AIM:To assess the treatment and tumor-related variables associated with outcome after treatment of spontaneously ruptured hepatocellular carcinoma (HCC).METHODS: Patients with ruptured HCC were identif ied. The compli...AIM:To assess the treatment and tumor-related variables associated with outcome after treatment of spontaneously ruptured hepatocellular carcinoma (HCC).METHODS: Patients with ruptured HCC were identif ied. The complications, mortality and survival were assessed. The relationship between tumor size and the severity of hemoperitoneum and between tumor size and grade were examined.RESULTS: From January 1993 to January 2008, 556 patients with HCC with or without cirrhosis were evaluated; of which, 16 (2.87%) presented with spontaneous rupture. All but 1 patient had cirrhosis. Twelve patients underwent surgical resection while 4 underwent trans-cutaneous arterial catheter embolization (TAE) (trans-cutaneous arterial embolization). Early mortality (<30 d) was 25% (4 of 16) and was inversely relatedto Child-Pugh score; 3 of the 4 early deaths occurred in patients treated with TAE with 1 of 12 occurring in the resected group. There was no correlation between tumor size and grade or between size and severity of hemoperitoneum.CONCLUSION: Tumor size did not correlate with severity of the hemoperitoneum. There was an inverse relationship between G1-G3 (grade of cellular differentiation) HCC and dimensions.展开更多
AIM:To analyze gastric polypoid lesions in our patient- population with respect to histopathologic features and demographic,clinical,and endoscopic characteristics of patients. METHODS:Clinical records and histopathol...AIM:To analyze gastric polypoid lesions in our patient- population with respect to histopathologic features and demographic,clinical,and endoscopic characteristics of patients. METHODS:Clinical records and histopathologic reports of patients with gastric polypoid lesions were analyzed retrospectively.All lesions had been totally removed by either endoscopic polypectomy or hot biopsy forceps.The histopathologic slides were re-evaluated by the same histopathologist. RESULTS:One-hundred and fifty gastric polypoid lesions were identified in 91 patients.There were 53(58 %)women and 38(42 %)men with a median age of 53(range,31 to 82)years.The most frequent presenting symptom was dyspepsia that was observed in 35(38.5 %)patients. Symptoms were mostly related to various associated gastric abnormalities such as chronic gastritis or H pylori infection rather than polypoid lesion itself.Polypoid lesions were commonly located in the antrum followed by cardia.Out of 150 lesions,80(53 %)had the largest dimensions less than or equal to 5 mm and only 7 were pedunculated.The frequencies of hyperplastic polyps,foveolar hyperplasia,and fundic gland polyps were 46 %,18 %,and 14 % respectively. We also detected gastritis varioliformis in 12 specimens, lymphoid follicles in 9,4 adenomatous polyps in 4,polypoid lesions with edematous mucosa in 4,inflammatory polyps in 3,and carcinoid tumor in 1.Adenomatous changes were observed within two hyperplastic polyps and low grade dysplasia in one adenoma.Histopathologic evaluation of the surrounding gastric mucosa demonstrated chronic gastritis in 72(79 %)patients and H pylori infection in 45(49 %). CONCLUSION:Hyperplastic polyps are the mbst frequently encountered subtype of gastric polypoid lesions.They are usually associated with chronic gastritis or H pylori gastritis.Contrary to the previous belief,they may harbour adenomatous changes or dysplastic foci. Therefore,endoscopic polypectomy seems as a safe and fast procedure for both diagnosis and treatment of gastric polypoid lesions at the same session.In addition, edematous mucosa may appear misleadingly as a polypoid lesion in some instances and it can be ruled out only by histopathologic examination.展开更多
To characterize the expression of toll-like receptors (TLR) 2 and 4 in colorectal cancer (CRC) and in normal colorectal mucosa. METHODSWe analysed tissue samples from a prospective series of 118 unselected surgically ...To characterize the expression of toll-like receptors (TLR) 2 and 4 in colorectal cancer (CRC) and in normal colorectal mucosa. METHODSWe analysed tissue samples from a prospective series of 118 unselected surgically treated patients with CRC. Sections from formalin fixed, paraffin embedded specimens were analysed for TLR2 and TLR4 expression by immunohistochemistry. Two independent assessors evaluated separately expression at the normal mucosa, at the invasive front and the bulk of the carcinoma, and in the lymph node metastases when present. Expression levels in different locations were compared and their associations with clinicopathological features including TNM-stage and the grade of the tumour and 5-year follow-up observations were analysed. RESULTSNormal colorectal epithelium showed a gradient of expression of both TLR2 and TLR4 with low levels in the crypt bases and high levels in the surface. In CRC, expression of both TLRs was present in all cases and in the major proportion of tumour cells. Compared to normal epithelium, TLR4 expression was significantly weaker but TLR2 expression stronger in carcinoma cells. Weak TLR4 expression in the invasive front was associated with distant metastases and worse cancer-specific survival at 5 years. In tumours of the proximal colon the cancer-specific survival at 5 years was 36.9% better with strong TLR4 expression as compared with those with weak expression (P = 0.044). In contrast, TLR2 expression levels were not associated with prognosis. Tumour cells in the lymph node metastases showed higher TLR4 expression and lower TLR2 expression than cells in primary tumours. CONCLUSIONTumour cells in CRC show downregulation of TLR4 and upregulation of TLR2. Low expression of TLR4 in the invasive front predicts poor prognosis and metastatic disease.展开更多
