Markers of Epithelial-Mesenchymal Transition and Mucinous Histology Are Significant Predictors of Disease Severity and Tumor Characteristics in Early-Onset Colorectal Cancer.

Approximately 20% of patients with colorectal cancer (CRC) are diagnosed with a mucinous subtype of this tumor, have a worse prognosis, and often show resistance to available therapies. Molecules from the mucin family are involved in the regulation of epithelial-mesenchymal transition (EMT), which significantly determines the cancer aggressiveness. This study aimed to examine the diagnostic and prognostic significance of mucinous histology and EMT markers in patients with early-onset CRC and their association with disease severity and tumor characteristics. This study included tumor tissue samples from 106 patients diagnosed with CRC before the age of 45, 53 with mucinous and 53 with non-mucinous tumors. The EMT status was determined by immunohistochemical analysis of E-cadherin and Vimentin in tissue sections. Mucinous tumors had significantly higher Mucin-1 (p < 0.001) and cytoplasmic E-cadherin (p = 0.043) scores; they were significantly less differentiated (p = 0.007), more advanced (p = 0.027), and predominately affected right the colon (p = 0.039) compared to non-mucinous tumors. Epithelial tumors were significantly better differentiated (p = 0.034) and with less prominent tumor budding (p < 0.001) than mesenchymal tumors. Mucin-1 and Vimentin were independent predictors of tumor differentiation (p = 0.006) and budding (p = 0.001), respectively. Mucinous histology and EMT markers are significant predictors of disease severity and tumor characteristics in early-onset colorectal cancer.

Quality of life following two different techniques of an open ventral hernia repair for large hernias: a prospective randomized study.

BACKGROUND: We compare the health-related quality of life (QoL) of patients with incision hernias before and after surgery with two different techniques. METHODS: In this prospective randomized study, the study population consisted of all patients who underwent the first surgical incisional hernias repair during the 1-year study period. Patients who met the criteria for inclusion in the study were randomized into two groups: the first group consisted of patients operated by an open Rives sublay technique, and the second group included patients operated by a segregation component technique. The change in the quality of life before and 6 months after surgery was assessed using two general (Short form of SF-36 questionnaires and European Quality of Life Questionnaire-EQ-5D-3L), and three specific hernia questionnaires (Hernia Related Quality of Life Survey-HerQles, Eura HS Quality of Life Scale-EuraHS QoL, and Carolinas Comfort Scale-CCS). RESULTS: A total of 93 patients were included in the study. Patients operated on by the Rives technique had a better role physical score before surgery, according to the SF-36 tool, although this was not found after surgery. The postoperative QoL measured with each scale of all questionnaires was significantly better after surgery. Comparing two groups of patients after surgery, only the pain domain of the EuraHS Qol questionnaire was worse in patients operated by a segregation component technique. CONCLUSION: Both techniques improve the quality of life after surgery. Generic QoL questionnaires showed no difference in the quality of life compared to repair technique but specific hernia-related questionnaires showed differences.

Ultrasonographic Evaluation of Fatty Pancreas in Serbian Patients with Non Alcoholic Fatty Liver Disease-A Cross Sectional Study.

Background and Objectives: The aim of the study was to determine the association between presences of fatty pancreas (FP) with the features of metabolic syndrome (MeS) in patients with non-alcoholic fatty liver disease (NAFLD) and to establish a new noninvasive scoring system for the prediction of FP in patients with NAFLD. Material and Methods: 143 patients with NAFLD were classified according to FP severity grade into the two groups and evaluated for diagnostic criteria of MeS. All patients underwent sonographic examination with adiposity measurements and the liver biopsy. Liver fibrosis was evaluated semi-quantitatively according to the METAVIR scoring system and using non-invasive markers of hepatic fibrosis. Results: Waist circumference (WC) was predictive for increased risk of FP in NAFLD patients. Elevated fasting plasma glucose, total cholesterol, serum amylase and lipase levels were associated with presence of severe FP (p value = 0.052, p value = 0.007, p value = 0.014; p value = 0.024, respectively). Presence of increased amounts of mesenteric fat was associated with severe FP (p value = 0.013). The results of this study demonstrated highly significant association between NAFLD and presence of FP. The model for predicting the presence of FP was designed with probability value above 6.5. Conclusion: Pancreatic fat accumulation leads to worsening of pancreatic function which in turns exacerbates severity of metabolic syndrome associated with both, NAFLD and NAFPD.

