Anatomical classification of the shape and topography of the operated stomach

The aim of the study was to present the classification of anatomical variances of the operated stomach, based on the radiological and historical data. Different anatomical variations of the operated organ were revealed in 431 out of 2034 patients examined in years 2006-2010. Four primary groups were established: abnormal position along longitudinal (I) and horizontal axis (II), as well as abnormal shape (III) and stomach connections (IV). An additional group (V) encloses mixed forms that connect features of two or more primary groups. The first group contains the partial and total translocation of the stomach into the thoracic cavity after the partial or total esophagectomy. Depends on the applied surgical techniques used during the total esophagectomy, the stomach could be located in the front or back to the pericardial sac. An elongated and gestrectatical form often with signs of pylorostenosis is visible in patients treated by the vagotomy. The consequences of fundoplication included: lack or narrow cardiac angle, and often mild form of the stomach cascade. The most common abnormal shape of the stomach was secondary to the gastrectomy and gastric bending. The final organ shape depends on the type of applied surgical procedure that maintains physiological connection with the duodenum or un-anatomical one, mostly with the jejunal loop. In banding, the body of the stomach forms hourglass on the level of the artificial adjustable band, typically fitted for the surgical slim purpose

Assessment of prognostic significance of cytoplasmic survivin expression in advanced oesophageal cancer.

Survivin is a member of the family of proteins, which inhibit apoptosis (inhibitor of apoptosis proteins - IAP). Expression of survivin was found in colorectal cancer, neuroblastoma, bladder cancer, non-small cell lung cancer, and breast cancer. There is some recent data indicating the correlation of poor prognosis and worse response to chemotherapy in patients with oesophageal squamous cell carcinoma (OSCC) expressing survivin. The aim of the present study was to assess survivin expression in cancerous tissue of patients with advanced OSCC and to test the potential correlation between survivin expression and clinicopathological data. Forty two patients (mean age 58.36+/-8.97 yrs), who were oesophagectomised due to squamous cell carcinoma of the thoracic oesophagus between 1998 and 2000, were retrospectively analysed. Cytoplasmic survivin expression, examined immunohistochemically, was found in 35 (83.33%) cases. No statistically significant correlation between survivin expression in the tumour and patients' gender, TNM stage, or vascular involvement was noted. The mean survival of patients with cytoplasmic survivin expression (17.81+/-5.51 months) was not statistically different to those with negative survivin staining (16+/-6.28 months) as assessed by Mantel-Cox test (p=0.49). Univariate regression analysis revealed UICC staging as the only predictor of survival in the analysed group (

Raman scattering excitation in monolayers of semiconducting transition metal dichalcogenides

Raman scattering excitation (RSE) is an experimental technique in which the spectrum is made up by sweeping the excitation energy when the detection energy is fixed. We study the low-temperature ($T$=5~K) RSE spectra measured on four high quality monolayers (ML) of semiconducting transition metal dichalcogenides (S-TMDs), $i.e.$ MoS$_2$, MoSe$_2$, WS$_2$, and WSe$_2$, encapsulated in hexagonal BN. The outgoing resonant conditions of Raman scattering reveal an extraordinary intensity enhancement of the phonon modes, which results in extremely rich RSE spectra. The obtained spectra are composed not only of Raman-active peaks, $i.e.$ in-plane E$'$ and out-of-plane A$'_1$, but the appearance of 1$^{st}$, 2$^{nd}$, and higher-order phonon modes is recognised. The intensity profiles of the A$'_1$ modes in the investigated MLs resemble the emissions due to neutral excitons measured in the corresponding PL spectra for the outgoing type of resonant Raman scattering conditions. Furthermore, for the WSe$_2$ ML, the A$'_1$ mode was observed when the incoming light was in resonance with the neutral exciton line. The strength of the exciton-phonon coupling (EPC) in S-TMD MLs strongly depends on the type of their ground excitonic state, $i.e.$ bright or dark, resulting in different shapes of the RSE spectra. Our results demonstrate that RSE spectroscopy is a powerful technique for studying EPC in S-TMD MLs.Comment: 9 pages, 6 figures, ES

Endoskopowe, histopatologiczne i molekularne wykładniki Aberrant Crypt Foci (ACF)