Gastric carcinoma is one of the most frequent malignancies in the world and its clinical behavior especially depends on the metastatic potential of the tumor.In particular,lymphatic metastasis is one of the main predi...Gastric carcinoma is one of the most frequent malignancies in the world and its clinical behavior especially depends on the metastatic potential of the tumor.In particular,lymphatic metastasis is one of the main predictors of tumor recurrence and survival,and current pathological staging systems reflect the concept that lymphatic spread is the most relevant prognostic factor in patients undergoing curative resection.This is compounded by the observation that two-thirds of gastric cancer in the Western world presents at an advanced stage,with lymph node metastasis at diagnosis.All current therapeutic efforts in gastric cancer are directed toward individualization of therapeutic protocols,tailoring the extent of resection and the administration of preoperative and postoperative treatment.The goals of all these strategies are to improve prognosis towards the achievement of a curative resection(R0 resection) with minimal morbidity and mortality,and better postoperative quality of life.展开更多
Patients with inflammatory bowel disease (IBD) have an increased risk of 10%-15% developing colorectal cancer (CRC) that is a common disease of high economic costs in developed countries. The CRC has been increasing i...Patients with inflammatory bowel disease (IBD) have an increased risk of 10%-15% developing colorectal cancer (CRC) that is a common disease of high economic costs in developed countries. The CRC has been increasing in recent years and its mortality rates are very high. Multiple biological and biochemical factors are responsible for the onset and progression of this pathology. Moreover, it appears absolutely necessary to investigate the environmental factors favoring the onset of CRC and the promotion of colonic health. The gut microflora, or microbiota, has an extensive diversity both quantitatively and qualitatively. In utero, the intestine of the mammalian fetus is sterile. At birth, the intestinal microbiota is acquired by ingesting maternal anal or vaginal organisms, ultimately developing into a stable community, with marked variations in microbial composition between individuals. The development of IBD is often associated with qualitative and quantitative disorders of the intestinal microbial flora (dysbiosis). The healthy human gut harbours about 10 different bacterial species distributed in colony forming units which colonize the gastrointestinal tract. The intestinal microbiota plays a fundamental role in health and in the progression of diseases such as IBD and CRC. In healthy subjects, the main control of intestinal bacterial colonization occurs through gastric acidity but other factors such as endoluminal temperature, competition between different bacterial strains, peristalsis and drugs can influence the intestinal microenvironment. The microbiota exerts diverse physiological functions to include: growth inhibition of pathogenic microorganisms, synthesis of compounds useful for the trophism of colonic mucosa, regulation of intestinal lymphoid tissue and synthesis of amino acids. Furthermore, mucus seems to play an important role in protecting the intestinal mucosa and maintaining its integrity. Changes in the microbiota composition are mainly influenced by diet and age, as well as genetic factors. Increasing evidence indicates that dysbiosis favors the production of genotoxins and metabolites associated with carcinogenesis and induces dysregulation of the immune response which promotes and sustains inflammation in IBD leading to carcinogenesis. A disequilibrium in gut microflora composition leads to the specific activation of gut associated lymphoid tissue. The associated chronic inflammatory process associated increases the risk of developing CRC. Ulcerative colitis and Crohn’s disease are the two major IBDs characterized by an early onset and extraintestinal manifestations, such as rheumatoid arthritis. The pathogenesis of both diseases is complex and not yet fully known. However, it is widely accepted that an inappropriate immune response to microbial flora can play a pivotal role in IBD pathogenesis.展开更多
We present an unusual case of corrosive esophageal injury following liquid glue ingestion. The endoscopic f indings were tissue sloughing and blackened appearance of the esophagogastric junction,due to caustic esophag...We present an unusual case of corrosive esophageal injury following liquid glue ingestion. The endoscopic f indings were tissue sloughing and blackened appearance of the esophagogastric junction,due to caustic esophageal injuries following ingestion of glue containing toluene.展开更多
Background: Liver transplant is a potential cure for liver failure and hepatic malignancy but there are many techniques which have been described for vascular reconstruction. This study was to compare the prevalence o...Background: Liver transplant is a potential cure for liver failure and hepatic malignancy but there are many techniques which have been described for vascular reconstruction. This study was to compare the prevalence of non-anastomotic biliary stricture and other surgical complications based on Clavien-Dindo scoring system, in initial portal reperfusion(sequential) versus simultaneous or initial artery reperfusion. Data sources: Meta-analysis of published studies comparing the outcomes of both techniques was carried out. Data search was conducted across the major databases and studies were selected under the guidance of the Cochrane guidelines for systematic reviews and meta-analysis. Results: Seven studies were included to address the primary and the secondary outcomes. No statistical difference was found in the incidence of non-anastomotic biliary strictures(OR = 0.40; P = 0.14), regardless of reperfusion technique. The pooled estimate of the Clavien-Dindo grading of complications was not significantly different between the techniques, though Clavien-Dindo II complications were higher in the simultaneous or initial artery reperfusion group than the initial portal reperfusion group(OR = 2.73; P = 0.01). Similarly, there was no difference in the operative time, hospital stay and other outcomes addressed in this report. Conclusions: The available evidence suggests that there is no significant difference demonstrated in the rate of non-anastomotic biliary strictures or other complications, between the two techniques, except for Clavien-Dindo II complications.展开更多