Can preoperative CEA and CA19-9 serum concentrations suggest metastatic disease in colorectal cancer patients?

OBJECTIVE: This study was designed to investigate the efficiency of preoperative serum carcinoembryonic antigen (CEA) and carbohydrate cancer antigen (CA19-9) levels for diagnosing synchronous liver metastases and lymph node in colorectal carcinoma (CRC) patients. SUBJECTS AND METHODS: A total of 300 patients with histologically diagnosed CRC were included in this study between May 2014 and March 2015. The data were obtained prospectively from patient's medical records: medical history, demographics, tumor location, differentiation (grade), depth of the tumor (T), lymph node metastases (N), distant metastases (M), lymphatics, venous and perineural invasion, and disease stage. Tumor markers were measured with an electrochemiluminescent assay and the reference value was 5ng/ml for CEA and for Ca19-9, 37u/ml. RESULTS: There was A high statistically significant difference in the levels of serum CEA and CA19-9 between different disease stages of CRC (P<0.001). Regarding different T stages of CRC, We noticed a significant statistical difference in CEA (stage I 3.76±8.73; II 5.68±17.27, III 7.56±14.81, and IV 70.90±253.23) and CA 19-9 levels (stage I 9.65±11.03, II 9.83±11.09; III 19.58±36.91, and IV 228.9±985.38, respectively). The mean CEA and CA19-9 serum levels were significantly higher in patients with regional lymph nodes involvement (CEA 37.21±177.85 vs 4.79±9.90, CA19-9 119.51±687.71 VS 12.24±17.69, respectively, P<0.05) and in liver metastases (CEA 86.56±277.65 vs. 5.98±12.98, and CA19-9 273.27±1073.46 vs. 4.98±3142, respectively, with P<0.001) in comparison to patients without lymph node involvement and liver metastases. We noticed a cut-off value for lymph nodes involvement, for CEA and CA 19-9, 3.5 ng/mL and 7.5 U/mL, respectively. While, a cut-off value for the presence of synchronous liver metastases of these two markers was 3.5ng/mL AND 5.5 U/mL. CONCLUSION: Our study showed that tumor makers, CEA and CA19-9, can be used as diagnostic factors regarding the severity of CRC specifically to suggest metastatic disease in CRC.

Current trends in clinical genetics of colorectal cancer.

Recent innovations in molecular biology and colorectal cancer (CRC) genetics have facilitated the understanding of the pathogenesis of sporadic and hereditary CRC syndromes. The development of technology has enabled data collection for a number of genetic factors, which lead to understanding of the molecular mechanisms underlying CRC. The incidence and the nature of CRC is a mixture of genetic and environmental factors. The current field of interest is to understand how molecular basis could shape predisposition for developing CRC, disease progression and response to chemotherapy. In this article, we summarize new and developing genetic markers, and assess their clinical value for inherited and sporadic CRC.

Comparison of functional outcome of colonic J-pouch and latero-terminal anastomosis in low anterior resection for rectal cancer.

INTRODUCTION: Functional results after low anterior resection for rectal cancer are an issue of increasing attention among colorectal surgeons and others interested in this subject. The consensus on ideal reconstruction type has not been achieved to date, although the number of papers on this subject has been published in recent years. OBJECTIVE: We conducted a prospective, parallel group study comparing latero-terminal with colonic J-pouch anastomosis in terms of defecatory function in patients undergoing stapled low colorectal/ coloanal anastomosis. METHODS: A total of 80 patients were included in this study with either latero-terminal or colonic J-pouch anastomosis. Defecatory function was evaluated using the modified version of MSKCC questionnaire 6, 12 and 24 months after the operation. Fecal continence was evaluated using the Wexner continence score. RESULTS: In both groups, trend towards improvement was registered in all measured variables in all three control intervals. This can apply to bowel frequency, urgency, night soiling, fragmentation and incomplete evacuation. However, the difference was not statistically significant, and when reviewing the trend of results we can note that in the J-pouch group steady state has not been reached even after 24 month control. CONCLUSION: This trial did not reveal any significant differences in defecatory function 6, 12 and 24 months after low anterior resection (LAR) between patients with a latero-terminal anastomosis and those with colonic J-pouch anastomosis. Our results did not confirm superiority of colonic J-pouch over the latero-terminal anastomosis

Microsatellite instability affecting the T17 repeats in intron 8 of HSP110, as well as five mononucleotide repeats in patients with colorectal carcinoma.