According to the Vogelstein theory, the carcinogenesis model in colorectal cancer is one of the best-characterized models of a multistep and multilevel process associated with the progression from normal colonocyte through aberrant crypt foci (ACF) and adenoma with dysplasia to invasive carcinoma. ACF are not visible in standard colonoscopy but are well identified with the use of highmagnification chromoendoscopy with methylene blue or indigo carmine staining. As compared with endoscopic images of normal crypts, ACF orifices appeared 2-3 times larger and had a thicker epithelial lining of a fissured and/or stellate shape, and, moreover, the mucosa staining in the ACF area was much more intense. Under a microscope ACF agglomerations were noted, consisting of several to 200 intestinal glands characterised by various types of lesions (hyperplastic or dysplastic) affecting both the cyto- and histo-architecture. The distribution of ACF correlates well with adenomas and predilection area for the occurrence of polyps, as well as colorectal cancer (CRC) localization. The epidemiologic, genetic and enzymatic chance of ACF occurrence should be similar to that of adenomas and CRC, and their presence is a good predictor of future CRC development. ACF may be precursors of adenoma and colon cancer in APC and a K-ras-dependent pathways, as well as a rare pathogenetic pathway evoked by microsatellite instability (MSI) combined with DNA hypermethylation. ACF are the first morphologically identifiable (endoscopically and microscopically) precursors of colorectal cancer.Zgodnie z teorią Vogelsteina karcinogeneza w raku jelita grubego (RJG) jest wieloetapowym i wielopoziomowym procesem zaburzenia regulacji dojrzewania nabłonka błony śluzowej jelita, począwszy od prawidłowej komórki macierzystej tego nabłonka, przez ogniskanieprawidłowych krypt jelitowych (ACF),następnie stadium gruczolaka/dysplazji, na gruczolakoraku kończąc. ACF są niewidoczne w rutynowej kolonoskopii, natomiast dobrze identyfikowalne w kolonoskopii o wysokiej rozdzielczości, połączonej z barwieniem błony śluzowej jelita grubego, przy użyciu błękitu metylenowego lub indygokarminu. W porównaniu z obrazem endoskopowym prawidłowych krypt, w ACF ujście krypt jest 2-3x większe, szczelinowatego i/lub gwiazdkowatego kształtu, przy czym te krypty są otoczone pogrubiałym nabłonkiem a na obszarze ACF błona śluzowa jelita grubego intensywniej chłonie (ciemniejsze wybarwianie się) znacznikowy barwnik. W badaniu mikroskopowym ACF stwierdza się gniazda składające się z od kilku do 200 gruczołów jelitowych, objętych różnego typu zmianami (rozrostowymi i/lub dysplastycznymi) dotyczącymi zarówno cyto-, jak i histoarchitektoniki. Rozmieszczenie ACF w jelicie grubym dobrze koreluje z obszarem predylekcyjnym dla występowania zarówno polipów, jak i dla raka jelita grubego. Uwarunkowania epidemiologiczne, genetyczne i enzymatyczne w ACF są podobne do występujących w gruczolakach i RJG, wobec czego obecność ACF może być dobrym wskaźnikiem ryzyka wystąpienia RJG. ACF mogą być prekursorami gruczolaków i RJG powstających na dwóch szlakach patogenetycznych karcinogenezy: klasycznym szlaku związanym z mutacją genów APC i K-ras oraz z rzadszym szlakiem patogenetycznym, spowodowanym niestabilnością mikrosatelitarną (MSI), połączoną z hipermetylacją DNA. ACF są powszechnie uważane za pierwsze identyfikowalne morfologicznie (endoskopowo i mikroskopowo) prekursory raka jelita grubego

Application of endoscopic tattooing in intraoperative localization of colon tumours and sentinel lymph nodes

Introduction. Minimally invasive techniques in colorectal surgery have become increasingly popular and are considered a standard of care in most surgical cenres. Locating the tumour during laparoscopic procedure can be technically challenging. Incorrect localization of the primary lesion may lead to a non-radical resection margin. The technique of endoscopic tattooing (ET) prior to surgery or endoscopic treatment is considered a useful tool. Various dyes can be used for this purpose, such as: Indian ink, methylene blue, indigocarmine, toluidine blue, isosulfan blue, haematoxylin and eosin, indoxin green. This procedure is recommended by international scientific societies (ASGE and ESGE). Objective. The purpose of the study is to review the current literature on the use of ET in large intestine tumour lesions. Materials and method. A MEDLINE literature search of English language articles addressing the use of ET to enable intraoperative tumour localization in colorectal surgery was performed to evaluate and summarize the feasibility of this technique. Results. The use of ET enables the easy and safe localization of colorectal tumurs during minimally invasive colorectal procedures. The percentage of complications is insignificant. Conclusions. The available literature proves the safety and benefits of using the ET prior to surgical or endoscopic treatment. ASGE and ESGE recommend the use of ET in marking tumours before surgical treatment, and the area after endoscopic resection for further evaluation

Assessment of prognostic significance of cytoplasmic survivin expression in advanced oesophageal cancer.

