Haralampos Harissis

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.

Surgical management of hydatid liver disease

BACKGROUND large retrospective clinical study describing the long-term experience of a single center in the surgical management of liver echinococcosis in an endemic area. METHODS 232 patients were operated for liver hydatid disease between 1978 and 2012. Seventy-three patients (Group A) underwent a radical procedure (total pericystectomy or hepatectomy), while 145 (Group B) were treated with a more conservative method (partial cystectomy, with external drainage, omentoplasty or capitonnage) and 14 (Group C) received a combination of total and partial cystectomies. Morbidity, mortality, post-operative complications and recurrence rates in the long-term setting were retrospectively evaluated. RESULTS Group A patients were treated with zero mortality and a morbidity rate of 10.95%. No recurrence was documented. In Group B, mortality reached 2.76%, (p = 0.153 compared to Group A) morbidity 24.13% (p = 0.021) and there were 10 cases of relapse (6.9%) at three-year complete follow-up (p = 0.989). Extrahepatic sites of disease were not uncommon. DISCUSSION radical surgical procedures were better tolerated by patients and yielded better results in terms of recurrence rates.

Pleomorphic hepatocellular carcinoma following consumption of hypericum perforatum in alcoholic cirrhosis

Hepatocellular carcinoma (HCC) often develops in patients with underlying liver disease, yet HCC with syncytial giant cells (SGCs) is extremely rare. Herein, we report a 55-year-old man with a 6-year history of alcoholic cirrhosis who during his regular checkup presented with marked elevation of alpha-fetoprotein. Clinical examination and imaging analyses revealed a tumor-like lesion in segment 4 of the liver, which was removed by limited wedge resection. Histological analysis by hematoxylin and eosin staining indicated pleomorphic and atypical nodules, with some SGCs, embedded within the boundaries of the neoplastic lesion. The adjacent liver parenchyma showed microvesicular steatosis, pericellular fibrosis, and moderate hemosiderin accumulation (grade 2, as determined by Prussian blue iron stain) in hepatocytes and Kupffer cells but no copper accumulation (as determined by orcein stain). Immunohistochemical analysis showed hepatocyte antigen-positive staining for the neoplastic cells and SGCs. The diagnosis was made for cirrhosis-related HCC with SGCs. The previous reports of pleomorphic HCC have featured osteoclast-like (i.e., mesenchymal type) giant cells, making this case of epithelial type giant cells very rare. The patients 6-month history of hypericum perforatum/St Johns wort self-medication may have prompted the cirrhosis or HCC progression or the unusual SGC manifestation.

Submucosal resection of the appendiceal base

of Victoria and as to whether this demonstrates inadequate publishing efforts in NSW or excellence in publishing efforts in Victorian or perhaps both. The health system is similar although public hospital outpatient clinics in NSW are less supported, leading to new patient referrals being made to private practice rooms and perhaps creating an imperative for urologists to focus upon covering private practice costs. If these differences remain stagnant or increase, there should be efforts to identify underlying reasons.

Mastectomy vs breast-conserving surgery: an old dilemma comes again for early breast cancer.

