Comparing 5-Year Survival Rates Before and After Re-stratification of Stage I-III Right-Sided Colon Cancer Patients by Establishing the Presence/Absence of Occult Tumor Cells and Lymph Node Metastases in the Different Levels of Surgical Dissection.

BACKGROUND: To establish the impact of re-stratification on the outcomes of patients (stage I-III right-sided colon cancer) based on the presence/absence of occult tumor cells (OTC) and/or metastatic lymph nodes in the different levels of surgical dissection. METHODS: Consecutive patients were drawn from a multicenter prospective trial. After surgery, the surgical specimen was divided into the D1/D2 and D3 volumes before being further analyzed separately. All lymph nodes were examined with cytokeratin CAM 5.2 immunohistochemically. Lymph nodes containing metastases and OTC (micrometastases; isolated tumor cells) were identified. Re-stratification was as follows: RS1, stages I/II, no OTC in D1/D2 and D3 volumes; RS2, stages I/II, OTC in D1/D2 and/or D3; RS3, stage III, lymph node metastases in D1/D2, with/without OTC in D3; RS4, stage III, lymph node metastases in D3, with/without OTC in D3. RESULTS: Eighty-seven patients (39 men, 68.4 + 9.9 years) were included. The standard stratified (SS) group contained the following: stages I/II (SS1) 57 patients; stage III (SS2) 30 patients. Re-stratified (RS) contained RS1 (38), RS2 (19), RS3 (24), and RS4 (6) patients. Lymph node ratio (OTC) RS2: 0.157 D1/D2; 0.035 D3 and 0.092 complete specimens. Lymph node ratio RS3: 0.113 D1/D2; complete specimen 0.056. Overall survival and disease-free survival were p = 0.875 and p = 0.049 for SS and p = 0.144 and p = 0.001 for RS groups, respectively. CONCLUSION: This re-stratification identifies a patient group with poor prognosis (RS4). Removing this group from SS2 eliminates all the differences in survival between RS2 and RS3 groups. The level of dissection of the affected nodes may have an impact on survival. CLINICAL TRIAL: "Safe Radical D3 Right Hemicolectomy for Cancer through Preoperative Biphasic Multi-Detector Computed Tomography (MDCT) Angiography" registered at http://clinicaltrials.gov/ct2/show/NCT01351714.

Interactions of occult tumor spread and surgical technique on overall and disease-free survival in patients operated for stage I and II right-sided colon cancer.

PURPOSE: To determine if "medial to lateral" (ML) dissection with devascularization first is superior to "lateral to medial" (LM) dissection regarding numbers of lymph node micro metastases (MM) and isolated tumor cells (ITC) as well as 5-year disease-free (5YDFS) and 5-year overall survival (5YOS) in stage I/II right-sided colon cancer. METHODS: Two datasets are used. ML group consists of consecutive stage I/II patients from a prospective trial. LM group is the original dataset from a previous publication. All harvested lymph nodes are examined with monoclonal antibody CAM 5.2 (immunohistochemically). Lymph node harvest and 5YOS/5YDFS were compared between ML/LM groups, stage I/II tumors and MM/ITC presence/absence. RESULTS: 117 patients included ML:51, LM:66. MM/ITC positive in ML 37.3% (19/51), LM 31.8% (21/66) p = 0.54. The 5YDFS for patients in ML 70.6% and LM 69.7%, p = 0.99, 5YOS: 74.5% ML and 71.2% LM (p = 0.73). No difference in 5YDFS/5YOS between groups for Stage I/II tumors; however, LM group had an excess of early tumors (16) when compared to ML group, while lymph node harvest was significantly higher in ML group (p < 0.01) 15.1 vs 26.7. 5YDFS and 5YOS stratified by MM/ITC presence/absence was 67.5%/71.4%, p = 0.63, and 75.0%/71.4%, p = 0.72, respectively. Death due to recurrence in MM/ITC positive was significantly higher than MM/ITC negative (p = 0.012). CONCLUSION: Surgical technique does not influence numbers of MM/ITC or 5YDFS/5YOS. Presence of MM/ITC does not affect 5YOS/5YDFS but can be a potential prognostic factor for death due to recurrence. CLINICAL TRIAL: Safe Radical D3 Right Hemicolectomy for Cancer through Preoperative Biphasic Multi-Detector Computed Tomography (MDCT) Angiography" registered at http://clinicaltrials.gov/ct2/show/NCT01351714 .

