Prognostic Significance of Solitary Lymphnode Metastasis and Micrometastasis in Gastric Cancer

Gastric cancer (GC) used to be one of the most common malignancies in the world and still is the second leading cause of malignancy-related death in the Far East. The most significant factors that were found to be associated with the clinical outcome in patients with non-metastatic (M0) gastric cancer is tumor's depth of invasion, the presence and the extend of lymphnode involvement, as well as the histological type according to Lauren (intestinal or diffuse). Although it is generally accepted that D2 gastrectomy is the procedure of choice to achieve adequate oncologic excision, there are quite many concerns for its use in patients with early gastric cancer (EGC), where No or N1 specimens are frequently reported. The last two decades, with the evolvement of cancer cell detection techniques, the attend of the medical community is focused on GC patients with solitary lymphnode metastasis (SLN) or micrometastasis (mM). There is a discussion whether SLN should be attributed as the “real” sentinel node (SN) and its projection on patients' survival. The aim of this study is to review the recent literature and attempt to clarify the clinical significance of SLN in gastric cancer

Advanced trauma life support course for medical students. A new era?

IntroductionTrauma represents a major public health issue and is one of the leading causes of death and disability worldwide. A systematic approach toward dealing with trauma patients was facilitated through the ATLS program, which has become a milestone in trauma care. Our new ATLS course for medical students was set in motion in 2015. Our aim was to make medical students familiar with trauma patients interactively, through a program like ATLS, and here we present the results of this endeavor.MethodsA two-day ATLS-Medical Student (MS) course was offered from November 2015 to July 2018, and analysis was performed retrospectively on the data gathered over a three-month period through online questionnaires. Before graduating, 261 newly qualified medical doctors were interviewed and evaluated as part of the ATLS course.ResultsAfter the course, the vast majority of medical students (251 MSs; 96.16%) felt more capable of managing severely injured patients and 58% of students felt that the medical services they offered were better due to the ATLS training. Regarding the educational fee for the course, 56.7% of the students reported that they felt the fee of 100 euros was fair.DiscussionThe interactive format of the course, which differs from more traditional methods of teaching, has been endorsed by medical students. Though they lack clinical experience, that does not prohibit them from acquiring more specialized or specific knowledge, enabling them to excel. Most of the students improved their skillset either in theoretical knowledge, practical skills, or even in the emotional component of the course, i.e., dealing with treating a severely injured patient. It was decided that the program would be re-evaluated and extended to all Greek Medical Schools.ConclusionThe advantage of providing doctors with trauma training at the beginning of their careers is evident. For that reason, it was decided that the program would be re-evaluated and extended to all Greek Medical Schools

Mature Ovarian Teratoma with Carcinoid Tumor in a 28-Year-Old Patient

Introduction. Coexistence of carcinoid tumor inside a mature cystic teratoma is an extremely rare phenomenon, especially in young women. We present the case of a 28-year-old woman diagnosed with a right ovarian carcinoid and treated uneventfully with conservative surgical approach. Case Report. A 28-year-old woman, gravid 0, parity 0, presented to our department for her annual gynecological examination and Pap smear test. During her examination, a mobile cystic mass was detected in the right lower abdomen. Ultrasound indicated a right ovarian mass 10.5 × 6.3 cm, confirmed by CT scan. Further investigation revealed AFP levels (1539 ng/mL). The ovarian mass was excised by laparoscopy, leaving intact the remaining right ovary. Frozen sections showed a mature cystic teratoma. However, paraffin sections revealed the presence of a small carcinoid within the teratoma’s gastric-type mucosa. The patient was set to a close followup. Nine months postoperatively, ultrasound pelvis imaging and CT scan of the abdomen as well as serum tumor markers have shown no evidence of recurrence disease. Conclusion. Despite the weak evidence, fertility spare surgical approach for women wanting to preserve their genital tract might be a reasonable option

Gastrointestinal stromal tumors (gist)

With the opportunity of five patients we treated in our department we discuss the diagnostic and therapeutic problems that can occur with the management of stromal tumors.Materials and methods: In the time period 2001-2005 we treated 5 patients with GIST, three females and two males, with median age 58,2 years. The patients presented with non-specific dull abdominal pain (2 patients), epigastric pain, gastric distention/dyspepsia (1 patient), and lower gastrointestinal hemorrhage/anaemia (2 patients). The imaging techniques that we used as an aid for the diagnosis were: computed tomography in all patients, barium radiography of the small intestine in one patient, scintigraphy of the abdomen with Technetium 99m-labeled RBCs in one patient, endoscopy of the upper GI tract in 2 patients and colonoscopy in 2 patients. The tumors were located in the small intestine (ileum) in three patients, the stomach in one patient and the mesocolon in one patient. We performed three enterectomies with end to end anastomosis, one subtotal gastrectomy and one removal of the transverse colon and mesocolon. Three of the tumors were mainly spindle cell type, one epithelioid cell type and one mixed spindle and epithelioid cell type. 4 of the patients were CD117 and CD34 positive and one patient negative for both andibodies. One patient deceased 16 days after the operation. Two patients with tumors of the small intestine are alive at the present time 5 and 4 years respectively but we have no records of postoperative follow up. One patient 3,5 years later has no indication of tumor recurrence of the small intestine on CT. The patient with the tumor of the stomach is the only patient that received Imatinib Mesylate and continues to be diseasefree after 9 months of treatment.Conclusion: Through the review of the literature we observe that the use of imatinib represents an effective, revolutionary, target therapy for GIST. Stromal tumors is a simple form of cancer with limited genetic abnormalities and mutations and it still remains to be seen if this type of therapeutic procedure can be used in more complex and common tumors, such as the cancer of the colon and others. Also, further clinical investigation must determine the ideal dose and duration of imatinib treatment and the combination with surgical treatment and other new target therapies

Primary aldosteronism in patients with adrenal incidentaloma: Is screening appropriate for everyone?

Primary aldosteronism (PA) is a common form of secondary hypertension. Several guidelines recommend that patients with adrenal incidentaloma have a high probability of suffering from PA. We conducted a prospective study of 269 consecutive adults with adrenal incidentaloma to investigate the prevalence and clinical characteristics of PA. In total, 9 participants were detected with PA, suggesting a prevalence of 3.35% among the study population. PA participants had a higher blood pressure level by 14/20.8 mm Hg and a lower serum potassium level by 0.8 mmol/L (P < .05). Importantly, all patients with PA presented with concurrent indications (hypertension with or without hypokalemia) for screening of the disease, but they have not undergone relative screening by the referring physician, thus casting doubts about the appropriate implementation of current guidelines in real‐life practice. Intense efforts are needed to familiarize physicians with recommendations for PA to minimize undiagnosed cases and the detrimental sequelae of this endocrine form of hypertension