Limberg flap reconstruction for the treatment of pilonidal sinus disease.

Pilonidal disease is a common chronic disorder of the sacrococcygeal area affecting young people. Recent reports have advocated different surgical approaches, such as open or closed technique, but recurrence complicates all forms of treatment. We conducted this case review to evaluate the validity of Limberg flap reconstruction method in the treatment of chronic recurrent pilonidal disease. In the period between September 2003 and December 2004, 32 male patients with complicated/recurrent pilonidal disease were operated on using the Limberg flap reconstruction method. The patients' mean age was 26.4 + 1.6 years (range 19-47 years). All patients fared well, had a satisfactory wound healing, had minimal pain and were mobilized immediately after surgery. They stayed at hospital for 6 to 32 hours. No patient had serious wound infection or flap ischemia. They all returned to normal activity within 4 to 12 days. Follow-up ranged between 14 and 28 months. No patient had recurrence during the above period. Limberg flap reconstruction has several advantages compared to the classical surgical methods for the treatment of pilonidal disease. The patients have a short hospital stay, are mobilized soon after surgery and have a minimal morbidity and recurrence rate.

The threat of soil salinity: A European scale review.

Soil salinisation is one of the major soil degradation threats occurring in Europe. The effects of salinisation can be observed in numerous vital ecological and non-ecological soil functions. Drivers of salinisation can be detected both in the natural and man-made environment, with climate and the foreseen climate change also playing an important role. This review outlines the state of the art concerning drivers and pressures, key indicators as well as monitoring, modeling and mapping methods for soil salinity. Furthermore, an overview of the effect of salinisation on soil functions and the respective mechanism is presented. Finally, the state of salinisation in Europe is presented according to the most recent literature and a synthesis of consistent datasets. We conclude that future research in the field of soil salinisation should be focused on among others carbon dynamics of saline soil, further exploration of remote sensing of soil properties and the harmonization and enrichment of soil salinity maps across Europe within a general context of a soil threat monitoring system to support policies and strategies for the protection of European soils.

Non-parasitic splenic cysts: a report of three cases.

Primary splenic cyst is a relatively rare disease, and the majority of cases are classified as epithelial cysts. Three cases with nonparasitic splenic cysts are presented: two epithelial and one pseudocyst. All cases had an atypical symptomatology, consisted mainly of fullness in the left upper abdomen and a palpable mass. Preoperative diagnosis was established with ultrasonography and computerized tomography. Two cases with large cysts located in the splenic hilum were treated with open complete splenectomy. The most recent case, a pseudocyst, was managed laparoscopically with partial cystectomy. All cases did not have any problems or recurrence during follow-up. Laparoscopic partial cystectomy is an acceptable procedure for the treatment of splenic cysts, because it cures the disease preserving the splenic tissue. Complete splenectomy is reserved for cases in which cyst excision cannot be done otherwise.

Sequential recurrences of ovarian granulosa cell tumour 10 and 11 years after initial diagnosis as haemoperitoneum and subhepatic mass: a case report and review of the literature.

Adult granulosa cell tumours (GCTs) are rare ovarian neoplasms characterised by an indolent course and a propensity for late recurrence. Due to frequent endocrine manifestations most GCTs are diagnosed at an early stage. However, clinical behaviour can not be safely predicted on the basis of conventional clinicopathologic parameters. Surgery remains the cornerstone of therapeutic management. We report on a rare case of a Stage IA GCT twice recurring ten and 11 years after initial surgical treatment. The first recurrence presented as an acute abdomen due to haemoperitoneum after tumour rupture. The second recurrence presented as a subhepatic mass. This case emphasises the need for extended, lifelong follow-up even for patients with early stage, apparently completely removed GCTs. Prognostic parameters and therapeutic options especially for patients with recurrent disease are discussed.

Leucovorin and 5-fluorouracil versus levamisole and 5-fluorouracil as adjuvant chemotherapy in rectal cancer.

