Marco Santangelo

Can biliary carcinoembryonic antigen identify colorectal cancer patients with occult hepatic metastases

BackgroundTwenty-five percent of radically treated colorectal cancer patients already have occult hepatic metastases (OHM) that will later be observed during postoperative follow-up. Instrumental examinations, i.e., intraoperative ultrasound or Doppler perfusion index, have not improved diagnosis. As carcinoembyonic antigen (CEA) levels are useful to reveal hepatic metastases from colorectal cancer, determination of CEA in the bile rather than the blood may allow preclinical diagnosis of OHM thanks to the reduced volume of bile.MethodsOne hundred radically treated colorectal cancer patients were enrolled in the study. Bile was withdrawn from the gallbladder intraoperatively and biliary CEA levels determined using an immuno-enzymatic method (normal value 0–5 ng/ml). Eighty-nine fully evaluable patients were followed up for three years postoperatively to monitor hepatic metastases. Preoperative blood CEA, lymph node metastases and biliary CEA were compared in order to assess which procedure was more efficient in identifying patients who would develop hepatic metastases.ResultsEleven of the 89 evaluable patients developed hepatic metastases: 9/11 presented elevated biliary CEA levels (mean: 12.73; range: 5.1–26.2); 8/11 had high preoperative blood CEA values; and 9/11 were at anatomopathological stage N+. In the 78 patients who did not develop hepatic metastases, biliary CEA was within normal limits in 73/78, preoperative blood CEA was normal in 60/78, and 58/78 patients were at anatomopathological stage N−. Hence, the sensitivity of biliary CEA was 81.8%, specificity was 93.6%, and diagnostic accuracy was 92.1%.ConclusionsDetermination of biliary CEA seems to be more efficient in identifying patients presenting OHM who require frequent clinical examinations or adjuvant cancer treatment.

Idiopathic Myenteric Ganglionitis Underlying Acute 'Dramatic' Intestinal Pseudoobstruction: Report of an Exceptional Case

Inflammation of the myenteric plexus of the gastrointestinal tract is a very rare pathological condition, with few reports in the medical literature. This pathological condition causes atonic gut motor dysfunction and is principally secondary to other diseases, being reported nearly solely as a paraneoplastic phenomenon in neuroendocrine lung tumors, including small cell carcinomas or neuroblastomas. In addition it can also be associated with disorders of the central nervous system, although it has rarely been described in Chagas disease. It has been named ‘idiopathic myenteric ganglionitis’ because no apparent causes can be demonstrated. We report the clinicopathologic findings of an exceptional case of a young woman affected by severe chronic constipation suddenly changing into acute intestinal pseudoobstruction with dramatic evolution. Relationships between ganglionitis, idiopathic constipation and acute intestinal pseudoobstruction as well as therapeutic implications are discussed.

Appendiceal-sigmoid fistula presenting in a man with ulcerative colitis: a case report.

IntroductionUlcerative colitis is a chronic disease characterized by diffuse mucosal inflammation limited to the colon. It mostly affects young adults, yet a large number of middle-aged and older patients with ulcerative colitis have also been reported.Case presentationA 58-year-old Caucasian man presented to our hospital in August 2006 with continuous and diffuse abdominal pain, meteorism, fever and bloody diarrhea. He had a two-year history of ulcerative colitis. Our patient was treated with intravenous medical therapy. As his condition worsened, he underwent surgery. An explorative laparotomy revealed that the entire colon was distended and pus was found around an appendiceal-sigmoid fistula.ConclusionsTherapy for ulcerative colitis is a rapidly evolving field, with many new biological agents under investigation that are likely to change therapeutic strategies radically in the next decade. Indications for surgery are intractability (49%), stricture, dysplasia, toxic colitis, hemorrhage and perforation. To the best of our knowledge, this is the first case of an appendiceal-sigmoid fistula in a patient affected by ulcerative colitis reported in the literature. Fistulae between the appendix and the sigmoid tract are rarely reported in cases of diverticular disease and appendicitis.

Oesophageal stent in unresectable cancer in elderly

In our department we prefer to use nitinol self-expanding stents (Esophacoil, Instent Inc., USA) for the radial force that allow complete and rapid expansion even in the presence of thigh stenoses, the rapid relief of dysphagia, adaptability of the spirals to the strictures with consequently greater adhesion to the neoplasia and lower percentage of dislocations, the lower percentage of tumoural ingrowth due to the serrated matching to the spirals.

Prognostic factors of gastric cancer in the elderly

Hypertension, heart disease and malnutrition were found to be the most frequently comorbidities. In our series the most common localization of the cancer was in the lower third (43.7%). So we performed total gastrectomy in 45 patients (56.9%) and partial gastrectomy in 34 patients (42.1%). Perigastric lymphadenectomy was performed in 38 patients (48.6%) while D2 gastrectomy was performed in 41 patients (51.4%).

Thermic ablation with RF of liver metastases from colorectal cancer

Aim of this study was to evaluate the role of radiofrequency ablation in the treatment of the hepatic metastasis of colorectal cancer. From November 1997 to July 2002 49 radiofrequency ablations have been performed in 19 patients (11 male and 8 female; mean age 65 years: range 50-78 years). The disease-free period was between 5 and 32 months. Nodules had a diameter <3 cm in 4 cases while in 3 cases a single lesion was present. One patient had a single lesion after 2 courses of intravenous systemic chemotherapy which had a reduced greater lesion (from 6 to 3 cm) while a 2 cm lesion had disappeared. In the remaining 12 patients the mean number of lesions is 3 (range 1-13) with a diameter between 3 and 12 cm. The radiofrequency ablation has been performed during laparotomy and vascular exclusion through clampage of the liver hilum in 4 cases and percutaneously under ultrasound guide in the remaining 15 cases. All patients underwent follow up by computed tomography, CEA level and ultrasound every 3 months. One patient only has completed a 4 year follow up and is alive without local recurrence but with a cerebral metastasis. The other 18 patients have a 32 months follow up with a survival of 50% (9 on 18). In conclusion in our experience the radiofrequency ablation is a valid alternative method in the treatment of the hepatic metastasis of colorectal cancer.

Prostatic mapping in diagnosis and follow-up for prostatic cancer patients treated by CT-RT

Aim of study Prostate cancer (PCa) ranks third in cancer incidence and is the fourth leading cause of cancer-related deaths in Italy. The widespread use of the PSA test in clinical practice has been associated with a constant increase in the number of diagnosed PCa cases both in the USA (170 per 100,000) and Europe. In Italy the rate rose from 20 cases per 100,000 in 1976 to 40 per 100,000 in 1997.