A gastrointestinal stromal tumor with mesenteric and retroperitoneal invasion

<p>Abstract</p> <p>Background</p> <p>Gastrointestinal stromal tumors are rare visceral sarcomas arising in the gastrointestinal tract wall. In this report we present a case of gastrointestinal stromal tumors with mesenteric and retroperitoneal invasion, describe and discuss its computed tomography findings.</p> <p>Case presentation</p> <p>A 57-years-old male patient has been complaining of abdominal distention, weight lose, and hematuria. During physical examination, significant distention and multiple palpable tumor masses were identified on the abdomen. Abdominal computed tomography showed multiple, well-defined, soft tissue masses with homogenous and heterogeneous pattern, in the mesenteric and retroperitoneal areas. Unlike specific features of gastrointestinal stromal tumor, renal obstruction and atypical central calcification without chemotherapy that has not been yet described were seen in this case. Computed tomography did not reveal liver metastases and/or the lymph nodes with pathological size. Ultrasonography-guided true-cut^®biopsy was made, histopathologic and immunohistochemical analyses demonstrated stromal tumor which, C-KIT (+). The patient underwent left ureterectomy, left nephrectomy and total colectomy. Postoperative histopathological analyses revealed lower grade malignant GISTs. As of 17 months after the surgery, he is alive and free of recurrence.</p> <p>Conclusion</p> <p>When intraabdominal, multiple, large (>5 cm), well-circumscribed, homogenous or heterogeneous mass lesions without ascites, omental caking and lymph nodes metasteses were seen, gastrointestinal stromal tumors should be considered in the differential diagnosis.</p

A classical technique applied to laparoscopic rectal cancer surgery: transillumination of the inferior mesenteric root and its tributaries

One of the major concerns associated with current techniques of laparoscopic rectal resections is the accurate, safe identification of the inferior mesenteric root and its tributaries, especially in patients with thickened, fatty mesentery. The classical technique of transillumination was applied successfully by the use of two telescopes, each with a different light source in laparoscopic rectal procedures. Therefore, this approach can decrease conversion and morbidity rates during the learning curve

A pilot study: ensuring optimal adjustment for determinations of predictive values of preoperative investigations before starting a non-operative management protocol in locally advanced mid-distal rectal cancer

Purpose: Before starting a non-operative-management (NOM) protocol in locally advanced mid-distal rectal cancer, we have conducted a pilot study to find out the predictive value of our preoperative investigations. Methods: Between 2013 and 2017, 35 patients with locally advanced (cT3-4, N-any) primary mid-distal rectal adenocarcinoma were included in the study. We had two groups: Standard long-term chemoradiotherapy (CRT) (Group-1) and CRT + Consolidation chemotherapy (Group-2) groups. Both groups were evaluated regarding clinical (endoscopic-radiological) and pathologic response to neoadjuvant therapy. Each patient's data were prospectively recorded and findings were assessed according to NOM protocol and the clinical decisions recorded. The study was oriented to specify the predictive value of oncology team's hypothetical decisions in determining the right candidate for nonoperative management of rectal cancer. All patients underwent surgery with total mesorectal excision (TME) technique; thus, the hypothetical clinical decisions and pathologic results were compared. Results: The sensitivity and specificity of endoscopy were 57.1% and 87.5%; PPV was 80%, NPV was 70%, and accuracy was 73.3%. The sensitivity of MRI tumor regression grade scoring was 60%, specificity was 90%, PPV was 75%, NPV was 81.8%, and accuracy was 80%. The sensitivity and specificity of the final clinical decision were 80% and 90%; PPV was 80%, NPV was 90%, and accuracy was 86.6% in predicting proper management Conclusion: An institutional adjustment for determinations of predictive values of preoperative investigations is beneficial before the start of nonoperative management protocol

Metastatic Lymph Node Ratio (Nratio) is an Independent Parameter of TNM Classification in Gastric Cancer Prognosis