Navigating the mesentery: Part III. Unusual anatomy of ileocolic vessels.

AIM: The ileocolic vessels are important landmarks in advanced surgery of the midgut. The aim of the present study is to present variations of ileocolic vessels relevant to complete mesocolic excision with D3 lymphadenectomy of the right colon, within their detailed and precise morphometric framework and deriving from a large and consistent series of operated patients. METHODS: An ongoing prospective trial 'Safe Radical D3 Right Hemicolectomy for Cancer through Preoperative Biphasic Multidetector Computed Tomography Angiography' was reviewed. The imaging datasets underwent manual segmentation and 3D reconstruction, and the results were validated at surgery. A total of 356 patients were included in the study. RESULTS: A cross-section of the series revealed five cases (1.4%) with variation of ileocolic vessels relevant to complete mesocolic excision or D3 extended mesenterectomy. There were two cases with absence of a true classical ileocolic artery, two cases with absence of a true classical ileocolic vein, and one case of precocious bifurcation of the ileocolic artery, left to the superior mesenteric vein. The entire D3 area in all the cases was thoroughly documented and analysed from the morphometric point of view (calibres, lengths of vessels, crossing patterns). CONCLUSION: The preoperative visualization of a patient's individual 3D anatomy is a powerful tool in identifying the variations whose negligence could have dire consequences in complete mesocolic excision of the right colon.

Arterial supply of the trigeminal ganglion, a micromorphological study.

BACKGROUND: In this study, we explored the specific microanatomical properties of the trigeminal ganglion (TG) blood supply and its close neurovascular relationships with the surrounding vessels. Possible clinical implications have been discussed. MATERIALS AND METHODS: The internal carotid and maxillary arteries of 25 adult and 4 foetal heads were injected with a 10% mixture of India ink and gelatin, and their TGs subsequently underwent microdissection, observation and morphometry under a stereoscopic microscope. RESULTS: The number of trigeminal arteries varied between 3 and 5 (mean 3.34), originating from 2 or 3 of the following sources: the inferolateral trunk (ILT) (100%), the meningohypophyseal trunk (MHT) (100%), and from the middle meningeal artery (MMA) (92%). In total, the mean diameter of the trigeminal branches was 0.222 mm. The trigeminal branch of the ILT supplied medial and middle parts of the TG, the branch of the MHT supplied the medial part of the TG, and the branch of the MMA supplied the lateral part of the TG. Additional arteries for the TG emerged from the dural vascular plexus and the vascular network of the plexal segment of the trigeminal nerve. Uniform and specific intraganglionicdense capillary network was observed for each sensory trigeminal neuron. CONCLUSIONS: The reported features of the TG vasculature could be implied in a safer setting for surgical approach to the skull base, in relation to the surrounding structures. The morphometric data on TG vasculature provide anatomical basis for better understanding the complex TG blood supply from the internal and external carotid arteries.

The superficial palmar branch of the radial artery: a corrosion cast study.

BACKGROUND: Surgical procedures such as thenar flaps and radial artery (RA) harvesting call for an elaborate anatomical study of the RA's superficial palmar branch (SPB). The aim of this study was to describe the branching pattern of this vessel related to the morphometric characteristics and variations of this artery. MATERIALS AND METHODS: Twenty 4% formalin solution-injected hands were dissected. For the morphometric study we used another group of 35 human hands of adult persons, injected with methyl methacrylate fluid into the ulnar and radial arteries. As soon as polymerisation was completed, a 40% solution of potassium hydroxide was applied for corrosion. The vascular arterial casts were examined under the stereoscopic microscope and precise drawings of each specimen were made. RESULTS: In the majority of cases (75%) SPB passed superficially, over the abductor pollicis brevis muscle. The mean diameter of the SPB, very variable depending on its length and field of supply, was 1.52 ± 0.49 mm, ranging from 0.8 to 2.7 mm. Developed SPB type, was present in 31.4% of hands, with the diameter of 1.7 mm and larger (mean 1.95 mm), continuing distally to become the radialis indicis artery, with an average calibre of 1.2 mm, and with important branches to the thumb. In most hands (68.6%), the hypoplastic SPB, was present, with a mean diameter of 1.17 mm, and the field of supply within the thenar area. CONCLUSIONS: Knowledge of the SPB dominance and existence of anastomotic vessels in its field of supply are of importance to avoid the risk of possible ischaemic sequelae in the hand associated with harvesting the RA.

