Cutaneous Metastasis at a Surgical Drain Site after Gastric Cancer Resection

Cutaneous metastasis from intra-abdominal malignant solid tumours such as gastric adenocarcinoma is very rare. Here, we report the case of a 76-year-old male patient with a T4N2M0, poorly differentiated, signet-ring cell gastric carcinoma, who underwent potentially curative resection of the tumour and developed cutaneous metastasis at the site of the surgical drain 4 months after the operation while he was on chemotherapy. The lesion involved the skin and the subcutaneous fat only. A CT scan revealed local recurrence at the resection bed but no distant metastases. The patient died 1 month later. It is concluded that the development of cutaneous metastasis after gastric carcinoma resection indicates tumour recurrence or disseminated disease and is associated with poor prognosis

Synchronous Breast and Rectal Cancers in a Man

Breast cancer in men is relatively rare and its coexistence with other primary non-breast cancers exceptional. Here, we report the case of a 50-year-old man who presented with symptoms of rectal adenocarcinoma and in whom a synchronous, asymptomatic cancer of the left breast was found incidentally at physical examination

Synchronous Carcinoma of the Ampulla of Vater and Colon Cancer

Carcinoma of the papilla of Vater is a relatively rare tumor and its coexistence with other primary sporadic cancers is very exceptional. Here we report the case of a 76-year-old man who presented with painless obstructive jaundice, pathologically elevated liver function tests and increased serum levels of carbohydrate antigen 19-9 and carcinoembryonic antigen. Endoscopic retrograde cholangiography revealed a large polypoid mass in the ampulla of Vater. A large tumor in the ascending colon was also incidentally detected by abdominal computed tomography. Endoscopic biopsies from both lesions showed adenocarcinomas. Metastases to the liver and to the hepatoduodenal ligament and hepatic artery lymph nodes were found during surgery. Right colectomy and a biliary bypass were performed. Histological analysis showed an ampullary adenocarcinoma with metastases to regional lymph nodes and the liver and a colonic adenocarcinoma with local invasion into the pericolic fat. Treatment with gemcitabine plus cisplatin was suggested postoperatively. The association of sporadic ampullary and colonic adenocarcinomas and the mutually increased risk of developing either a synchronous or a metachronous tumor following each other should be considered in patients with primary ampullary or colorectal cancer during the preoperative evaluation and postoperative follow-up of these patients

Ischemic Colitis of the Left Colon in a Diabetic Patient

Diabetes mellitus may affect the gastrointestinal tract possibly as a result of autonomic neuropathy. Here we present a 68-year-old male with non-insulin-dependent diabetes mellitus who presented with prolonged watery diarrhea and in whom imaging studies demonstrated ischemic colitis of the left colon. Resection of the affected colon resulted in sustained disappearance of symptoms

Outcomes and risk score for distal pancreatectomy with celiac axis resection (DP-CAR) : an international multicenter analysis

Background: Distal pancreatectomy with celiac axis resection (DP-CAR) is a treatment option for selected patients with pancreatic cancer involving the celiac axis. A recent multicenter European study reported a 90-day mortality rate of 16%, highlighting the importance of patient selection. The authors constructed a risk score to predict 90-day mortality and assessed oncologic outcomes. Methods: This multicenter retrospective cohort study investigated patients undergoing DP-CAR at 20 European centers from 12 countries (model design 2000-2016) and three very-high-volume international centers in the United States and Japan (model validation 2004-2017). The area under receiver operator curve (AUC) and calibration plots were used for validation of the 90-day mortality risk model. Secondary outcomes included resection margin status, adjuvant therapy, and survival. Results: For 191 DP-CAR patients, the 90-day mortality rate was 5.5% (95 confidence interval [CI], 2.2-11%) at 5 high-volume (1 DP-CAR/year) and 18% (95 CI, 9-30%) at 18 low-volume DP-CAR centers (P=0.015). A risk score with age, sex, body mass index (BMI), American Society of Anesthesiologists (ASA) score, multivisceral resection, open versus minimally invasive surgery, and low- versus high-volume center performed well in both the design and validation cohorts (AUC, 0.79 vs 0.74; P=0.642). For 174 patients with pancreatic ductal adenocarcinoma, the R0 resection rate was 60%, neoadjuvant and adjuvant therapies were applied for respectively 69% and 67% of the patients, and the median overall survival period was 19months (95 CI, 15-25months). Conclusions: When performed for selected patients at high-volume centers, DP-CAR is associated with acceptable 90-day mortality and overall survival. The authors propose a 90-day mortality risk score to improve patient selection and outcomes, with DP-CAR volume as the dominant predictor

