Adrenal metastasis as first presentation of hepatocellular carcinoma

BACKGROUND: Metastases from hepatocellular carcinoma (HCC) can be found in the lung and adrenal gland. We report case of a patient who presented with adrenal metastasis as the first clinical manifestation of HCC. CASE PRESENTATION: A patient was referred for surgical treatment for a tumor in retro-peritoneal space. The computerized tomography (CT) scan revealed a mass originating from the left adrenal gland. The patient underwent left adrenalectomy and the exploration of abdominal cavity did not reveal any other palpable lesions. Histologically, the resected lesion was a poorly differentiated metastatic tumor from HCC. Seven months later patient was readmitted complaining of cachexia, icterus, and significant weight loss. CT scan revealed hyperdense lesions of the liver CONCLUSION: HCC may have atypical presentations like in present case. Fine needle aspiration/tru-cut(® )biopsy might be useful in the investigation of an accidentally discovered adrenal mass regardless of the size and can lead to the detection of a primary tumor

Our local experience with the surgical treatment of ampullary cancer

BACKGROUND: The aim of this study is to report the outcome after surgical treatment of 32 patients with ampullary cancers from 1990 to 1999. METHODS: Twenty-one of them underwent pancreaticoduodenectomy and 9 local excision of the ampullary lesion. The remaining 2 patients underwent palliative surgery. RESULTS: When the final histological diagnosis was compared with the preoperative histological finding on biopsy, accurate diagnosis was preoperatively established in 24 patients. The hospital morbidity was 18.8% as 9 complications occurred in 6 patients. Following local excision of the ampullary cancer, the survival rate at 3 and 5 years was 77.7% and 33.3% respectively. Among the patients that underwent Whipple's procedure, the 3-year survival rate was 76.2% and the 5-year survival rate 62%. CONCLUSION: In this series, local resection was a safe option in patients with significant co-morbidity or small ampullary tumors less than 2 cm in size, and was associated with satisfactory long-term survival rates

Laparoscopic Management for Carcinoid Metastasis to the Spleen

We report a rare case of a laparoscopic splenectomy performed for a carcinoid metastasis. The patient represented with pleuritic left-sided chest pain from pleural deposits 9 years following resection of a primary lung carcinoid tumour. They were found to have a 4.7 cm splenic lesion on CT with a probable left acetabular metastasis demonstrated on Gallium PET scan. The patient underwent laparoscopic splenectomy for debulking treatment of the splenic lesion that was confirmed to be a splenic metastasis of the resected carcinoid lung tumour. Following an uncomplicated recovery, the patient was discharged on the second postoperative day. On discharge, she received adjuvant therapy with Lutetium 177 DOTATATE. This is the first report of a carcinoid splenic metastasis successfully treated with laparoscopic splenectomy

A case of Meigs syndrome mimicking metastatic breast carcinoma

<p>Abstract</p> <p>Background</p> <p>Adnexal masses are not uncommon in patients with breast cancer. Breast cancer and ovarian malignancies are known to be associated. In patients with breast cancer and co-existing pleural effusions, ascites and adnexal masses, the probability of disseminated disease is high. Nevertheless, benign ovarian masses can mimic this clinical picture when they are associated with Meigs' syndrome making the work-up and management of these patients challenging. To our knowledge, there are no similar reports in the literature and therefore we present this case to highlight this entity.</p> <p>Case presentation</p> <p>A 56-year old woman presented with a 4 cm, grade 2, invasive ductal carcinoma of her left breast. Pre-treatment staging investigations showed a 13.5 cm mass in her left ovary, a small amount of ascites and a large right pleural effusion. Serum tumour markers showed a raised CA125 supporting the malignant nature of the ovarian mass. The cytology from the pleural effusion was indeterminate but thoracoscopic biopsy failed to show malignancy. The patient was strongly against mastectomy and she was commenced on neo-adjuvant Letrozole 2.5 mg daily with a view to perform breast conserving surgery. After a good response to the hormone manipulation, the patient had breast conserving surgery, axillary sampling and laparoscopic excision of the ovarian mass which was eventually found to be a benign ovarian fibroma.</p> <p>Conclusion</p> <p>Despite the high probability of disseminated malignancy when an ovarian mass associated with ascites if found in a patient with a breast cancer and pleural effusion, clinicians should be aware about rare benign syndromes, like Meigs', which may mimic a similar picture and mislead the diagnosis and management plan.</p

