Additional prognostic factors in right colon cancer staging.

Based on the theory--which is now acknowledged-of a clinical difference between proximal and distal colon cancer and on the results of recent genetic and microbiological studies, a minority of authors have assumed that also in the sphere of right-sided colon cancer, tumors at three different locations, namely, the cecum and ascending and transverse colon, can be considered to be biologically different. These studies have provided the basis for a retrospective study carried out on 50 patients admitted to our department from 1996 to 2008 for tumor pathology of the right colon. The tumor was considered to be a unified biological entity and assessed in relation to the three above-mentioned locations. The results verify that the aggressive of the tumor increases from the cecum to the transverse, with a higher percentage of cecal tumors being in I stage, more tumors in the ascending colon being in II stage, and more transverse tumors, with the largest percentage of N+ and M+, in stages III and IV. This difference in biological behavior for the three tumor locations has been also found in terms of sensitiveness, both pre- and post-operation, of tumor markers CEA, TPA, and CA19-9. Clinical data revealed a binary relationship between the transverse, cecum, and ascending tumors, which ultimately affects patient mortality, which increases in a directly proportional way from the cecum to the transverse-in the case of a tumor at one of these locations

Thromboembolic tendency (TE) in IBD (Inflammatory bowel disease) patients.

The acronym IBD identifies the ulcerative colitis (URC), Crohn's disease (CD) and the undeterminate colitis (UC) 7. Inflammatory bowel diseases are characterized by variegated etiopathogenesis, probably autoimmune. They have in common a histological damage of a granulomatous/ulcerative kind and also the same manifestations which includes the alternation of remissions and exacerbations 1. They have a remarkable familiarity (13.5%) although it is more evident in CD than in URC. The incidence of IBD varies according to different geographical areas but with a steady increasing trend above all in CD and the diffusion seems to be linked to genetic factors (association with HLA-A2 and B 18) and to geographical factors. Today the etiopathogenesis is still debated. The latest theories seem to confirm an autoimmune genesis. IBD show a remarkable tendency in developing secondary remote manifestations in a different location from the intestinal one: extraintestinal manifestations (EM). They can appear simultaneously with the primitive intestinal manifestation or they can precede or follow after years. According to the most reliable etiopathogenetic hypothesis, EM give rise to "metastasizations" of autoantibodies activated in the bowel from the "ideational intestinal brain"; once the autoantibodies are activated, they are able to attack any organ, tissue or system causing damage directly or mediated. In support of this theory there is the evidence that almost all EM regress with a cortison-based/immunosuppressant treatment. In literature we have descriptions of the extraintestinal remissions of symptoms after total proctolectomia and ileo-anal pouch. Among EM we find following manifestations: hepatobiliary, osteoarticular, muscular, dermatological, stomatological, ophthamological, gynaecological, urological, metabolic, perianal etc. Recently another manifestation has appeared which consists in a remarkable thromboembolic tendency (TE) in IBD patients. TE and IBD are an important field of research as TE occurs in young patients aggressively causing significant morbidity (stroke, retinal vascular occlusive thrombus deposition in cerebral, retinal and mesenteric vessels, massive pulmonary embolism). Several studies describe thrombosis in venous and arterial district in IBD patients as 4% but according to autopsy studies the percentage is more than 30% 2. Among the causes of the TE disease we have: thrombocytosis, increase of the coagulation factors, mutation of V factor of Laiden 8, hyperhomocysteinemia (due to the combined deficit of methylene-hydrofolate-tetra reductase (MTHFR), B12 vitamin and folate) observed mutation of MTHFR gene in some IBD patients. Finally, surgery determines an additional TE risk in these patients compared to non-IBD patients who have the same operation. Some studies describe mortality of 1-1,2% after restorative proctolectomia due to TE complications (pulmonary-cerebral and mesenteric district