Navigating the mesentery: part II. Vascular abnormalities and a review of the literature.

AIM: Vascular abnormalities present advantages and/or disadvantages for the patient undergoing surgery. The aims of this study were to define, classify and demonstrate the courses, and to assess the clinical value, of arterial and venous abnormalities in the central mesentery. METHOD: We conducted a review of the anatomy of 340 patients planned for enrolment in the 'Safe Radical D3 Right Hemicolectomy for Cancer through Preoperative Biphasic MDCT Angiography' trial, 312 of whom were submitted to surgery. Vascular abnormalities were analysed in context with surgical notes and images. A meta-analysis of the literature was performed. RESULTS: Arterial Abnormalities were found in 28 (8.2%) of the 340 patients and were classified into the following three groups based on anticipated surgical difficulty: group 1, accessory or replaced arteries to solid organs [14 (4.1%)]; group 2, arterial shunts [11 (3.2%)] between the coeliac trunk and the superior mesenteric artery, which resulted in bleeding in three patients; and group 3, common stem abnormalities [3 (0.9%)]. Two groups of superior mesenteric vein abnormalities were noted. The first included morphological abnormalities in a single vein [4 (1.2%)]: aneurysm [1 (0.3%)]; and ring variants of principal tributaries [3 (0.9%)]. The second included double superior mesenteric vein trunks [31 (9.1%)]: genuine bifid [10 (2.9%)]; and pseudo bifid [21 (6.2%)]. The meta-analysis revealed 26 articles, including 10 series of anatomical dissections or angiographies [1970 cases with 205 (10.4%) arterial abnormalities] and 16 case reports, none of which described a clinical or surgical setting. CONCLUSION: Vascular abnormalities occur frequently. Arterial abnormalities are a hazard when inadvertent injury occurs during surgery. Preoperative knowledge of a bifid superior mesenteric vein is useful.

Vascular anatomy of the thenar eminence: its relevance to a pedicled or free thenar flap.

BACKGROUND: The aim of this study was to clarify the arterial supply of the skin covering the prominent part of the thenar eminence in order to describe the possibility and potential for harvesting a pedicled or a free flap from the thenar eminence. MATERIALS AND METHODS: The arteries were studied in 30 post-mortem specimens of human hands; 3 previously perfused with 4% formaldehyde solution, and injected with black India ink, and 27 injected with methyl-methacrylate and afterwards corroded in 40% potassium hydroxide solution. RESULTS: In all hands we found two little palmar arteries coming from the anatomical snuff-box portion of the radial artery. We labelled the first (proximal) branch as the middle thenar artery, because it supplies the middle third of the thenar eminence skin. Its diameter varied from 0.25 to 0.55 mm (mean 0.4 mm). The distal, more prominent branch of the radial artery, vascularised the lateral third of the thenar eminence skin, and was named the lateral thenar artery; its diameter ranged from 0.40 to 0.90 mm (mean 0.67 mm). The superficial palmar branch of the radial artery, always present, was classified as: hypoplastic, average or prominent, with a diameter ranging from 0.8 to 2.7 mm (mean 1.47 mm). CONCLUSIONS: Three individually developed branches of the radial artery supplied the skin of the thenar eminence. Cutaneous branches of these three arteries were interconnected via anastomotic vessels.

Bowel function and quality of life after superior mesenteric nerve plexus transection in right colectomy with D3 extended mesenterectomy.

