Technique of double incision laparoscopic cholecystectomy (DILCH) as an alternative to SILS

Background. Single incisions laparoscopic surgery (SILS) applied for cholecystectomy can ensure a good cosmetic effect expecting without no visible scarring cosmetic effect after surgical procedures, but needrequires implementation of special ports, as well as articulating and banked instruments to be more comfortable for the surgeon. The aim of this paper is to present three three-ports cholecystectomy through two well hidden incisions – umbilical and suprapubic, – performed by with typical laparoscopic instruments. Methods. Ten consecutive elective patients with typical, symptomatic cholelithiasis were qualified for DILS cholecystectomy. All acute cases were excluded from intervention. Typical CO2 pneumoperitoneum was done after umbilical skin incision. Two ports, 5 mm and 11 mm, were inserted in the maximum external edges of this incision. The second incision for 11 mm optical trocar for optic was performed in the suprapubic median line, just in the hairy zonewithin the hair line, to hidden conceal himit. Results. DILCH were performed without any conversions to classical LCH or open cholecystectomy. Each procedure was different according to technical improvement of access and manipulation of instruments manipulations. Time of interventions ranged between from 2 hours for the first patients to 1 hour for the last according to the learning curve. No complications were observed and all patients were discharged as after conventional LCH. Conclusions. DILCH as a three three-port laparoscopic intervention, performed with typical laparoscopic instruments, is more convenient for the surgeon than single incision LCH. Transfer of the optic from the umbilical port site to hidden the concealed suprapubic hairy region gives thereprovides more space for instruments but didn’t did not spoil theed good cosmetic effect of intervention. This procedure is easy to learn and in case of technical problems we can always apply additional ports like foras in typical LCH. Background. Single incisions laparoscopic surgery (SILS) applied for cholecystectomy can ensure a good cosmetic effect expecting without no visible scarring cosmetic effect after surgical procedures, but needrequires implementation of special ports, as well as artic- ulating and banked instruments to be more comfortable for the surgeon. The aim of this paper is to present three three-ports chole- cystectomy through two well hidden incisions – umbilical and suprapubic, – performed by with typical laparoscopic instruments. Methods. Ten consecutive elective patients with typical, symptomatic cholelithiasis were qualified for DILS cholecystectomy. All acute cases were excluded from intervention. Typical CO2 pneumoperitoneum was done after umbilical skin incision. Two ports, 5 mm and 11 mm, were inserted in the maximum external edges of this incision. The second incision for 11 mm optical trocar for optic was per- formed in the suprapubic median line, just in the hairy zonewithin the hair line, to hidden conceal himit. Results. DILCH were performed without any conversions to classical LCH or open cholecystectomy. Each procedure was different according to technical improvement of access and manipulation of instruments manipulations. Time of interventions ranged between from 2 hours for the first patients to 1 hour for the last according to the learning curve. No complications were observed and all patients were discharged as after conventional LCH. Conclusions. DILCH as a three three-port laparoscopic intervention, performed with typical laparoscopic instruments, is more convenient for the surgeon than single incision LCH. Transfer of the optic from the umbilical port site to hidden the concealed supra- pubic hairy region gives thereprovides more space for instruments but didn’t did not spoil theed good cosmetic effect of intervention. This procedure is easy to learn and in case of technical problems we can always apply additional ports like foras in typical LCH.

Comparison of CD15, galectin-3 and HBME-1 expression in follicular thyroid neoplasms

Wstęp: Ocena złośliwości nowotworów pęcherzykowych tarczycy jest częstym problemem diagnostycznym, dlatego istotne jest wykazanie różnic w ekspresji niektórych antygenów w zmianach łagodnych i złośliwych. Celem pracy było porównanie ekspresji CD15, galektyny-3 i HBME-1 w rakach i gruczolakach pęcherzykowych. Materiał i metody: Materiał stanowiła grupa 38 gruczolaków pęcherzykowych (23 klasyczne, 5 z naciekaniem torebki, 10 oksyfilnych) oraz 15 raków pęcherzykowych (9 klasycznych i 6 oksyfilnych). W czasie badania wykonano barwienia rutynowe oraz immunohistochemiczne z przeciwciałami przeciw następującym antygenom: galektyna-3, CD15, HBME-1. Wyniki: W całej grupie stwierdzono istotne statystycznie różnice w ekspresji CD15 między gruczolakiem a rakiem pęcherzykowym. Klasyczne raki pęcherzykowe (bez oksyfilnych) różniły się od klasycznych (nieoksyfilnych i nienaciekających torebki) gruczolaków ekspresją HBME-1 i CD15. Gruczolaki naciekające torebkę różniły się od klasycznych gruczolaków ekspresją HBME-1. Gruczolaki oksyfilne i raki oksyfilne wykazywały podobną ekspresję badanych przelek.Introduction: Estimation of malignancy in thyroid follicular neoplasms is a common diagnostic problem, thus revealing of differences in expression of some antigens in both benign and malignant lesions seems to be essential. The aim of this study is to evaluate the immunohistochemical expression of CD15, galectin-3 and HBME-1 in follicular adenomas and carcinomas. Material and methods: Samples of 38 follicular adenomas (23 "classical", 5 with intracapsular invasion, 10 oncocytic) and 15 follicular carcinomas (9 "classic", 6 oncocytic) were stained immunohistochemically with anti-CD15, galectin-3 and HBME-1. Results: In the whole group we found statistically significant differences in CD15 expression between follicular adenomas and carcinomas. "Classic" follicular carcinomas (without oncocytic tumors) showed stronger CD15 and HBME- 1 expression than "classic" adenomas. Adenomas with intracapsular invasion differed from "classic" adenomas only in HBME-1 expression. In oncocytic tumors the expression of examined antigens was similar. Conclusions: 1. In the group of nonoxyphilic tumors positive reaction with HBME-1 was more common in adenomas with intracapsular invasion and carcinomas, but positive reaction with anti-CD15 - only in carcinomas. We suggest that reactivity with these antibodies could mark malignancy. 2. Oncocytic tumors had similar expression of CD15 and HBME-1 and galectin-3

Wielomiesięczny czas wolny od progresji u chorej z uogólnionym nowotworem neuroendokrynnym jelita cienkiego po leczeniu skojarzonym oktreotydem LAR i terapią izotopową

Long-acting somatostatin analogs are considered as a first line of treatment in well-differentiated metastatic gastroenteropancreatic neuroendocrine neoplasms with symptoms of carcinoid syndrome, because of relief symptoms and antiproliferative effect. According to the results of PROMID study (Placebo-Controlled, Double-Blind, Prospective, Randomized Study on the Effect of Octreotide LAR in the control of Tumor Growth in Patients With Metastatic Neuroendocrine Midgut Tumors), median time to progression is 14.3 months during treatment with octreotide. In this case report we presented 46-year-old woman with primary diagnosis of hepatocellular carci­noma, treated with palliative chemiotherapy (doxorubicin, dexamethasone, cyclophosphamide) with hematologic side effects and after that in follow-up. Because of uncommon course of HCC, histopathology examination was reviewed. The new diagnosis was metastases of well-differentiated neuroendocrine tumor (G1 in WHO 2010 clas­sification). During diagnostic imaging (computed tomography of chest and abdomen, Gallium-68-DOTA-TATE PET/CT) primary tumor in small intestine was found. The final diagnosis was well-differentiated neuroendocrine neoplasm of small intestine with distant metastasis and carcinoid syndrome. Improvement of general condition and 26 months stabilization of the disease was observed after concomitant treatment with long-acting octreotide and peptide receptor radionuclide therapy.Leczeniem farmakologicznym z wyboru w nowotworach neuroendokrynnych przewodu pokarmowego przebiega­jących z objawami zespołu rakowiaka są długodziałające analogi somatostatyny, redukujące objawy aktywności hormonalnej guzów oraz mające działanie antyproliferacyjne. Według danych badania PROMID średni czas wolny od progresji podczas leczenia długodziałającym oktreotydem wynosi 14,3 miesiąca. Prezentowany przy­padek dotyczy 46-letniej kobiety z rozpoznanym początkowo rakiem wątrobowokomórkowym (HCC), leczonym chemioterapią paliatywną (doksorubicyna, deksametazon, cyklofosfamid), a następnie z powodu powikłań hematologicznych pozostawionym w obserwacji. Ze względu na nietypowy przebieg HCC poddano weryfikacji badanie histopatologiczne, rozpoznając przerzut wysokozróżnicowanego nowotworu neuroendokrynnego (G1 wg WHO 2010). W wykonanych badaniach obrazowych (tomografia komputerowa klatki piersiowej i jamy brzusznej, 68Ga-DOTA-TATE-PET/CT) uwidoczniono zmianę w jelicie cienkim, mogącą odpowiadać ognisku pierwotnemu. Rozpoznano wysokozróżnicowany nowotwór neuroendokrynny jelita cienkiego w fazie uogólnienia przebiegający z objawami zespołu rakowiaka. Po zastosowanym leczeniu skojarzonym długodziałającym analogiem somato­styny — oktreotydem LAR oraz terapią znakowanymi izotopowo analogami somatostatyny 90Y/177Lu-DOTA-TATE uzyskano poprawę sprawności chorej o 2 stopnie w skali ECOG/WHO oraz 26-miesięczną stabilizację choroby

MTARC1 and HSD17B13 Variants Have Protective Effects on Non-Alcoholic Fatty Liver Disease in Patients Undergoing Bariatric Surgery

The severity of hepatic steatosis is modulated by genetic variants, such as patatin-like phospholipase domain containing 3 (PNPLA3) rs738409, transmembrane 6 superfamily member 2 (TM6SF2) rs58542926, and membrane-bound O-acyltransferase domain containing 7 (MBOAT7) rs641738. Recently, mitochondrial amidoxime reducing component 1 (MTARC1) rs2642438 and hydroxysteroid 17-beta dehydrogenase 13 (HSD17B13) rs72613567 polymorphisms were shown to have protective effects on liver diseases. Here, we evaluate these variants in patients undergoing bariatric surgery. A total of 165 patients who underwent laparoscopic sleeve gastrectomy and intraoperative liver biopsies and 314 controls were prospectively recruited. Genotyping was performed using TaqMan assays. Overall, 70.3% of operated patients presented with hepatic steatosis. NASH (non-alcoholic steatohepatitis) was detected in 28.5% of patients; none had cirrhosis. The increment of liver fibrosis stage was associated with decreasing frequency of the MTARC1 minor allele (p = 0.03). In multivariate analysis MTARC1 was an independent protective factor against fibrosis ≥ 1b (OR = 0.52, p = 0.03) and ≥1c (OR = 0.51, p = 0.04). The PNPLA3 risk allele was associated with increased hepatic steatosis, fibrosis, and NASH (OR = 2.22, p = 0.04). The HSD17B13 polymorphism was protective against liver injury as reflected by lower AST (p = 0.04) and ALT (p = 0.03) activities. The TM6SF2 polymorphism was associated with increased ALT (p = 0.04). In conclusion, hepatic steatosis is common among patients scheduled for bariatric surgery, but the MTARC1 and HSD17B13 polymorphisms lower liver injury in these individuals

Bortezomib plus melphalan and prednisone for initial treatment of plasma cell myeloma in transplant-ineligible patient with renal failure

Niewydolność nerek pogarsza rokowanie chorych na szpiczaka plazmocytowego (PCM). W artykule przedstawiono opis 82-letniego chorego na PCM klasy IgG lambda w stadium zaawansowania klinicznego IIIB według Durie-Salmona, o 3. stopniu zaawansowania według Międzynarodowego Systemu Prognostycznego, ze współistniejącą niewydolnością nerek, leczonego bortezomibem w skojarzeniu z melfalanem i prednizonem. Dotychczas pacjent uzyskał bardzo dobrą odpowiedź częściową na leczenie. Poprawa jakości odpowiedzi na leczenie chorych na PCM dotyczy także osób po 75. roku życia leczonych zgodnie z protokołami chemioterapii opartymi na nowych lekach.Renal failure worsens prognosis of patients with plasma cell myeloma (PCM). The case of 82-year old patient diagnosed with PCM, categorized as stage IIIB according to Durie-Salmon classification, as stage III according to International Staging System classification and renal impairment treated with regimen containing bortezomib, melphalan, prednisone, was presented. As far the patient achieved very good partial response to treatment. Improvement of quality of response is also remarkable in patients with PCM older than 75 years old, treated with chemotherapy based on novel drugs

