Altered expression of cytokines, chemokines, growth factors, and soluble receptors in patients with colorectal cancer, and correlation with treatment outcome.

Insofar as they play an important role in the pathogenesis of colorectal cancer (CRC), this study analyzes the serum profile of cytokines, chemokines, growth factors, and soluble receptors in patients with CRC and cancer-free controls as possible CRC signatures. Serum levels of 65 analytes were measured in patients with CRC and age- and sex-matched cancer-free controls using the ProcartaPlex Human Immune Monitoring 65-Plex Panel. Of the 65 tested analytes, 8 cytokines (CSF-3, IFN-γ, IL-12p70, IL-18, IL-20, MIF, TNF-α and TSLP), 8 chemokines (fractalkine, MIP-1ß, BLC, Eotaxin-1, Eotaxin-2, IP-10, MIP-1a, MIP-3a), 2 growth factors (FGF-2, MMP-1), and 4 soluble receptors (APRIL, CD30, TNFRII, and TWEAK), were differentially expressed in CRC. ROC analysis confirmed the high association of TNF-α, BLC, Eotaxin-1, APRIL, and Tweak with AUC > 0.70, suggesting theranostic application. The expression of IFN-γ, IL-18, MIF, BLC, Eotaxin-1, Eotaxin-2, IP-10, and MMP1 was lower in metastatic compared to non-metastatic CRC; only AUC of MIF and MIP-1ß were > 0.7. Moreover, MDC, IL-7, MIF, IL-21, and TNF-α are positively associated with tolerance to CRC chemotherapy (CT) (AUC > 0.7), whereas IL-31, Fractalkine, Eotaxin-1, and Eotaxin-2 were positively associated with resistance to CT. TNF-α, BLC, Eotaxin-1, APRIL, and Tweak may be used as first-line early detection of CRC. The variable levels of MIF and MIP-1ß between metastatic and non-metastatic cases assign prognostic nature to these factors in CRC progression. Regarding tolerance to CT, MDC, IL-7, MIF, IL-21, and TNF-α are key when down-regulated or resistant to treatment is observed.

Tuberculous severe acute colitis. A case report.

INTRODUCTION: and importance: Intestinal tuberculosis represents 2% of the ten million cases of tuberculosis reported in 2018. Herein, we report a case of tuberculous severe acute colitis. It is a rare and life-threatening condition. Our literature review found only five published cases. It occurs generally in immunocompromised patients. Extended colonic inflammation seems to be the main predictive factor of death. Moreover, an early diagnosis and rapid onset of antituberculous treatment are mandatory to save the patient's life. CASE PRESENTATION: Herein, we present a case of tuberculous severe acute colitis with a review of the reported cases. The patient presented with a severe and idiopathic acute colitis. He was put on broad-spectrum antibiotics and intravenous corticosteroids. At day two, he developed septic shock and colic perforation. Colectomy was performed. Microbiology investigation and pathology examination confirmed tuberculous colitis. CLINICAL DISCUSSION: Tuberculous severe acute colitis occurs generally in immunocompromised patients. Extended colic inflammation seems to be the main predictive factor of death. Moreover, an early diagnosis and rapid onset of antituberculous treatment are mandatory to save the patient's life. However, diagnosis is difficult as symptoms aren't specific. Microbiology and pathology were compulsory to retain colic tuberculosis in all the reported cases. CONCLUSION: Tuberculous severe acute colitis is a challenging and life-threatening condition. It usually occurs in immunocompromised patients. Abdominal CT-scan may evoke the diagnosis. Microbiology and pathology are mandatory to retain the diagnosis. Early diagnosis and onset of antituberculous treatment are compulsory to save the patient's life.

Enterosalpingeal fistula complicating Crohn's disease: Report of two cases and review of the literature.

