Laparoscopic cholecystectomy in an ambulatory setting--initial experience in Croatia.

BACKGROUND/AIMS: The purpose of this study was to discover if ambulatory laparoscopic cholecystectomy is feasible in our environment and to determine the factors which will predict its success. METHODOLOGY: From November 12th 2002, to February 25th 2005 one hundred and fifty patients were admitted to our surgical ward of the General Hospital in Bjelovar due to cholelithiasis or biliary colic. Patients were unselected. Six to eight hours after the surgery we rated the ability of the patients to be discharged from the hospital (although they weren't discharged). RESULTS: The research has shown that 61% of the patients were eligible for ambulatory procedure. Among ultrasonographic attributes the most significant independent predictive factor of potential complications, prolongation of the procedure and ineligibility of the patient for the ambulatory laparoscopic cholecystectomy in our study was the thickened wall of the gallbladder. Among non-ultrasound preoperative attributes, the most important are the anamnestic data of prior cholecystitis and ASA classification. Pain was the most common reason why the patients were classified as non-candidates (36.6%). In the second place (25.4%) was the negative subjective patient's judgement to be discharged when all objective parameters were good. CONCLUSIONS: LC is also feasible in our environment but the patient's own motivation is the key factor in our situation.

Primary glomangioma of the esophagus mimicking esophageal papilloma.

We report a case of glomangioma of the esophagus in a 28-year-old woman who presented with a 3-year history of vague discomfort, pain and heat in the neck. At initial gross examination, the tumor mimicked an esophageal papilloma. The resected esophageal specimen contained a polypoid, whitish-gray mass, which measured 3 cm in maximum diameter. Microscopically the tumor consisted of loose fibrovascular stroma heavily infiltrated with mononuclear inflammatory cells and covered with focally hyperkeratotic, parakeratotic and acanthotic squamous epithelium without atypia. In the deeper area immediately above the true muscular layer of the esophageal wall, microscopical examination revealed the neoplasm consisting of numerous, small-to-medium branched vessels covered by regular endothelium and filled with erythrocytes. The loose stroma around the vessels contained poorly circumscribed nests of small, round to oval cells with a uniform appearance. Immunohistochemically, the tumor cells were immunoreactive for smooth muscle actin and vimentin and non-immunoreactive for CD34, CD117, desmin, pan-cytokeratin, synaptophisin, neuron-specific enolase and S-100 protein. Despite its bland histology, the infiltrative growth pattern was suggestive of aggressive behavior; thus, an appropriate clinical follow-up was recommended. An accurate diagnosis and an understanding of the behavior of these rare tumors, especially in an unusual location, are crucial to their management and clinical outcome.

Prognostic relevance of tumour-associated macrophages and von Willebrand factor-positive microvessels in colorectal cancer.

Tumour-associated macrophages (TAM) are involved in tumour angiogenesis and anti-tumour immune response. In colorectal cancer (CRC), an association of high microvascular density (MVD) and unfavourable prognosis has been reported by some investigators. However, heterogeneous patient groups were studied. We, therefore, analysed the correlation between TAM and MVD and the prognostic relevance of MVD, TAM and T lymphocyte infiltration for long-term survival in a homogeneous group of 70 patients with moderately differentiated cancers of the International Union Against Cancer (UICC) stages II and III, who did not receive chemotherapy. MVD was evaluated using immunohistochemistry with antibodies against CD34 and von Willebrand factor (vWF). TAM and T lymphocytes were visualised with antibodies against CD68 and CD3, respectively. Statistical analysis did not reveal a significant correlation between TAM and T lymphocyte numbers and MVD. Multivariate analysis of immunohistochemical data from all CRC patients and the subgroup of patients with UICC stage-II CRC identified TAM- and vWF-positive microvessel numbers as prognostically relevant markers. Low numbers of TAM- and high numbers of vWF-positive microvessels were associated with an unfavourable prognosis. In conclusion, TAM- and vWF-positive microvessel numbers may serve as independent prognostic markers for patients with UICC stage-II and -III CRC and may help to identify patients with an unfavourable prognosis.