PURPOSE: To evaluate the effectiveness of 6-month therapy with leucovorin (LV)+5-fluorouracil (5-FU) versus 12-month therapy with levamisole (LVS)+5-FU, as adjuvant chemotherapy in patients with completely resected Aster-Coller stage B(2) or C(1)/C(2) rectal cancer (RC). PATIENTS AND METHODS: One hundred and fifty patients with surgically resected RC were enrolled. Seventy patients with stage B(2) and 80 with stage C were randomly assigned to adjuvant chemotherapy with 5-FU+LXx6 months or 5-FU+LVSx12 months. Patient characteristics were equally balanced between the examined groups. Adjuvant chemotherapy consisted of LV 20 mg/m(2) intravenously (i.v.) plus 5-FU 450 mg/m(2) i.v. bolus every week plus LVS tablets 50 mg t.i.dx3 days every 2 weeks for 1 year. RESULTS: After a median follow up for survivors of 8.7 years (range 1.8-10.5), all of the patients were evaluable. There were no significant differences between the two treatment groups with respect to the recurrence rates (p=0.821). Moreover, there were no significant differences between the two tratment groups in disease-free survival (DFS) (p=0.84) [B(2)(p=0.805) and C (p=0.978)] and overall survival (OS) rates for patients of either stage B(2) or C (p=0.78). Toxicities were more frequent in the 5-FU+LVS versus 5-FU+LV group: myelosuppression (grade 3 leucopenia, 12 versus 4%, p<0.04), diarrhea (grade 0, 60 versus 76%, p<0.02), and liver toxicity (increase of transaminases >3-fold, 12 patients versus 2, p<0.03.). No patient stopped chemotherapy because of toxicity, and there were no treatment-related deaths. CONCLUSION: Adjuvant chemotherapy in RC with LV+5-FU for 6 months is equally effective and less toxic than LVS+5-FU for 12 months.

Modeling suspended sediment transport and assessing the impacts of climate change in a karstic Mediterranean watershed.

Mediterranean semi-arid watersheds are characterized by a climate type with long periods of drought and infrequent but high-intensity rainfalls. These factors lead to the formation of temporary flow tributaries which present flashy hydrographs with response times ranging from minutes to hours and high erosion rates with significant sediment transport. Modeling of suspended sediment concentration in such watersheds is of utmost importance due to flash flood phenomena, during which, large quantities of sediments and pollutants are carried downstream. The aim of this study is to develop a modeling framework for suspended sediment transport in a karstic watershed and assess the impact of climate change on flow, soil erosion and sediment transport in a hydrologically complex and intensively managed Mediterranean watershed. The Soil and Water Assessment Tool (SWAT) model was coupled with a karstic flow and suspended sediment model in order to simulate the hydrology and sediment yield of the karstic springs and the whole watershed. Both daily flow data (2005-2014) and monthly sediment concentration data (2011-2014) were used for model calibration. The results showed good agreement between observed and modeled values for both flow and sediment concentration. Flash flood events account for 63-70% of the annual sediment export depending on a wet or dry year. Simulation results for a set of IPCC "A1B" climate change scenarios suggested that major decreases in surface flow (69.6%) and in the flow of the springs (76.5%) take place between the 2010-2049 and 2050-2090 time periods. An assessment of the future ecological flows revealed that the frequency of minimum flow events increases over the years. The trend of surface sediment export during these periods is also decreasing (54.5%) but the difference is not statistically significant due to the variability of the sediment. On the other hand, sediment originating from the springs is not affected significantly by climate change.

Rapid alterations of serum oxidant and antioxidant status with the intravenous administration of n-6 polyunsaturated fatty acids.

In an attempt to achieve the safe intravenous administration of two n-6 polyunsaturated fatty acids (PUFAs), gamma-linolenic acid (GLA) and arachidonic acid (AA), and to study the subsequent changes on the total oxidant and antioxidant status, various steadily increasing doses of each acid were injected intravenously at different infusion times in 28 male rabbits. Blood samples were collected at 15-min time intervals by the hepatic veins and from the carotid artery; oxidant status was determined by the thiobarbiturate assay and total antioxidant status (TAS) was assessed by a colorimetric assay. Both n-6 PUFAs were administered with safety at a dose of 25 mg/kg within 10 min accompanied by an increase of malonodialdehyde concentrations in the hepatic veins and in the carotid artery 30-45 min, respectively, after the end of the infusion of GLA and/or AA. Similar changes did not occur in red cell membranes after the infusion of AA. TAS presented reciprocal changes to malonodialdehyde production; the main consumption of TAS was observed in all samples 30-60 min after the end of the infusion of n-6 PUFAs. The above-mentioned rapid alterations occurring in both serum oxidant and antioxidant status after GLA might have a future clinical therapeutic significance in conditions like cancer and disseminated infectious diseases.

