Duodeno-pancreatic neuroendocrine tumours

Duodeno-pancreatic neuroendocrine tumours (DP-ETs) are increasingly diagnosed today due to the widespread use of modern imaging methods. Duodeno-pancreatic endocrine tumours should be treated by radical surgical resection, which offers a high chance for cure when the disease is localized. A high index of suspicion is required in these patients for the presence of a multiple endocrine neoplasia type syndrome. We present four patients with DP-ET surgically treated at our department between 2000 and 2004. Histological/immunohistochemical diagnosis was somatostatin-producing tumour in the first patient, oncocytic endocrine tumour positive for neurone-specific enolase and focally for chromogranin in the second patient, glucagonoma and pancreatic polypeptide-producing endocrine pancreatic tumour in the third patient, and gastrin, somatostatin, calcitonin, insulin and adrenocorticotropic hormone (ACTH)-producing tumour in the fourth. The second patient died 6.5 years following surgery due to disseminated disease. © 2009 The Authors. Journal compilation © 2009 Blackwell Publishing Ltd

Good results after major pancreatic resections in a middle-volume center

Objectives: Recently, hospital and surgeon volume is widely discussed as a prognostic factor after major pancreatic surgery. We present our experience regarding major pancreatectomy in a middle-volume center. Methods: During the last 11 years, 66 patients underwent major pancreatectomy (pancreaticoduodenectomy [n = 52], distal pancreatectomy with splenectomy [n = 13], and central pancreatectomy [n = 1]). Postoperative course and long-term outcome were recorded and analyzed. Results: One patient died after pancreaticoduodenectomy for ampullary cancer (total mortality of approximately 1.5% for the whole group of patients or 1.9% for the group of patients who underwent pancreatoduodenectomy). None of our patients was reoperated on. Transient pancreatic fistula was observed in 46 patients (36 patients after pancreatoduodenectomy [69%] and 10 patients after distal pancreatectomy [77%]). Two patients required percutaneous computed tomography-guided drainage of fluid collections, whereas in another one, a tube thoracostomy was performed to drain a pleuritic fluid collection. Delayed gastric emptying was observed in 6 patients after pancreatoduodenectomy. Median survival for the whole group of patients was 17 months. Conclusions: Major pancreatic resections can be performed safely, with acceptable morbidity and mortality and good long-term results, even in middle-volume centers. However, experience is required from the part of the operating surgeon.Abbreviations: PD - pancreatoduodenectomy, DP - distal pancreatectomy, PPPD - pylorus-preserving pancreatoduodenectomy Copyright © 2010 by Lippincott Williams & Wilkins

Kallikrein-related peptidase 13 (KLK13) gene expressional status contributes significantly in the prognosis of primary gastric carcinomas

ObjectivesGastric cancer is a fatal human malignancy with poor prognosis. Modifications in gene expression, including those of the kallikrein-related peptidase family, have been portrayed in gastric carcinogenesis. Given KLK13 involvement in human malignancies, we aimed to uncover its prognostic strength in stomach cancer. Design and methodsQuantitative analysis of KLK13 profiles was accomplished in human gastric cancer cells and in a statistically significant sample size of stomach tissue specimens with the development of the highly sensitive real-time PCR methodology. ResultsDecreased KLK13 expression was demonstrated in cancerous compared with their matching non-malignant pairs (p=0.002) and in poorly differentiated gastric tumors (p=0.029). KLK13-positive patients were shown to live considerably longer (p=0.014) and with low risk of disease recurrences (p=0.043). ConclusionsThis is the first study disclosing the possible clinical utility of KLK13 as a new tumor biomarker capable of predicting a favorable outcome for gastric cancer patients. © 2010

Alcohol and psychoactive drugs increased the pre-hospital mortality in 655 fall-related fatalities in Greece: A call for management protocols

