Roman Bandurski

Pre-treatment serum and plasma levels of matrix metalloproteinase 9 (MMP-9) and tissue inhibitor of matrix metalloproteinases 1 (TIMP-1) in gastric cancer patients

Abstract Background: The invasion and metastases of gastric cancer (GC) depends on the activities of matrix metalloproteinases and tissue inhibitors of metalloproteinases. It was suggested that the concentration of plasma matrix metalloproteinase-9 (MMP-9) is better than the concentration of serum MMP-9 for prediction of evolution of GC. The aim of the present study was to compare the clinical usefulness of plasma and serum tissue inhibitor of metalloproteinases-1 (TIMP-1) in the diagnosis and prognosis of GC. Methods:Plasma and serum concentrations of TIMP-1, MMP-9 and carcinoembryonic antigen (CEA) were assayed in 73 patients with GC and 61 healthy controls. The diagnostic criteria and prognostic value for the measurands were defined. Results: Plasma and serum TIMP-1, MMP-9 and CEA were significantly higher in GC patients compared with healthy controls. The area under the ROC curve (AUC) (0.961), diagnostic sensitivity (89%) and accuracy (91%) of plasma TIMP-1 were higher than those for MMP-9 and CEA. An increased pre-treatment concentration of plasma TIMP-1 was a significant independent prognostic factor for the survival of patients with GC. Conclusions: These findings suggest that the plasma TIMP-1 is a better biomarker than the serum TIMP-1 and might be useful for the diagnosis of GC and prognosis of patient survival. Clin Chem Lab Med 2009;47:1133–9.

Soluble angiogenesis markers in gastric tumor patients.

Gastric cancer is the second commonest cause of cancer-associated death in the world. Its molecular markers can be useful not only for diagnostic, but also prognostic purposes. The aim of the study was to assess the usefulness of soluble angiogenesis markers such as endoglin and VEGFR2 in gastric cancer patients and to compare these results with those of VEGF levels. As a secondary objective, we compared the concentrations of all three soluble markers in plasma and serum. The study was performed on 26 patients with gastric cancer (17 intestinal-type and 9 diffuse-type), and additionally in 2 patients with B cell lymphoma and 2 with gastro-intestinal stromal tumor. In summary, we showed increases in circulating VEGF-A in patients with both types of gastric cancer. The levels of VEGFR2 did not change significantly in patients with gastric cancer as compared to healthy subjects. Interestingly, after the operation greater levels of VEGFR2 were observed in patients without metastases. Both VEGF and VEGFR2 circulating levels were greater in patients with lymphoma, when compared to both gastric cancer patients and the control group. However, because of small number of patients, this requires further studies. Presented data suggests that endoglin does not seem to be a valuable tool in the assessment of gastric cancer invasion and spread.

Ectopic Pancreas Imitating Gastrointestinal Stromal Tumor (GIST) In The Stomach

Ectopic pancreas is a rare congenital disorder defined as pancreatic tissue lacking vascular or anatomic communication with the normal body of the pancreas. Most cases of ectopic pancreas are asymptomatic, but it may become clinically evident depending on the size, location and the pathological changes similar to those observed in case of the normal pancreas. It is often an incidental finding and can be located at different sites in the gastrointestinal tract. The most common locations are: the stomach, duodenum or the proximal part of small intestine. The risk of malignancy, bleeding and occlusion are the most serious complications. Despite the development in diagnostics, it still remains a challenge for the clinician to differentiate it from neoplasm. In this report, we described a case of 28-years old woman who presented recurrent epigastric pain. The upper gastrointestinal endoscopy revealed gastrointestinal stromal tumor on the border of the body and antrum of the back wall of great curvature of the stomach. The histopathological examination after surgery showed heterotopic pancreatic tissue. Ectopic pancreas should be considered in the differential diagnosis of gastric mass lesions.