Total and caspase-cleaved cytokeratin 18 in chronic cholecystitis: A prospective study

<p>Abstract</p> <p>Background</p> <p>Cell death mode has been studied in cancer, autoimmune, and neurodegenerative diseases. In this study, apoptosis and necrosis are investigated for the first time in patients with chronic calculous cholecystitis.</p> <p>Methods and materials</p> <p>Thirty five (35) patients (27 women and 8 men, aged 55.65 ± 13.48 years) with symptomatic chronic calculous cholecystitis underwent laparoscopic cholecystectomy. The early specific apoptotic tendency (caspase-cleaved cytokeratin 18) was studied in these patients with M30 Apoptosense ELISA and the total cytokerarin 18 (both derived from apoptosis and necrosis) with M65 ELISA. The ratio M30/M65 (caspase-cleaved to total cytokeratin 18) was also computed. According to the histopathological examination, the patients were divided in two groups: group A included patients with chronic inactive cholecystitis (n = 10), and group B those with chronic active cholecystitis (n = 25).</p> <p>Results</p> <p>The concentrations of caspase-cleaved cytokerarin 18 (CK18), and especially those of total CK18, were higher in bile samples than in serum samples. In group B, there were significant differences between serum and bile samples regarding both caspase-cleaved CK18 and total CK18. Cells staining positive for caspase-cleaved CK18 were present in the epithelial cells of the mucosa of the gallbladder.</p> <p>Conclusion</p> <p>CK18 is expressed in the gallbladder epithelial cells. The concentrations of both caspase-cleaved CK18 and total CK18 were higher in bile samples than in serum samples. The levels of total CK18, as well as caspase-cleaved CK18, do not seem to differ between active and inactive chronic cholecystitis.</p

Outcomes After Distal Pancreatectomy with Celiac Axis Resection for Pancreatic Cancer: A Pan-European Retrospective Cohort Study

BACKGROUND: Western multicenter studies on distal pancreatectomy with celiac axis resection (DP-CAR), also known as the Appleby procedure, for locally advanced pancreatic cancer are lacking. We aimed to study overall survival, morbidity, mortality and the impact of preoperative hepatic artery embolization (PHAE). METHODS: Retrospective cohort study within the European-African Hepato-Pancreato-Biliary-Association, on DP-CAR between 1-1-2000 and 6-1-2016. Primary endpoint was overall survival. Secondary endpoints were radicality (R0-resection), 90-day mortality, major morbidity, and pancreatic fistulae (grade B/C). RESULTS: We included 68 patients from 20 hospitals in 12 countries. Postoperatively, 53% of patients had R0-resection, 25% major morbidity, 21% an ISGPS grade B/C pancreatic fistula, and 16% mortality. In total, 82% received (neo-)adjuvant chemotherapy and median overall survival in 62 patients with pancreatic ductal adenocarcinoma patients was 18 months (CI 10-37). We observed no impact of PHAE on ischemic complications. CONCLUSIONS: DP-CAR combined with chemotherapy for locally advanced pancreatic cancer is associated with acceptable overall survival. The 90-day mortality is too high and should be reduced. Future studies should investigate to what extent increasing surgical volume or better patient selection can improve outcomes