Biochemical modulation of fluorouracil: comparison of methotrexate, folinic acid, and fluorouracil versus folinic acid and fluorouracil in advanced colorectal cancer: a randomized trial.

Recent advances in biochemical pharmacology have revealed the basis for the biological modulation of 5-fluorouracil (5-FU) by methotrexate (MTX) and folinic acid (FA). Sequential use of MTX given 24 h prior to 5-FU has resulted in enhanced cell kill in vitro and in vivo. In addition, administration of FA prior to 5-FU has led to potentiation of 5-FU action by stabilization of the ternary complex of thymidine synthase. In the present randomized study, two groups of patients with advanced colorectal cancer were treated as follows: 43 patients (pts) in group A received 5-FU + FA, whereas 45 pts in group B received 5-FU + FA + MTX. The dosage was as follows: group A received FA i.v. at 300 mg/m2 per day, prior to i.v. 5-FU at 500 mg/m2 per day on days 1-4; group B was given MTX i.v. at 130 mg/m2 per day on day 0, followed 24 h later by FA at 15 mg q6h x 6, and 5-FU + FA was started on day 1 and given at the same doses and schedule described for group A. Objective responses were achieved by 8/43 pts in group A (1 complete response and 7 partial responses) and by 18/45 pts in group B (3 complete and 15 partial responses), all occurring in the liver. There was no significant difference in the median time to progression (group A 6.1 months, group B 6.8 months) or the median survival (group A 9.2 months, group B 10.3 months). Toxicity was significantly greater in group B [grade 2-3 mucositis 20% versus only 2% in group A (P < 0.0001); grade 3 diarrhea in group B 15% versus 3% in group A (P < 0.001)]. According to our results, double biological modulation of 5-FU with MTX + FA led to an enhanced response rate with increased toxicity as compared with the 5-FU + FA regimen given at less than its maximally tolerated dose.

Leucovorin and fluorouracil vs levamisole and fluorouracil as adjuvant chemotherapy in rectal cancer.

The aim of this study was to evaluate the effectiveness of 6-month therapy with leucovorin (LV) + 5-fluorouracil (5-FU) vs 12 months of therapy with levamisole (LVZ) + 5-FU, as adjuvant chemotherapy in patients with completely resected Dukes' stage B2 or C rectal cancer. One hundred and fifty patients with surgically resected rectal carcinoma, were enrolled in the present study; Dukes' stage B2 (n=70) or C (n=80), were randomly assigned to chemotherapy with 5-FU + LV x 6 months or 5-FU + LVZ x 12 months. Patient characteristics were equally balanced between the examined groups. Adjuvant CT consisted of LV 20 mg/m(2) intravenously (i.v.) plus 5-FU 450 mg/m(2) i.v., on days 1-5 every 4 weeks for 6 cycles or 5-FU 450 mg/m(2) i.v. every week plus LVZ 50 mg t.i.d x 3 days for 1 year. All patients received radiotherapy with a three-field technique to a total dose of 45 Gy, over 5 weeks. After a median follow-up of 7.4 years there were no significant differences between the two treatment groups with respect to the recurrence rates (P=0.821). Moreover, there was no difference in disease-free survival for patients stage Dukes' B2 (log-rank p=0.73); median for LV group 90 (8-131) months, and for LVZ group 86.5 (3-129) months. No difference was noted in disease-free survival for patients stage Dukes' C (log-rank p=0.73); median for LV group 60 (17-128) months, and for LVZ group 64 (2-123) months. There was no difference in overall survival for patients stage Dukes' B2 (log-rank p=0.75); median for LV group 90 (22-131) months, and for LVZ group 86 (10-129) months. For stage Dukes' C (log-rank p=0.73); median for LV group 67 (17-128) months, and for LVZ group 64 (5-123) months. Toxicities were as follows in the 5-FU + LVZ vs 5-FU + LV group; myelosuppression (leucopenia grade 3, 12% vs 4%, p<0.04), diarrhea (grade 0, 60% vs 76%, p<0.02), and liver toxicity (increase of transaminases >3-fold, 12 patients vs 2, p<0.03), were more frequent in LVZ group. None of the patients stopped chemotherapy because of the toxicity, and there were no toxicity-related deaths. In conclusion, adjuvant chemotherapy in RC with LV + 5-FU for 6 months is equally effective and less toxic than LVZ + 5-FU for 12 months.

Ampullary carcinoid and jejunal stromal tumour associated with von Recklinghausen's disease presenting as gastrointestinal bleeding and jaundice.

We report a very rare case of a 36-year-old woman with von Recklinghausen's disease, synchronous carcinoid of the ampulla of Vater and stromal tumour of the jejunum, who presented with gastrointestinal bleeding and jaundice.

Focal adhesion kinase expression is not a prognostic predictor in colon adenocarcinoma patients.

AIM: Focal adhesion kinase (FAK) is an enzyme of the tyrosine kinase group linked to signaling pathways between cells and their extracellular matrix. FAK expression in tumor cells in vitro may correlate with their ability for invasion and metastasis. METHODS: FAK protein expression was examined immunohistochemically in 80 cases of colon adenocarcinoma, and correlated with clinicopathological parameters; tumor proliferative capacity, reflected by Ki-67 antigen expression; and survival. RESULTS: All tumor samples were FAK positive compared to normal colonic mucosa. FAK protein overexpression was seen in 32 out of 80 cases. FAK protein overexpression did not correlated with tumor histological grade, stage, Ki-67 positivity or survival. CONCLUSIONS: Raised FAK protein expression was noted by immunohistochemistry in human colon carcinoma cases. The implication are discussed.

Recurrent liposarcomas of the abdomen and retroperitoneum: three case reports.

We report three cases of patients with liposarcomas of the abdomen who had been treated during the last 13 years (1980-1993). Two patients were men, aged 29 and 51 years, with tumors of the retroperitoneal space and the third patient was a woman aged 64 years with a tumor in the peritoneal cavity. Therapeutic treatment was as aggressive as possible excision of the tumor. In the case of the first male patient, the histological examination revealed a retroperitoneal myxoid liposarcoma which recurred 5 times within 13 years. In the second male patient, it revealed a well differentiated retroperitoneal liposarcoma of the sclerosing type which recurred 5 times within 5 years since the first treatment. Finally, the one female patient had 2 recurrences of myxoid liposarcoma of the abdomen 9 years after the first operation, presented with an infected mass and has been well since then.

A phase-II study of liposomal doxorubicin and docetaxel in patients with advanced pancreatic cancer.

BACKGROUND: Both liposomal doxorubicin (LD) and docetaxel (D) have a broad range of activity against solid tumors, including advanced pancreatic cancer (APC), as single agents, while their combination has produced encouraging response rates in the treatment of several malignancies. We have conducted a Phase-II study in order to evaluate the tolerance and efficacy of their combination as front-line treatment in patients with APC. PATIENTS AND METHODS: Twenty-one chemotherapy-naïve patients with unresectable, locally-advanced or metastatic pancreatic cancer were enrolled. These included 16 males and 5 females with median age 66 years (range 57-80). Performance status (PS) was 0 (n = 10 pts), 1 (n = 7 pts) and 2 (n = 4 pts). D (80 mg/m2), and LD (30 mg/m2) were administered on day 1, every 3 weeks. RhG-CSF s.c. was given to all patients. At the time of analysis, all included patients were evaluated for toxicity and for response. RESULTS: A total of 92 cycles were administered (4.38 cycles/patient). Partial response was achieved in 6 patients, with a median duration of response of 3 months. Stable disease was observed in 7 patients and progressive disease in 8 patients. The median duration of survival was 10 months (95% CI, 6-14 months) and the actuarial 1-year survival rate was 33.33%. With regard to toxicity, grades 3,4 neutropenia occurred in 8 (38%) patients and grades 3,4 thrombocytopenia in 4 (19%) patients. Non-hematological toxicity was recorded in 15 (71%) patients: grades 3,4 diarrhea (3 pts, 14%), hypersensitivity reactions (3 pt, 14%), grade 2 neurotoxicity (6 pts, 29%) and palmar-plantar erythrodysesthesia (9 pts, 43%). CONCLUSION: The doxorubicin and docetaxel combination was well-tolerated by these poor prognosis patients. Although both drugs have a marginal activity in pancreatic cancer, most patients experienced significant clinical improvement, with acceptable toxicity.

Serum E-cadherin concentrations and their response during laparoscopic and open cholecystectomy.

BACKGROUND: Elevated serum levels of the cell adhesion molecule E-cadherin have been associated with the presence of tissue injury and inflammation. We compared soluble E-cadherin response during laparoscopic and open cholecystectomy. METHODS: The E-cadherin response to surgery was studied in 16 patients undergoing laparoscopic cholecystectomy and 12 patients undergoing open cholecystectomy. Serum E-cadherin levels were measured by an enzyme immunoassay (ELISA) preoperatively, 10 and 30 min after the commencement of surgery, and at 6 and 24 h following the operation. RESULTS: Serum E-cadherin levels decreased progressively during laparoscopic cholecystectomy; their concentrations at 24 h after surgery were significantly lower when compared with preoperative values. In the open cholecystectomy group, serum E-cadherin levels did not differ from preoperative values at any time point. Serum E-cadherin concentrations at 24 h after surgery and the cumulative E-cadherin response were significantly higher in the open cholecystectomy group than in the laparoscopic group. CONCLUSION: Compared with open cholecystectomy, the cumulative E-cadherin response is significantly reduced following laparoscopic cholecystectomy.

Percutaneous arterial embolization in the kidneys of dogs: a comparative study of eight different materials.

Forty-one dogs were subjected to percutaneous arterial embolization of branches of the renal artery or its main trunk with or without prior injury to the kidney, with eight different materials, i.e., homologous blood clot, muscle, fat, fascia, barium sulphate, plain catgut, gelfoam and polyvinyl alcohol (Ivalon). From the immediate observations made, as well as the haemodynamic, angiographic and histological studies over a period ranging from 24 h to several weeks, it was concluded that Ivalon was the best material for arterial embolization.

Combined epirubicin, 5-fluorouracil and folinic acid vs no treatment for patients with advanced pancreatic cancer: a prospective comparative study.

The combination of 5-fluorouracil (5-FU) and folinic acid (FA) has demonstrated activity in most gastrointestinal tumors. The addition of epirubicin (EPI) may increase the efficacy of the combination for cancers of the upper gastrointestinal tract, such as advanced pancreatic cancer. We examined two groups of patients, explaining the potential benefits and limitations of therapy, and those patients who agreed to undergo chemotherapy formed Group A and the remaining formed Group B. Therefore, the study was a non-randomized prospective comparison between patients receiving chemotherapy and those offered the best supportive care. Group A consisted of 42 patients; 19 underwent Roux-en-Y operation, and 23 were inoperable. Group B consisted of 48 patients who refused chemotherapy; 18 underwent Roux-en-Y operation, and 30 were considered inoperable. Chemotherapy consisted of FA 200 mg/m2/day, 5-FU 600 mg/m2/day both for 5 days, and EPI 35 mg/m2/day before FA-5-FU administration on days 1 and 2, every 28 days. All patients were evaluable for response and toxicity. Objective tumor responses (partial responses) in Group A were seen in 8 patients (19%) (6 women and 2 men), and 6 (14%) had stable disease. The estimated median survival was 27.6 weeks (mean 27.5) for Group A and 22.5 weeks (mean 24) (p=0.01) for Group B. From the onset of therapy, median duration of response was 16.6 weeks and median time to progression 11.8 weeks in Group A. Toxicity consisted primarily of myelosuppression, nausea and vomiting, diarrhea, alopecia, and mucositis. In Group A 12/42 patients became free from pain for a median duration of 10 months, 14/42 had improved appetite, and 15/42 had improved performance status in comparison to Group B, where no patients had improved performance status or symptoms. We conclude that the combination of EPI+FA+5-FU has moderate activity and increased toxicity in the treatment of advanced pancreatic cancer.

