Molecular mechanisms of liver damage during neoadjuvant treatment for hepatic metastases of colorectal cancer.

BACKGROUND: The main drawbacks of neoadjuvant chemotherapy of colorectal liver cancer metastases are related to the toxic liver damage. To determine the degree of biochemical and morphologic liver damage after therapeutic protocol treatment with "bevacizumab plus FOLFOX IV", as well as the correlation between the sex, age, the existence of metabolic syndrome, the length of neoadjuvant therapy treatment and the degree of liver damage. METHODS: The study includes the total of 60 colorectal cancer metastases operated patients, divided into two groups of 30 patients: the group of patients who were treated with "bevacizumab plus FOLFOX IV" protocol as a neoadjuvant therapy - prior to liver metastases surgery and the control group, patients with the liver resection done without previous neoadjuvant chemotherapy. The following parameters were examined: biochemical liver function parameters, the presence of metabolic syndrome, pathohistological assessment of the degree of steatosis and SOS syndrome. RESULTS: The increase in AF was observed in the experimental group (Z = 2.566, p = 0.010), Dbilirubin (Z = 1.970, p = 0.037), LDH (Z = 2.951, p = 0.003) and decrease in albumin values (t = 5.100, p <0.001). The pathohistological examination in only 3.3% showed moderate liver steatosis, while SOS syndrome was recorded in as many as two-thirds (66.66%) of patients in the study group. In 14 patients (46.7%) a mild degree was registered, and in 6 (20.0%) moderate levels of this type of liver damage. Pole (p = 0.13), age (p = 0.09) and length of administration of chemotherapy (p = 0.35), as well as the presence of metabolic syndrome (χ2 = 0.390, p = 0.830), did not have any statistically significant effect on the liver damage degree. CONCLUSION: In our study, after the administration of the "bevacizumab plus FOLFOX IV" protocol, a statistically significant increase in AF, Dbilirubin and LDH, as well as a decrease in albumin values, were found. Dominant liver damage was by type of SOS syndrome (66.7%), while steatosis of the liver was recorded in only 3.3% of patients. Gender, age, the presence of metabolic syndrome and the number of chemotherapy cycles did not have any statistic significance on the biochemical parameters and morphological degree of liver damage. KEY WORDS: Colorectal cancer metastases, Liver surgery, Oncology, Neoadjuvant chemotherapy, Liver damage.

Catastrophic necrotizing fasciitis after blunt abdominal trauma with delayed recognition of the coecal rupture--case report.

Necrotizing fasciitis (NF) is a rare bacterial infection with dramatic course, characterized by widespread necrosis of the skin, subcutaneous tissue, and superficial fascia which can often lead to death. We present a case of a 27-year-old male with NF. One day after experiencing blunt abdominal trauma caused by falling over bike handlebars, the patient was admitted to a regional hospital and treated for diffuse abdominal pain and large hematoma of the anterior abdominal wall. Due to worsening of general condition, he was referred to our hospital the following day and operated on urgently. Surgery revealed rupture of the coecum with peritonitis and abdominal wall infection. After surgery, fulminant necrotizing fasciitis developed. Antibiotics were prescribed according to wound cultures and subsequent necrectomies were performed. After 25 days, reconstruction of the abdominal wall with skin grafts was obtained. Despite all resuscitation measures including fluids, blood transfusions, and parenteral nutrition, lung infection and MODS caused death 42 days after initial operation. Blunt abdominal trauma can cause the rupture of intestine, and if early signs of peritoneal irritation should present, emergency laparotomy should be performed. Disastrous complication are rare but lethal.

Giant primary retroperitoneal myxoid leiomyoma: a case report.

INTRODUCTION: Leiomyomas are benign smooth muscle tumors that usually arise from the uterus. CASE REPORT: We present a patient with a 6-month history of vague abdominal discomfort, occasional nausea, vomiting and urinary incontinence. On examination, there was an extremely large firm unpainfull palpable abdominal mass. Laboratory investigation revealed mild leukocytosis and blood creatinine elevation. Abdominopelvic ultrasonography and computed tomography revealed a massive well bordered, encapsulated intraabdominal tumor, extending from the pelvis to epigastrium and almost completely fulfilling the pelvic and abdominal cavity. At laparotomy, tumor arising from the retroperitoneum was excised in toto. Histopathological examination disclosed that the tumor was composed mainly of smooth muscle cells and very rare fibrous connective tissue elements with myxomatous alteration and with no mitotic activity. The negative results of numerous additional parameters analyzed (pancytokeratin, epithelial membrane antigen, S100 protein, CD68, CD34, desmin, aktin) ruled out different origin of a tumor. One year after resection the patient had no complaints and no radiological evidence of tumor recurrence. CONCLUSION: Considering current limitations in radiological diagnosis, in toto resection of these tumors is necessary to rule out malignancy.

Ileocolic intussusception as a presenting sign of primary lymphoma of the colon.

INTRODUCTION: Intussusception is a rare phenomenon in adults. It is caused mainly by malignant neoplasm. Primary lymphoma of the colon is a rare malignancy of the large intestine. The association of intussusception in adult and primary colorectal lymphoma is a diagnostic challenge, since they occur with a variety of atypical symptoms. CASE OUTLINE: We report a case of ileocolic intussusception in a 26-year-old man induced by primary lymphoma of the cecum. He was admitted to our hospital for incomplete intestinal obstruction. After thorough diagnostic work-up (plain abdominal radiography, abdominal ultrasonography, multi-slice computerized tomography, colonoscopy with biopsy), the patient underwent surgery. Intraoperative findings confirmed lymphoma as the cause of intussusception. The right hemicolectomy was carried out with end-to-side ileo-transverse anastomosis. CONCLUSION: Primary colorectal lymphomas should be considered in differential diagnosis of intussusceptions in adults. The treatment of choice is a radical resection where all oncological standards must be fulfilled.