A mini-review of c-Met as a potential therapeutic target in melanoma.

Melanoma is the third highest rated cancer in prevalence. Surgery, radiotherapy and targeted/biological therapies in addition to chemotherapy are available options for management of this cancer. Met is an appealing target for management of this type of cancer, since it targets many cancer vital processors, such as angiogenesis, cell growth, scattering and differentiation. In this review, we provide an overview about pathway abnormalities associated with melanoma. We also provide a summary about the events involved in Met signaling and related signaling molecules. We also show the evidence of the importance of Met signaling pathway as a target in cancer management. We also summarize clinical evidence about the use of Met signaling in management of cancer and summarize available trials related to targeting Met in other cancers.

Xanthogranulomatous cholecystitis in the laparoscopic era is still a challenging disease.

BACKGROUND: Xanthogranulomatous cholecystitis is an unusual inflammatory process of the gallbladder which is difficult to diagnose and manage and may be confused with gallbladder cancer. Many surgeons and pathologists are not familiar with this condition. We aim to highlight this condition and to review the role of laparoscopy in its management. PATIENTS AND METHODS: We reviewed the records of 4406 patients who underwent cholecystectomy in 8 years at two teaching hospitals in North Jordan. Forty-two cases of Xanthogranulomatous cholecystitis were identified. The details of these patients were analyzed. The findings were compared with results of a previous study in all cholecystectomy patients conducted in the same centers. RESULTS: The incidence of Xanthogranulomatous cholecystitis was 0.95 %. Twenty-five patients (59.5 %) presented as acute emergencies. Nine patients (21.4 %) had jaundice. Ultrasound showed marked gallbladder wall thickening in 36 patients (85.7 %). Compared with all cholecystectomy patients, xanthogranulomatous cholecystitis patients showed higher conversion rate from laparoscopic to open cholecystectomy (31.4 vs. 3.2 %, p < 0.001) and higher morbidity (33.3 vs. 6.4 % p < 0.001). CONCLUSIONS: Xanthogranulomatous cholecystitis is rare. Acute presentation, associated jaundice, and gallbladder wall thickening should raise the suspicion of the condition. Laparoscopic cholecystectomy is associated with high conversion rate.

Bouveret's Syndrome: An Overlooked Diagnosis. A Case Report and Review of Literature.

Bouveret's syndrome is a rare cause of gastric outlet obstruction. Its diagnosis is often delayed or overlooked. It is characterized by the passage of a large gall bladder stone through a bilio-duodenal fistula, which becomes lodged in the duodenum causing duodenal obstruction. We report the case of a 70-year-old male with a history suggestive of gall bladder disease over a 1-year period. The diagnosis was confirmed by ultrasound, which showed a single large gall bladder stone and the patient was planned for elective laparoscopic cholecystectomy. One week prior to the elective surgery he presented with upper gastrointestinal bleeding for which he was admitted, diagnosed by a gastroenterologist as bleeding duodenal ulcer and treated by local epinephrine injection and blood transfusion. One week later he presented with a picture of acute gastric outlet obstruction, which proved by endoscopy to be due to a large stone impacted in the duodenum. Endoscopic management failed and the stone was managed by open surgery. The patient made a good postoperative recovery and for the last year he has remained free of symptoms.

Laparoscopic cholecystectomy in the elderly and young: a comparative study.

BACKGROUND/AIMS: To assess the safety and effectiveness of simple laparoscopic cholecystectomy in the elderly patients and to compare it with that in younger patients. METHODOLOGY: All patients underwent laparoscopic cholecystectomy in a four year period in a university hospital were retrospectively studied. They were divided in two groups according to the age: group A (65 years and above) and group B (below 65 years). Information about the diagnosis, operation time, intraoperative complications, conversion to open cholecystectomy, length of hospital stay, morbidity and mortality were collected. RESULTS: A total of 1539 patients underwent laparoscopic cholecystectomy during the study period, 234 (15.2%) patients in group A and 1305 (84.8%) patients in group B. Group A experienced higher rates of conversion to laparotomy (9% vs. 2.1%, p<0.005), longer operative time (105.5 vs. 89.7 minutes, p<0.005), longer hospital stay (6.2 vs. 2.1 days, p<0.005) and more morbidity (13.7% vs. 5.1%, p<0.005). The overall mortality was 0.3% with no significant statistical difference between both groups. CONCLUSIONS: Laparoscopic cholecystectomy is feasible in the elderly patients with low mortality and morbidity. However, it is associated with higher conversion rate, longer operation time, longer hospital stay and higher morbidity compared with younger patients.

Incidental extirpation of the parathyroid glands at thyroid surgery: risk factors and post-operative hypocalcemia.

The objective of this study was to estimate the incidence of incidental extirpation of the parathyroid glands during thyroid operations, and to investigate possible risk factors and post-thyroidectomy complications using a descriptive design in a university hospital setting. Hospital records for all thyroidectomies performed in the period between 1st February 2004 and 31 January 2008 for Incidence of incidental extirpation of the parathyroid glands during thyroid operations and post-thyroidectomy hypocalcemia were reviewed. Results showed that incidental parathyroidectomy occurred in 8.6%. Most of the excised parathyroid tissues were extracapsular. Malignant thyroid disease was a risk factor. Extent of surgery, age and sex were not risk factors for incidental parathyroidectomy. Results also showed that incidental parathyroidectomy was associated with transient hypocalcemia.

Laparoscopic diagnosis and management of an abdominal cocoon: a case report and literature review.

Abdominal cocoon is a rare cause of small bowel obstruction. It is characterized by the encasement of a variable length of the small intestine by a fibrous membrane. It occurs primarily in females with only few reported cases in males. We report the case of a 42-year-old male with a history suggestive of recurrent attacks of small bowel obstruction over a 6-month period, which used to resolve spontaneously or by conservative measures. At presentation, a mildly tender mobile mass was felt in the right lower part of the abdomen. Computed tomography scan of the abdomen showed clusters of small bowel loops encased within a well-delineated sac. The diagnosis was confirmed by diagnostic laparoscopy. Laparoscopic lyses and release of the entrapped bowel was performed. The postoperative period was uneventful. Follow-up over 18 months showed no clinical evidence of recurrence.