Pancreatico-jejunal anastomosis after pancreato- duodenectomy still represents the Achilles＇ heel of the proce- dure： the failure of this anastomosis is relatively common and it is the main cause of post-operative m...Pancreatico-jejunal anastomosis after pancreato- duodenectomy still represents the Achilles＇ heel of the proce- dure： the failure of this anastomosis is relatively common and it is the main cause of post-operative morbidity and mortality. Studies have described different reconstruction strategies for the control of the development of post-operative pancreatic fistula, but the strategy to obtain a safer pancreatico-jejunal anastomosis is still far from satisfaction. We report a novel variation of the invagination technique based on preliminary clinical experience in 8 patients who underwent pancreatico- jejunal anastomosis after pancreatoduodenectomy in our hepatobiliopancreatic center from 2008 to 2014. The varia- tion could obtain a safer intestinal invagination for a solid pancreatico-jejunal anastomosis even in the presence of soft pancreatic remnant.展开更多
This paper aims to update the therapeutical strategies in liver metastasis with complete clinical response(CCR) after chemotherapy and to determine if surgery is always necessary after CCR.The aim of chemotherapy is t...This paper aims to update the therapeutical strategies in liver metastasis with complete clinical response(CCR) after chemotherapy and to determine if surgery is always necessary after CCR.The aim of chemotherapy is to achieve a good clinical response rather than CCR of liver metastasis.The CCR of liver metastasis after chemotherapy cannot be considered synonymous with a cure.The resection of the hepatic segment where there was hepatic metastases with CCR after chemotherapy theoretically prevents recurrence,improves survival and makes it possible to conf irm whether there has been a complete pathological response.However,the medical literature about this topic is scarce and sometimes contradictory.展开更多
Background: Fournier’s gangrene is a fulminant infection of the genitourinary tract characterized by progressive necrosis of the skin and subcutaneous tissue of the external genitalia. Initially mainly seen involving...Background: Fournier’s gangrene is a fulminant infection of the genitourinary tract characterized by progressive necrosis of the skin and subcutaneous tissue of the external genitalia. Initially mainly seen involving the scrotum of elderly men with different moods of occurrence each unpleasantly lethal. With varying types of presentation only one thing has remained constant;the poor prognosis of this condition. Purpose/Aim: Thus, it’s important to study the trends of the presentation of this condition laying emphasis on the challenges in the management of these patients;both the negative and positive prognostic factors. Materials and Methods: Urology ward record books, clinic record books and operating theater records were used to identify patients managed for Fournier gangrene in ATBUTH Bauchi. A retrospective study of the medical files of all the patients managed from January 2011 to January 2024 was done. Data was analyzed using SPSS version 29. Results: Data from 47 patients seen during the period of study were carefully collected and analyzed. The age range is 2 weeks to 97 years. There were two neonates, one at 2nd week of life and the other at 3rd week. Mortality rate is 36%. The average time duration before presentation for patients that died was two weeks, a minimum of 9 days prior to presentation and a maximum of 21 days, about 10 of which came in septic shock and the remaining presented with fever and very extensive necrotizing fasciitis of the perineum. All the patients that died had diabetes mellitus as a comorbidity except the neonate. All the patients that survived were much younger, all were below 60 years of age (2 weeks - 53 years). Conclusion: Here, we share our experience managing patients with Fournier’s gangrene in our facility in the past 13-year period from January 2011 to January 2024. .展开更多
AIM:Gastric outlet obstruction caused by duodenal impaction of a large gallstone migrated through a cholecystoduodenal fistula has been referred as Bouveret's syndrome.Endoscopic lithotomy is the first-step treatm...AIM:Gastric outlet obstruction caused by duodenal impaction of a large gallstone migrated through a cholecystoduodenal fistula has been referred as Bouveret's syndrome.Endoscopic lithotomy is the first-step treatment, however,surgery is indicated in case of failure or complication during this procedure. METHODS:We report herein an 84-year-old woman presenting with features of gastric outlet obstruction due to impacted gallstone.She underwent an endoscopic retrieval which was unsuccessful and was further complicated by distal gallstone ileus.Physical examination was irrelevant. RESULTS:Endoscopy revealed multiple erosions around the cardia,a large stone in the second part of the duodenum causing complete obstruction,and wide ulceration in the duodenal wall where the stone was impacted.Several attempts of endoscopic extraction by using foreign body forceps failed and surgical intervention was mandatory.Preoperative ultrasound evidenced pneumobilia whilst computerized tomography showed a large stone,5 cm×4 cm×3 cm,logging at the proximal jejunum and another one,2.5 cm×2 cm×2 cm, in the duodenal bulb causing a closed-loop syndrome.She underwent laparotomy and the jejunal stone was removed by enterotomy.Another stone reported as located in the duodenum preoperatively was found to be present in the gallbladder by intraoperative ultrasound.Therefore, cholecystoduodenal fistula was broken down,the stone was retrieved and cholecystectomy with duodenal repair was carried out.She was discharged after an uneventful postoperative course.CONCLUSION: As the simplest and the least morbid procedure, endoscopic stone retrieval should be attempted in the treatment of patients with Bouveret's syndrome.When it fails, surgical lithotomy consisting of simple enterotomy may solve the problem. Although cholecystectomy and cholecystoduodenal fistula breakdown is unnecessary展开更多
AIM:To investigate stapled transanal rectal resection (STARR) procedures as surgical techniques for obstructed defecation syndrome (ODS) by analyzing specimen evaluation,anorectal manometry,endoanal ultrasonography an...AIM:To investigate stapled transanal rectal resection (STARR) procedures as surgical techniques for obstructed defecation syndrome (ODS) by analyzing specimen evaluation,anorectal manometry,endoanal ultrasonography and clinical follow-up.METHODS:From January to December 2007,we have treated 30 patients.Fifteen treated with double PPH-01 staplers and 15 treated using new CCS 30 contour.Resected specimen were measured with respect to average surface and volume.All patients have been evaluated at 24 mo with clinical examination,anorectal manometry and endoanal ultrasonography.RESULTS:Average surface in the CCS 30 group was 54.5 cm2 statistically different when compared to the STARR group (36.92 cm2).The average volume in the CCS 30 group was 29.8 cc,while in the PPH-01 it was23.8 cc and difference was statistically significant.The mean hospital stay in the CCS 30 group was 3.1 d,while in the PPH-01 group the median hospital stay was 3.4 d.As regards the long-term follow-up,an overall satisfactory rate of 83.3% (25/30) was achieved.Endoanal ultrasonography performed 1 year following surgery was considered normal in both of the studied groups.Mean resting pressure was higher than the preoperative value (67.2 mmHg in the STARR group and 65.7 mmHg in the CCS30 group vs 54.7 mmHg and 55.3 mmHg,respectively).Resting and squeezing pressures were lower in those patients not satisfied,but data are not statistically significant.CONCLUSION:The STARR procedure with two PPH-01 is a safe surgical procedure to correct ODS.The new Contour CCS 30 could help to increase the amount of the resected tissue without differences in early complications,post-operative pain and in hospital stay compared to the STARR with two PPH-01 technique.展开更多
Introduction: Hepatocellular carcinoma is the most common primary neoplasm of the liver and a significant cause of mortality in patients with cirrhosis. A retrospective cross-sectional study was performed to analyze e...Introduction: Hepatocellular carcinoma is the most common primary neoplasm of the liver and a significant cause of mortality in patients with cirrhosis. A retrospective cross-sectional study was performed to analyze epidemiological aspects related to risk factors, diagnosis, staging and first-line treatment in a closed population. Methods: The medical records of patients seen between November 1998 and May 2011 were revisited. Results: Of the 272 patients included in this study, 229 (84.2%) were male and the average age was 57.1 years (standard deviation 10.9 years). The most common etiology was hepatitis C virus infection in 145 (55.1%) patients, with this being the single cause in 88 (33.4%) patients. The largest masses ranged from 6 mm to 260 mm in diameter with a mean of 61.4 mm (standard deviation 41.5 mm). Only one mass was found in 145 (64.2%) cases, two masses in 26 (11.5%), three masses in 9 (4%) and 46 patients (20.3%) had multifocal disease. Early stage disease was diagnosed in 47 patients (22.0%), advanced stage in 65 (30.4%) and terminal stage in 32 (14.9%). Hepatocellular carcinoma was found by chance in 11%. Diagnosis was by means of imaging in 175 (68.1%) cases. The level of alpha-fetoprotein was measured in 209 patients, with 29.2% having levels lower than 20 ng/mL and 34.9% having levels above 400 ng/mL. Specific treatment was administered in 236 patients (86.8%) with hepatic chemoembolization in 127 (46.7%) and liver transplantation in 72 (26.5%);of these 33 (45.8%) received hepatic chemoembolization as a bridge to transplantation. Thirty-four patients (12.5%) received only supportive therapy. Conclusions: Patients are chiefly male and disease involvement generally occurs in the 5th decade of life. Cirrhosis was present in most patients and hepatitis C virus infection was the commonest etiologic agent. Only one imaging examination was required for diagnosis in most patients. The measurement of alpha-fetoprotein levels did not prove to be a good tool in the diagnosis of hepatocellular carcinoma. Intermediate, advanced and terminal stages predominated compared to early stages. Treatment was based on non-curative therapies.展开更多
Background: Radical lymph node dissection (RLND) is the treatment of choice in stage III melanoma patients. Over half of the observed complications were related to post-operative serum collection affecting wound heali...Background: Radical lymph node dissection (RLND) is the treatment of choice in stage III melanoma patients. Over half of the observed complications were related to post-operative serum collection affecting wound healing. The aim of this study was to evaluate the use of the LigaSureTM Small Jaw (LSJ) on postoperative drainage fluid volume and drainage permanence in patients undergoing RLND. Study design: This was a prospective single-center study in which consecutive melanoma patients underwent nodal dissection using the LSJ. Daily drainage volume and duration of drainage were recorded in post-operative course on days 3, 10 or 15 and day 20. Results: A total of 70 patients were included. Mean postoperative drainage volume was lower. Around two-thirds of patients had a drainage fluid volume of less than 50cc at 10 days. Mean time to drainage removal was 14.5 days. Conclusions: This is the first report of nodal dissection in patients with cutaneous melanoma using an electrothermal bipolar vessel sealing system. The technique was feasible, safe, and effective and resulted in reduced drainage fluid volume and drainage permanence.展开更多
Cancer stem cells(CSCs)are responsible for colorectal cancer(CRC)chemoresistance,recurrence,and metastasis.Therefore,identifying molecular stemness targets that are involved in tumor growth is crucial for effective tr...Cancer stem cells(CSCs)are responsible for colorectal cancer(CRC)chemoresistance,recurrence,and metastasis.Therefore,identifying molecular stemness targets that are involved in tumor growth is crucial for effective treatment.Here,we performed an extensive in vitro and in vivo molecular and functional characterization,revealing the pivotal role of the lysine methyltransferase SET and MYND Domain Containing 3(SMYD3)in colorectal cancer stem cell(CRC-SC)biology.Specifically,we showed that SMYD3 interacts with and methylates c-MYC at K158 and K163,thereby modulating its transcriptional activity,which is implicated in stemness and colorectal malignancy.Our in vitro data suggest that SMYD3 pharmacological inhibition or its stable genetic ablation affects the clonogenic and self-renewal potential of patient-derived CRC-SCs and organoids by altering their molecular signature.Moreover,we found that SMYD3 stable knock-out or pharmacological inhibition drastically reduces CRC tumorigenicity in vivo and CRC-SC metastatic potential.Overall,our findings identify SMYD3 as a promising therapeutic target acting directly on c-MYC,with potential implications for countering CRC-SC proliferation and metastatic dissemination.展开更多
基金Supported by Società Chirurgica Tarvisium (Tarvisium Surgical Society)
文摘AIM:To assess the treatment and tumor-related variables associated with outcome after treatment of spontaneously ruptured hepatocellular carcinoma (HCC).METHODS: Patients with ruptured HCC were identif ied. The complications, mortality and survival were assessed. The relationship between tumor size and the severity of hemoperitoneum and between tumor size and grade were examined.RESULTS: From January 1993 to January 2008, 556 patients with HCC with or without cirrhosis were evaluated; of which, 16 (2.87%) presented with spontaneous rupture. All but 1 patient had cirrhosis. Twelve patients underwent surgical resection while 4 underwent trans-cutaneous arterial catheter embolization (TAE) (trans-cutaneous arterial embolization). Early mortality (<30 d) was 25% (4 of 16) and was inversely relatedto Child-Pugh score; 3 of the 4 early deaths occurred in patients treated with TAE with 1 of 12 occurring in the resected group. There was no correlation between tumor size and grade or between size and severity of hemoperitoneum.CONCLUSION: Tumor size did not correlate with severity of the hemoperitoneum. There was an inverse relationship between G1-G3 (grade of cellular differentiation) HCC and dimensions.
文摘AIM:To analyze gastric polypoid lesions in our patient- population with respect to histopathologic features and demographic,clinical,and endoscopic characteristics of patients. METHODS:Clinical records and histopathologic reports of patients with gastric polypoid lesions were analyzed retrospectively.All lesions had been totally removed by either endoscopic polypectomy or hot biopsy forceps.The histopathologic slides were re-evaluated by the same histopathologist. RESULTS:One-hundred and fifty gastric polypoid lesions were identified in 91 patients.There were 53(58 %)women and 38(42 %)men with a median age of 53(range,31 to 82)years.The most frequent presenting symptom was dyspepsia that was observed in 35(38.5 %)patients. Symptoms were mostly related to various associated gastric abnormalities such as chronic gastritis or H pylori infection rather than polypoid lesion itself.Polypoid lesions were commonly located in the antrum followed by cardia.Out of 150 lesions,80(53 %)had the largest dimensions less than or equal to 5 mm and only 7 were pedunculated.The frequencies of hyperplastic polyps,foveolar hyperplasia,and fundic gland polyps were 46 %,18 %,and 14 % respectively. We also detected gastritis varioliformis in 12 specimens, lymphoid follicles in 9,4 adenomatous polyps in 4,polypoid lesions with edematous mucosa in 4,inflammatory polyps in 3,and carcinoid tumor in 1.Adenomatous changes were observed within two hyperplastic polyps and low grade dysplasia in one adenoma.Histopathologic evaluation of the surrounding gastric mucosa demonstrated chronic gastritis in 72(79 %)patients and H pylori infection in 45(49 %). CONCLUSION:Hyperplastic polyps are the mbst frequently encountered subtype of gastric polypoid lesions.They are usually associated with chronic gastritis or H pylori gastritis.Contrary to the previous belief,they may harbour adenomatous changes or dysplastic foci. Therefore,endoscopic polypectomy seems as a safe and fast procedure for both diagnosis and treatment of gastric polypoid lesions at the same session.In addition, edematous mucosa may appear misleadingly as a polypoid lesion in some instances and it can be ruled out only by histopathologic examination.
基金Supported by a grant from the Mary and Georg C Ehrnrooth Foundation,Finland
文摘To characterize the expression of toll-like receptors (TLR) 2 and 4 in colorectal cancer (CRC) and in normal colorectal mucosa. METHODSWe analysed tissue samples from a prospective series of 118 unselected surgically treated patients with CRC. Sections from formalin fixed, paraffin embedded specimens were analysed for TLR2 and TLR4 expression by immunohistochemistry. Two independent assessors evaluated separately expression at the normal mucosa, at the invasive front and the bulk of the carcinoma, and in the lymph node metastases when present. Expression levels in different locations were compared and their associations with clinicopathological features including TNM-stage and the grade of the tumour and 5-year follow-up observations were analysed. RESULTSNormal colorectal epithelium showed a gradient of expression of both TLR2 and TLR4 with low levels in the crypt bases and high levels in the surface. In CRC, expression of both TLRs was present in all cases and in the major proportion of tumour cells. Compared to normal epithelium, TLR4 expression was significantly weaker but TLR2 expression stronger in carcinoma cells. Weak TLR4 expression in the invasive front was associated with distant metastases and worse cancer-specific survival at 5 years. In tumours of the proximal colon the cancer-specific survival at 5 years was 36.9% better with strong TLR4 expression as compared with those with weak expression (P = 0.044). In contrast, TLR2 expression levels were not associated with prognosis. Tumour cells in the lymph node metastases showed higher TLR4 expression and lower TLR2 expression than cells in primary tumours. CONCLUSIONTumour cells in CRC show downregulation of TLR4 and upregulation of TLR2. Low expression of TLR4 in the invasive front predicts poor prognosis and metastatic disease.
文摘Gastric carcinoma is one of the most frequent malignancies in the world and its clinical behavior especially depends on the metastatic potential of the tumor.In particular,lymphatic metastasis is one of the main predictors of tumor recurrence and survival,and current pathological staging systems reflect the concept that lymphatic spread is the most relevant prognostic factor in patients undergoing curative resection.This is compounded by the observation that two-thirds of gastric cancer in the Western world presents at an advanced stage,with lymph node metastasis at diagnosis.All current therapeutic efforts in gastric cancer are directed toward individualization of therapeutic protocols,tailoring the extent of resection and the administration of preoperative and postoperative treatment.The goals of all these strategies are to improve prognosis towards the achievement of a curative resection(R0 resection) with minimal morbidity and mortality,and better postoperative quality of life.
文摘Patients with inflammatory bowel disease (IBD) have an increased risk of 10%-15% developing colorectal cancer (CRC) that is a common disease of high economic costs in developed countries. The CRC has been increasing in recent years and its mortality rates are very high. Multiple biological and biochemical factors are responsible for the onset and progression of this pathology. Moreover, it appears absolutely necessary to investigate the environmental factors favoring the onset of CRC and the promotion of colonic health. The gut microflora, or microbiota, has an extensive diversity both quantitatively and qualitatively. In utero, the intestine of the mammalian fetus is sterile. At birth, the intestinal microbiota is acquired by ingesting maternal anal or vaginal organisms, ultimately developing into a stable community, with marked variations in microbial composition between individuals. The development of IBD is often associated with qualitative and quantitative disorders of the intestinal microbial flora (dysbiosis). The healthy human gut harbours about 10 different bacterial species distributed in colony forming units which colonize the gastrointestinal tract. The intestinal microbiota plays a fundamental role in health and in the progression of diseases such as IBD and CRC. In healthy subjects, the main control of intestinal bacterial colonization occurs through gastric acidity but other factors such as endoluminal temperature, competition between different bacterial strains, peristalsis and drugs can influence the intestinal microenvironment. The microbiota exerts diverse physiological functions to include: growth inhibition of pathogenic microorganisms, synthesis of compounds useful for the trophism of colonic mucosa, regulation of intestinal lymphoid tissue and synthesis of amino acids. Furthermore, mucus seems to play an important role in protecting the intestinal mucosa and maintaining its integrity. Changes in the microbiota composition are mainly influenced by diet and age, as well as genetic factors. Increasing evidence indicates that dysbiosis favors the production of genotoxins and metabolites associated with carcinogenesis and induces dysregulation of the immune response which promotes and sustains inflammation in IBD leading to carcinogenesis. A disequilibrium in gut microflora composition leads to the specific activation of gut associated lymphoid tissue. The associated chronic inflammatory process associated increases the risk of developing CRC. Ulcerative colitis and Crohn’s disease are the two major IBDs characterized by an early onset and extraintestinal manifestations, such as rheumatoid arthritis. The pathogenesis of both diseases is complex and not yet fully known. However, it is widely accepted that an inappropriate immune response to microbial flora can play a pivotal role in IBD pathogenesis.
文摘We present an unusual case of corrosive esophageal injury following liquid glue ingestion. The endoscopic f indings were tissue sloughing and blackened appearance of the esophagogastric junction,due to caustic esophageal injuries following ingestion of glue containing toluene.
文摘Background: Liver transplant is a potential cure for liver failure and hepatic malignancy but there are many techniques which have been described for vascular reconstruction. This study was to compare the prevalence of non-anastomotic biliary stricture and other surgical complications based on Clavien-Dindo scoring system, in initial portal reperfusion(sequential) versus simultaneous or initial artery reperfusion. Data sources: Meta-analysis of published studies comparing the outcomes of both techniques was carried out. Data search was conducted across the major databases and studies were selected under the guidance of the Cochrane guidelines for systematic reviews and meta-analysis. Results: Seven studies were included to address the primary and the secondary outcomes. No statistical difference was found in the incidence of non-anastomotic biliary strictures(OR = 0.40; P = 0.14), regardless of reperfusion technique. The pooled estimate of the Clavien-Dindo grading of complications was not significantly different between the techniques, though Clavien-Dindo II complications were higher in the simultaneous or initial artery reperfusion group than the initial portal reperfusion group(OR = 2.73; P = 0.01). Similarly, there was no difference in the operative time, hospital stay and other outcomes addressed in this report. Conclusions: The available evidence suggests that there is no significant difference demonstrated in the rate of non-anastomotic biliary strictures or other complications, between the two techniques, except for Clavien-Dindo II complications.