Survivin is a member of the family of proteins, which inhibit apoptosis (inhibitor of apoptosis proteins - IAP). Expression of survivin was found in colorectal cancer, neuroblastoma, bladder cancer, non-small cell lung cancer, and breast cancer. There is some recent data indicating the correlation of poor prognosis and worse response to chemotherapy in patients with oesophageal squamous cell carcinoma (OSCC) expressing survivin. The aim of the present study was to assess survivin expression in cancerous tissue of patients with advanced OSCC and to test the potential correlation between survivin expression and clinicopathological data. Forty two patients (mean age 58.36+/-8.97 yrs), who were oesophagectomised due to squamous cell carcinoma of the thoracic oesophagus between 1998 and 2000, were retrospectively analysed. Cytoplasmic survivin expression, examined immunohistochemically, was found in 35 (83.33%) cases. No statistically significant correlation between survivin expression in the tumour and patients' gender, TNM stage, or vascular involvement was noted. The mean survival of patients with cytoplasmic survivin expression (17.81+/-5.51 months) was not statistically different to those with negative survivin staining (16+/-6.28 months) as assessed by Mantel-Cox test (p=0.49). Univariate regression analysis revealed UICC staging as the only predictor of survival in the analysed group (p<0.05). These results indicate that the cytoplasmic survivin expression does not seem to be the prognostic factor in advanced cases of OSCC

Polish Consensus on Treatment of Gastric Cancer; update 2017

Od roku 1986 kontynuowany jest projekt naukowy pt. „Polskie Badania nad Rakiem Żołądka”. Głównym celem tego projektu czyli wieloośrodkowych i interdyscyplinarnych badań jest poprawa wyników leczenia chorych na raka żołądka poprzez opracowanie i propagowanie optymalnych metod rozpoznawania i leczenia zarówno chirurgicznego, jak i skojarzonego. Jednym z ważniejszych osiągnięć projektu jest opracowanie i publikacja dokumentu pt. „Polski Konsensus w Sprawie Leczenia Chorych na Raka Żołądka”, którego pierwsza wersja została opublikowana w roku 1998. Kolejne wersje były aktualizowane adekwatnie do zmieniających się trendów w postępowaniu u chorych na raka żołądka. W Krakowie w dniach 3-4 czerwca 2016r. odbyło się sympozjum naukowe „Polski konsensus w sprawie leczenia raka żołądka – aktualizacja 2016”. W czasie sympozjum odbyła się sesja panelowa w trakcie wszyscy autorzy przedstawili publicznie założenia Konsensusu do dalszej dyskusji. Ponadto wspomniana sesja była poprzedzona zarówno dyskusją w formie korespondencji i jak i spotkaniem roboczym w celu ujednolicenia stanowiska. Należy podkreślić, że zawarte w Konsensusie wskazówki i zalecenia nie są arbitralnie przyjętymi zasadami postępowania w aspekcie prawnym a tym samym każdy lekarz/zespół lekarzy ma prawo podjęcia innych decyzji o ile będzie to korzystne dla chorego na raka żołądka. Konsensus omawia kolejno: a) zalecane kwalifikacje (stopnia zaawansowania, patologiczna, topografii węzłów chłonnych oraz zakresu wycięcia węzłów chłonnych, podziału raka połączenia przełykowo-żołądkowa) b) zasady rozpoznawania w tym zalecenia dotyczące badania endoskopowego i klinicznej oceny stopnia zaawansowania c) zalecenia dotyczące leczenia chirurgicznego (zakres resekcji, zakres limfadenektomii, taktyka postępowania w raku połączenia przełykowo-jelitowego) d) zalecenia dotyczące leczenia skojarzonego z chemioterapią lub radioterapią. e) miejsce chirurgii endoskopowej i małoinwazyjnej w leczeniu raka żołądka. Niniejsza publikacja jest podsumowaniem ustaleń sesji panelowej w trakcie wspomnianego sympozjum naukowego w Krakowie w 2016 roku.The “Polish Research on Gastric Cancer” project has been continued since 1986. The main aim of this project, which is a multicenter and interdisciplinary research, is enhancing the treatment results of gastric cancer patients by developing and promoting the use of optimal methods for diagnosis and treatment, both surgical as well as combined. One of the more important achievements of the project is the development and publication of a document named “Polish Consensus on Treatment of Patients with Gastric Cancer”, whose first version was published in 1998. Following versions were updated adequately to changing trends in the proceedings in patients with gastric cancer. A scientific symposium on “Polish Consensus on Treatment of Gastric Cancer – update 2016” was held in 3-4 June 2016 in Cracow. During the symposium a panel session was held during which all authors publicly presented the Consensus assumptions to be discussed further. Moreover, the already mentioned session was preceded by a correspondence as well as a working meeting in order to consolidate the position. It has to be underlined that the directions and guidelines included in the Consensus are not the arbitrarily assumed rules of conduct in a legal aspect and as such every doctor/team of doctors is entitled to make different decisions as long as they are beneficial to a patient with gastric cancer. The Consensus discusses as follows: a) recommended qualifications (stage of advancement, pathological, lymph node topography and the extent of lymphadenectomy, division of cancer of the gastroesophageal junction), b) rules for diagnostics including recommendations regarding endoscopic examination and clinical evaluation of the advancement stage, c) recommendations regarding surgical treatment (extent of resection, extent of lymphadenectomy, tactics of proceedings in cancer of the gastroesophageal junction), d) recommendations regarding combined treatment with chemotherapy or radiotherapy, e) place of endoscopic and less invasive surgery in the treatment of gastric cancer. This publication is a summary of the arrangements made in the panel session during the abovementioned scientific symposium in Cracow in 2016