INTRODUCTION AND IMPORTANCE: Reports of enterosalpingeal fistulae complicating Crohn's disease are scarce. They involve the last ileal loop and lead to a progressive destruction of the salpinx. Usually, no genital symptoms are found. In all the cases reported in the literature, the fistula was diagnosed intra-operatively and resection of the right salpinx was performed without the patient's pre-operative consent. CASE PRESENTATION: We describe 2 cases of women presenting with an Enterosalpingeal fistulae complicating Crohn's disease. Radiological findings allowed a pre-operative diagnosis. Thus, the patients were warned of the right salpinx resection and consent was obtained. CLINICAL DISCUSSION: Enterosalpingeal fistulae complicating Crohn's disease are exceptional. Indeed, to the best of our knowledge, only five cases have been reported till now. In all the reported cases, no genital signs were present. As for our patients who didn't experience such symptoms. Moreover, no radiological evidence of the enterosalpingeal fistula was found in the literature. Consequently, the fistula was always diagnosed intra-operatively. For our patients, radiological findings allowed a pre-operative diagnosis. This permitted to warn them of a possible resection of the fallopian tube. Intra-operative findings were unfortunately conflicting with its preservation. CONCLUSION: Enterosalpingeal fistula is an exceptional complication of the Crohn's disease. No clinical findings are present. The diagnosis should be evoked when the CT-scan or the MRI show an abnormal apposition between the fallopian tube, the last loop and the cecum. Surgical resection of the involved salpinx with the diseased intestinal segment is unfortunately usually needed in a young patient population.

Intraperitoneal migrating mesh plug wrongfully taken for right colon cancer: A case report.

BACKGROUND: The use of mesh has become nowadays a standard for hernia repairs. It allows a tension-free hernioplasty and has shown that it is an effective way to prevent recurrences. But complications have been described. Intraperitoneal migration of mesh plug is an uncommon complication. CASE REPORT: In this paper we report a case of a 57 year old male who has been operated on 12 years ago, he had a mesh plug repair for a ventral incisional hernia. The mesh migrated into the abdominal cavity and it was wrongfully taken for a locally advanced right colon cancer. Colonoscopy was done and biopsies were taken, but the results were not conclusive. He was operated on. We found the mesh that had migrated and eroded the hepatic flexure. There was a granulation tissue that also included some of the small intestine. There was also an abscess in the abdominal wall. He had an en-bloc resection of a part of the abdominal wall, small intestine and right colon. CONCLUSION: Mesh hernioplasty is a frequent, simple and effective procedure with a low recurrence rate but it can be associated to serious complications such as mesh migration.

Round cell sarcoma of the colon with CIC rearrangement.

BACKGROUND: The CIC-rearranged sarcoma is a very rare highly aggressive malignant soft tissue group of tumors. It has recently been described as highly aggressive soft tissue tumors of children and young adults sharing similar morphological features with the Ewing sarcoma. The digestive localization is exceptional. CASE PRESENTATION: A 14-year-old male presented with a history of abdominal pain for 1 year, which increased in intensity over the last 2 months. Imaging findings showed a large heterogeneous mesenteric mass on the left flank of the abdomen. Exploratory laparotomy was performed and revealed a large cystic hypervascularized mass depending on the transverse colon and mesocolon. A wide excision of the lesion was performed with segmental colectomy. No postoperative complications were noted. The microscopic examination revealed a vaguely nodular growth of undifferentiated small round cells, arranged in solid sheets separated by thin fibrous septa with a scarce stroma. After an uncomplicated post-operative course, the patient was referred for chemotherapy. The patient died 2 months later with a peritoneal and pleural progression. CONCLUSIONS: The CIC-rearranged sarcoma is an aggressive tumor. There is no standard therapy for this rare disease. Their treatment includes surgery and chemotherapy. Resistance to chemotherapy is common. Further publications and studies will help to determine a standard therapy for this rare disease.

Pharmacokinetics of bupivacaine after bilateral ultrasound-guided transversus abdominis plane block following cesarean delivery under spinal anesthesia.

BACKGROUND: Transversus abdominis plane block is an effective method of post-cesarean analgesia. There are no data available about plasma bupivacaine levels after this block in adults. This study aimed to assess bupivacaine pharmacokinetic parameters after ultrasound-guided transversus abdominis plane blocks following cesarean delivery under spinal anesthesia. METHODS: A prospective observational study in parturients undergoing elective cesarean delivery under hyperbaric bupivacaine spinal anesthesia was conducted. After surgery, patients received bilateral transversus abdominis plane block (50mg bupivacaine each side). Venous blood samples were collected immediately before performing the block and at 10, 20, 30, 45, 60, 90, 120, 180, 240, 720 and 1440minutes. High performance liquid chromatography was used to measure total plasma bupivacaine concentrations. Mean bupivacaine area under the curve (AUC) was calculated from 0 to 24hours. RESULTS: Data were collected from 17 parturients. Mean age and body mass index were 31±6y and 30±4kg/m2 respectively. Mean plasma bupivacaine concentration before the block was 171ng/mL. Mean peak concentration was 802.36ng/mL (range 231.8 to 3504.5ng/mL). Mean time to peak concentration was 30min and mean area-under-the-curve (0-24h) was 4505.4h.ng/mL. Mean elimination half-life was 8.75h. Three subjects had concentrations above the quoted toxic threshold and mild symptoms suggestive of neurotoxicity were reported by two subjects, but no treatment was required. CONCLUSION: Single-dose bilateral transversus abdominis plane block using 100mg of bupivacaine, after spinal anesthesia for cesarean delivery, can result in toxic plasma bupivacaine concentrations.

Adult intussusceptions: Clinical presentation, diagnosis and therapeutic management.

BACKGROUND: Adult intussusception is a rare clinical entity. It is an uncommon cause of intestinal obstruction in adult. It often presents with nonspecific symptoms and preoperative diagnosis remains difficult. The purpose of this study was to determine the clinical entity and surgical approach of adult intussusception. METHODS: We have conducted a retrospective descriptive study starting from 2006 until 2014. We reviewed data for all patients that had been admitted to our department for intestinal intussusception. RESULTS: Eight consecutive patients were admitted to our department. The mean age was 48 years old (20-71). The sex ratio was 0,6. The clinical presentation was acute in 5 cases. A computed tomography was performed in 6 cases. The diagnosis of gastrointestinal intussusception was made preoperatively in 100% of patients. All patients underwent surgery. An organic lesion was identified in 100% of the cases. In all cases, resection of the intussuscepted intestinal loop was done without intestinal reduction. All patients were well followed up and recurrences have been documented. CONCLUSION: In adults, intussusception is usually secondary to an organic cause. In the absence of signs of severity, etiologic diagnosis based on CT allows the diagnosis of the intussusception and sometimes can detect the causal lesion. Therapeutic sanction of intussusception is surgery and there is more emphasis towards resection without reduction.

[Prevention of hypotension during spinal anesthesia for elective caesarean section: coloading with HAE 130/0.4 vs normal saline solution]. / Prévention de l'hypotension induite par la rachianesthésie au cours de la césarienne programmée : coremplissage par HEA 130/0,4 vs sérum salé isotonique.

OBJECTIVE: The aim of this study was to compare the efficacy of HES 130/0.4 coloading compared to normal saline solution for prevention of hypotension during spinal anesthesia for elective caesarean section. STUDY DESIGN: Prospective, randomized. PATIENTS AND METHODS: One hundred and twenty ASA I and II patients scheduled for elective caesarean section were recruited. Patients were randomized to receive either 500mL of HES 130/0.4 (Voluven(®)) coloading (GroupV) or 500mL of normal saline solution coloading (GroupC). Spinal anesthesia technique and ephedrine administration were standardized in both groups. The primary endpoint was the incidence of maternal hypotension during spinal anesthesia for elective caesarean section. RESULTS: Hypotension occurred in 43 patients in group C and 24 patients in group V (p=0.001). Ephedrine consumption was significantly lower in group V (P=0.005). Nausea, vomiting and headache incidence was higher in group C (p=0.006). Apgar scores and umbilical blood gazes were comparable between groups. CONCLUSION: HES 130/0.4 coload was more effective than normal saline solution to prevent hypotension following spinal anesthesia for elective cesarean section. HES 130/0.4 coload reduced the incidence, the duration of longest hypotension, the need for ephedrine and the adverse maternal effects.

[Recurrence of hydatid cyst of liver: predictive factors: Tunisian experience]. / Les facteurs prédictifs de récidive du kyste hydatique du foie : l'expérience tunisienne.

