Laparoskopsko liječenje karcinoida crvuljka – prikaz slučaja

In this paper we present a case report of laparoscopic right hemicolectomy as the treatment of choice for appendiceal carcinoid tumor. A 43-year-old female patient was presented with signs and symptoms of acute appendicitis. An open appendectomy was performed, and the inflamed appendix with a tumefaction on it\u27s tip was removed. Pathohistological examination revealed a carcinoid tumor of the appendix, 2 by 2.5 cm in size, with a small satellite carcinoid in the surrounding tissue. Carcinoid cells occupied the whole thickness of the appendiceal wall. Considering the above mentioned histological characteristics a second operation was indicated. Laparoscopic right hemicolectomy was performed. It was accomplished with the use of three trocar ports. Ileotransverseal anastomosis was finished extracorporeally with the use of a stapling device. Pathological examination revealed a nodule of carcinoid tissue less than 1 cm in diameter close to the cecal wall. The postoperative period was uneventful. The patient was urged to see the oncology specialist for consideration of further oncologic therapy. Although appendectomy alone is effective in most cases of appendiceal carcinoid tumor, in some cases right hemicolectomy may be indicated. In such cases, the laparoscopic approach is safe and effective, and should be considered as the treatment of choice.U ovom radu prikazujemo slučaj laparoskopske desne hemikolektomije u liječenju karcinoida crvuljka. Bolesnica u dobi od 43 godine javila se liječniku sa znakovima i simptomima akutnog apendicitisa. Obavljena je otvorena apendektomija i uklonjen je upaljeni crvuljak s tumefakcijom na vrhu. Patohistološkim pregledom otkriven je karcinoid crvuljka veličine 2 x 2,5 cm, i mali satelitski karcinoid u okolnom tkivu. Karcinoidne stanice obuhvaćale su čitavu debljinu stijenke crvuljka. S obzirom na spomenute histološke značajke indicirana je druga operacija. Laparoskopska desna hemiktomija obavljena je uvođenjem triju troakara. Ileotransverzalna anastomoza završena je ekstrakorporalno s pomoću staplera. Patološkim je pregledom u blizini stijenke crvuljka otkriven mali čvor karcinoidnog tkiva manja od 1 cm u promjeru. Postoperacijski tijek protekao je bez poteškoća. Bolesnica je hitno upućena onkologu radi daljnjeg onkološkog liječenja. Iako je sama apedenktomija učinkovita u većini slučajeva karcinoida crvuljka, katkad je indicirana desna hemikolektomija. Držimo da je u tim slučajevima laparoskopski pristup siguran i učinkovit, i treba ga uzeti u obzir kao liječenje izbora

Laparoskopsko liječenje karcinoida crvuljka – prikaz slučaja

In this paper we present a case report of laparoscopic right hemicolectomy as the treatment of choice for appendiceal carcinoid tumor. A 43-year-old female patient was presented with signs and symptoms of acute appendicitis. An open appendectomy was performed, and the inflamed appendix with a tumefaction on it\u27s tip was removed. Pathohistological examination revealed a carcinoid tumor of the appendix, 2 by 2.5 cm in size, with a small satellite carcinoid in the surrounding tissue. Carcinoid cells occupied the whole thickness of the appendiceal wall. Considering the above mentioned histological characteristics a second operation was indicated. Laparoscopic right hemicolectomy was performed. It was accomplished with the use of three trocar ports. Ileotransverseal anastomosis was finished extracorporeally with the use of a stapling device. Pathological examination revealed a nodule of carcinoid tissue less than 1 cm in diameter close to the cecal wall. The postoperative period was uneventful. The patient was urged to see the oncology specialist for consideration of further oncologic therapy. Although appendectomy alone is effective in most cases of appendiceal carcinoid tumor, in some cases right hemicolectomy may be indicated. In such cases, the laparoscopic approach is safe and effective, and should be considered as the treatment of choice.U ovom radu prikazujemo slučaj laparoskopske desne hemikolektomije u liječenju karcinoida crvuljka. Bolesnica u dobi od 43 godine javila se liječniku sa znakovima i simptomima akutnog apendicitisa. Obavljena je otvorena apendektomija i uklonjen je upaljeni crvuljak s tumefakcijom na vrhu. Patohistološkim pregledom otkriven je karcinoid crvuljka veličine 2 x 2,5 cm, i mali satelitski karcinoid u okolnom tkivu. Karcinoidne stanice obuhvaćale su čitavu debljinu stijenke crvuljka. S obzirom na spomenute histološke značajke indicirana je druga operacija. Laparoskopska desna hemiktomija obavljena je uvođenjem triju troakara. Ileotransverzalna anastomoza završena je ekstrakorporalno s pomoću staplera. Patološkim je pregledom u blizini stijenke crvuljka otkriven mali čvor karcinoidnog tkiva manja od 1 cm u promjeru. Postoperacijski tijek protekao je bez poteškoća. Bolesnica je hitno upućena onkologu radi daljnjeg onkološkog liječenja. Iako je sama apedenktomija učinkovita u većini slučajeva karcinoida crvuljka, katkad je indicirana desna hemikolektomija. Držimo da je u tim slučajevima laparoskopski pristup siguran i učinkovit, i treba ga uzeti u obzir kao liječenje izbora