文摘Pancreatico-jejunal anastomosis after pancreato- duodenectomy still represents the Achilles＇ heel of the proce- dure： the failure of this anastomosis is relatively common and it is the main cause of post-operative morbidity and mortality. Studies have described different reconstruction strategies for the control of the development of post-operative pancreatic fistula, but the strategy to obtain a safer pancreatico-jejunal anastomosis is still far from satisfaction. We report a novel variation of the invagination technique based on preliminary clinical experience in 8 patients who underwent pancreatico- jejunal anastomosis after pancreatoduodenectomy in our hepatobiliopancreatic center from 2008 to 2014. The varia- tion could obtain a safer intestinal invagination for a solid pancreatico-jejunal anastomosis even in the presence of soft pancreatic remnant.
文摘This paper aims to update the therapeutical strategies in liver metastasis with complete clinical response(CCR) after chemotherapy and to determine if surgery is always necessary after CCR.The aim of chemotherapy is to achieve a good clinical response rather than CCR of liver metastasis.The CCR of liver metastasis after chemotherapy cannot be considered synonymous with a cure.The resection of the hepatic segment where there was hepatic metastases with CCR after chemotherapy theoretically prevents recurrence,improves survival and makes it possible to conf irm whether there has been a complete pathological response.However,the medical literature about this topic is scarce and sometimes contradictory.
文摘Background: Fournier’s gangrene is a fulminant infection of the genitourinary tract characterized by progressive necrosis of the skin and subcutaneous tissue of the external genitalia. Initially mainly seen involving the scrotum of elderly men with different moods of occurrence each unpleasantly lethal. With varying types of presentation only one thing has remained constant;the poor prognosis of this condition. Purpose/Aim: Thus, it’s important to study the trends of the presentation of this condition laying emphasis on the challenges in the management of these patients;both the negative and positive prognostic factors. Materials and Methods: Urology ward record books, clinic record books and operating theater records were used to identify patients managed for Fournier gangrene in ATBUTH Bauchi. A retrospective study of the medical files of all the patients managed from January 2011 to January 2024 was done. Data was analyzed using SPSS version 29. Results: Data from 47 patients seen during the period of study were carefully collected and analyzed. The age range is 2 weeks to 97 years. There were two neonates, one at 2nd week of life and the other at 3rd week. Mortality rate is 36%. The average time duration before presentation for patients that died was two weeks, a minimum of 9 days prior to presentation and a maximum of 21 days, about 10 of which came in septic shock and the remaining presented with fever and very extensive necrotizing fasciitis of the perineum. All the patients that died had diabetes mellitus as a comorbidity except the neonate. All the patients that survived were much younger, all were below 60 years of age (2 weeks - 53 years). Conclusion: Here, we share our experience managing patients with Fournier’s gangrene in our facility in the past 13-year period from January 2011 to January 2024. .
文摘AIM:Gastric outlet obstruction caused by duodenal impaction of a large gallstone migrated through a cholecystoduodenal fistula has been referred as Bouveret's syndrome.Endoscopic lithotomy is the first-step treatment, however,surgery is indicated in case of failure or complication during this procedure. METHODS:We report herein an 84-year-old woman presenting with features of gastric outlet obstruction due to impacted gallstone.She underwent an endoscopic retrieval which was unsuccessful and was further complicated by distal gallstone ileus.Physical examination was irrelevant. RESULTS:Endoscopy revealed multiple erosions around the cardia,a large stone in the second part of the duodenum causing complete obstruction,and wide ulceration in the duodenal wall where the stone was impacted.Several attempts of endoscopic extraction by using foreign body forceps failed and surgical intervention was mandatory.Preoperative ultrasound evidenced pneumobilia whilst computerized tomography showed a large stone,5 cm×4 cm×3 cm,logging at the proximal jejunum and another one,2.5 cm×2 cm×2 cm, in the duodenal bulb causing a closed-loop syndrome.She underwent laparotomy and the jejunal stone was removed by enterotomy.Another stone reported as located in the duodenum preoperatively was found to be present in the gallbladder by intraoperative ultrasound.Therefore, cholecystoduodenal fistula was broken down,the stone was retrieved and cholecystectomy with duodenal repair was carried out.She was discharged after an uneventful postoperative course.CONCLUSION: As the simplest and the least morbid procedure, endoscopic stone retrieval should be attempted in the treatment of patients with Bouveret's syndrome.When it fails, surgical lithotomy consisting of simple enterotomy may solve the problem. Although cholecystectomy and cholecystoduodenal fistula breakdown is unnecessary
文摘AIM:To investigate stapled transanal rectal resection (STARR) procedures as surgical techniques for obstructed defecation syndrome (ODS) by analyzing specimen evaluation,anorectal manometry,endoanal ultrasonography and clinical follow-up.METHODS:From January to December 2007,we have treated 30 patients.Fifteen treated with double PPH-01 staplers and 15 treated using new CCS 30 contour.Resected specimen were measured with respect to average surface and volume.All patients have been evaluated at 24 mo with clinical examination,anorectal manometry and endoanal ultrasonography.RESULTS:Average surface in the CCS 30 group was 54.5 cm2 statistically different when compared to the STARR group (36.92 cm2).The average volume in the CCS 30 group was 29.8 cc,while in the PPH-01 it was23.8 cc and difference was statistically significant.The mean hospital stay in the CCS 30 group was 3.1 d,while in the PPH-01 group the median hospital stay was 3.4 d.As regards the long-term follow-up,an overall satisfactory rate of 83.3% (25/30) was achieved.Endoanal ultrasonography performed 1 year following surgery was considered normal in both of the studied groups.Mean resting pressure was higher than the preoperative value (67.2 mmHg in the STARR group and 65.7 mmHg in the CCS30 group vs 54.7 mmHg and 55.3 mmHg,respectively).Resting and squeezing pressures were lower in those patients not satisfied,but data are not statistically significant.CONCLUSION:The STARR procedure with two PPH-01 is a safe surgical procedure to correct ODS.The new Contour CCS 30 could help to increase the amount of the resected tissue without differences in early complications,post-operative pain and in hospital stay compared to the STARR with two PPH-01 technique.