Breast-conserving surgery with adjuvant multimodal treatment has been the standard of care for women with early breast cancer. Adjuvant radiotherapy, chemotherapy, and targeted therapy with hormonal therapy for estrogen receptors (ER) positive and trastuzumab for human epidermal growth factor receptor 2 (HER2) improves both locoregional and distant recurrence rates. Despite this improvement in ipsilateral breast cancer recurrence (IBCR), long-term follow-up data have revealed the problem of local recurrence alone without any distant recurrence event. Thus, mastectomy could potentially eliminate the IBCR risk. Should we come back to mastectomy, letting out BCS? In a recent issue of Annals of Surgical Oncology, McGuire et al. examined whether in their institution there is really a trend toward mastectomy and which factors could explain this trend. The authors performed a 13-year trend analysis of the selection of mastectomy vs BCS in 5865 patients. Mastectomy rates during the periods of 1994–1998, 1999–2003, and 2004–2007 were 33%, 33%, and 44%, respectively (P \ .01). Immediate reconstruction rates decreased during the same periods from 16%, 5%, and 7%, respectively (P \ .01). On logistic regression analysis, gender, age \ 40 years, increased tumor size, and lymphovascular invasion were significant independent predictors of mastectomy. The mastectomy rate increased during the period 1999–2003 (odds ratio [OR] 1.2) and during 2004–2007(OR 1.8). This study confirmed an increasing choice toward mastectomy in the authors’ institution. Possible reasons were younger population with higher lifetime risk, higher stage disease, and more biologically aggressive or diffuse tumors. Patient preference, fear of genetic or recurrence risk, and ‘‘intangible’’ factors seemed to shift decisions toward mastectomy. This renewed trend towards mastectomy could be satisfied for specific indications. Decision-making on mastectomy rather than BCS could be satisfied in selected cases. These include failure of clear resection margins by BCS, presence of multicentricity, multifocality, and family history with BRCA1 or BRCA2 positive genetic testing result. Young age alone without BRCA1/2-positivity and particularly for women with ER and HER2 positive tumor who can receive tamoxifen and trastuzumab is an indication for BCS. These patients have a long-term relatively low risk for IBCR. Current exciting research using next-generation sequencing and advances in personal genomics systems biology provides strong promises for the development of novel biomarkers in cancer. Such molecular markers are needed to distinguish patients at low risk for local recurrence who benefit from BCS from those at high risk for local recurrence for whom mastectomy is more beneficial. Until then, criteria for decision-making surgery depend on multifocality, failure of BCS to achieve tumorfree resection margins, ER/HER2 status, and genetic BRCA testing.

A case of encapsulating peritoneal sclerosis presented shortly after renal transplantation

Encapsulating peritoneal sclerosis (EPS) is a rare but serious complication of peritoneal dialysis (PD), characterized by extensive intraperitoneal fibrosis and encasement of bowel loops. It typically associates with long-term PD and progressive loss of ultrafiltration. The management of EPS has evolved substantially from the original report of this entity and now includes immunosuppressive agents, antifibrotic agents, nutritional support, and surgical intervention. Although the exact cause of this condition remains obscure and despite the possible positive effect of immunosuppression on EPS, it has been described in the post-transplant setting upon the discontinuation of PD. We report such a case of a former PD patient who presented with EPS a month after renal transplantation. This article will highlight the current views regarding the management of post-transplant EPS and introduce the problem of long-term PD patients on the deceased-donor transplant waiting list.

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.

Node Micrometastases Detection After Neoadjuvant Chemotherapy in Breast Cancer: Is It of Clinical Value?

TO THE EDITORS: It is thought that detection of micrometastases (mi) or isolated tumor cells (ITCs) in sentinel lymph node biopsy (SLNB) or axillary lymph nodes (ALNs) in breast cancer can have prognostic and predictive clinical utility. The American Joint Committee on Cancer (AJCC) recommends lymph node classification into: pN0 (no metastases [ 2 mm), pN1mi (small metastases [ 0.2 mm to \ 2 mm) and pN0(i ?) (ITC deposits \ 0.2 mm). However, nobody knows whether detection of mi or ITCs in SNLB should be followed by axillary lymph node dissection (ALND) or if this identification of minimal disease in SLNB or ALNs is a predictive marker for response to adjuvant chemotherapy offering a survival benefit. Even more complicated is the topic of detection of mi or ITCs in ALNs after neoadjuvant chemotherapy (NAC). However, even if mi or ITCs detection has prognostic value, what is the clinical utility given that NAC has been completed? Sakakibara and colleagues aim to approach these still unanswered questions. 1 In their report published in the September issue of the Annals of Surgical Oncology, they retrospectively analyzed the data of 80 patients with a diagnosis of cytologically proven axillary metastases who received NAC. Using multislice sectioning and cytokeratin immunohistochemistry, all patients were categorized into four groups: no metastasis with conventional or microscopic examination, pN0(i ?), pN1mi, and pN1 (metastases [ 2 mm). Survival was significantly better among patients with no nodal metastasis or ITCs in lymph nodes than in those with nodal micrometastases. The authors conclude that residual micrometastatic (pN1mi) disease but not presence of ITCs in ALNs after NAC for patients with cytologically proven axillary metastases on initial diagnosis is a predictor of poor survival.