Extracorporeal shockwave lithotripsy and litholytic therapy in cholelithiasis

Extracorporeal shockwave lithotripsy (ESWL) and litholytic therapy were used in 100 patients over a period of 16 months. ESWL was carried out with a Lithostar Plus and chenodeoxycholic acid was used as the lytic agent, given until 3 months after complete disappearance of stones. Within a period of 8–12 months, stones disappeared completely in 82 per cent of the patients who had a single stone ≤ 20 mm in diameter and in 50 per cent of those with a single stone > 20 mm in size or with multiple stones. Complications requiring surgery developed in five patients: three had acute cholecystitis and two developed acute pancreatitis. Of the patients in whom complete stone clearance was achieved, two of 11 followed up developed recurrence of stones 4 months after cessation of lytic therapy. Copyright © 1992 British Journal of Surgery Society Ltd

Relationship of angiogenesis and p53 protein expression in colorectal carcinomas

Objective. Recently, new functions have been attributed to the p53 protein, particularly a prominent role in the regulation of angiogenesis. Tumours expressing mutant forms of p53 protein may be associated with increased angiogenesis. The aim of this study is to investigate the relationship between p53 protein expression and the quantitative expression of tumour angiogenesis in colorectal carcinomas. Patients and methods. Sections from paraffin-embedded blocks from 46 patients with primary colorectal carcinomas that had been completely removed were analysed. p53 protein expression and all vascular structures were evaluated by immunohistochemistry. The vessel parameters of angiogenesis including vascular surface density (VSD), number of vessels per mm2 (NVES) and number of vessels in unit area (n) were assessed by morphometry. Mann-Whitney U-test was used for comparing the extent of neovascularization in p53-positive and -negative cases. Results. Twenty-four (52%) cases were p53+ and 22 (48%) were p53-. Mean VSD, NVES and n values for p53 protein-positive and -negative groups were as follows: VSD 96.7 ± 65.4/mm vs 79.6 ± 45.24/mm; NVES 104.8 ± 97.5/mm2 vs 62.2 ± 44.3/mm2; n 79.7 ± 74.2 vs 52 ± 35.7, respectively. There was no association between the angiogenesis parameters and p53-positive and -negative cases, when VSD (P = 0.226) or n (P = 0.176) were considered, but a statistically significant difference was obtained for NVES values (P = 0.035). Conclusion. The authors concluded that tumoural angiogenesis assayed by morphometric investigation in colorectal carcinomas might be related to p53 protein expression when NVES is considered. This finding supports the possible role of p53 protein in increased angiogenesis in colorectal tumours

Evaluation of prosthetic mesh closure in semiopen-abdomen patients

Background. To avoid the adverse consequences of abdominal compartment syndrome and to reduce the high mortality the celiotomy wound in patients with abdominal sepsis was closed without tension using prosthetic mesh. This produces a semiopen situation that permits staged reinterventions together with the functional reconstitution of the continuity of the abdominal wall. Material and methods. Twenty-five patients with intra-abdominal sepsis of various causes were evaluated retrospectively to assess the results of semiopen management of the septic abdomen and reoperations on demand in severe peritonitis. All of the patients were in a state of neglected peritonitis, and had at least one failing organ system. The Mannheim Peritonitis Index (MPI) scoring system was used for stratification of abdominal sepsis. Results. The mean MPI score of 25 patients was 24, ranging 10 to 33. Eight (32%) patients were reexplored (MPI = 21). There were overall 9 (36%) complications in patients with mean MPI score of 23. Six (24%) mesh-related complications (infection and enterocutaneous fistulas) developed (MPI = 19). The mean MPI score of patients without complications was 24. Four (16%) patients died with index MPI score of 26 due to fulminant hepatitis, myocardial infarction, and multiple organ failure. The admission period averaged 63 days. Conclusions. In 25 critically ill patients with abdominal sepsis the mortality was lower than expected, relative to heterogeneous data from the literature; also, major complications occurred less frequently although the mean MPI score was high. The authors conclude that this approach is a reliable contribution to the complex treatment of these patients. © Springer-Verlag 2002

Glucose transporter-1 (GLUT-1): a potential marker of prognosis in rectal carcinoma?

The aim of the study is to evaluate the pattern and level of expression of glucose transporter-1 (GLUT-1) in rectal carcinoma in relation to outcome as a potential surrogate marker of tumour hypoxia. Formalin-fixed tumour sections from 43 patients with rectal carcinoma, who had undergone radical resection with curative intent, were immunohistochemically stained for GLUT-1. A mean of three sections per tumour (range 1–12) were examined. Each section was semiquantitatively scored; 0, no staining; 1, 50% and a score given for the whole section, the superficial (luminal) and deep (mural) part of the tumour. Staining was seen in 70% of tumours. Increased staining was noted adjacent to necrosis and ulceration. A diffuse and patchy pattern of staining, with and without colocalisation to necrosis was seen. Patients with high GLUT-1-expressing tumours (score 3 vs 0–2) had a significantly poorer overall survival (P=0.041), which was associated with poorer metastasis-free survival with no difference in local control. No significant correlation was seen with other prognostic factors. There was a strong correlation between the score for the superficial and deep parts of the tumour (r=0.81), but a significant relationship with outcome was only found in the deep part (P=0.003 vs P=0.46). In conclusion, increased GLUT-1 expression in rectal tumours was an adverse prognostic factor and is worth further evaluation as a predictive marker of response to therapy