia, perineum and abdominal wall. Several etiologic factors have been reported, microorganisms isolated and co-morbidity factors identified. Immediate and accurate diagnosis decreases mortality rate, which ranges from 3-67%. Aggressive resuscitation and surgical debridement consist the appropriate treatment. MATERIAL AND METHODS: Six cases of Fournier's gangrene treated the last ten years were reviewed. Three of them presented with mild infection while the other three with severe. The mean time interval between first symptoms and initial treatment was 2.1 days. The diagnosis was set immediately and the treatment included fluid-electrolyte resuscitation, aggressive surgical debridement, and broad-spectrum antibiotics administration. RESULTS: All patients survived. The defects healed by second intention in four patients and only in two patients specific plastic reconstructive techniques were required. Hyperbaric oxygenation administrated in one patient induced surprisingly the healing of the lesion. CONCLUSIONS: The Authors confirm that Fournier's gangrene is a rare and potentially fatal disease. Early suspicion, accurate diagnosis and multimodality treatment including aggressive surgical intervention are essential for successful outcome.
Abstract: Primary and secondary liver tumors are highly malignant with a very high morbidity and mortality. Although surgical resection is generally accepted as the mainstay of treatment, only a small number of patients are suitable for curative resection. Interventional multimodality therapies provide an alternative to liver resection with minimal morbidity and mortality and quite promising outcomes. These include transcatheter arterial chemoembolization (TACE), percutaneous ethanol (PEI) or other injection techniques, radiofrequency ablation (RFA), microwave coagulation therapy (MCT), cryoablation and interstitial laser photocoagulation (ILP). Techniques, indications and outcomes are discussed.
Abstract: BACKGROUND: Totally implantable central venous access devices (intraports) are commonly used in cancer patients to administer chemotherapy or parenteral nutrition. Rupture of intraport is a rare complication. PATIENTS AND METHODS: During 3 years period, a total of 245 intraports were placed in cancer patients for chemotherapy. Four of these cases (two colon cancer and one each of pancreas and breast cancer) had rupture of the intraport catheter, these forms the basis of present report. RESULTS: Mean time insitu for intraports was 164 (35) days. Median follow-up time was 290 days and total port time in situ was 40180 days. The incidence of port rupture was 1 per 10,000 port days. Three of the 4 cases were managed by successful removal of catheters. In two of these the catheter was removed under fluoroscopic control using femoral route, while in the third patient the catheter (partial rupture) was removed surgically. One of the catheters could not be removed and migrated to right ventricle on manipulations. CONCLUSION: Port catheter rupture is a rare but dreaded complication associated with subcutaneous port catheter device placement for chemotherapy. In case of such an event the patient should be managed by an experienced vascular surgeon and interventional radiologist, as in most cases the ruptured catheter can be retrieved by non operative interventional measures.
Abstract: BACKGROUND: Several techniques have been described in liver hydatid disease surgery, with most well known partial cystectomy, capitonage and introflexion. METHODS: We present a technical modification on open partial cystectomy for liver hydatid disease. We performed this operation in 2 patients with liver echinococcosis. The cyst is being unroofed and evacuated from the daughter cysts. The identified bile vessels ligated. The remnants of the anterior wall (capsule of the cyst) are anchored with sutures in the posterior wall in a manner that the cavity of the cyst disappears. RESULTS: In both patients the disease eradicated. No postoperative complications were observed including bile leaking and/or abscess formation. CONCLUSIONS: Our technique helps in the fast, and effective mobilization of the patient, as well as in the minimization of postoperative bile leaking.
Abstract: Actinomycosis is an infrequent chronic progressive granulomatous and suppurative disease. This infection is caused by Actinomyces israelii, normally present in healthy individuals. We present a rare case of a combined intra- and extra- abdominal actinomycosis in a 50 year old female patient, with no underlying predisposing factors. The patient complained of a right lower quadrant pain. Although we first diagnosed a peri-appendiceal abscess, the CT scan suggested a right colon tumor. The patient underwent segmental colectomy and the histological examination of the specimen revealed colon actinomycosis. A review of the possible pathogenesis and therapeutic modalities is also presented.
Abstract: AIM: To determine whether ECG changes observed after laparoscopic cholecystectomy could be correlated with procedure characteristics. MATERIAL AND METHODS. We studied prospectively 500 patients who underwent laparoscopic cholecystectomy for documented gallstones and prior history of cardiovascular disease, volume of carbon dioxide insufflated in the peritoneal cavity, duration of the procedure and intra-abdominal pressure created. RESULTS: We found that 9 (1.8%) patients developed LV strain, 2 (0.4%) patients--atrial fibrillation, 2 (0.4%) patients--tachyarrhythmia in the presence of AF, 1 (0.2%) patient--RBBB and 1 (0.2%) patient--myocardial ischemia with ST depression regarding these ECG leads. Statistical analysis of the data was performed using multifactorial logistic regression analysis. These changes were not correlated to the above referred procedure characteristics. CONCLUSION: We conclude that ECG changes are frequent events after laparoscopic cholecystectomy (3%) but are not correlated to prior history of cardiovascular disease, the duration of the procedure, the volume of carbon dioxide insufflated and the intra-abdominal pressure.