BACKGROUND: The aim of this study was to ascertain the impact of injury to the superior mesenteric nerve plexus caused by right colectomy with D3 extended mesenterectomy as performed in the prospective multicenter trial: "Safe Radical D3 Right Hemicolectomy for Cancer through Preoperative Biphasic Multi-detector Computed Tomography" in which all soft tissue surrounding the superior mesenteric vessels from the level of the middle colic artery to that of the ileocolic artery was removed. METHODS: Bowel function and gastrointestinal quality of life in two consecutive cohorts that underwent right colectomy with and without D3 extended mesenterectomy were compared. Main outcome measures were the Diarrhea Assessment Scale (DAS) and Gastrointestinal Quality of Life Index (GIQLI). The data were collected prospectively through telephone interviews. RESULTS: Forty-nine patients per group, comparable for age, sex, length of bowel resected but with significantly shorter follow-up time in the experimental group, were included. There was no difference in total DAS scores, subscores or additional questions except for higher bowel frequency scores in the D3 group (p = 0.02). Comparison of total GIQLI scores and subscales showed no difference between groups. Regression analysis with correction for confounding factors showed 0.48 lower bowel frequency scores in the D2 group (p = 0.022). Within the D3 group presence of jejunal arteries cranial to the D3 dissection area showed 1.78 lower DAS scores and 0.7 lower bowel frequency scores. CONCLUSIONS: Small bowel denervation after right colectomy with D3 extended mesenterectomy leads to increased bowel frequency but does not impact gastrointestinal quality of life. Individual anatomical variants can affect postoperative bowel function differently despite standardized surgery.

Navigating the mesentery: a comparative pre- and per-operative visualization of the vascular anatomy.

AIM: Awareness of anatomy is critical for performing safe surgery within the root of the mesentery. Our aim was to investigate the anatomical relationship between the superior mesenteric artery (SMA) and vein (SMV) and their branches within a predefined D3 area of the right colon and to compare preoperatively established three-dimensional (3D) mesenteric vessel anatomy from CT with that found at surgery. METHOD: Prospective data were collected on 139 patients included in the 'Safe Radical D3 Right Hemicolectomy for Cancer Through Preoperative Biphasic Multi-detector Computed Tomography (MDCT) Angiography' trial. CT data sets were 3D reconstructed before surgery and compared with photographs taken during the operation. RESULTS: The ileocolic artery was present and correctly identified in all patients and crossed the SMV anteriorly in 58 (41.7%). Seventeen patients had a right colic artery at surgery and there were three false-negative and one false-positive CT findings, yielding a diagnostic accuracy of 97.1%, sensitivity of 85.7% and specificity of 95.2%. Positive and negative predictive values were 94.7% and 97.5%, respectively. The middle colic artery was absent in one (0.7%) patient and multiple (nine double and one triple) in 10 (7.2%) patients. A mean of 3.8 ± 1.2 jejunal arteries and 2.0 ± 0.8 jejunal veins arose from the SMA and SMV. Jejunal veins crossed the SMA in the D3 area anteriorly in 30.9% of patients. In 26 (18.7%) patients, additional veins drained into the SMV, including pancreaticoduodenal in 16, right colic in six and both in two. The inferior mesenteric vein entered the SMV in 58 (41.7%) patients and crossed the D3 area in three (2.2%). CONCLUSION: CT-reconstructed anatomy has high specificity, sensitivity, accuracy and reliability.

Non-assisted versus neuro-navigated and XperCT-guided external ventricular catheter placement: a comparative cadaver study.

