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

Nadroparine-induced skin necrosis on a patient with essential thrombocythaemia: a case report

Skin necrosis is a rare but serious complication of subcutaneously administered low-molecular-weight heparin. We report a case of a 53-year-old female patient with skin necrosis induced by subcutaneous administration of nadroparine. The patient suffered from essential thrombocythaemia on a background of chronic myeloproliferative disease. She was admitted to our clinic with a subacute ileus due to endometriosis of the rectosigmoid junction. She underwent a high anterior resection and she received pre- and postoperative antithrombotic prophylaxis with subcutaneous nadroparine on a daily basis. On the 6th and 7th postoperative days, two skin necroses occurred at two injection sites

Endoscopic application of n-butyl-2-cyanoacrylate on esophagojejunal anastomotic leak: a case report

<p>Abstract</p> <p>Introduction</p> <p>This case report describes an esophagojejunal anastomotic leak following total gastrectomy for gastric cancer. The leak was treated successfully with endoscopic application of <it>n</it>-butyl-2-cyanoacrylate. This is the first case report on the endoscopic application of cyanoacrylate alone for the treatment of an anastomotic leak.</p> <p>Case presentation</p> <p>This report describes a case of a 68-year-old Caucasian man who underwent surgery for gastric cancer. He underwent total gastrectomy and esophagojejunal anastomosis with Roux-en-Y anastomosis plus transverse colectomy. An anastomotic leak was treated conservatively at first for a total of three weeks. However, the leak persisted; therefore, the decision was made to apply topical endoscopic <it>n</it>-butyl-2-cyanoacrylate.</p> <p>Conclusion</p> <p>The endoscopic application of <it>n</it>-butyl-2-cyanoacrylate alone can be used successfully to treat esophagojejunal anastomotic leakage.</p

Metabolic profiling stratifies colorectal cancer and reveals adenosylhomocysteinase as a therapeutic target

The genomic landscape of colorectal cancer (CRC) is shaped by inactivating mutations in tumour suppressors such as APC, and oncogenic mutations such as mutant KRAS. Here we used genetically engineered mouse models, and multimodal mass spectrometry-based metabolomics to study the impact of common genetic drivers of CRC on the metabolic landscape of the intestine. We show that untargeted metabolic profiling can be applied to stratify intestinal tissues according to underlying genetic alterations, and use mass spectrometry imaging to identify tumour, stromal and normal adjacent tissues. By identifying ions that drive variation between normal and transformed tissues, we found dysregulation of the methionine cycle to be a hallmark of APC-deficient CRC. Loss of Apc in the mouse intestine was found to be sufficient to drive expression of one of its enzymes, adenosylhomocysteinase (AHCY), which was also found to be transcriptionally upregulated in human CRC. Targeting of AHCY function impaired growth of APC-deficient organoids in vitro, and prevented the characteristic hyperproliferative/crypt progenitor phenotype driven by acute deletion of Apc in vivo, even in the context of mutant Kras. Finally, pharmacological inhibition of AHCY reduced intestinal tumour burden in ApcMin/+ mice indicating its potential as a metabolic drug target in CRC

Novel roles of ADF/cofilins in maintenance of homeostasis in normal and malignant epithelial cells

Actin cytoskeletal regulation is of critical importance for a number of diverse cellular functions, including cell motility, endocytosis, cell division and transcription. Tight regulation of actin is critical for many aspects of cancer biology and in particular invasion and metastasis. ADF/cofilins are among the most important actin regulatory proteins. Mammals have three highly conserved members, ADF, CFL1 and CFL2, which regulate actin dynamics by severing and depolymerizing actin filaments. Despite a huge literature on the roles of ADF/cofilins in actin treadmilling and cell migration in vitro and in cancer cell behavior during invasion, very little is known about their collective roles in tissue homeostasis. By employing genetic knock-outs of ADF, in conjunction with conditional depletion of CFL1 using a Cre-LoxP system under the control of the keratin 14 promoter, we were able to study the effects of ADF/CFL1 loss in vivo in the mouse epidermis. Furthermore, by generating ADF-null squamous cell carcinoma (SCC) cell lines and by transiently downregulating CFL1 with RNAi, we were able to investigate further the cellular responses after ADF/CFL1 depletion in vitro. Co-depletion of ADF and CFL1 from the mouse epidermis triggered loss of tissue homeostasis characterized by abnormal thickening of the tissue, actin filament accumulation and nuclear deformation. Loss of ADF/CFL1 in cultured malignant keratinocytes also led to aberrant cell morphology accompanied by unrestrained accumulation of actin stress fibers tethered to enlarged focal adhesions. Enhanced SRF/MAL-mediated transcription fuels this uncontrolled actin polymerization which is also mediated by Arp3. Furthermore, these actin filaments are decorated with phospho-myosin light chain, which indicates their contractile nature. As a consequence, the increased intracellular acto-myosin tension results in nuclear deformation, which is promoted by the deregulated actin filaments tethered to the nuclear envelope via the linker of nucleoskeleton and cytoskeleton (LINC) complex. Overall, we describe new conceptual insight into the cellular functions of ADF/cofilins. We show that their activities are essential for the dynamic regulation of contractile actin filaments that, if left unchecked, lead to loss of cellular homeostasis and cell death promoted by loss of nuclear integrity. Additionally, the critical roles of nuclear actin and actin-associated proteins have recently started being appreciated. Thus, for the first time we set out to investigate new functions of cofilins in the nucleus using proteomics, and identify new cofilin binding partners that implicate them in novel cellular pathways, expanding our knowledge on these small actin-binding proteins

