Long noncoding RNA CCAT1 rs67085638 SNP contribution to the progression of gastric cancer in a Polish population.

The role of the long noncoding RNA CCAT1 NC_000008.10:g.128220661C > T (rs67085638) in the development of colon cancer has been reported. Therefore, we assessed the prevalence of rs67085638 in patients with gastric cancer (GC). We also evaluated the effect of rs67085638 on B-cell-specific Moloney leukaemia virus insertion site 1 (BMI1) transcripts in primary GC and counterpart histopathologically confirmed disease-free margin tissue. Using high-resolution melting analysis, we evaluated rs67085638 frequency in patients with the GC genotype (n = 214) and controls (n = 502) in a Polish Caucasian population. qRT-PCR was used to determine BMI1 transcripts. We observed the trend of rs67085638 association in all patients with GC (ptrend = 0.028), a strong risk of the GC genotype in male (ptrend = 0.035) but not female (ptrend = 0.747) patients, and the association with non-cardia GC (ptrend = 0.041), tumour stages T3 (ptrend = 0.014) and T4 (ptrend = 0.032), differentiation grading G3 (ptrend = 0.009), lymph node metastasis stage N3 (ptrend = 0.0005) and metastasis stage M0 (ptrend = 0.027). We found that significantly increased BMI1 transcripts were associated with the primary GC genotype classified as grade G3 (p = 0.011) and as lymph node metastasis N3 (p = 0.010) and counterpart marginal tissues (p = 0.026, p = 0.040, respectively) from carriers of the T/T versus C/C genotypes. rs67085638 may contribute to increased BMI1 transcripts and the progression and rapid growth of GC.

The gentamicin-collagen implant and the risk of distant metastases of rectal cancer following short-course radiotherapy and curative resection: the long-term outcomes of a randomized study.

PURPOSE: A previous randomized study conducted by our group showed that application of gentamicin-collagen implant (GCI) into the pelvic cavity after total mesorectal excision (TME) reduced the incidence of distant metastases. Therefore, we decided to conduct a confirmatory study. METHODS: Patients with rectal cancer were included in the study if they met the following criteria: adenocarcinoma of the rectum, preoperative short-term radiotherapy (5 × 5 Gy), and WHO performance score 0-1. RESULTS: One hundred seventy-six patients were randomly assigned either to an experimental group in which GCI was applied (n = 81) or to a control group without GCI (n = 81). Median follow-up was 80 months. Cumulative incidence of distant metastases at 5 years was higher in the control group compared to the experimental group: 23.5 vs 8.6% (HR 2.4 [95% CI 1.1-5.5], P = 0.005). Overall survival (OS), disease-free survival (DFS), and cancer-specific survival (CSS) did not differ between the experimental group and the control group: HR 0.95 [95% CI 0.55-1.70], P = 0.864; HR 0.85 [95% CI 0.50-1.45], P = 0.548, and HR 0.5 [95%CI 0.22-1.22], P = 0.093, respectively. The predefined by the protocol subgroup analysis for yp stage III disease showed better DFS in the experimental group compared to the control group; HR 0.47 [95%CI 0.23-0.97], P = 0.042). CONCLUSIONS: The results confirmed our previous finding that GCI applied in the pelvis significantly reduced the rate of distant metastases in patients after radical rectal cancer resection.

Small bowel necrosis as a consequence of spontaneous deflation and migration of an air-filled intragastric balloon - a potentially life-threatening complication.

Intragastric balloon placement is a common method of treatment of obesity and is often used by non-surgical teams in endoscopy departments. The likelihood of spontaneous intragastric balloon damage is a well-known phenomenon. We describe a patient who was disqualified from surgical obesity treatment and in whom intragastric fluid-filled balloons had already been inserted twice and removed due to their intolerance. Therefore we qualified this patient for placement of the air-filled balloon Heliosphere BAG. Two months after the planned check-up, he arrived at the surgery department complaining of nausea and vomiting and due to symptoms of ileus diagnosed with an X-ray and ultrasound examination we qualified him for emergency surgery. We would like to emphasise the following issues: the necessity of air-filled balloon removal according to the producer's instructions and multidisciplinary specialist team care along with appropriate diagnostic tools in every case of intragastric balloon insertion.

Robotic stereotactic body radiation therapy for liver-limited malignant tumors.

INTRODUCTION: Stereotactic body radiotherapy (SBRT) is rapidly gaining favor as a new treatment modality for malignant liver tumors. Most of the studies have recruited patients with disseminated disease originating from the liver. This study focuses on disease limited to the liver. AIM: To perform a retrospective analysis of all patients with liver tumors treated by robotic stereotactic body radiation therapy in a single center. MATERIAL AND METHODS: The study included 13 patients with 22 lesions. The inclusion criteria were: patients with 1-4 inoperable liver lesions and absence of any extrahepatic disease. All but 3 patients received 3 fractions delivered by the Cyberknife system of a total of 45 grey (Gy). The other 3 patients received 30 Gy. RESULTS: The median follow-up time was 10.8 months (range: 7-16). The median dose was 41.5 Gy (range: 30-45). One lesion regressed (8%). In 5 patients, the disease was locally stabilized (38%), and in 7 other patients progression occurred (54%). Twelve patients (92%) are still alive, and 1 patient (8%) died. In 1 patient a new cancer (leukemia) was diagnosed. CONCLUSIONS: The SBRT is well tolerated and effective for local control of most liver malignant tumors. It appears that SBRT is best suited for those patients in whom systemic recurrence can be controlled by chemotherapy. Further studies are mandatory to elucidate these effects on tumors of varying histology and to elaborate upon criteria used to select patients who can benefit most from this treatment.

Safety of living donor in pediatric liver transplantation--analysis of 100 consecutive donors.