AIM: To investigate mononucleotide markers: BAT-25, BAT-26, NR-21, NR-22 and NR-24 in patients with colorectal cancer (CRC), and the status of HSP110T17, KRAS, BRAF and the MLH1 promoter mutations in microsatellite unstable CRC. METHODS: Genetic assessments were performed on samples obtained following resection of CRC in 200 patients. RESULTS: Allelic variations of HSP110T17 were found in all 18 patients with microsatellite instabilities (MSIs) in at least three markers (high-frequency MSI). By contrast, mutations of HSP110T17 were absent in all 20 patients with no MSI frequency. Eight out of 182 patients with low (instability in one marker) or no frequency MSI had allelic shifts due to polymorphisms of BAT-25 (1.5%), NR-21 (1.75%) and NR-24 (1.5%). BRAF mutations were associated with >5 bp shortening of HSP110T17. CONCLUSION: Patients with high-frequency MSI CRC had allelic variations of HSP110T17. BRAF mutations occur along with greater shortening in HSP110T17 during oncogenesis via the MSI pathway.

Rare late mesh complications following inguinal prolene hernia system hernioplasty: report of three cases.

We have treated three patients who developed late mesh infections 7 years after inguinal hernioplasty caused by contact of an underlay prolene hernia system (PHS) patch with the intestines. In two patients, the cause was the development of a fistula between the underlay patch preperitoneally positioned in Bogros space and the appendix, and in one, a sigmoid colon fistula that developed as a consequence of penetration of the underlay PHS patch into the sigmoid colon. In the patients with contact of an underlay PHS patch with the appendix, total PHS excision, appendectomy, McVay herniorrhaphy and drainage through a direct inguinal approach were applied. In the patient with a sigmoid colon lesion, total PHS excision, left hemicastration, suturing of the sigmoid colon fistula, and a McVay herniorrhaphy with drainage were performed through a direct inguinal approach, followed by midline laparotomy and protective bipolar ileostomy. Late mesh infection developing several years after PHS inguinal hernioplasty is usually the consequence of intestinal erosions and fistulas due to contact between the underlay PHS patch and the intestines.

Use of vacuum-assisted closure device in a disastrous form of abdominal sepsis and stoma site infection: systematic review and report of a case.

Use of Vacuum-Assisted Closure (VAC) for treatment of open abdomen has been established predominantly in cases of severe abdominal trauma, resulting with high percentage of primary fascial closure. The role of VAC technique in cases of severe diffuse peritonitis is not definitely incorrigible. However, in cases of severe complicated abdominal sepsis VAC come up as a last resort.

Outcome of overlapping anal sphincter repair after 3 months and after a mean of 80 months.

BACKGROUND: The aim of this study was to determine the functional results of anal sphincter repair after a long follow-up (mean 80.1 months). METHODS: In the period 1990-2002, 65 sphincter repairs were performed. Obstetric trauma was the cause of incontinence in 72.3% cases, fistulotomy in 13.8%, nonspecific trauma in 9.2%, and war injury in 4.6%. At the time of surgery, 12 patients had undergone an urgent stoma procedure. In all cases, anal manometry, electromyography, and defecography were performed. The severity of incontinence was evaluated preoperatively using the Wexner score system. Anterior sphincteroplasty was performed in 52 cases, lateral in 9 cases, and posterior in 4 cases. RESULTS: The results were determined according to the Wexner score system and the Browning-Parks scale. The Wexner score was calculated 3 months after operation and during every follow-up visit. Preoperative scores and those at the first and last follow-up visits were analyzed. Three months after operation excellent results were achieved in 55.5%, good in 18.5%, fair in 16.9%, and poor in 9.2% patients. After follow-up (mean 80.1 months), 26.8% had excellent results, 21.4% had good results, 12.5% had fair results, and 39.3% of patients had a poor outcome. Results determined by the Wexner score system improved from 17.8 preoperatively to 3.6 three months after operation, but deteriorated over time to 6.3 after longer follow-up (p<0.001). CONCLUSION: Overlapping sphincter repair provides satisfactory results in more than two-thirds of patients initially, but the results tend to worsen over time and are satisfactory in half of patients after longer follow-up.

