Concurrence of primary malignant melanoma of the esophagus with adenocarcinoma of sigmoid colon and villous adenoma of cecum: a case presentation.

In this paper, a 74 years old male patient with complaints of dysphagia and hemoptysis is presented. Endoscopy revealed black colored mass protruding to the lumen at distal esophagus. Diagnosis of malignant melanoma was confirmed with biopsy. Examinations for staging purposes revealed masses at sigmoid colon and cecum. Biopsy was performed with colonoscopy. The mass at the sigmoid colon was diagnosed as adenocarcinoma and the mass at the cecum was diagnosed as villous adenoma. Although the treatment strategy is not straightforward, surgical treatment is the most important step. For this reason, patient underwent three field esophagectomy, anterior resection and right hemicolectomy in the first place. The patient is currently receiving his adjuvant chemotherapy and immunotherapy at postoperative 6th month. According to our knowledge, concurrence of these tumors with two different origins has only been reported in 1 patient before. Our patient has the significance of being the second reported case.

Comparison of the classic Limberg flap and modified Limberg flap in the treatment of pilonidal sinus disease: a retrospective analysis of 416 patients.

PURPOSE: Pilonidal sinus disease (PSD) is usually seen on the sacrococcygeal region in adolescent patients. The current study analyzed the outcome of the rhomboid excision and the Limberg flap procedure (cLF) in comparison to the modified Limberg flap procedure (mlF) for PSD. METHODS: Four hundred and sixteen patients with PSD were operated on under spinal or general anesthesia by cLF and mlF. The patients were divided into two groups. In Group 1, cLF was performed on 211 patients. In Group 2, mlF was performed on 205 patients. RESULTS: No significant difference was detected between Groups 1 and 2 in terms of sex, age, preoperative disease period, follow-up time, the mean hospital stay, and hypoesthesia. The mlF group had better clinical results than the cLF group. The recurrence rate was statistically higher in the cLF group 1 than in the mlF group (P = 0.036). The time to return to work, time to walk without pain, and time to be able to sit on the toilet without pain were longer in the cLF group (P = 0.001). The maceration and wound infection rate were statistically higher in the cLF group than in the mlF group (P = 0.020 and P = 0.019, respectively). CONCLUSION: The mlF is a more effective treatment than cLF for the surgical management of PSD.

Reduction of postsurgical adhesions in a rat model: a comparative study.

BACKGROUND: Adhesion formation after peritoneal surgery is a major cause of postoperative bowel obstruction, infertility, and chronic pelvic pain. In this study, we compared the possible individual effects of phosphatidylcholine (PC), Seprafilm II, and tissue plasminogen activator (t-PA) and the combined effects of phosphatidylcholine and t-PA on postoperative adhesion formation in a rat surgical model. MATERIALS AND METHODS: A total of 50 Wistar male rats underwent median laparotomy and standardized abrasion of the visceral and parietal peritoneum. phosphatidylcholine, Seprafilm II, and t-PA alone and phosphatidylcholine and t-PA in combination were applied intraperitoneally at the end of the surgical procedure. Seven days after surgery, a relaparotomy was performed for adhesion grading and histopathological examination. RESULTS: A comparison of adhesion stages demonstrated a significant difference between the control group and the study groups (p<0.001). The adhesion grade of the combined treatment group was statistically different from that of the other groups (p<0.05). In the t-PA group and the combined group, six and two rats, respectively, developed hematomas locally on the cecum. CONCLUSIONS: PC, t-PA, and Seprafilm II used individually reduced the adhesion grade. The t-PA and phosphatidylcholine combination was most effective in reducing adhesion formation. On the other hand, usage of t-PA alone or in combination may increase risk of bleeding. More detailed studies are needed, and future studies on the efficacy of a material for decreasing adhesion formation should include a comparison of several control materials in the same model.

Adipokines and ghrelin in gastric cancer cachexia.

AIM: To investigate the roles of the adipocytokines, ghrelin and leptin in gastric cancer cachexia. METHODS: Resistin, ghrelin, leptin, adiponectin, insulin and insulin-like growth factor (IGF-I), were measured in 30 healthy subjects, and 60 gastric cancer patients of which 30 suffered from cancer-induced cachexia and 30 served as a control group. The relationships between hormones, body mass index (BMI) loss ratio, age, gender, and Glasgow Prognostic Score (GPS) were investigated. RESULTS: Cachexia patients had higher tumor stage and GPS when compared with non-cachexia patients (P < 0.05). Ghrelin, resistin, leptin, adiponectin and IGF-I, showed a significant correlation with BMI loss ratio and GPS (P < 0.05). A strong correlation was seen between GPS and BMI loss (R = -0.570, P < 0.0001). Multivariate analysis indicated that BMI loss was significantly independent as a predictor of ghrelin, resistin, leptin and IGF-I (P < 0.05). Existence of an important significant relationship between resistin and insulin resistance was also noted. CONCLUSION: These results showed that serum ghrelin, leptin, adiponectin, and IGF-I play important roles in cachexia-related gastric cancers. No relationship was found between resistin and cancer cachexia. Also, because of the correlation between these parameters and GPS, these parameters might be used as a predictor factor.

Strangulation of a prolapsed rectal cancer in labor: a case report.

BACKGROUND: Colorectal cancer during pregnancy is uncommon. Most patients present in late pregnancy, and the tumor is localized to rectum in up to 85% of cases. Delayed diagnosis due to confusing significant lower gastrointestinal symptoms with pregnancy-associated gastrointestinal changes is a common feature. From the increasing intraabdominal pressure during delivery, a tumor can prolapse throu the anus and develop incarceration and strangulation, but that is seen a extremely rarely, CASE: A 33-year-old woman was found to have a prolapsing rectal cancer through the anus during delivery, and it progressed to incarceration, CONCLUSION: Colorectal cancer during pregnancy is rare and mostly localized to the rectum. To manage a strangulated rectal prolapse that occurs in labor, consideration should be given to perineal rectosigmoidectomy under general anesthesia. The choice of surgical procedure is controversial if the preoperative diagnosis is not clear.

Long-term results of limberg flap procedure for treatment of pilonidal sinus: a report of 200 cases.

PURPOSE: In the past, various methods of surgical or nonsurgical treatment of sacrococcygeal pilonidal sinus have been used. The most common problem in the treatment of this disease is recurrence. In the present study, our aim was to determine the long-term results of the Limberg flap procedure. METHODS: We present 200 consecutive patients with pilonidal sinus who underwent the Limberg flap procedure between 1992 and 2001. Twenty-six (13 percent) of the 200 patients were operated on because of recurrent pilonidal sinus. Under general or local anesthesia, all sinus tracts were resected en bloc, and the Limberg flap was prepared from the gluteal region. We used a suction drain. We met all patients and recorded their complaints and complications of treatment. RESULTS: Five sinuses recurred (2.5 percent). Minimal flap necrosis occurred in only six patients (3 percent). In three patients (1.5 percent), seroma developed. Wound infection occurred in three patients (1.5 percent). The mean hospital stay was 3.1 days, whereas the mean time to return to work was 12.8 days. CONCLUSION: The Limberg flap procedure is a good treatment choice for pilonidal sinus because of its low complication rate, the short time to return to normal activity, and good long-term results. This procedure has good postoperative results and is a comfortable surgical method for the patient.