BACKGROUND AND PURPOSE: Accurate placement of an external ventricular drain (EVD) for the treatment of hydrocephalus is of paramount importance for its functionality and in order to minimize morbidity and complications. The aim of this study was to compare two different drain insertion assistance tools with the traditional free-hand anatomical landmark method, and to measure efficacy, safety and precision. METHODS: Ten cadaver heads were prepared by opening large bone windows centered on Kocher's points on both sides. Nineteen physicians, divided in two groups (trainees and board certified neurosurgeons) performed EVD insertions. The target for the ventricular drain tip was the ipsilateral foramen of Monro. Each participant inserted the external ventricular catheter in three different ways: 1) free-hand by anatomical landmarks, 2) neuronavigation-assisted (NN), and 3) XperCT-guided (XCT). The number of ventricular hits and dangerous trajectories; time to proceed; radiation exposure of patients and physicians; distance of the catheter tip to target and size of deviations projected in the orthogonal plans were measured and compared. RESULTS: Insertion using XCT increased the probability of ventricular puncture from 69.2 to 90.2 % (p = 0.02). Non-assisted placements were significantly less precise (catheter tip to target distance 14.3 ± 7.4 mm versus 9.6 ± 7.2 mm, p = 0.0003). The insertion time to proceed increased from 3.04 ± 2.06 min. to 7.3 ± 3.6 min. (p < 0.001). The X-ray exposure for XCT was 32.23 mSv, but could be reduced to 13.9 mSv if patients were initially imaged in the hybrid-operating suite. No supplementary radiation exposure is needed for NN if patients are imaged according to a navigation protocol initially. CONCLUSION: This ex vivo study demonstrates a significantly improved accuracy and safety using either NN or XCT-assisted methods. Therefore, efforts should be undertaken to implement these new technologies into daily clinical practice. However, the accuracy versus urgency of an EVD placement has to be balanced, as the image-guided insertion technique will implicate a longer preparation time due to a specific image acquisition and trajectory planning.

Injury to the axillary nerve after reverse shoulder arthroplasty: an anatomical study.

BACKGROUND: Subclinical neurological lesions after reverse shoulder arthroplasty are frequent, mainly those involving the axillary nerve. One of the major reported risk factors is postoperative lengthening of the arm. The purpose of this study was to evaluate the anatomical relationship between the axillary nerve and prosthetic components after reverse shoulder arthroplasty. The study hypothesis was that inferior overhang of the glenosphere relative to glenoid could put this nerve at risk. MATERIAL AND METHODS: Eleven fresh frozen shoulder specimens were dissected after having undergone reverse shoulder arthroplasty using a classic deltopectoral approach. RESULTS: The mean distance from the inferior border of the glenoid to the inferior edge of the glenosphere was 6.0±4.3mm (range, 1.0 to 16.2mm). The axillary nerve was never closer than 15mm to the glenosphere. The main anterior branch of the axillary nerve was in close contact with the posterior metaphysis or humeral prosthetic implant. The mean distance between the nerve and the humeral implants was 5.2±2.1mm (range, 2.0 to 8.1mm). CONCLUSIONS: The proximity of the axillary nerve to the posterior metaphysis or humeral implants may be a risk factor for axillary nerve injury after reverse shoulder arthroplasty. CLINICAL RELEVANCE: This study quantifies the proximity of the axillary nerve to the implant after reverse shoulder arthroplasty. LEVEL OF EVIDENCE: Basic science study, cadaver study.

3D for D3: role of imaging for right colectomy in a case with congenital superior mesenteric vein aneurysm and co-existing anomalous irrigation.

BACKGROUND: The D3 right colectomy for cancer requires dissection in the vicinity of the superior mesenteric vessels, which requires preoperative 3D imaging in these patients. CASE REPORT: We present a patient with a caecum adenocarcinoma cancer which underwent D3 resection of the right colon, preceded by pre-operative MDCT with 2D multiplanar reconstruction and 3D volume rendering. RESULTS: The dataset analysis revealed a rare congenital aneurysm of the superior mesenteric vein below the spleno-mesenteric confluence and a co-existing anomalous irrigation in the form of an ileo-mesenteric trunk. The surgical procedure was carried out as planned and the patient presents no signs of recurrence of the disease one year after the intervention. CONCLUSIONS: The case presented - with a rare and complicated vascular situs - illustrates particularly well that multimodal post-processing of the CT dataset for volume rendering allows proper assessment of the arrangement of pertinent blood vessels, and, consequently in the planning, setup and accomplishing the delicate operation, avoiding the surgical pitfalls and iatrogenic injuries.

Gastric varices without portal hypertension: role of left inferior vena cava?