Cystic echinococcosis is a public health problem. Surgery represents the basic treatment and the surgeon is regularly faced with the choice of the appropriate surgical procedure (radical versus conservative surgical approach). The conservative procedure is safe and easy but can lead to a recurrence in the site of residual cavity. The aim of this study was to evaluate the predictive factors of the recurrence of hepatic hydatid cysts, to optimize surgical management and to implement preventive measures. The current retrospective study included 391 patients with hepatic hydatid cysts operated at our institution from 1996 to 2006. The diagnosis of recurrence was suspected by radiological survey and confirmed at laparotomy. The univariate study of predictive factors of recurrence was based on the Fisher test and the multivariate one on the logistic regression model. The recurrence rate reached 12% in our study with an average period of 50 months. Univariate analysis showed that the predictive factors of recurrence were: the rural origin of patients, the voluminous cysts larger than 7 cm, and unilocular hydatid cyst. Multivariate analysis showed that only voluminous cysts and unilocular ones were the predictive factors of recurrence. The unilocular and voluminous hydatid cysts represent the cysts that relapse frequently because of their immunogenic character and the presence of exocysts in the pericysts. This is very important for the therapeutic strategy the main aim of which is to prevent the recurrence.

[Preloading with HES 130/0.4 versus normal saline solution to prevent hypotension during spinal anaesthesia for elective caesarean section]. / Préremplissage par HEA 130/0,4 versus sérum salé isotonique dans la prévention de l'hypotension au cours de la rachianesthésie pour césarienne programmée.

OBJECTIVE: To evaluate the efficacy of HES 130/0.4 preload compared to normal saline solution for prevention of hypotension during spinal anaesthesia for elective caesarean section. STUDY DESIGN: Prospective, randomized. PATIENTS AND METHODS: Sixty ASA I patients scheduled for elective caesarean section were randomized to receive either 1000 mL of normal saline solution preload (Group C) or 500 mL of HES 130/0.4 preload (Group V) within 15 minutes prior to spinal anaesthesia. Spinal anaesthesia techniques and ephedrine administration was standardized in both groups. The primary endpoint was the incidence of maternal hypotension before fetal extraction. RESULTS: The incidence of hypotension before fetal extraction was significantly lower in group V compared to group C (40% vs 66%, P=0.03). Ephedrine consumption was significantly lower in group V (7.6 ± 13 mg vs 16.4 ± 15 mg). Lowest systolic blood pressure was significantly higher in group V (96 ± 14 vs 85 ± 14 mmHg, P=0.005). Incidence of adverse maternal effects and neonatal consequences were similar in both groups. CONCLUSION: HES 130/0.4 preload reduced the incidence of hypotension, the duration of longest hypotension, and the need for ephedrine during spinal anaesthesia for elective caesarean section. However, the efficacy of HES 130/0.4 alone in prevention of maternal hypotension during spinal anaesthesia for caesarean section is still insufficient.

[Spinal anaesthesia for Caesarean section: dose injection speed have an effect on the incidence of hypotension?]. / Rachianesthésie pour césarienne: la vitesse d'injection a-t-elle une influence sur l'incidence de l'hypotension?

OBJECTIVE: To study effect of injection rate on spinal blockade and haemodynamic of spinal bupivacaine for Caesarean section. STUDY DESIGN: Prospective and randomized. PATIENTS AND METHODS: Sixty ASA I-II patients scheduled for elective Caesarean section were randomized to receive either fast (20 seconds, group R, n=30) or slow (60 seconds, group L, n=30) spinal injection of 10 mg of hyperbaric bupivacaine 0.5% associated with 25 microg of fentanyl and 100 microg of morphine. Sensory and motor blockade and haemodynamic parameters were recorded. RESULTS: Profiles of sensory and motor block were similar in both groups. Variations of arterial blood pressure and total dose of ephedrine were not different between R and L groups. However, the number of patient with systolic blood pressure lower than 100 mmHg were significantly lower in L group than in R group (p=0.04). Incidences of adverse effects were similar in both groups. CONCLUSION: Result of the present study suggests that a slow rate of injection would induce lower incidence of hypotension induced by spinal bupivacaine for Caesarean section.