Adrenal incidentaloma or epinephroma and review of the literature. Differential diagnosis of adrenal incidentaloma.

Objective: A thorough review of the literature concerning Adrenal Incidentalomas (AI) was conducted. Results: We started with the definition and the history of the term Adrenal Incidentaloma. We introduce a new term, the term Epinephroma. We described the epidemiological characteristics of Adrenal Incidentalomas. We cited and commented the characteristics and pitfalls of various radiological modalities. We went on citing the various arguments in literature about the size of the tumour, the natural history, the biochemical characteristics and the treatment of Adrenal Incidentalomas. Conclusion: advances in modern medical technologies has offered us an armamentarioum of new diagnostic modalities which has improved a lot our differential diagnostic abilities concerning an incidental adrenal tumour. However, despite the advances, still a lot of challenges exist.

Expression of tissue IGF 1, TGFbeta and EGFR in the sequential steps of intestinal adaptation in a rat model of short bowel syndrome.

BACKGROUND: The long-term morphological changes and the expression of tissue growth factors IGF 1, TGFbeta and EGFR in the gut mucosa, during the process of intestinal adaptation were examined. METHODS: Four groups of rats were used: a. Sham rats (n = 10) underwent bowel transection and reanastomosis, b. SBS rats underwent an 80% small bowel resection: group A rats (n = 10) were sacrificed 15 days after surgery, group B (n = 10), 30 days after surgery, and group C (n = 10), 60 days after surgery. Morphological small bowel parameters (villus height, lumen diameter and others) of adaptation were examined sequentially. Tissue samples were studied immunohistochemically for the detection of IGF 1, TGFbeta, and EGFR. RESULTS: There was a significant increase in all morphological parameters at day 15, in the intestinal samples; a further increase followed at day 30 and day 60 (p < 0.0001). Accordingly, an increase in the expression of IGF 1, TGFbeta and EGFR was noted at day 15 (p < 0.05), and at day 30 (NS). CONCLUSION: Intestinal adaptation is an ongoing process lasting more than 2 months after massive small bowel resection. Peptide growth factors are expressed in the intestine continuously during this period, but the first two weeks are the most critical for the mucosal growth.

Prosthetic repair of incisional hernia combined with elective bowel operation.

BACKGROUND AND AIMS: Incisional hernia repair with mesh is considered a clean operation and it is not recommended to be perfomed at the same time with a potentially contaminated operation. The aim of this study is to assess the short-term results of a group of patients who underwent a colon operation and simultaneous incisional hernia repair with an onlay polypropylene mesh technique. PATIENTS AND METHODS: From Novemberto June 2006, 19 patients underwent incisional hernia repair with polypropylene mesh, with simultaneous colonic operation. In 13 patients reestablishment of bowel continuity after a Hartmann procedure was done, whereas in four patients a loop colostomy was closed. Two patients underwent colectomy for cancer. RESULTS: Post-operatively one patient had a seroma and two others had wound infections which required mesh removal. The mean follow-up was 70.15 +/- 48.40 months (range 3 to 142 months). During this period five patients died, four from progression of malignancy and one from myocardial infarction. Three patients (15.78%) developed recurrence, two patients with previous Hartmann's operation for complicated diverticulitis and wound infection and the third patient due to inappropriate mesh fixation with buttonhole hernia development. CONCLUSION: Prosthetic repair of incisional hernias can be safely performed simultaneously with a colonic operation, with an acceptable rate of infectious complications and recurrence. It is unjustifiable to avoid the use of mesh in a potentially contaminated field when an appropriate technique is used.

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.

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.

The prognostic significance of autoantibodies against dsDNA in patients with colorectal adenocarcinoma.

BACKGROUND: The tumors of the gastrointestinal system have been associated with various immune disorders. The goal of this study was to correlate the presence of the anti-dsDNA autoantibodies in the serum of patients with colorectal adenocarcinoma suffering from the prognosis of their disease. PATIENTS AND METHODS: We investigated 55 patients with colorectal adenocarcinoma, 26 patients with benign surgical disease and 40 healthy volunteers for the presence of anti-dsDNA autoantibodies pre-operatively and one month post-operatively, with an ELISA technique. RESULTS: The difference of prevalence of anti-dsDNA antibodies between the group of cancer patients and the two control groups was statistically significant (p < 0.001). After a 3-year follow-up, the difference of incidence of the recurrences between the positive and the negative group for anti-dsDNA autoantibodies of the CA patients was statistically significant (P < 0.01). CONCLUSION: The presence of anti-dsDNA autoantibodies in patients with colorectal cancer indicated a better outcome of the course of the disease.