From songs with political context to "skyladiko": the composition of the popular cultural identity in Greece during the third hellenic democracy

This doctoral thesis deals with the processes of the constitution of the “popular” social and cultural identity in Greece during the period right after the Restoration of Democracy (Metapolitefsi), especially between 1974 and 1989. In particular, it aims to research the changes that happened in the field of popular culture, most importantly the transition from the dominance of the “political song” in the period between 1974 and 1977, to the gradual emergence of the "skyladiko" scene from then on. At the same time, this thesis emphasizes the most crucial aspects of these changes, such as the legitimization of the element of 'revelry' (“glenti”), a trend that stands in opposition with the ethos of the pre-dictatorial period. Furthermore, this thesis focuses on the reception of these changes by the Greek political parties. More specifically, it examines the reception strategies of popular music by the two major parties, PASOK and New Democracy, by the two Communist Parties, as well as by several researchers of popular music, such as the writers of the music magazine Defi (trans.: “Tamburine”). Especially PASOK’s reception is crucial, since it was Greece’s ruling party for the most part of the 1980s, thus it contributed in various ways to the recognition of popular music, foreseeing from early on its potential for political capitalization. In this direction, this thesis will utilize citations from the press, party archives and interviews.H παρούσα διδακτορική διατριβή πραγματεύεται τις διαδικασίες συγκρότησης της «λαϊκής» κοινωνικής και πολιτιστικής ταυτότητας στην Ελλάδα κατά την περίοδο της πρώιμης και ύστερης μεταπολιτευτικής περιόδου, εστιάζοντας συγκεκριμένα στην περίοδο από το 1974 έως το 1989. Ειδικότερα, στοχεύει στη διερεύνηση των μεταβολών που συντελούνται στο χώρο της λαϊκής κουλτούρας κατά την περίοδο αυτή, με πιο σημαντική τη μετάβαση από την περίοδο κυριαρχίας του πολιτικού τραγουδιού στο χρονικό διάστημα μεταξύ 1974 και 1977, έως τη σταδιακή ανάδυση της σκηνής του «σκυλάδικου» και της «μεγάλης πίστας» κατά τη δεκαετία του 1980. Παράλληλα, η έρευνα θα στραφεί στις κεντρικότερες πτυχές αυτών των μεταβολών, όπως η απενοχοποίηση του στοιχείου του «γλεντιού», μια τάση που βρίσκεται σε αντίθεση με τα ειωθότα της προδικτατορικής περιόδου. Επιπροσθέτως, η διατριβή εστιάζει στην πρόσληψη των μεταβολών αυτών από ολόκληρο το πολιτικό και κομματικό φάσμα. Πιο συγκεκριμένα, θα εξεταστούν οι διαφορετικές στρατηγικές προσλήψης της λαϊκής μουσικής από τα δύο μεγάλα κόμματα, το ΠΑΣΟΚ και τη Νέα Δημοκρατία, από τα δύο Κομμουνιστικά Κόμματα, καθώς και από ερευνητές της λαϊκής μουσικής, όπως οι αρθρογράφοι του μουσικού περιοδικού Ντέφι. Αναφορικά με το ΠΑΣΟΚ, η πρόσληψή του παρουσιάζει ιδιαίτερο ενδιαφέρον, καθώς, ως κυβερνόν κόμμα κατά το μεγαλύτερο μέρος της δεκαετίας του 1980, συνέβαλε ποικιλοτρόπως στην αναγνώριση του λαϊκού τραγουδιού, διακρίνοντας εγκαίρως τις δυνατότητες πολιτικής αξιοποίησης της λαϊκής μουσικής. Σε αυτή την κατεύθυνση, θα αξιοποιηθούν παραθέματα από τον Τύπο και από κομματικά αρχεία

Surgical treatment of hepatic metastases from colorectal cancer

Colorectal carcinoma is one of the most frequent cancers in Western societies with an incidence of around 700 per million people. About half of the patients develop metastases from the primary tumor and liver is the primary metastatic site. Improved survival rates after hepatectomy for metastatic colorectal cancer have been reported in the last few years and these may be the result of a variety of factors, such as advances in systemic chemotherapy, radiographic imaging techniques that permit more accurate determination of the extent and location of the metastatic burden, local ablation methods, and in surgical techniques of hepatic resection. These have led to a more aggressive approach towards liver metastatic disease, resulting in longer survival. The goal of this paper is to review the role of various forms of surgery in the treatment of hepatic metastases from colorectal cancer