VERTICAL GASTROPLASTY AS A TREATMENT FOR CLINICALLY SEVERE OBESITY. A CLINICAL AND BIOCHEMICAL EVALUATION

IN THIS STUDY THE OUTCOME IN 35 PATIENTS WITH CLINICALLY SEVERE OBESITY (MORBIDOBESITY) WHO UNDERWENT VERTICAL BANDED OR VERTICAL RING GASTROPLASTY IS DESCRIBED. THE PATIENTS WERE SELECTED ACCORDING THE ESTABLISHED CRITERIA FOR OBESITY SURGERY. AFTER AN EXTENSIVE PREOPERATIVE EVALUATIONS 15 PATIENTS UNDERWENT V.B.G. AND 20 PATIENTS UNDERWENT V.R.G. DURING THE 56-MONTH FOLLOW-UP A QUITE SATISFACTORY WEIGHT LOSS WAS ACHIEVED WITH NO DIFFERENCE IN THE SUCCESS RATE AND NO REGAIN OF WEIGHT. MORBIDITY IN THE EARLY POSTOPERATIVE PERIOD AND COMPLICATIONS IN THE LATER POSTOPERATIVE PERIOD WERE LIGHT AND MINIMAL. A DRAMATIC IMPROVEMENT OF COMMORBID CONDITIONS WAS OCCURED AFTER WEIGHT LOSS. FURTHERMORE NUTRITIONAL, METABOLIC AND BIOCHEMICAL ALTERATIONS DURING THE POSTOPERATIVE PERIOD WERE MINIMAL WITHOUT DEVELOPMENT OF NUTRIENT DEFICIENCIES. IT IS CONCLUDED THAT V.B.G. OR V.R.G. IS THE OPERATION OF CHOICE FOR THE TREATMENT OF MORBIDITY OBESE PATIENTS.Η ΠΑΡΟΥΣΑ ΕΡΓΑΣΙΑ ΠΕΡΙΛΑΜΒΑΝΕΙ ΣΤΟ ΓΕΝΙΚΟ ΜΕΡΟΣ ΤΗΣ ΕΚΤΕΝΗ ΑΝΑΦΟΡΑ ΣΤΗΝ ΑΙΤΙΟΠΑΘΟΓΕΝΕΙΑ ΚΑΙ ΤΗΝ ΕΠΙΔΗΜΙΟΛΟΓΙΑ ΤΗΣ ΚΛΙΝΙΚΑ ΣΟΒΑΡΗΣ ΠΑΧΥΣΑΡΚΙΑΣ ΚΑΘΩΣ ΚΑΙ ΣΤΙΣΣΥΝΤΗΡΗΤΙΚΕΣ ΚΑΙ ΧΕΙΡΟΥΡΓΙΚΕΣ ΜΕΘΟΔΟΥΣ ΑΝΤΙΜΕΤΩΠΙΣΗΣ ΤΗΣ ΝΟΣΟΥ. ΣΤΟ ΔΕΥΤΕΡΟ (ΕΙΔΙΚΟ) ΜΕΡΟΣ ΑΝΑΦΕΡΟΝΤΑΙ ΤΑ ΑΠΟΤΕΛΕΣΜΑΤΑ ΤΗΣ ΚΛΙΝΙΚΟΕΡΓΑΣΤΗΡΙΑΚΗΣ ΠΑΡΑΚΟΛΟΥΘΗΣΗΣ 35 ΑΣΘΕΝΩΝ ΠΟΥ ΥΠΟΒΛΗΘΗΚΑΝ ΣΕ ΚΑΘΕΤΗ ΔΙΑΜΕΡΙΣΜΑΤΟΠΟΙΗΣΗ. Η ΜΕΛΕΤΗ ΑΥΤΗ ΕΙΧΕ ΣΚΟΠΟ ΝΑ ΕΡΕΥΝΗΣΕΙ ΤΗΝ ΑΠΟΤΕΛΕΣΜΑΤΙΚΟΤΗΤΑ ΤΩΝ ΔΥΟ ΤΕΧΝΙΚΩΝ (MASON ΚΑΙ ECKHOUT) ΚΑΘΕΤΗΣ ΔΙΑΜΕΡΙΣΜΑΤΟΠΟΙΗΣΗΣ ΤΟΥ ΣΤΟΜΑΧΟΥ ΟΣΟΝ ΑΦΟΡΑ ΤΗ ΜΕΤΕΓΧΕΙΡΗΤΙΚΗ ΑΠΩΛΕΙΑ ΒΑΡΟΥΣ ΚΑΘΩΣ ΚΑΙ ΤΗ ΜΕΤΕΓΧΕΙΡΗΤΙΚΗ ΝΟΣΗΡΟΤΗΤΑ. ΕΠΙΠΛΕΟΝ ΔΙΕΡΕΥΝΗΘΗΚΕ Η ΕΞΕΛΙΞΗ ΤΗΣ ΣΥΝΟΔΟΥ ΤΗΣ ΠΑΧΥΣΑΡΚΙΑΣ ΝΟΣΗΡΟΤΗΤΑΣ ΚΑΙ ΙΔΙΑΙΤΕΡΑ ΟΙ ΑΙΜΑΤΟΛΟΓΙΚΕΣ ΒΙΟΧΗΜΙΚΕΣ ΚΑΙ ΛΟΙΠΕΣ ΜΕΤΑΒΟΛΙΚΕΣ ΜΕΤΑΒΟΛΕΣ ΚΑΙ ΔΙΑΤΑΡΑΧΕΣ ΜΕΤΑ ΤΗΝ ΑΠΩΛΕΙΑ ΒΑΡΟΥΣ ΟΠΩΣ ΠΡΟΕΚΥΨΕ ΑΠΟ ΤΗ ΜΕΛΕΤΗ ΑΥΤΗ ΚΑΙ ΟΙ ΔΥΟ ΤΕΧΝΙΚΕΣ (MASON ΚΑΙ ECKHOUT) ΠΡΟΚΑΛΟΥΝ ΙΣΟΔΥΝΑΜΗ ΚΑΙ ΑΚΡΩΣ ΙΚΑΝΟΠΟΙΗΤΙΚΗ ΑΠΩΛΕΙΑ ΒΑΡΟΥΣ Η ΟΠΟΙΑ ΣΥΝΟΔΕΥΕΤΑΙΑΠΟ ΔΡΑΜΑΤΙΚΗ ΒΕΛΤΙΩΣΗ ΤΗΣ ΣΥΝΟΔΟΥ ΝΟΣΗΡΟΤΗΤΑΣ. ΕΠΙΠΛΕΟΝ ΟΙ ΜΕΤΕΓΧΕΙΡΗΤΙΚΕΣ ΜΕΤΑΒΟΛΙΚΕΣ ΔΙΑΤΑΡΑΧΕΣ ΤΗΣ ΜΕΘΟΔΟΥ ΚΡΙΝΟΝΤΑΙ ΟΙ ΙΔΙΑΙΤΕΡΑ ΗΠΙΕΣ ΚΑΙ ΑΝΕΥ ΚΛΙΝΙΚΗΣ ΣΗΜΑΣΙΑΣ. ΓΙΑ ΤΟ ΛΟΓΟ ΑΥΤΟ Η ΕΝΙΣΧΥΜΕΝΗ ΚΑΘΕΤΗ ΔΙΑΜΕΡΙΣΜΑΤΟΠΟΙΗΣΗ ΤΟΥ ΣΤΟΜΑΧΟΥ ΑΠΟΤΕΛΕΙ ΜΕΘΟΔΟ ΕΚΛΟΓΗΣ ΓΙΑ ΤΗ ΧΕΙΡΟΥΡΓΙΚΗ ΑΝΤΙΜΕΤΩΠΙΣΗ ΤΗΣ ΚΛΙΝΙΚΑ ΣΟΒΑΡΗΣ ΠΑΧΥΣΑΡΚΙΑΣ