A variant vascular anatomy was detected during regular analysis of multidetector computed tomography angiography of the abdomen in a 70 year-old female patient, referred to the department of surgery for laparoscopic right colectomy for colon cancer. The anomalous vessel was located left to the aorta, and was consistent with a persistent left inferior vena cava. It was connected by two retroaortic rootlets to the dorsal surface of the regular right inferior vena cava and had four notable tributaries - an anastomosis with the iliolumbar trunk, ovarian vein, renal vein and the inferior phrenic vein. In the upper abdomen, the left inferior vena cava took a tortuous course, passing at first between the spleen and the diaphragm, then curving below the inferior splenic border and terminating in an irregular network in the posterior region of gastric fundus and cardia, close to the splenic hilum, without supradiaphragmatic continuation. Despite this extraordinary termination, there were no signs of portal hypertension or data on previous occurrence of this condition.

The absence of the vomer in the first and early second trimester of pregnancy - a new marker of trisomy 21 and trisomy 13.

PURPOSE: The aim of this study was to measure the two frontomaxillo-facial (FMF) angles: the FMF-vomer (FMF-v) and the FMF-palate (FMF-p), and to visualize the vomer in the 1(st) and early 2(nd) trimester, in order to ascertain whether they can be used as markers for trisomy 21 and trisomy 13. MATERIALS AND METHODS: A 2D ultrasound scan was performed in the 340 normal and 12 abnormal pregnancies, using the linear, convex and endovaginal probes. RESULTS: We visualized the FMF angles within 1 to 5 minutes in 253 (72 %) of cases by using the linear probe. FMF-v angle was significantly smaller that the FMF-p angle (79.8° vs. 89.7°, 71.5° vs. 84.5° for the two trimesters, respectively), and that the value of both angles decreased in the second trimester. There was not one single case of trisomy in which vomer could be identified in the 1 (st) and early 2 (nd) trimester. The FMF-p angle failed to present difference between normal cases and the ones with trisomy (89.5°). There was not one single case of trisomy (21 or 13) in which vomer or FMF-v could be identified in the first or early second trimester. The diagnostic accuracy of vomer as a marker for trisomy was 0.985. CONCLUSION: If the vomer cannot be visualized in the 1 (st) and early 2 (nd) trimester, it is important to check the karyotype, and it is not necessary to measure the FMF-p angle. The high resolution probe (L 12 - 5 Mhz) enables easier assessment of the vomer.

3D relations between right colon arteries and the superior mesenteric vein: a preliminary study with multidetector computed tomography.

BACKGROUND: 3-D relations between the ileocolic (ICA), right colic artery (RCA) with the superior mesenteric vein (SMV) have been described in cadavers. However, no data exists on preoperative evaluation of these relations. AIM: To define the length of crossing and 3-D position of the ICA and RCA to the SMV in patients undergoing multidetector computerized tomography (MDCT) angiography. METHODS: MDCT angiographies were analyzed with the aid of Osirix v.3.0.2. image processing application. All the datasets included arterial and venous phase, undergoing multimodal visualization: 2D multiplanar reconstruction with maximum intensity projection and 3D Volume rendering. The anatomical relations were analyzed in various planes (orthogonal and oblique), depending upon their particular course. When a clear spatial reference was achieved, the distance of the colic artery from their origin on the aorta to the right border of the SMV was measured, and its position noted. RESULTS: 50 MDCT were analyzed (29 male). RCA occurred in 27 patients (54.0%), 25 (92.6%) passed anterior to the SMV. Length of crossing was 22.7±8.1 (8.3-41.3) mm. The ICA occurred in 48 (96%) passing under the SMV in 38 (79.2%). Length of crossing 15.4±5.8 (14.0-26.6) mm. CONCLUSIONS: RCA occurs in 54% patients, passes over the SMV in 92.6% specimens and leaves a 22.7 mm stump. ICA passes under the SMV in most cases, leaving a 15.4 mm stump. These data could be of crucial importance to the surgeon facing laparoscopic right colectomy for cancer.

Kaposi's sarcoma after repeated surgical procedures in an immunocompetent patient: the lymphatic hypothesis.