Introduction: The frequency of alcohol and psychoactive drugs in fall-related fatalities and their effect on type, severity of injury and location of death constitute the subjects of this study. Methods: A retrospective analysis based on autopsy and toxicology compared demographics, location of injury; intention for the injury, height of fall, Abbreviated Injury Scale - 90 (AIS-90), post-mortem Injury Severity Score (ISS), and location of death. Results: Amongst 655 fall-related fatalities screened for alcohol and psychoactive drugs 123 (18.8%) were classified in the positive toxicology group (PTG) and the remaining in the negative toxicology group (NTG). The median ages were 48 (16-94) years for the PTG and 62 (12-96) years for the NTG. The screened represent 31% of the national toll. The median height of fall was 7 m and the median blood alcohol concentration was 53 (1.5-630) mg/dl. Males were more likely to be included in the PTG than females (21.6 versus 13.6%; p = 0.014) as were the aged between 11 and 60 years. The odds of severe (AIS ≥ 3) head, thoracic, abdominal, extremity, and spine injuries were not influenced by toxicology status. Fatalities of the PTG were as likely to have severe trauma (ISS ≥ 16) as were fatalities of the NTG (93.5 versus 90.8%; p = 0.34). There was no significant difference of ISS between PTG (median ISS 43, range: 6-75) and NTG (median ISS 35, range: 3-75). Nevertheless, 76.4% of the subjects of the PTG died during the pre-hospital stage of care compared to 60.5% of the subjects of the NTG, which was highly significant (or = 2.80, p = 0.001) after controlling for confounders as age, gender, intention for injury, height of fall, and ISS. Conclusions: In fall related trauma, alcohol and psychoactive drugs increased the risk of death during the pre-hospital stage by 2.80 times. This is strong evidence that specific protocols for their early management should be instituted. © 2010 Elsevier Ltd. All rights reserved

Resuscitative thoracotomy after stab heart injury. Two cases of tamponade, managed in a rural hospital

Two trauma cases are presented which were managed in a rural hospital by the same general surgeon team. The cases were two young men who were admitted to the hospital from prison in the last three years. Both of them sustained stab heart wound. They were hemodynamically unstable. The first one suffered a cardiac arrest after his arrival in the operating room. Both patients underwent an emergency left anterolateral thoracotomy according to the DSTC course principles and the current guidelines of Trauma Surgery. The first patient had a left ventricle wound and a lung laceration and the second a wound on the right ventricle. Both patients underwent definite surgical repair. They were referred hemodynamically and respiratorily stable to a cardiothoracic ICU in Athens. They were discharged with no postoperative complications a few days after the initial operation

Motor vehicle collision fatalities involving alcohol and illicit drugs in Greece: The need for management protocols and a reassessment of surveillance

Aims: The frequency and the effect of alcohol and illicit drugs on injury type, severity and location of death in motor vehicle collision (MVC) fatalities were investigated. Design: Retrospective case-control study based on autopsy and toxicology. Settings: Single faculty accepting referrals from Greater Athens and prefectures. Participants: Consecutive pre-hospital and in hospital fatalities. Measurements Demographics, toxicology, abbreviated injury scale (AIS), injury severity score (ISS), and location of death. Findings: Of the 1860 screened subjects, 612 (32.9%) constituted the positive toxicology group (PTG) for alcohol or illicit drugs or both and the 1248 (67.1%) the negative toxicology group (NTG). The median age was 34 (4-90) years for the PTG and 45 (3-97) years for the NTG. The PTG included significantly higher proportions of males and motorcyclists. The PTG had a 50% increased risk for a severe (AIS≥3) cervical spine and 85% for a severe upper extremity injury, compared to the NTG. A total of 29.2% of the PTG and 22.4% of the NTG deaths were non-preventable (ISS = 75). The frequency of severe trauma (ISS≥16) was comparable between PTG and NTG (P = 0.87). The PTG presented with a median ISS of 43 (6-75) versus 41 (2-75) of the NTG, hence without significant difference (P = 0.11). The pre-hospital death rate was 77.8% for the PTG versus 58% of the NTG (P < 0.001). The analysis confirmed that the odds of positive toxicology were considerably higher in the subjects who arrived dead at the hospital (OR 2.62, P < 0.001). Conclusions: In the greater Athens region, almost a third of motor vehicle collision-related fatalities involved alcohol, illicit drugs or both. Individuals screened positive for alcohol or drugs were 2.6 times more likely to die before hospital admission than those with a negative toxicology screen, despite comparable injury severity. Specific evidence-based management protocols and reassessment of surveillance are required. © 2010 The Authors, Addiction © 2010 Society for the Study of Addiction