Mukokela u bolesnice s recidivom karcinoma dojke - prikaz slučaja i pregled literature

Mucocele or cystic distention of the appendix is a rare entity found in only 0.25% of all appendectomies and 8% of all appendicular tumors. We report a case of a 68-year-old female patient in whom asymptomatic mucocele was found at abdominal CT imaging a month after excision of recurrent invasive ductal carcinoma to the right pectoral region, and 26 years after modifed radical mastectomy. After adequate preoperative treatment, a right hemicolectomy was performed with the final pathology of mucocele of the appendix.Mukokela, odnosno cistično proširenje apendiksa rijetka je pojava koja se pronalazi u samo 0,25 % apendektomija, te čini samo 8 % svih tumora crvuljka. Prikazujemo slučaj 68-godišnje pacijentice kod koje je asimptomatska mukokela pronađena na CT-u abdomena mjesec dana nakon ekscizije recidiva duktalnog invazivnog karcinoma desne pektoralne regije, 26 godina nakon modificirane radikalne mastektomije. Nakon odgovarajuće preoperativne obrade učinjena je desna hemikolektomija s konačnim patohistološkim nalazom mukokele apendiksa

Transanal ekscizija za rektalni karcinom - multidisciplinarni pristup?

Incidence of rectal cancer in Croatia was 1174 cases in 2012. Most cases were diagnosed at an advanced stage, however there are a few diagnosed in cT1-2N0M0 stage which opens a window for transanal resection. These patients have to be staged meticulously not to disregard possible local spread of disease and nodal involvement. Endorectal ultrasound is not always easily available, therefore MRI is usually the method of choice for preoperative staging. Nevertheless, since the implementation of this mode of treatment advances in neoadjuvant and adjuvant therapy and multidisciplinary approach to treatment have blurred these clear cut indications. In this paper we discuss specificities in selection, treatment and follow up of these patients.Incidencija karcinoma rektuma u Hrvatskoj je oko 1174 slučajeva u 2012 godini. Većina slučajeva je dijagnosticirana u poodmaklim stadijima bolesti, ipak odre|en broj se dijagnosticira u cT1-T2N0M0 stadiju što otvara mogućnost za transanalnu eksciziju. Pacijenti kod kojih se predvi|a trananalna ekscizija moraju biti u potpunosti slikovno obrađena kako se preoperativno ne bi previdjela proširenja bolest. Endorektalni ultrazvuk nije široko dostupan, tako da se najčešće koristi MR pri odluci o vrsti zahvata. Unatoč dosta jasno definiranim indikacijama za ovaj zahvat, napredak u neoadjuvantom i adjuvantnom pristupu te multidisciplinarnosti liječenja je iste relativizirao. U ovom preglednom radu raspravit ćemo izbor, vrstu liječenja i praćenja ovih pacijenat

Masivna endometrioza koja klinički oponaša tumor – neuobičajen slučaj intususcepcije crvuljka

Appendiceal intussusception is a rare clinical entity that, in women of reproductive age, may be caused by endometriosis. We report a case of a 36-year-old woman presenting with abdominal pain. The patient underwent laparoscopic surgery, during which a suspicion of a cecal tumor was raised. A laparoscopic right hemicolectomy was performed. The patohistological exam showed an intussuscepted appendix, and the cause of the intussusception was massive endometriosis involving the colon, ileum, and appendix. It is important not to mistake appendiceal intussusception and appendiceal endometriosis with other intraabdominal pathologies whose symptoms they can mimic.Intususcepcija crvuljka je rijedak klinički entitet koji u žena reproduktivne dobi može biti uzrokovan endometriozom. U članku je prikazan slučaj 36-ogodišnje žene koja se javila u hitnu službu s bolovima u abdomenu. Učinjena je laparoskopska operacija tijekom koje je postavljena sumnja na tumor cekuma te je napravljena desnostrana hemikolektomija. Patohistološki nalaz je pokazao intususcepciju crvuljka čiji je uzrok bio opsežna endometrioza koja je zahvatila debelo crijevo, ileum i crvuljak. Važno je prepoznati intususcepciju i endometriozu crvuljka, jer ih je lako zamijeniti za drugu intraabdominalnu patologiju, čije simptome mogu oponašati

Sentimag biopsija limfnog čvora stražara u konzervativnoj kirurgiji dojke – preliminarni rezultati

Segmentectomy and sentinel lymph node biopsy is a golden standard for early breast cancer (clinical and radiological cT1-2, c N0). Recently, superparamagnetic iron oxide (SPIO) nanoparticle tracer has been introduced enabling intraoperative tracer injection. We prospectively recorded data on tumor histology, marked lymph nodes and their final histology and patient characteristics for early breast cancer patients who underwent breast conservative surgery. At 128 female breast cancer patients underwent sentinel lymph node biopsy by SentiMag. Three patients were excluded from further analysis because the postoperative pathology report was ductal carcinoma in situ (DCIS). The identifi cation rate was 95.2 % (119 of 125). Of the 19.2 % (24 of 125) patients with lymph node involvement, 1.6% (2 of 125) had micrometastasis, and 1 % (1 of 125) had single tumor cells within the sentinel, l at least a micrometastasis. Of 30 positive lymph nodes removed, 24 (80 %) were true sentinel nodes. The average lymph node retrieval rate was 2.3 nodes per patient. SentiMag’s performance was comparable to published data and to standard sentinel with blue patent die and/or technetium. The benefi t of easier application and logistics is a great advantage.Segmentektomija i biopsija limfnog čvora stražara zlatni su standard za kirurško liječenje ranog raka dojke (klinički i radiološki cT1-2, c N0). Čestice superparamagnetskog željeznog oksida (superparamagnetic iron oxide, SPIO) od nedavno se koriste kao unutaroperacijski nanočestični obilježivač. Prospektivno smo bilježili demografske podatke o bolesnicama, histologiju tumora te označenih i neoznačenih limfnih čvorova. U 128 bolesnica učinjena je biopsija limfnog čvora stražara u aksili detektorom SentiMag. Tri bolesnice su isključene, jer je konačan patohistoloski nalaz bio carcinoma ductale in situ (DCIS). Limfni čvor je pronađen u 119 od 125 bolesnica (95.2%), pozitivne limfne čvorove su imale 24 (19.2%), makrometasaze 2 (1.6%) i mikrometastaze 1 bolesnica (0.08%). Od 30 pozitivnih odstranjenih limfnih čvorava, obilježenih je bilo 24 (80 %). Prosječno su po bolesnici izvađena 2.3 limfna čvora. Mogućnost otkrivanja limfnog čvora stražara SentiMagom usporediva je s dosad objavljenim podatcima i zlatnim standardom. Prednosti metode su lakše rukovanje i minimalna logistika

ASSOCIATION BETWEEN DURATION OF DIALYSIS AND HELICOBACTER PYLORI INFECTION IN DIALYSIS PATIENTS AT THE UNIVERSITY CLINICAL HOSPITAL MOSTAR

Introduction: Association of Helicobacter pylori (HP) infection with the length of dialysis in dialysis patients is contradictory. This study was conducted in order to determine the association between the duration of dialysis and the HP infection status in the dialysis patients. Furthemore, biochemical parameters were monitored in two subject groups that were included in this study. Subjects and methods: The study included 51 patients on chronic hemodialysis program who had gastrointestinal symptoms. The subjects were divided in two groups per the length of dialysis treatment. In this study we analyzed age, gender, the time period since the onset of the chronic hemodialysis program, body mass index, biochemical parameters, and whether the patients have arterial hypertension and/or diabetes. The presence of HP antigen was determined in the stool samples with use of he UlcoGnost AG test plate. Results: The incidence of HP infection in hemodialysis patients, with some of the gastrointestinal symptoms, was 25.5%. Patients on hemodialysis for less than 24 months had lower incidence of HP infection than those on hemodialysis program for more than 24 months. HP positive and HP negative subjects were also compared by gender, age, biochemical parameters and body mass index. There was no statistical significant difference between the groups in any of those characteristics. When comparing the HP status of the subjects with the presence of arterial hypertension and diabetes, no statistically significant difference was found between the groups. Conclusion: This study showed negative correlation between HP infection and the length of hemodialysis program. Analysis of age, gender, body mass index, biochemical parameters, presence of arterial hypertension and/or diabetes showed no statistically significant difference was found between the hemodialysis patients who were HP positive and those who were HP negative. Additional studies are needed to elucidate the correlation mechanism between the HP infection and the duration of dialysis, in order to examine how long the dialysis time period is the most susceptible to HP infection, and then to improve the prognosis of patients with renal disease

Kirurško liječenje kolorektalnih metastaza u jetri

Approximately 50% of patients with colorectal cancer (CRC) will developduring their lifespan. Majority of colorectal liver metastases (CLM) patients will be unresectable at the time of diagnosis due to extensive intrahepatic and/or extrahepatic disease. R0 liver resection is still the only available treatment that allows long-term survival. In last two decades, the 5-year overall survival (OS) after curative liver resection of CLM has increased up to 58%. These improved outcomes are mainly due to multidisciplinary treatment of these patients. The definition of resectability has changed, so nowdays, the goal is the completion of R0 resection and normal liver function maintenance. Conversional (neoadjuvant) chemotherapy, portal vein embolization, two-stage hepatectomy, and tumour ablation are effective approaches to improve resectability for initially unresectable patients. The role of perioperative chemotherapy, for clearly resectable patients, still needs to be clarified. It results in longer disease-free survival (DFS) and OS times, but it is not clear whether it is the neoadjuvant or the adjuvant component that provides the benefit.Disadvantages of neoadjuvant chemotherapy are either progression or complete remission during treatment, and their managment is challenging. According to available data the efficacy of adjuvant chemotherapy after CLM resection is questionable. However, the ideal chemotherapy and its optimal sequencing in the course of treatment are uncertain.Equally, the influence of chemotherapy-associated toxicity on the outcome of liver resection needs to be further explored. There is debate over whether the primary tumour and metastases should be removed at the same time or in a staged manner. Targeted therapy with novel biological agents such as bevacizumab and cetuximab, in addition to traditional chemotherapy, has been shown to improve the survival of unresectable CLM patients. The majority of patients will develop recurrent disease in the liver within the first two years after surgery, despite any mode of treatment that they have received. Therefore, a repeat resection is recommended as the only chance to prolong DFS and OS. Consequently, all of these issues demand an modern oncosurgical and multidisciplinary approach to the each individual with liver surgeon having a central role in treatment planning.Oko 50% bolesnika s rakom debelog crijeva razviti će metastaze u jetri tijekom svog životnog vijeka. Nažalost, većina bolesnika sa metastatskim kolorektalnim karicnomom će biti inoperabilna u vrijeme postavljanja dijagnoze zbog opsežne intrahepatičke i / ili ekstrahepatičke bolesti. R0 resekcija jetre je još uvijek jedini dostupni oblik liječenja koji omogućuje dugoročno preživljenje. U posljednja dva desetljeća, 5-godišnje preživljenje nakon kurativne resekcije jetre poraslo je na 58%. Ti poboljšani rezultati su uglavnom posljedica multidisciplinarnog liječenja tih bolesnika, iako je optimalnog algoritam još uvijek upitan. Definicija resektabilnosti se promijenila, pa se danas kao cilj liječenja postavlja mogućnost R0 resekcije uz normalno postoperativno održavanje jetrene funkcije. Neoadjuvantna kemoterapija, embolizacija poralne vene, hepatekto mija u dva akta ilokalna ablacija su učinkoviti pristupi u konverziji inicijalno inoperabilnih pacijenata u operabilne. Ulogu perioperativne kemoterapije, za evidentno operabilne bolesnike, još treba razjasniti. Perioperativna kemoterapija rezultira duljim periodom bez bolesti i ukupnim preživljenjem, ali nije jasno da li je neoadjuvanta ili adjuvantna komponenta ta koja pruža korist. Potencijalni nedostaci neoadjuvantne kemoterapije su ili napredovanje ili potpuna remisija tijekom liječenja, a liječenje tih bolesnika je izazov. Prema sadašnjim podacima iz literature, učinkovitost adjuvantne kemoterapije nakon resekcije metastatskog kolorektalnog karcinoma je upitna. Isto tako, idealni kemoterapijski protokol, sa ili bez bioloških agensa, i njeno optimalno sekvenciranje u tijeku liječenja je upitno. Isto tako, utjecaj, s kemoterapijom povezane toksičnosti, na ishod kirurškog liječenja treba dodatno istražiti. Još uvijek se raspravlja o tome da li primarni tumor i metastaze treba ukloniti u isto vrijeme ili operacijama u dva akta. Za jasno inoperabilnog bolesnika, još je uvijek upitno da li primarni tumor treba resecirati. Ciljana terapija s novim biološkim agensima, kao što su bevacizumab i cetuksimab, uz tradicionalne kemoterapijske protokole, dokazano poboljšava preživljenje kod definitivno inoperabilnih bolesnika. Većina bolesnika s metastatskim kolorektalnim karcinomom (55% -60%), će se razviti intrahepatalni recidiv unutar prve dvije godine nakon kirurškog zahvata, bez obzira na modalitet liječenja. Stoga se ponovljene resekcije jetre preporučuju kao jedina moguća opcija koja može produžiti život ovim bolesnicima. Prema tome, sva ova otvorena pitanja zahtijevaju suvremenionko-kirurški pristup svakom pojedinom bolesniku, u sklopu multidisciplinarnog tima, s kirurgomu glavnoj ulozi kod planiranja liječenja