Local excision as a treatment for tumors of ampulla of Vater

BACKGROUND: Although local excision (ampullectomy) was first described by Halsted in 1899, its adequacy as an alternative surgical treatment for the ampullary tumors is still a matter of debate. The aim of this study was to evaluate the results of ampullectomy as a curative treatment for benign and malignant tumors arising from the ampulla, in a 14-year single-institution experience. METHODS: From 1990 to 2004, a total of 20 patients of adenocarcinoma (12) or adenoma (8) of the ampulla of Vater underwent local excision. Clinical data were collected and morbidity, mortality, as well as long-term survival were evaluated. The usefulness of several pre or intraoperative diagnostic methods was also recorded. Median follow-up was 85 (range 6–180) months. RESULTS: The combination of endoscopic preoperative biopsies and intraoperative frozen section examination adequately diagnosed ampullary tumors in all cases. The postoperative morbidity and mortality were 0%, whereas the 3 and 5-year survival rates for the patients with adenocarcinoma was 75 % and 33.3 % respectively. All the patients with adenoma are still alive without any sign of recurrence. CONCLUSION: In our series, local excision was a safe option, associated with satisfactory long-term survival rates in patients with benign lesions and in those with small(<2 cm), pT1, well differentiated ampullary tumours without nodal involvement

The effect of insoulin like growth factor I on healing of colonic anastomoses in rats under 5-fluorouracil treatment

The aim of this experimental study was to investigate whether IGF-Ι can protect the colonic healing from the adverse effects of intraperitoneal administration of 5-FU. Eighty female Wistar rats were randomised into four groups of 20 rats for each. Immediately after anastomoses were performed, rats in the control group were injected with 3cc of intraperitoneal saline solution, which was repeated daily until killed. Rats in the 5-FU and IGF-I + 5-FU groups received 5-FU in a dose of 20mg/kg body weight intraperitoneally, from the day of operation until killed. Rats in the IGF-I and IGF-I +5-FU groups received IGF-I in a dose of 2mg/Kg body weight intraperitoneally, immediately after the anastomosis was performed and on 2nd, 4th, and 6th PO day. Rats were sacrificed on the 7th PO day. The dehiscence rate in the 5-FU group was 30% and it was significantly higher compared to the control and IGF-I group (p=0.020). However, in the IGF-I + 5FU group, the dehiscence rate decreased to 10%. The administration of IGF-I resulted in a significant raise of bursting pressure in the IGF-I + 5-FU group compared to the 5-FU group (p<0.001). There was no statistical difference in bursting pressure between the IGF-I + 5-FU and control groups (p=1.000). The hydroxyproline levels were higher in the IGF-I and the IGF-I + 5-FU groups as a result of the stimulating act of IGF-I. In conclusion, IGF-I when given intraperitoneally seems to mediate the adverse effects of 5-FU on the colonic healing in rats.Η πειραματική αυτή μελέτη είχε σκοπό να μελετήσει την πιθανή θετική επίδραση του IGF-I στην επούλωση των αναστομώσεων του παχέος εντέρου σε επίμυες, υπό ενδοπεριτοναϊκή θεραπεία με 5-FU. Ογδόντα άρρενες επίμυες Wistar τυχαιοποιήθηκαν σε 4 ομάδες των 20 πειραματόζωων. Αμέσως μετά την ολοκλήρωση της αναστόμωσης στους επίμυες τα ομάδας ελέγχου χορηγήθηκε ενδοπεριτοναϊκά διάλυμα φυσιολογικού ορού (2cc), το οποίο επαναλαμβανόταν καθημερινά μέχρι τη θυσία τους. Στους επίμυες των ομάδων 5-FU και IGF-I + 5-FU χορηγήθηκε 5-FU ενδοπεριτοναϊκά σε δόση 20mg/kg ΒΣ, από την ημέρα της επέμβασης μέχρι τη θυσία, καθημερινά. Στους επίμυες των ομάδων IGF-I και IGF-I + 5-FU χορηγήθηκε IGF-I ενδοπεριτοναϊκά σε δόση 2mg/kg ΒΣ, αμέσως μετά τη διενέργεια της αναστόμωσης καθώς και τη 2η, 4η και 6η Μ.Η. Οι επίμυες θυσιάζονταν την 7η Μ.Η. Η συχνότητα διάσπασης της αναστόμωσης στην ομάδα 5-FU ήταν 30%, στατιστικά σημαντικά υψηλότερη από τις ομάδες ελέγχου και IGF-I (p=0.020). Στην ομάδα IGF-I + 5-FU το ποσοστό αυτό ελαττώθηκε στο 10%. Η χορήγηση του IGF-I οδήγησε σε σημαντική αύξηση της πίεσης διάσπασης στην ομάδα IGF-I +5-FU σε σχέση με την ομάδα ελέγχου (p<0.001). Δεν υπήρξε στατιστικά σημαντική διαφορά στην πίεση διάσπασης μεταξύ της ομάδας IGF-I + 5-FU και της ομάδας ελέγχου (p=1.000). Τα επίπεδα υδροξυπρολίνης ήταν υψηλότερα στις ομάδες IGF-I και IGF-I + 5-FU ως αποτέλεσμα της θετικής επίδρασης του παράγοντα IGF-I. Συμπερασματικά, η ενδοπεριτοναϊκή χορήγηση του παράγοντα IGF-I έχει ως αποτέλεσμα τον περιορισμό της αρνητικής δράσης της 5-φθοριοουρακίλης στην επούλωση των αναστομώσεων του παχέος εντέρου σε επίμυες