BACKGROUND/AIM: The aim of this study was to evaluate safety of donors of liver fragments of different size and regeneration of the remaining liver. METHODOLOGY: Between October 1999 and January 2007 liver segments II and III were harvested from 90 donors and segments II, III and IV from 10 donors. Liver volumetry by computed tomography (CT) and biochemical liver function tests were performed at baseline and 7 days, 30 days and 12 months after the operation. RESULTS: CT-assisted volumetry correlated with mass of harvested graft (r=0.779; p<0.05). Twelve months after resection mean regeneration index was 138.64% +/- 23.98% in donors of segments II, III and IV and 109.93% +/- 18.36% in donors of segments II and III (p<0.02). Transient elevation of bilirubin and trans-aminases and decreased prothrombin index were observed in the early postoperative period. Twelve months after the operation mean levels of these parameters were within normal limits. No deaths and no severe complications were observed during the follow-up. CONCLUSIONS: CT-assisted volumetry permits an adequate estimation of liver fragments intended for harvesting. Harvesting of II and III or II, III and IV segments does not compromise donor's safety. Liver regeneration is significantly greater after harvesting of II, III and IV segments than that of II and III segments.

Results of liver transplantation for hepatocellular cancer.

BACKGROUND: Liver transplantation (LTx) for hepatocellular carcinoma (HCC) in cirrhotic liver is nowadays generally accepted treatment modality. AIM OF STUDY: Overview of the indications and results of the LTx in the patients with HCC, the first one performed in 2001. MATERIAL/METHODS: Among 357 adult liver transplant recipients in the period 1994-04.2005, in 26 (7%) the indication was HCC (16 men: 10 women, age 20-65, mean 46.5 years). HCC developed in cirrhotic liver in 25 pts. 12 (48%) were Child C, 10 (30%)--Child B and 3 (12%)--Child A patients. As underlying disease in 2 patients (8%) was alcoholic cirrhosis, in 7 (28%)--HBV cirrhosis, in 12 (48%)--HCV cirrhosis and in 4 (16%)--HBV/HCV cirrhosis. Milano criteria were met in 20 patients (77%). The mean waiting list time was 2.9 months (range 1-6 months). Seven patients underwent liver resection and 1 transarterial chemoembolization prior to LTx. 11 patients (42%) were operated on with use of veno-venous bypass, in 15 patients (58%) the piggy back technique was applied. Rapamycine based immunosuppression was preferred in post-LTx treatment. RESULTS: Operative mortality was 0.4 patients required relaparotomy for intraperitoneal bleeding. 21 patients (81%) are alive in good general condition, 19--free of the disease. 5 patients died 7-28 months after LTx (mean 16.7). The mean survival time is 20 months (range 1-38). CONCLUSIONS: Liver transplantation is safe and effective method of treatment of the selected patients with HCC in cirrhotic liver. Further investigations concerning the precise indications, timing of the transplantation and adjuvant treatment are necessary.

Small bowel transplantation--harvesting technique and graft preparation in pigs.

BACKGROUND: In more and more frequently occurring short bowel syndrome, requiring total parenteral nutrition therapy, the complications of the latter not seldom prevent its use. The idea of treating these patients with small bowel transplantation pushed the authors to start the program aiming at development of small bowel harvesting, preservation and transplantation technique in experimental settings. Additionally, an attempt to find which, if any, and to what extent, histological changes of the preserved bowel may be of prognostic value for the early transplant failure. MATERIAL/METHODS: The experiment was carried out on 20 pigs. Two distinct techniques, corresponding to two clinical circumstances in humans, were tested. In the first group of animals, the small bowel was harvested during a model of multivisceral operation, corresponding to the organ harvesting from a brain-dead donor. In the remaining pigs, an isolated segment of the small bowel was explanted, constituting a model of a living related donor surgery. All small bowels were preserved in hypothermia, in Celsior preserving solution for a different, predefined period. During 16 procedures, the harvested small bowel segment was replanted in the same donor, using different vascular anastomotic techniques. RESULTS: Vascular thrombosis was significantly more frequent in grafts anastomosed by end-to-side technique, as well as in more proximal bowel segments, regardless the anastomotic technique. Following two hours of reimplantation, excised bowel segments did not demonstrate significant differences on histological examination, as compared to the hypothermia-preserved segments (from the same donor) of the same age from primary excision. In most cases, the increase of mucosal damage with preservation time was observed, although statistical significance was reached only for the presence of erosions and necrotic lesions. CONCLUSIONS: On the basis of this experiment one may state, that an ileal graft, assuring the long vascular pedicle (derived from ileocolic vessels) and vascular end-to-end anastomoses are at lesser risk of early vascular thrombosis. While applying the presented technique of purging the graft and its preservation, the act of transplantation itself practically does not influence the histological structure of the bowel, thus is not related to the early graft failure which seems to depend, to the greatest extent, upon the technical aspects of the procedure.

[Amanita phalloides poisoning as an indication for liver transplantation in three family members]. / Zatrucie muchomorem sromotnikowym jako wskazanie do transplantacji watroby u trzech czlonków rodziny.

Amanita phalloides poisoning is one of the most dramatic medical invents. The course of the illness may vary from mild to the lethal, with signs of fulminant liver insufficiency with coma and multiorgan failure. When hepatic encephalopathy (III/IV degrees) occurs the prognosis is very poor. In definite cases the liver transplantation is necessary. The authors present severe Amanita phalloides poisoning in three family members, who due to fulminant hepatic failure underwent liver transplantation. The two of them (son and father) transplanted accordingly in fifth and seventh day after poisoning, survived. Mother, in whom transplantation started in ninth day after poisoning, died intraoperativel with signs of massive hemorrhage, and cardiac arrest.