Christina Bali

Assessment of local stage in rectal cancer using endorectal ultrasonography (EUS).

BackgroundPreoperative staging of rectal cancer is essential for the selection of the optimal treatment. This study aims to evaluate the accuracy of endorectal ultrasonography (EUS) in local staging of rectal cancer.Patients and methodsDuring a 4-year period, 33 patients with biopsy-proven rectal cancer underwent evaluation of the invasion of the rectal wall, the mesorectal lymph nodes status and the pelvic organs using EUS. We compared the EUS findings (uTN) to the histopathology examination of the resected specimens (pTN) according to TNM classification.ResultsMost patients had T3 tumours. Overall accuracy in assessing the depth of rectal wall invasion (T) and the lymph node status was 79% and 59% respectively. Two patients previously treated by preoperative chemoradiation were correctly staged only for N stage.ConclusionsEUS is a valuable diagnostic tool in local staging of rectal cancer. Progressively increasing experience will overcome the obstacles in accurate interpretation of ultrasound images.

Management of synchronous abdominal aortic aneurysm and complicating colorectal cancer.

Concomitant management of synchronous abdominal aortic aneurysm (AAA) and colorectal cancer (CRC) is mandatory in cases in which both entities are life threatening for the patient. The endovascular aneurysm repair (EVAR) method can contribute toward concomitant management by offering the avoidance of an otherwise threatening vascular graft infection. We present a case of a complicating CRC and a synchronous AAA, which were successfully treated at the same hospitalization. The AAA was treated first by EVAR, and the colon resection followed 3 days later. The patients postoperative course was uneventful. EVAR, if the standard criteria are met, could comprise an alternative and reliable solution for treating concomitant AAA and CRC even in the acute setting.

BMI and lymph node ratio may predict clinical outcomes of gastric cancer.

AIM BMI and the lymph node (LN) ratio can affect short- and long-term outcomes of patients with gastric cancer. PATIENTS & METHODS This study includes 104 consecutive patients with gastric adenocarcinoma who underwent curative gastrectomy divided in two groups: overweight group (group A) and normal weight group (group B). RESULTS We found that 53.4% of our patients were overweight (group A). The overall rate of postoperative complications was 16.3%, while mortality was 1%. Statistical analyses revealed that postoperative morbidity was significantly higher in group A (p < 0.05). Long-term survival was significantly higher in group B. Cox regression showed a statistically significant correlation between higher BMI and poor long-term survival after curative gastrectomy. Multivariate analysis has identified age and the LN ratios as independent prognostic factors of survival. CONCLUSION In this retrospective analysis, BMI and LN ratio were independently associated with survival in patients with gastric cancer. Further studies are needed to confirm our findings.

A patient presenting with acute abdomen due to metastatic small bowel melanoma: a case report.

IntroductionMalignant tumors of the small bowel are rare. Melanoma of the small intestine is in most cases metastatic from a primary skin lesion. Perforation of small bowel melanoma is an extremely rare entity. To the best of our knowledge this is the fifth case published to date.Case presentationWe report a rare case of acute abdomen due to perforated metastatic small bowel melanoma in a 38-year-old Caucasian man.ConclusionsIn the majority of cases small bowel melanoma represents metastasis from cutaneous sites. Although rare, the possibility of abdominal metastatic melanoma presenting with the clinical picture of acute abdomen must be always considered by the operating surgeon in patients with a history of primary cutaneous malignant lesion.

Appendiceal diverticulitis in a femoral hernia causing necrotizing fasciitis of the right inguinal region: report of a unique case

De Garengeot’s hernia—a rare finding occurring mostly in women—is defined by the presence of the vermiform appendix within the sac of a femoral hernia. The incidence of appendicitis is rarer still, with less than a 100 cases reported to date. We present a unique case of an 84-year-old male patient with perforated appendiceal diverticulitis within a De Garengeot’s hernia causing abscess and necrotizing infection of the overlying soft tissues.