Impact of COVID-19 Lockdown on Physical Activity in a Sample of Greek Adults

It is well known that physical inactivity increases the risk of global death; however, the impact of the coronavirus disease 2019 (COVID-19) lockdown strategy on physical activity (PA) remains unclear. This study compared PA&mdash;i.e., daily occupation, transportation to and from daily occupation, leisure time activities, and regular sporting activities&mdash;prior (PRE) and during (POST) the on-going COVID-19 outbreak in the Greece lockdown environment. A Greek version of the web-based Active-Q questionnaire was used to access PA. The questionnaire was filled out twice (once each for the PRE and POST conditions) by 8495 participants (age = 37.2 &plusmn; 0.2 years (95% confidence interval (CI), 36.9&ndash;37.5); males = 38.3% (95%CI, 36.7&ndash;40.0); females = 61.7% (95%CI, 60.4&ndash;63.0). The relative frequency of overall sporting activities, which, prior to lockdown, occurred at least once per month, and overall participation in competitive sports was significantly reduced (8.6% (95%CI, 7.9&ndash;9.3) and 84.7% (95%CI, 82.9&ndash;86.6) respectively). With the exception of overall leisure time activities, which were significantly increased in the POST condition, daily occupational, transportation, and sporting activities significant reduced (p &lt; 0.05). Overall PA was reduced in all genders, age, body mass index (BMI) and PA level subgroups in the POST condition, and an interaction between the males and High PA subgroups was observed. The change in overall PA (from PRE to POST conditions) was &minus;16.3% (95%CI, &minus;17.3 to &minus;15.4), while in daily occupational, transportation, and sporting activities, it was &minus;52.9% (95%CI, &minus;54.8&ndash;51.0), &minus;41.1% (95%CI, &minus;42.8&ndash;39.5) and &minus;23.9% (95%CI, &minus;25.1&ndash;22.8), respectively. Thus, the lockdown period is highly associated with a negative change in overall PA. During lockdown, inactivity increased dramatically, with males and the high PA population affected significantly more. The decline in PA is a great concern due to possible long-term consequences on public health and healthcare system