Objective: Lymph node metastasis is known to be an important prognostic factor in the gastric cancers. In different staging classifications, the nodal involvement is evaluated in terms of the location and/or number of the metastatic lymph nodes. However, in the Western countries the minimum number of 15 lymph nodes required for an evaluation has been obtained in only 30% of the radical resections performed in the gastric cancer cases; and due to the heterogeneous survival responses in the same stage patients and the phase shifts, use of the metastatic lymph node ratio (N-ratio) rather than of the total number of positive nodes has recently been recommended for the nodal evaluation. In this study, our main objective is to retrospectively analyze the effect of the prognostic parameters to the five-year survival in the gastric cancers, and to particularly investigate the prognostic value of the N-ratio

The Effect of Glyceryl Trinitrate Ointment on Posthemorrhoidectomy Pain and Wound Healing: Results of a Randomized, Double-Blind, Placebo-Controlled Study

PURPOSE: Spasm of the internal sphincter may be a source of anal pain and delayed healing after hemorrhoidectomy. This study assessed whether glyceryl trinitrate (GTN) ointment reduces pain and promotes wound healing after hemorrhoidectomy

Sphincter-Saving Robotic Total Mesorectal Excision Provides Better Mesorectal Specimen and Good Oncological Local Control Compared with Laparoscopic Total Mesorectal Excision in Male Patients with Mid-Low Rectal Cancer

Introduction: Laparoscopic rectal resection with total mesorectal excision is a technically challenging procedure, and there are limitations in conventional laparoscopy. A surgical robotic system may help to overcome some of the limitations. The aim of our study was to compare long-term oncological outcomes of robotic and laparoscopic sphincter-saving total mesorectal excision in male patients with mid-low rectal cancer

Nitric Oxide May Mediate Nipple Erection

The nipple is a specialized structure that can become erect by cold, sexual arousal, breast-feeding, or other tactile stimulations, which can induce the milk ejection reflex and sexual arousal because of intense sensory innervation. The studies that have been conducted thus far to identify the mechanism of nipple erection (NE) are not sufficient. It has been stated that NE occurs via activation of the sympathetic nervous system and smooth muscle contraction. The purposes of this study were to investigate the existence of nitric oxide synthase (NOS) in the nipple-areola complex (NAC) to explain the NE mechanism. Considering that smooth muscle relaxation might be effective in NE, endothelial and neuronal NOS expression and localization were investigated via immunohistochemical methods on sagittal sections from 17 human NACs. The results of this study indicate that eNOS is expressed in the vascular endothelium, ductal epithelium, and smooth muscles, whereas nNOS is expressed in the neural fibers, smooth muscles, ductal epithelium, and vascular endothelium in the NAC. Sinusoidal spaces with endothelial layers similar to those found in penile cavernosal tissue are not found in the NAC. Various mediators are known to affect the function of the NAC smooth muscles; however, this study demonstrates that enzymes (eNOS and nNOS) that synthesize nitric oxide are expressed in the NAC

Laparoscopic management of chronic gastric volvulus: A case report

Gastric volvulus (GV) is a rare pathological entity, which is difficult to diagnose, may rapidly progress to infarction and necrosis of the stomach, and can be fatal. A 68-year-old woman presented to the surgical outpatient clinic of Istanbul University, Istanbul Faculty of Medicine, in August, 2006, with a 3-month history of nausea, vomiting, and recurrent abdominal pain. Physical examination revealed epigastric tenderness, but otherwise within normal limits. An urgent abdominal computed tomographic examination revealed only a paraesophageal hernia. A mesenteroaxial gastric volvulus with a large paraesophageal hernia was found on laparoscopy. The surgical procedure involved derotation of the stomach and closure of the paraesophageal hernia with a dual V-shaped graft gastropexy to the triangular ligament of liver; in addition, a laparoscopic cholecystectomy was performed. We found that derotation of stomach and gastropexy to the triangular ligament is technically easy to perform and is a safe procedure in the treatment of gastric volvulus

Laparoscopic repair of a Morgagni hernia in a child

Morgagni hernias are anomalies of the sternal insertions of the diaphragmatic bundles and represent 1% to 4% of all surgically treated diaphragmatic hernias. We present a case of a laparoscopic repair of Morgagni hernia incidentally found in a 4-year-old boy. Primary laparoscopic closure of the defect with interrupted silk sutures was performed. The patient had uneventful recovery and is asymptomatic at 2 months of follow-up. We propose that the laparoscopic approach is feasible and effective treatment of this kind of hernia