Modified staged surgical approach to coexisting severe coronary artery disease and large abdominal aortic aneurysm.

Abstract  Surgical management of coexisting severe coronary artery disease and large or symptomatic abdominal aortic aneurysm may be required in patients who are unsuitable candidates for minimally invasive interventions. Although several options have been proposed, the optimal timing to deal with both entities, in order to achieve the best outcome, is still debatable. This report presents a modified approach based on a two‐stage treatment in a single anesthetic session.

Identification of novel genes by whole-exome sequencing can improve gastric cancer precision oncology

AIM By identifying cancer driver genes involved in tumorigenesis, whole-exome sequencing (WES) analyses enable the development of robust biomarkers and novel therapeutic targets to reach precision oncology. PATIENTS & METHODS WES analyses were performed in matched gastric cancer-normal gastric tissues from two patients. We compared genes highlighted with those of a database and recent WES/whole-genome sequencing studies. RESULTS We identified 32 highlighted gastric cancer genes, two of these (DEFB118 and RNF43) may provide future potential clinical implications. CONCLUSION Definitive evidence on extensive genetic heterogeneity suggests the need for large-scale next-generation sequencing studies to validate gastric cancer driver genes catalog. This list represents the foundation for developing genome-based biomarkers to guide precision gastric cancer treatment.

Modified extended (D2) lymphadenectomy in patients with gastric cancer: Preliminary experience

BackgroundGastric cancer is the second cause of cancer death in the world. The benefits of extended lymphadenectomy (D2) in Western patients with gastric cancer are still controversial.AimTo present our preliminary experience of performing a modified extended (D2) lymphadenectomy in patients with gastric cancer.MethodsThis study included 16 patients with gastric cancer who underwent curative gastrectomy with extended lymphadenectomy (D2) at the University Hospital of Ioannina in Northwest Greece. Operative safety and perioperative outcomes were evaluated.ResultsSixteen patients with gastric cancer were treated with extended lymphadenectomy (D2). The median number of lymph nodes dissected was 33. Three patients developed surgical complications (anastomotic leakage, bleeding, wound infection), and three patients non-surgical complications (urinary tract infection, upper respiratory infections). The overall complications rate was 37.5%. The median period of post-operative stay was ten days. Five patients presented prolonged lymphorrhoea (more than 100 cc from the drainage tube for more than eight days post-operatively). There was no post-operative mortality.ConclusionsOur preliminary results from performing D2 lymphadenectomy in patients with gastric cancer are encouraging in terms of morbidity and mortality. Clearly, a larger number of patients over a longer period of time would be needed in order to draw safe conclusions.

One-Stage Hybrid Repair of Multiple Degenerative Aneurysms

The development of multiple aneurysms in different segments of the arterial tree requiring treatment is a challenge for the vascular surgeon as their management often demands more than one surgical procedure. We report a case of a 71-year-old male suffering from multiple aneurysms in four different segments of the arterial tree in combination with disabling claudication of his left leg. The patient was managed in a single session with a combination of classic open surgical and endovascular techniques in order to treat his aneurysms and revascularize his leg. This case illustrates the prospect to combine classic open surgical and endovascular techniques for the optimal management of multileveled arterial pathology. Combined therapy simplifies management and allows the one-stage treatment of these patients, while minimizing the overall operative risk.

Successful Nonoperative Management of Spontaneous Splenic Hematoma and Hemoperitoneum due to CMV Infection.

Introduction. Spontaneous splenic hematoma or splenic rupture due to CMV infection in immunocompetent adults is rare and life-threatening. Case Report. Herein we report a rare case of spontaneous splenic hematoma and hemoperitoneum due to CMV infection in a 23-year-old Caucasian male in whom conservative management was successful. Conclusion. Spontaneous splenic hematoma and spontaneous splenic rupture are extremely rare conditions during primary CMV infection. Though rare, they must be always considered by the operating surgeon, because any misinterpretation may result in unfavorable outcomes.