Adenosquamous carcinoma arising within a retrorectal tailgut cyst: report of a case.

Retrorectal, developmental tail gut cysts, include dermoid cysts, rectal duplication cysts and retrorectal cyst-hamartomas. Retrorectal cyst-hamartomas (RCH) are derived from remnants of the tail gut, the most caudal part of the embryonic hind gut, which normally involutes by the 8(th) wk of embryonic development (3-8 mm stage). They have specific radiological and histopathological features that distinguish them from other similar formations (dermoid cysts, enteric duplication cysts and teratomas). We report a patient with adenosquamous carcinoma arising within RCH, who underwent complete resection of the cyst through anterior laparotomy, and reached complete (recurrence-free for 14 mo, so far) functional recovery. The cyst was incidentally discovered during hysterectomy 12 years ago. Diagnostic, therapeutic and histopathological aspects of this rare case are discussed. The mentioned period between diagnosis and surgical treatment suggests that RCH, given enough time, can develop malignant degeneration, and should be resected at the time of diagnosis.

[Long-term results of treatment of injuries of the sectoral and segmental bile ducts]. / Udaljeni rezultati lecenja povreda sektorskih i segmentalnih zucnih vodova.

INTRODUCTION: Surgically important variations of the sectoral and segmental bile ducts of the right lobe of the liver appear in a significant proportion of patients. Frequency of the injuries to these ducts is not known as the ligature of small ducts may pass without major consequences. MATERIAL AND METHODS: Over a 27 year period (1. Jan 1974-31. Dec 2001) along with 168 patients with benign biliary strictures of type I, II, III and IV according to Bismuth's classification, we treated 13 patients with operative sectoral or segmental bile duct injuries, four patients from our institution and nine patients transferred from elsewhere. The injury was recognized at original surgery in all four patients operated in our institution. Primary repair was performed in three patients, in two patients direct end-to-end repair over T-tube and in one patient with anastomosis between the injured duct and Roux-en-Y jejunal limb, while in one patient the injured duct was ligated. In no one of nine patients transferred from elsewhere the injury was recognized during original surgery. Four patients were sent with biliary peritonitis, another four patients with external biliary fistula and one patient for pain and fever due to liver abscess. RESULTS: All three patients in whom the primary repair was performed had a quick and uneventful recovery and they stayed symptom-free so far. The patient in whom the injured duct was ligated died after series of complications. Four patient sent to us with biliary peritonitis were treated with relaparotomy, lavage and drainage and all developed external biliary fistula. Three of these patients had their fistula ceased spontaneously within few weeks, while in one patient the fistula didn't show signs of ceasing so that injured duct had to be anastomosed with Roux-en-Y jejunal limb. Two out of four patients sent for external biliary fistula had it ceased spontaneously, while in two patients anastomosis between duct and Roux-en-Y jejunal limb was necessary. The last, 13th patient, who had sectoral duct severed and ligated was reoperated, liver abscess drained and duct anastomosed with Roux-en-Y jejunal limb. That patient developed an anastomotic stricture a year later and he was successfully reoperated and stayed symptom-free so far. All 12 patients have been followed up from nine months to 27 years (average 9.2 years) and neither developed biliary symptoms. CONCLUSION: We conclude that the management of these injuries depends upon the time of recognition of the lesion, size of the injured duct and of the type and stage of complications.

[Duodenal obstruction due to chronic pancreatitis]. / Opstrukcija duodenuma usled hronicnog pankreatitisa.

Chronic pancreatitis may cause a number of obstructive complications. Obstructions of the pancreatic and common bile duct are the most frequent, obstruction of the duodenum is rare and obstruction of the colon is very rare. Duodenal stenosis caused by chronic pancreatitis is usually moderate so that the surgical treatment is not necessary except if operation is necessary for other obstructive complications. The severe isolated duodenal stenosis for which surgery is mandatory is rare. We present a 46-year old male suffering from chronic alcoholic pancreatitis causing almost complete duodenal obstruction in whom surgical treatment was necessary. The truncal vagotomy and gastroenterostomy were performed. With abstinence of alcohol, low fat diet and substitute therapy more than 3 years after surgery the patient is symptom-free. He regained the previous weight and shows tendency to become fat.