Three cases of primary hydatidosis of the gluteus muscle: our experience in clinical, diagnostic and treatment aspects.

Three cases of primary hydatidosis of the gluteus muscle treated in our department during the last 10 years are described. The first was initially misinterpreted as perineal or sciatic hernia. The diagnosis was set in the operating room. In the second case we included in our differential diagnosis the possibility of parasitic involvement at unusual sites. The diagnosis was confirmed by ultrasonography followed by computed tomography (CT) scans in order to rule out liver and pulmonary involvement. The last patient was initially operated elsewhere but finally came to us to treat his complications. At years following surgery there was no evidence of recurrence in any of the patients, but the last one still suffers from recurrent fasciitis and sciatica.

Differences in colorectal cancer patterns between right and left sided colorectal cancer lesions.

PURPOSE: Colorectal carcinomas that arise proximal (right) or distal (left) to the splenic flexure exhibit different clinical and biological characteristics. Although various hypotheses have been proposed to explain these differences, their origin remains unclear. In this study we investigated the clinicopathologic differences between left and right colon tumors and comment on the possible explanatory theories behind them. METHODS: This study included a total of 388 retrospectively collected cases of colorectal cancer, surgically treated from 1999 to 2004. Differences of patients' demographic data and tumor micro- and macroscopic characteristics between left and right-sided tumors were investigated and analysed. RESULTS: Patients with right-sided colon cancer were significantly older (mean age 70 vs. 68 years; p<0.05) and had more lymph nodes examined than patients with left colon tumors (mean number of nodes 18.9 vs. 12.6; p<0.05). There was a lower proportion of T1 stage right-sided tumors (3.1 vs. 5%) and a higher proportion of stage T2-4 (96.9 vs. 95%) compared with left-sided tumors (p<0.001 for x2 test of all T stages). Furthermore, right-sided tumors had a higher mean width and depth (4.3 vs. 3.8 cm and 1.8 vs. 1.6 cm, respectively; p<0.05). Finally, there was a higher percentage of poorly differentiated right colon tumors (41.4 vs. 17.5%; p<0.001). CONCLUSION: Right-sided colon tumors affect older patients and are diagnosed at more advanced disease stages. The underlying mechanisms that provoke these differences remain unclear. Further studies are needed in order to better understand the true nature of these differences and their possible clinical implications.

Protein expression of bax, bcl-2, and p53 in patients with non-Hodgkin's gastric lymphoma: prognostic significance.

The biologic significance of bcl-2, bax, and p53 gene expression in patients with non-Hodgkin's gastric lymphoma is unknown. We examined the prognostic value of these genes in 36 patients with gastric lymphoma treated in our clinic between 1990 and 1995. Paraffin-embedded specimens from 36 patients who underwent primary resection of the stomach for gastric lymphoma were analyzed immunohistochemically for p53, bax, and bcl-2 gene expression. Expression of bax was seen in 24 of 36 patients (66.7%), p53 expression was found in 8 of 36 tumors (22.2%), and bcl-2 cytoplasmic staining was detected in 6 of 36 patients (16.7%). We performed a univariate analysis to examine the possible correlation between the expression of these genes and the survival of our patients. Expression of bax protein proved to be a statistically significant prognostic factor (p = 0.049). Protein expression of p53 and bcl-2 did not statistically correlate with survival. In the bcl-2-negative (-) patient group (30 patients), those who were bax-positive had a statistically significant better survival than those who were bax-negative (63.3% vs. 36.7%, p = 0.03). There was also a statistically significant correlation between p53 expression and the grade of the tumor (p = 0.0014). P53 protein expression increased along with the grade. Expression of bax is a significant prognostic factor in patients with gastric lymphoma. Its prognostic value increases significantly when studied in bcl-2-negative patients; but expression of bax failed to be an independent prognostic factor. Expression of bcl-2 and p53 has no prognostic significance. Expression of p53 seems to represent a marker for loss of differentiation.

Lipomatosis of the ileocecal valve leading to episodes of partial small bowel obstruction.

The cases of two female patients with lipomatosis of the ileocecal valve inducing episodes of intestinal obstruction are presented. A barium enema with air contrast was performed in patient 1; patient 2 was operated on to treat ileus. Resection of the fatty tissue from the ileocecal valve was performed at operation, after histologic diagnosis on frozen section. These cases suggest that limited resection removing fatty tissue is effective and preferable to more radical resection.

Combination of serum carcino-embryonic antigen and C-reactive protein--a useful test in preoperative staging of colorectal cancer.

The value of the simultaneous estimation of serum carcino-embryonic antigen (CEA) and C-reactive protein (CRP) concentrations in staging patients with colorectal neoplasias was evaluated. The study included 95 patients with benign or malignant epithelial tumors of colon and rectum. The simultaneous negative values of CEA and CRP were able to exclude stage D tumors with a specificity of 92.6% (P less than 0.001). Simultaneously positive values of CEA and CRP were able to diagnose stage C or D tumors with a specificity of 92.1% (P less than 0.001). It is concluded that the combination of CEA and CRP tests can substantially contribute to the preoperative staging and assessment of the extent of colorectal cancer.

Value of serum acute-phase reactant proteins and carcinoembryonic antigen in the preoperative staging of colorectal cancer. A multivariate analysis.

In 55 patients with benign or malignant neoplasias of the large bowel, serum carcinoembryonic antigen (CEA), C-reactive protein (CRP), alpha 1-antitrypsin (AAT), alpha 1-acid glycoprotein (AAG) levels, and the percentage of serum protein electrophoretic components were measured. Statistical analysis showed significant correlations between serum CEA, CRP, AAG, and AAT levels and the percentage of serum beta-globulins with the stage of the disease. Multivariate discriminant analysis gave a final prognostic model that included serum CEA, CRP, and AAT levels and the percentage of the serum beta-globulins with a significance of P less than 0.000001. The authors conclude that the serum acute-phase protein levels, in combination with serum CEA concentrations, have a definite role in the preoperative staging of large bowel cancer.

[Adenosquamous carcinoma of the gallbladder]. / I carcinomi adenosquamosi della cistifellea.

Between 1976 and 1987, 49 patients with cancer of the gallbladder were treated. In three specimens, histologic characteristics of adenosquamous carcinoma were detected, namely blasts deriving from both squamous and glandular epithelium. These carcinomas, relatively rare, are usually found in the gastrointestinal tract, the thyroid, the breast and the female genital apparatus.

Unusual primary locations of hydatid disease. Case report.

Two unusual cases of primary hydatid disease are described. In one of them a retroperitoneal cyst, presenting as a palpable abdominal mass, was strongly adherent to the inferior vena cava and dislocated the right kidney. Partial cystectomy and drainage were performed. The other cyst, of the right ischiorectal fossa, was initially misinterpreted as a perineal of sciatic hernia. It was completely removed. No other site of hydatid disease was found and the patients remain well 3 and 4 years postoperatively.

Long term consequences of bacterial colonization of the biliary tract after choledochostomy.

We studied 48 patients--36 who underwent cholecystectomy and choledochotomy-choledochostomy for cholesterol gallstones and 12 patients as controls who underwent different types of extrabiliary operations. In our material, we observed that, in a high proportion of instances, infected bile during the early postoperative period remained contaminated for six months postoperatively--in an obviously unobstructed bile duct. In patients in whom Escherichia coli was isolated both early and late postoperatively, a statistical significancy was found. This phenomenon consists of a favorable condition for precipitation of calcium bilirubinate, triggering new pigment stone formation.