Hepatocellular carcinoma - diagnosis and treatment

Rak wątrobowo-komórkowy najczęściej jest następstwem wirusowego zapalenia wątroby. W ciągu ostatnich dekad wskaźniki zachorowalności i umieralności zwiększają się. U większości chorych nowotwór rozpoznaje się w zaawansowanym stadium. Możliwość określenia populacji o zwiększonym ryzyku wystąpienia nowotworu uzasadnia prowadzenie u chorych z marskością programu wczesnego wykrywania za pomocą obrazowania wątroby w odstępach 6-miesięcznych. Rozpoznanie powinno być oparte na ocenie stanu klinicznego łącznie z obrazowaniem i badaniem mikroskopowym. Resekcja jest leczeniem z wyboru u chorych z ograniczeniem choroby do jednej okolicy wątroby i jej prawidłową czynnością oraz nieobecnością cech wrotnego nadciśnienia. Przeszczepienie wątroby stanowi najlepszą metodę w przypadku niewielkich zmian stwierdzonych w przebiegu marskości wątroby. Chemioembolizacja i termoablacja są skutecznymi metodami postępowania w przypadku niewielkich zmian o średnicy do 3 cm w przypadku braku możliwości ich resekcji lub przed transplantacją wątroby. Systemowa chemioterapia ma niewielką wartość, natomiast zastosowanie sorafenibu - drobnocząsteczkowego inhibitora angiogenezy - może przedłużyć czas przeżycia u wybranych chorychHepatocellular carcinoma usually is a consequence of underlying viral hepatitis. Both, the incidence and mortality rates have increased in recent decades. The majority of patients are still diagnosed with advanced disease. The identifiable population at risk of development malignancy makes early detection a realistic possibility and every 6 months liver imaging is currently recommended for patients with cirrhosis. The diagnosis should be based on clinical findings together with radiologic imaging and microscopic examination. Resection is preferred treatment for patients with the disease confined to one region of the liver and preserved hepatic function with no evidence of portal hypertension. Liver transplantation is the best option for small lesions found in cirrhosis. Chemoembolization and thermoablation are effective methods of treatment of small - up to 3 cm in diameter - lesions in patients who otherwise are not candidates for resection or as a bridge to liver transplantation. Systemic chemotherapy is of marginal value, whereas the use of sorafenib - a small-molecule angiogenesis inhibitor - may prolong survival in well-selected patients

A rare CD5-positive subgroup of diffuse large B-cell lymphoma – clinical, morphological and immunophenotypic features in Polish patients

The aim of the study was to assess the incidence of CD5-positive diffuse large B-cell lymphoma (DLBCL) in the Polish population and to describe its morphologic and clinical characteristics. The study included 36 patients with CD5-positive DLBCL, diagnosed and treated in the Maria Skłodowska-Curie Institute and Oncology Centre, Warsaw, Poland and the Medical University of Warsaw, Poland in the years 2002-2013. The control group consisted of 28 patients with CD5-negative DLBCL. CD5-positive DLBCL accounted for 6.26% of all DLBCL cases diagnosed in the Maria Skłodowska-Curie Institute and Oncology Centre in the years 2008-2012. The incidence is comparable to other European countries, lower than noted in Japan and higher than in the US. Patients with CD5-positive DLBCL, in comparison to the CD5-negative group, were characterized by: (1) older age (≥ 60 vs. younger) and worse general status (ECOG ≥ 2 vs. < 2), (2) lower frequency of complete remission (CR), (3) higher expression of unfavorable prognostic factors (BCL2, FOXP1, CD44) and MMP-9, and (4) lower expression of favorable prognostic factors (CD30, cyclin D1, cyclin D3) and TIMP-2

No-visible-scar cholecystectomy

Introduction: Single incision laparoscopic surgery (SILS) is a laparoscopic method providing a good cosmetic effect,but requiring the application of special ports and instruments enabling the surgeon to perform the procedure.We report three-ports cholecystectomy through umbilical and suprapubic incisions performed with typical laparos -copic instruments which calls no-visible-scar cholecystectomy (NVSC).Material and methods: Twenty patients with symptomatic cholelithiasis were qualified for NVSC. Typical CO2 pneumoperitoneumwas done after umbilical skin incision. Two ports of 5 mm were inserted in the maximum externaledges of this incision. After cystic duct and cystic artery dissection the right one was exchanged for a port of 11 mm.The second incision for the 11-mm trocar for the laparoscope was done in the suprapubic median line within the hairarea.Results: Cholecystectomies were performed without any conversion to classical laparoscopic cholecystectomy (LCH)or open surgery. They were not technically identical due to the gradual improvement in the access and manipulationof instruments. The time of the intervention ranged from 2 hours during the introduction of the new method to 50 minfor the last procedures. No postoperative complications were observed and all patients were discharged not later thanafter conventional LCH.Conclusions: NVSC is a three-port laparoscopic intervention performed with typical laparoscopic instruments. It ismore convenient for the surgeon than single incision LCH, because the placement of the optic in the suprapubic regiongives more space for the instruments. It also provides a very good cosmetic effect of the intervention. The describedprocedure is easy to learn and in case of technical problems additional ports can be applied (as in typical LCH)