Abstract: OBJECTIVE: To detect and analyse ki-ras point mutations in colorectal adenomas and carcinomas in patients from Greece, where mortality rate from colorectal cancer is lower than that in other European countries and the USA. PATIENTS AND METHODS: As a method we used PCR-RFLP technique, to examine ki-ras codons 12 and 13 mutations in 450 paraffin embedded tissues, consisting of 141 normal mucosas, 165 adenomas and 144 sporadic colorectal cancers taken from 141 patients. RESULTS: Frequency of ki-ras mutations was 3.2% (3/93) in small adenomas, 5.2% (3/57) in greater than 1 cm adenomas, 20% (3/15) in tissues where adenoma and cancer coexisted and 39.5% (57/144) in colorectal cancer. CONCLUSION: These data showed that the frequency of ki-ras mutations was low in all sizes of polyps and high in carcinomas in a sample of a population, characterized by a low mortality rate from colorectal cancer. Ki-ras mutations were not an early event of colon carcinogenesis in these patients and the low frequency of ki-ras mutations in adenomas may probably have some relevance to the low mortality rate. Our findings could be explained, not by the dietary habits of this population, but by the presence of other hitherto unknown environmental factors.

Abstract: BACKGROUND: Frank intrabiliary rupture of hydatid hepatic cyst is a common complication in patients with echinococcal cysts of the liver. The early diagnosis of this condition with early and appropriate operative intervention can save a high number of these patients from death. STUDY DESIGN: Of 208 patients with hydatid cysts of the liver, 27 patients (13 percent) had intrabiliary rupture of the cyst. These 27 patients were managed as follows. Intrabiliary lavage of the debris remnants and biliary contents was done first, followed by radical treatment of the hepatic cyst, and finally safe drainage of the biliary tree through a T tube, choledochoduodenal anastomosis, or sphincterotomy. For radical treatment of the cyst and the residual cavity, we performed an excision of the dome and external drainage of the cavity in 17 cysts, a marsupialization in nine cysts, a partial pericystectomy in three cysts, and a reduction of the cavity and external drainage in two cysts. RESULTS: The patients were followed up for as many as 14 years, and with the exception of one patient, no complications related to the method of treatment occurred. CONCLUSIONS: The ideal treatment for intrabiliary rupture of hydatid hepatic cyst after early diagnosis is traditional lavage of the biliary tree, followed by radical treatment of the cyst and free drainage of the bile ducts. With this method, hepatectomy and cystojejunostomy and their drawbacks and complications are avoided.

Abstract: