Hilar cholangiocarcinoma – long-term results of radical and palliative treatment

Introduction. Hilar cholangiocarcinoma (HC) is the tumor that requires multidisciplinary approach and treatment. The 3- and 5- year survivals of HC patients treated with surgery and palliative methods were evaluated in the study. Material and methods. A study covered 368 patients treated between 2000–2014. Of them, 137 patients were categorized for surgery (RT group), and 231 for palliative treatment (PT group). The overall 3- and 5- year survivals were determined by the log rank test. Cox hazard regression model revealed the relative prognostic factors. Results. The 3- and 5- year survival rates accounted for 38% and 21% after surgery, but 13% and 0 after palliative treatment (p < 0.0001). Radical tumor resection, negative lymph nodes, and early tumor T stage were the factors conducive to survival. Conclusions. Surgery, if the radical tumor resection is possible, offers a chance for long-term survival. The positive effects of surgery treatment are lost against most of the majority of palliative patient

Przetoka kałowa odbytniczo- skórna jako powikłanie niskiej przedniej resekcji z powodu raka odbytnicy i radioterapii

Faecal fistula is an abnormal passage which communicates with anus, bladder or vagina. Fistulas are usually caused by inflammatory diseases, surgery or radiation therapy. We present a patient with rare manifestation of faecal fistula with fluctuation above left knee and with sepsis. His past medical history includes anal cancer surgical management of and adjuvant radiation therapy 5 years prior the admittance. He was unsuccessfully treated in other hospital. After subcutaneous and intramuscular drainage and after conversion from loop- into end colostomy fistulae lost their communication. The patient has fully recovered.Przetoki kałowe najczęściej łącza się z odbytem, pęcherzem, pochwą. Są powikłaniem chorób zapalnych , leczenia operacyjnego i radioterapii. Bardzo rzadko zdarzają się przypadki jak opisany poniżej chory ze spektakularnym chełbotaniem stolca tuz nad kolanem lewym, w sepsie. Chory 5 lat po leczeniu chirurgicznym raka odbytnicy i uzupełniającej radioterapii, leczony nieskutecznie w równoległym ośrodku. Drenaż zmian podskórnych i śródmięśniowych oraz zamiana kolostomii pętlowej na końcową definitywnie odłączyły zasilanie przetoki co przyczyniło się do pełnego wyzdrowienia chorego

Hilar cholangiocarcinoma – the long-term results of radical and palliative treatment

Introduction. Hilar cholangiocarcinoma (HC) is a tumor that requires a multidisciplinary approach and treatment. The 3- and 5-year survival rates of HC patients treated with surgery and palliative methods were evaluated in the study. Material and methods. The study covered 368 patients treated between 2000–2014. Of them, 137 patients were ca­tegorized for surgery (RT group), and 231 for palliative treatment (PT group). The overall 3- and 5-year survival rates were determined by the log-rank test. The Cox hazard regression model revealed the relative prognostic factors. Results. The 3- and 5-year survival rates accounted for 38% and 21% after surgery, but 13% and 0 after palliative treatment (p < 0.0001). Radical tumor resection, negative lymph nodes, and early tumor T stage were the factors conducive to survival. Conclusions.  Surgery, if the radical tumor resection is possible, offers a chance for long-term survival. The effects of surgical treatment are of little consequence in the face of poor treatment outcomes of palliative patients, however

Actuarial Patency Rates of Hepatico-Jejunal Anastomosis after Repair of Bile Duct Injury at a Reference Center

Background: Bile duct injury complicates patients’ lives, despite the subsequent repair. Repairing the injury must restore continuity of the bile tree and bring the patient into a state of cure referred to as “patency”. Actuarial primary or actuarial secondary patency rates, depending on whether the patient underwent primary or secondary repair of injury, are proposed to be a proper metric in evaluating outcomes. This study was undertaken to assess outcomes of 669 patients with bile duct injuries Strasberg D and E type referred to the department from public surgical wards between 1990 and 2020. In 442 patients, no attempt was made to repair prior to a referral, and in 227 an attempt to repair was made which failed. Methods: Observations were summarized on December 31st, 2020. The retrospective analysis included: primary patency attained (Grade A result), secondary patency attained (Grade C result), patency loss, and actuarial patency rates of the bile tree at 2, 5, and 10 years. Results: Twenty-five (3.7%) patients died after repair surgery. Actuarial patency rates at 2, 5, and 10 years of follow-up were 93%, 88%, and 74% or 86%, 75%, and 55% in patients attaining Grade A and Grade C outcomes, respectively (p < 0.001). Conclusion: Bile duct injury stands out as a surgical challenge, requiring specialized management at a referral center. Improper proceeding after an injury is the factor leading to faster loss of anastomotic patency

Cannabidiol Protects against the Reinstatement of Oxycodone-Induced Conditioned Place Preference in Adolescent Male but Not Female Rats: The Role of MOR and CB1R

Cannabidiol (CBD), a phytocannabinoid, appeared to satisfy several criteria for a safe approach to preventing drug-taking behavior, including opioids. However, most successful preclinical and clinical results come from studies in adult males. We examined whether systemic injections of CBD (10 mg/kg, i.p.) during extinction of oxycodone (OXY, 3 mg/kg, i.p.) induced conditioned place preference (CPP) could attenuate the reinstatement of CPP brought about by OXY (1.5 mg/kg, i.p.) priming in adolescent rats of both sexes, and whether this effect is sex dependent. Accordingly, a priming dose of OXY produced reinstatement of the previously extinguished CPP in males and females. In both sexes, this effect was linked to locomotor sensitization that was blunted by CBD pretreatments. However, CBD was able to prevent the reinstatement of OXY-induced CPP only in adolescent males and this outcome was associated with an increased cannabinoid 1 receptor (CB1R) and a decreased mu opioid receptor (MOR) expression in the prefrontal cortex (PFC). The reinstatement of CCP in females was associated with a decreased MOR expression, but no changes were detected in CB1R in the hippocampus (HIP). Moreover, CBD administration during extinction significantly potentialized the reduced MOR expression in the PFC of males and showed a tendency to potentiate the reduced MOR in the HIP of females. Additionally, CBD reversed OXY-induced deficits of recognition memory only in males. These results suggest that CBD could reduce reinstatement to OXY seeking after a period of abstinence in adolescent male but not female rats. However, more investigation is required