文摘Introduction: Hepatocellular carcinoma is the most common primary neoplasm of the liver and a significant cause of mortality in patients with cirrhosis. A retrospective cross-sectional study was performed to analyze epidemiological aspects related to risk factors, diagnosis, staging and first-line treatment in a closed population. Methods: The medical records of patients seen between November 1998 and May 2011 were revisited. Results: Of the 272 patients included in this study, 229 (84.2%) were male and the average age was 57.1 years (standard deviation 10.9 years). The most common etiology was hepatitis C virus infection in 145 (55.1%) patients, with this being the single cause in 88 (33.4%) patients. The largest masses ranged from 6 mm to 260 mm in diameter with a mean of 61.4 mm (standard deviation 41.5 mm). Only one mass was found in 145 (64.2%) cases, two masses in 26 (11.5%), three masses in 9 (4%) and 46 patients (20.3%) had multifocal disease. Early stage disease was diagnosed in 47 patients (22.0%), advanced stage in 65 (30.4%) and terminal stage in 32 (14.9%). Hepatocellular carcinoma was found by chance in 11%. Diagnosis was by means of imaging in 175 (68.1%) cases. The level of alpha-fetoprotein was measured in 209 patients, with 29.2% having levels lower than 20 ng/mL and 34.9% having levels above 400 ng/mL. Specific treatment was administered in 236 patients (86.8%) with hepatic chemoembolization in 127 (46.7%) and liver transplantation in 72 (26.5%);of these 33 (45.8%) received hepatic chemoembolization as a bridge to transplantation. Thirty-four patients (12.5%) received only supportive therapy. Conclusions: Patients are chiefly male and disease involvement generally occurs in the 5th decade of life. Cirrhosis was present in most patients and hepatitis C virus infection was the commonest etiologic agent. Only one imaging examination was required for diagnosis in most patients. The measurement of alpha-fetoprotein levels did not prove to be a good tool in the diagnosis of hepatocellular carcinoma. Intermediate, advanced and terminal stages predominated compared to early stages. Treatment was based on non-curative therapies.
文摘Background: Radical lymph node dissection (RLND) is the treatment of choice in stage III melanoma patients. Over half of the observed complications were related to post-operative serum collection affecting wound healing. The aim of this study was to evaluate the use of the LigaSureTM Small Jaw (LSJ) on postoperative drainage fluid volume and drainage permanence in patients undergoing RLND. Study design: This was a prospective single-center study in which consecutive melanoma patients underwent nodal dissection using the LSJ. Daily drainage volume and duration of drainage were recorded in post-operative course on days 3, 10 or 15 and day 20. Results: A total of 70 patients were included. Mean postoperative drainage volume was lower. Around two-thirds of patients had a drainage fluid volume of less than 50cc at 10 days. Mean time to drainage removal was 14.5 days. Conclusions: This is the first report of nodal dissection in patients with cutaneous melanoma using an electrothermal bipolar vessel sealing system. The technique was feasible, safe, and effective and resulted in reduced drainage fluid volume and drainage permanence.
基金funded by the Italian Ministry of Health“Starting Grant”SG-2019-12371540 to P.S.,“Ricerca Corrente 2022-2024”to C.F.“Ricerca Corrente 2022-2024”to V.D.+4 种基金“Ricerca Corrente 2023-2025”to V.G.by the Italian Association for Cancer Research(AIRC)IG-23794 to C.S.and IG19172 to A.D.R.,an AIRC Fellowship for Italy to M.L.S.(ID26678-2021)an AIRC Fellowship for Italy to E.D.N.(ID31217-2024)Bilateral CNR/RFBR grant to A.D.R.Funded by the European Union-Next Generation EU-NRRP M6C2-Investment 2.1 Enhancement and strengthening of biomedical research in the NHS(PNRR-POC-2023-12378288)to V.Gthe Carlo Erba Foundation(Cecilia Cioffrese Award for young researchers).
文摘Cancer stem cells(CSCs)are responsible for colorectal cancer(CRC)chemoresistance,recurrence,and metastasis.Therefore,identifying molecular stemness targets that are involved in tumor growth is crucial for effective treatment.Here,we performed an extensive in vitro and in vivo molecular and functional characterization,revealing the pivotal role of the lysine methyltransferase SET and MYND Domain Containing 3(SMYD3)in colorectal cancer stem cell(CRC-SC)biology.Specifically,we showed that SMYD3 interacts with and methylates c-MYC at K158 and K163,thereby modulating its transcriptional activity,which is implicated in stemness and colorectal malignancy.Our in vitro data suggest that SMYD3 pharmacological inhibition or its stable genetic ablation affects the clonogenic and self-renewal potential of patient-derived CRC-SCs and organoids by altering their molecular signature.Moreover,we found that SMYD3 stable knock-out or pharmacological inhibition drastically reduces CRC tumorigenicity in vivo and CRC-SC metastatic potential.Overall,our findings identify SMYD3 as a promising therapeutic target acting directly on c-MYC,with potential implications for countering CRC-SC proliferation and metastatic dissemination.
