Endoscopic mucosal resection (EMR) in the management of large colo-rectal polyps.

BACKGROUND: Colonoscopic polypectomy plays a major role in preventing colo-rectal cancer. However, resection of sessile, broad-based pedunculated and flat lesions carries a high risk of perforation. Endoscopic Mucosal Resection (EMR) may significantly reduce this risk. We aim to assess the safety and efficacy of EMR in our unit. PATIENTS AND METHODS: A review of a prospective database over a 3-year period identified 87 patients who underwent endoscopic polypectomy for polyps in sizes from 10 to 50 mm, performed by two experienced endoscopists. A total of 33 EMRs were performed on 30 lesions in 24 of these patients. RESULTS: Median size of lesions was 20 mm. Most were located in the rectum and sigmoid. 22 lesions were resected en-bloc while 8 were resected piecemeal. Histologically these lesions were predominantly adenomatous polyps. An incidental focus of adenocarcinoma was found in 7 lesions. Histologically complete excision was achieved in 10 lesions. Although histological completeness of excision was not confirmed in 19 lesions, repeat colonoscopy confirmed successful excision. Only one lesion was incompletely excised requiring surgical resection. Bleeding occurred during 2 EMRs, both times successfully controlled by further injection of adrenaline locally. There was no case of bowel perforation. Further surveillance colonoscopy was performed according to established guidelines. Median follow-up period was 21 months. None of the patients diagnosed with adenocarcinoma showed any evidence of recurrence. CONCLUSION: Within our unit endoscopic mucosal resection appeared to be safe and effective procedure for resecting large colorectal polyps not suitable for conventional polypectomy. This data would support prompt referral of lesions fulfilling these criteria to specialist units offering this service to avoid unnecessary surgery.

Potential prognostic and therapeutic roles for cytokines in breast cancer (Review).

Cytokines are known to have both stimulatory and inhibitory effects on breast cancer growth depending on their relative concentrations and the presence of other modulating factors in the tumour microenvironment. Certain cytokines appear to prevent an effective immune response being mounted, permitting cancer growth, whereas others promote the immune system's anti-tumour capability. Furthermore, the systemic levels of certain cytokines, e.g. IL-6 and IL-18, independently show promising correlations with disease stage and progression. With advances in methods for delivery of cytokines to a tumour site, the enhanced induction of anti-tumour immunity by targeted cytokine release is becoming a realistic option. Here, we review the role of cytokines in the immune response against breast cancer and assess their potential as prognostic indicators and/or use in immune therapy. A literature search was conducted using Medline, restricted to articles published in the English language, using combinations of the following MeSH terms: cytokines, breast cancer, immunology, immunotherapy and interleukins. Focused searches using keywords relevant to the role of cytokines in breast cancer immunology yielded >200 references.

Primary carcinoma of the appendix - Hull series.

BACKGROUND: Appendiceal carcinoma (AC) is a rare entity that does not have a well-defined treatment strategy. At presentation, most patients are clinically thought to have appendicitis and the diagnosis is made only by formal histology. Once the diagnosis of AC is made, patients are treated by various strategies including surgery, chemotherapy depending on nodal status of the disease. AIM: To review the Hull hospitals' experience with AC. METHODS: Between 1982 and 2002, 10 patients with primary AC were seen. The histopathology reports of all appendiceal specimens removed were traced. Follow-up was by chart review or patient follow-up as appropriate. We did not include patients with primary carcinoid tumours or secondary adenocarcinoma. RESULTS: There was an equal sex distribution. All patients underwent surgery, 3 had post-operative chemotherapy. Complete follow-up information was available with a median follow-up time of 56 months, with a range of 12-168 months. Five patients survived at least 4 years from the time of diagnosis. CONCLUSION: Long-term survival in patients with AC is possible.

Radioresistance in carcinoma of the breast.

Radiotherapy plays an important role in the management of breast cancer. Whilst its role in achieving local control following surgery in patients with early stage cancer is well established, there is still unclear evidence to explain the factors governing radioresistance in patients who develop recurrences both in the breast and axilla. Radiotherapy induces damage to the DNA. Various cell cycle damage check points and DNA damage repair pathways have been demonstrated. Ataxia telangiectasia mutant (ATM) kinase, which is a member of phosphatidylinositol-3 kinase (PI-3K) family appears to play a central role in DNA damage check point pathways. Over-expression of Insulin like growth factor-I receptor (IGF-IR), Human Epidermal Growth factor receptors (HERS), Vascular Endothelial growth factor (VEGF) on the cell surface and increased concentration of Epidermal Growth factor in the extracellular fluid have been associated with radioresistance. Specific genes such as p53, BRCA, Bcl-2 and chromosomal characteristics like telomere lengths have also been identified as playing significant roles in radiation responsiveness of a cell. This article reviews the current data on general principles of radiotherapy, the cellular mechanisms that operate in response to radiation damage and various molecular markers, intranuclear and extranuclear which have been demonstrated to influence radiation sensitivity in breast cancer cells.

Gynaecomastia and the plant product "Tribulis terrestris".

Gynaecomastia is the commonest benign breast condition seen in men. It is well recognised that certain drugs that alter the normal sex hormonal profile in the body can induce gynaecomastia. Recently, an increasing use of androgenic-anabolic steroids among young men especially body-builders has increased the incidence of gynaecomastia. We report a case of a young weight-trainer who developed gynaecomastia due to oral intake of a herbal tablet which he used as a steroid alternative for body-building.