Adhesion molecules as targets for the treatment of neoplastic diseases

The quest for therapeutic specificity is implicit in all branches of medicine. In cancer treatment, cytotoxic agents, such as chemotherapy and radiotherapy, comprise the current therapeutic modality. Unfortunately, when used against most solid malignancies, their therapeutic indices are relatively low due to the significant damage they inflict on normal tissues. Furthermore, cure rates have remained essentially static over the last two decades. Specificity in killing neoplastic cells, while sparing healthy ones is therefore the only alternative approach, with several molecules qualifying as candidates for targeting therapy. Reduction of cell-cell and cell-matrix adhesion are, early tumorigenesis events also implicated in the invasive and metastatic process. The fact that abnormal adhesive marker expression is a feature commonly shared by most malignancies, along with its tendency to occur as both an early and late event in neoplastic development, makes these molecules potential candidates for antineoplastic targeted therapies. This review presents the perspectives of specific anti-adhesion molecule targeting as a possible therapeutic approach in neoplastic diseases

The clinical significance of apoptosis and M30 expression in colonic cancer progression

Background/aim: The aim of this study is to identify the significance of M30, an early apoptosis indicator, in colorectal cancer and its liver metastasis. Patients and methods: The expression of M30 was immunohistochemically estimated at colonic and liver metastatic tissues of 66 patients. The results were correlated to clinical and pathological features of the tumors. Results: High expression of M30 was observed in 15.5% of cases. No metastatic tissue showed expression of M30, while stage D tumors (metastasis included) showed a statistic significant lower expression of M30, when compared to earlier tumor stages. Conclusion: Low expression of M30 implies the development of resistance mechanisms against apoptosis, facilitating the progression of colon cancer