A 63-year-old Swiss patient developed acquired nodules on his right palm after 3 localized surgeries, called 'needle fasciotomy', for Dupuytren's disease. Kaposi's sarcoma (KS) was diagnosed in a biopsy of a nodule. A positive immunolabeling and serology for human herpesvirus 8 has been found, but human immunodeficiency virus and hepatitis C identification remained negative. The nodules were limited to the surgically traumatized area. This first report of a nonimmunocompromised patient developing a KS after repeated surgeries in a unique peculiar localized area with a dense lymphatic network sustains the hypothesis that tissue alterations involving the lymphatic system could play a central role in the occurrence of KS.

Vascular relationships in right colectomy for cancer: clinical implications.

AIMS: The study aim was to provide data on pattern and length of crossing of the ileocolic artery (ICA) and right colic artery (RCA) with the superior mesenteric vein (SMV). METHODS: Specimens from 30 fresh human cadavers underwent corrosion casting. Methylacrylate was injected into the SMV and superior mesenteric artery (SMA). Length of crossing was measured with a scaleable ruler and copper wire. Values are mean (SD; range). RESULTS: ICA was present in all specimens and crossed posterior to the SMV in 19 (63.33%) of 30 specimens. Length of crossing was 17.01 (7.84; 7.09-42.89) mm. RCA was present in 19 (63.33%) of 30 specimens. RCA crossed anterior to SMV in 16 (84.21%) of 19 specimens. Length of crossing was 20.63 (8.09; 6.3-35.7) mm. CONCLUSIONS: ICA was always present, crossed posterior to SMV in 60% of specimens with a crossing length of 17 mm. RCA was present in 63% of specimens, crossed anterior to the SMV in 84% of specimens with a crossing length of 20 mm. Clinical implications include arterial length left behind with main nodes, arterial bleeding and safety of laparoscopic access.

PCR detection of helicobacter pylori genome in colonic mucosa: normal and malignant.

BACKGROUND AND AIMS: The aim of this study was to detect Helicobacter pylori (H. pylori) in colorectal cancer tissue specimens and relate the possible role of this microorganism in the etiology of colorectal cancer. PATIENTS AND METHODS: From February 2002 to April 2003 83 CRC patients (55 male, 28 female) and 40 control patients (19 male, 21 female) entered the prospective study. The biopsy samples of CRC tissue and normal mucosa were obtained during open surgery on CRC patients. In the control patients biopsy samples were taken during colonoscopy. Pathology confirmed adenocarcinoma in all the CRC patients. The existence of genetic material of H. pylori was determined by detection of the ureA gene by nested PCR. K-ras PCR was also performed on all patients. RESULTS: H. pylori PCR was positive in 1 case (1.2%) of CRC in the tumour tissue and in all 5 samples (6.0%) of the normal colonic mucosa in the cancer patients. The control patients were PCR positive to H. pylori in 13 samples (32.5%). According to Chi-square test, there is no statistical correlation between H. pylori infection and CRC (x2 = 2.9395; p > 0.05) but there is a significant prevalence of H. pylori infection in controls compared to CRC (x2 = 15.5625; p < 0.01). The K-ras PCR showed gene mutations in 19 tumour tissues of CRC (31.6%) and in 2 cases (3.4%) of normal colonic mucosa of CRC patients . In controls K-ras PCR showed one gene mutation (3.0%). There is a significant statistical correlation between K-ras mutation and CRC (x2 = 16.0694; p < 0.01). CONCLUSION: Our established PCR for H. pylori is feasible for CRC tissue as well. However, H. pylori is not considered to play an important role in the pathogenesis of CRC. The identification of K-ras mutations in routine PCR analysis correlates with the presence of CRC.

Immature ovarian teratoma in a young girl: very short course and lethal outcome. A case report.

Immature teratomas of the ovary represent less than 1% of all ovarian teratomas. They contain several tissues that derive from the three embryologic layers: ectoderm, mesoderm, and endoderm. We report the case of a 17-year-old girl who presented with an immature teratoma of the left ovary that recurred 3 months later as an inoperable malignant neuroepithelial peritoneal tumor resembling a glioblastoma. She died 3 weeks after the second explorative operation. The very aggressive course and fast lethal outcome could be explained by the patient's refusal to receive chemotherapy after the initial operation.