Abstract: Plantar fasciitis is the most common diagnosis for pain in the inferior aspect of the heel among runners, accounting for 10% of injuries that occur in connection with running. The etiology of pain is multifactorial. The aim of the present study is to report our experience in the treatment of plantar fasciitis in athletes and compare our diagnostic strategy and treatment modalities with the current practice. MATERIAL AND METHODS: We treated 32 athletes with plantar fasciitis from 1997-2002. The diagnostic procedure included detailed history, clinical examination and imaging techniques. Conservative treatment consisted of anti-inflammatory drugs, stretching exercises, suitable training routines and special orthotic insoles, which offer a good chance of complete resolution of symptoms. Surgical fasciotomy should be reserved for use in patients in whom conservative measures have failed. RESULTS: Conservative treatment consisting of rest, anti-inflammatory medications, stretching exercises and special orthotic insoles was efficient in 26 patients (81%), while only 6 (19%) had to be treated surgically. CONCLUSION: Plantar fasciitis is a common disorder among athletes. Patient's history, clinical examination and common imaging techniques help to make the correct diagnosis. The patient should be treated conservatively at first and only in severe cases surgically.
Abstract: Acute pancreatitis (AP), mainly the severe necrotizing type, results in extreme energy demands which might lead, if prolonged, to severe malnutrition. Besides that, starving during AP contributes to gut barrier dysfunction, the main cause of bacterial translocation and sepsis. The aim of nutritional support in AP is to prevent malnutrition and protect the gut by maintaining mucosal integrity. Traditionally, nutritional support during the acute phase of the disease has been provided through total parenteral nutrition (TPN) solutions. However, recent animal and human studies have identified new patterns of pancreatic secretion and hormonal stimulation during the course of AP, different from those assumed for years. Thus it has become feasible to use the natural enteral route for nutrition with potential benefits compared with TPN.
Abstract: We report a rare case of localized perirenal retroperitoneal fibrosis (RPF) in a woman presenting with anemia. The increased diagnostic capabilities and imaging characteristics of CT and MRI are emphasized. Extensive search through the literature revealed that perirenal distribution of RPF has been reported in eight cases, being unilateral in only three.
Abstract: BACKGROUND: A mixed pattern of glandular and neuroendocrine elements is rare in tumours at any site within the gastrointestinal tract but particularly so in the gallbladder. CASE OUTLINE: A 72-year-old woman presented with abdominal pain and jaundice and was found to have a large mass in the fundus of the gallbladder.The mass was radically excised to include a wedge of liver and the hepatoduodenal lymph nodes. Histopathological examination of the resected gallbladder showed an invasive tumour composed of both adenocarcinoma and endocrine cell carcinoma, with apparent transitions between them. The patient received no further treatment and died two months later. DISCUSSION: There are 14 previous case reports of mixed adeno/endocrine carcinoma of the gallbladder. Histochemical similarities between the two neoplastic components of the present tumour would support their origin from a common precursor cell, but the alternative hypothesis of coincidental neoplastic change in two different cell types cannot be excluded.
Abstract: The medical records of 365 patients with the diagnosis of malignant melanoma who underwent axillary (n = 210) or groin (n = 155) dissection at a cancer referral center were reviewed. Sixty-one patients were referred after excisional biopsy of a palpable, histologically positive node. After node dissection, 75% of these patients were found to have additional, microscopically involved nodes, which confirms the advisability of node dissection after biopsy of a positive regional node.
Abstract: The loss of HLA antigens by neoplastic cells is considered important for tumor growth and metastasis, inasmuch as it may allow tumors to escape immune surveillance. We have observed reduced expression of HLA antigens in sporadic colon cancer and adenomas from familial adenomatous polyposis patients. We now studied the expression of HLA class I antigens in patients with sporadic adenomas, which are precursors of colorectal cancer. Expression of HLA class I antigens was studied by immunohistochemistry in (a) sporadic colon adenomas, (b) histologically normal mucosa distant from the adenomas, (c) histologically normal colonic mucosa from patients with history of sporadic colon adenomas, and (d) colonic mucosa from normal subjects. HLA class I antigen expression was moderately reduced in 56% and severely reduced in 44% of the adenomas; this reduction was significant when compared to controls (P < 0.0001). The reduction of HLA class I expression in adenomas was related to the grade of dysplasia of the adenomas. HLA class I expression of normal appearing mucosa was decreased in 76% of patients with adenoma (P < 0.0001) and in 54% of patients with history of adenoma (P < 0.005) compared to normal controls. These changes were antigen specific, inasmuch as the expression of carcinoembryonic antigen, a surface antigen, was not affected. Our findings suggest that reduced HLA class I expression is an early event in the cell transformation process from normal to neoplastic state, preceding in many cases the onset of histological changes. HLA class I could be potentially used as a premalignant marker in the colon.