E-cadherin expression correlates with tumor differentiation in colorectal cancer.

BACKGROUND/AIMS: Epithelial cadherin (E-cadherin) is the main cell-cell adhesion molecule in all epithelia. Aberrant expression of this molecule has been implicated in tumor invasion and metastasis. We evaluated E-cadherin expression and cellular localization in colorectal cancer and investigated its relationship to histopathological features. METHODOLOGY: The expression of E-cadherin was evaluated in 57 formalin-fixed, paraffin-embedded specimens of colorectal cancer by immunohistochemistry. RESULTS: In normal colonic mucosa, E-cadherin was expressed uniformly at the cell membrane. Abnormal E-cadherin expression and/or cellular distribution was found in 46% of tumors. There was a significant correlation between E-cadherin expression and tumor grade with a trend towards reduced E-cadherin expression as the tumor grade increased. The association between E-cadherin expression and tumor stage was not significant. CONCLUSIONS: Abnormal E-cadherin expression in colorectal cancer correlates with loss of differentiation.

E-cadherin expression as a differentiation marker in gastric cancer.

BACKGROUND/AIMS: E-cadherin is a cell-cell adhesion molecule involved in tumor progression and metastasis. We evaluated the E-cadherin expression pattern in gastric cancer and investigated its relationship to histopathological features. METHODOLOGY: The expression of E-cadherin was evaluated in 83 formalin-fixed, paraffin-embedded specimens of gastric cancer by immunohistochemistry. RESULTS: In benign gastric mucosa, E-cadherin was expressed uniformly at the cell membrane. Abnormal E-cadherin expression with loss of membranous localization was found in 55 (56%) cancer specimens. Aberrant E-cadherin expression was found more often in diffuse (96%) and mixed type tumors (91%) than in intestinal type tumors (47%) (p=0.0001). A significantly higher proportion of signet-ring (84%) and undifferentiated tumors (87%) showed abnormal E-cadherin expression compared with adenocarcinomas with glandular morphology (57%) (p=0.01). There was a significant correlation between abnormal E-cadherin expression and degree of differentiation (p=0.0001), local tumor extent (p=0.002), and the presence of lymph node metastases (p=0.04). CONCLUSIONS: Loss of normal E-cadherin expression may serve as a differentiation marker in gastric cancer.

Expression patterns of the E-cadherin-catenin cell-cell adhesion complex in gastric cancer.

BACKGROUND/AIMS: The E-cadherin-catenin complex plays a key role in intercellular adhesion of epithelial cells. Aberrant expression and/or function of its components have been implicated in tumor progression and metastasis. We evaluated the expression of the E-cadherin-catenin complex in gastric cancer by immunohistochemistry and investigated its relationship to histopathological features. METHODOLOGY: The expression of E-cadherin, alpha-, beta-, and gamma-catenin, and p120 protein was evaluated by immunohistochemistry in 36 formalin-fixed, paraffin-embedded specimens of gastric cancer. RESULTS: In benign gastric mucosa all five molecules co-localized at the cell membrane. Reduced E-cadherin, alpha-, beta-, and gamma-catenin, and p120 expression was found in 67%, 61%, 50%, 64%, and 56% of cases, respectively. The expression of E-cadherin and beta-catenin correlated significantly with the histological type and the degree of tumor differentiation. gamma-Catenin expression correlated only with the histological type of the tumor. The expression of E-cadherin correlated significantly with alpha-, beta- and gamma-catenin, and p120 expression, respectively. The expression of E-cadherin and alpha-catenin showed the highest concordance. CONCLUSIONS: In gastric cancer, reduced E-cadherin, catenin and p120 expressions are related events with E-cadherin showing the most frequent aberrations.