Bilio-digestive double bypass for nonresectable pancreatic cancer.

In spite of extensive preoperative investigation, surgical exploration is often the only way to determine whether a pancreatic cancer is curatively resectable. If curative resection is not possible, palliation of cholestasis and eventual duodenal obstruction is mandatory. This is best achieved by construction of a bilio-digestive double bypass. Many different techniques have been described but considerable rates of delayed gastric emptying have added high morbidity to the procedure. We propose a retrocolic construction technique combining an omega loop with a Roux-en-Y reconstruction which to our knowledge has not been published before.

KAI1, a new metastasis suppressor gene, is reduced in metastatic hepatocellular carcinoma.

Down-regulation of KAI1 expression has been shown to be associated with formation of metastases or disease progression in prostate and pancreatic cancer. In the present study we analyzed the expression pattern of KAI1 in metastatic and nonmetastatic hepatocellular carcinomas (HCCs) in comparison with normal livers to evaluate whether alteration of KAI1 also facilitates the metastatic ability in this malignancy. Thirty-nine primary HCCs and 10 normal liver tissue samples were studied for KAI1 messenger RNA (mRNA) expression with use of Northern blot analysis and in situ hybridization. By Northern blot analysis, moderate to strong KAI1 mRNA expression was present in normal liver samples. In contrast, KAI1 mRNA expression in tissue samples of primary HCCs was markedly decreased compared with normal controls. The normal/tumor ratio of KAI1 mRNA expression was 2.6:1 (P <.01). Primary HCCs that gave rise to metastasis showed significantly lower KAI1 mRNA levels than nonmetastasized HCCs (P <. 05). As seen by in situ hybridization, moderate to strong cytoplasmic KAI1 mRNA staining was present in almost all normal hepatocytes. Bile ducts, blood vessels, and connective tissue showed no or only faint KAI1 mRNA expression in the normal liver samples. In nonmetastatic HCCs, the cancer cells exhibited in situ hybridization signals that were similar to the normal controls. In contrast, most of the primary HCC cells in samples with metastases showed only faint or moderate KAI1 mRNA expression predominantly in the perinuclear regions. When KAI1 mRNA expression of primary hepatocellular cancer cells was compared with metastasized cancer cells in lymph nodes, with intrahepatic satellite metastasis, or with peritoneal metastasis in the same patients, significantly lower (P <.01) KAI1 mRNA levels were present in the metastasized HCC cells. Reduced KAI1 mRNA in HCC cells seems to influence their metastatic ability and thereby enhances the malignant potential of HCC.

[Role of endoluminal ultrasonography in the treatment of rectal carcinoma]. / Le rôle de la sonographie endoluminale dans le traitement du carcinome du rectum.

Endoluminal sonography is an excellent technique in preoperative staging of rectal carcinoma. This minimally invasive technology makes individual planning of therapy possible and is a very good tool in postoperative follow-up and documentation. In comparison with the techniques of CT and MRI it is less expensive and the mobile unit can easily be moved e.g. into the operating theatre. There are no contraindications for this examination, postoperative tissue scars and metal implants will not disturb the imaging. We think that endoluminal sonography will be able to facilitate individual decision making in the treatment of rectal carcinoma.

An unusual manifestation of Meckel's diverticulum: bleeding and perforation--a case report.

Meckel's diverticulum is the most common congenital abnormality of the gastrointestinal tract. Bleeding of the diverticulum from a peptic ulcer due to ectopic gastric mucosa makes up 25% of all complications in the disease. We report a case of a 20 year old male with chronic anemia, severe hematochezia and perforation due to Meckel's diverticulum. Segmental small bowel resection was performed. Difficulty of preoperative diagnosis is discussed, indication for incidental diverticulectomy is established and the literature reviewed.