Cecal Volvulus as a Rare Cause of Intestinal Obstruction

Caecal volvulus is very rare causa of the intestinal obstruction. It ocures in 1- 1,5% of all intestinal obstructions. It is known that there is only on treatment in this situation which is surgery. It is classified as an obstruction because of strangulation.We present a case of the 46 year old patient, who was operated because of intestinal obstruction. During the operation caecal volvulus has been found, with gangrene of the appendices.

Own experiences of endoscopic self-expandable stent placement for malignant colorectal ileus

Introduction Acute low neoplasm ileus requires emergency surgery. Nowadays there are increased numbers of patients with comorbidities, which causes higher risk of intra- and postoperative complications. Aim To evaluate the clinical usefulness of endoscopic self-expandable stent placement for malignant colorectal ileus. Material and methods Twenty-one patients (8 women and 13 men), mean age 66.7 years, with low neoplasm obstruction, underwent endoscopic stenting of the stricture. This procedure was performed as a bridge to the surgery especially for high-risk patients. Eight of them had coagulation system impairment, 5 severe metabolic disorders, 4 circulatory insufficiency, 3 severe malnutrition and 1 patient undiagnosed synchronic rectal tumor. In 10 patients cancer was located in the sigmoid colon, in 7 in the rectum, in 2 in the ascending colon, and the transverse and ascending colon was involved in another 2 patients. Results All 21 patients (100%) underwent endoscopic stenting successfully. There were no complications after stent placement. The authors underline that placement of expandable metallic stents for patients with malignant colon obstruction with acute ileus is a safe and effective method. It gives an opportunity for quick balance of fluid, electrolyte, and the coagulation system and improvement of efficiency of the circulatory and respiratory system. Conclusions Endoscopic treatment of ileus helps precisely estimate tumor advancement and gives the possibility of a single stage radical surgical procedure.

Ménétrier's disease, a premalignant condition, with coexisting advanced gastric cancer: A case report and review of the literature

Ménétrier’s disease (MD) is a rare type of hypertrophic gastropathy involving the body of the stomach, which is characterized by thickening of the mucous membrane in the form of giant rugal folds, hypochlorhydria and protein loss. The potential for malignant transformation of this lesion remains a controversial topic. Therefore, in the present study, a case of a 51-year-old male exhibiting MD with coexisting advanced gastric cancer is described; a review of the literature is also presented. The present case emphasized that MD requires particular attention and should be regarded as a premalignant condition due to the previously documented cases of its coexistence with gastric cancer, in addition to the lack of knowledge regarding its pathogenesis and effective therapeutic management.

Rare Case of Multifocal (Adrenal and Extra - Adrenal ) Myelolipoma

Adrenal myelolipoma is an extremely rare lesion, which is composed of adipose and hematopoetic tissue. The above-mentioned lesion was first described by Gierke in 1905, with the term myelolipoma used for the first time by Oberling in 1929. The Authors of the study presented a case of a 57 year-old female patient diagnosed with a multifocal adrenal and extra- adrenal myelolipoma.

Young Patient Age as the Cause of Delayed Diagnosis of Gastrointestinal Carcinoma

Most patients diagnosed with gastrointestinal carcinomas are older people. The above-mentioned fact may lead to an erroneous finding that the problem does not concern patients aged between 20 and 30 years. Unfortunately, this assumption is often the reason for late diagnosis and delayed treatment of these malignancies. The study presented an example of three patients subject to surgical management of gastrointestinal carcinomas at the II Department of General and Gastroenterological Surgery, Medical University in Białystok.

A patient with oesophagoduodenal anastomosis after total gastrectomy for gastric cancer – 22-year follow-up

Około 95% wszystkich nowotworów żołądka stanowi rak. W Polsce odnotowuje się rocznie ok. 5246 nowych zachorowań. Jedyną skuteczną metodą leczenia jest postępowanie chirurgiczne, które może być połączone z chemioterapią czy też radioterapią. Proponowanych jest kilkadziesiąt różnych sposobów odtworzenia ciągłości przewodu pokarmowego po całkowitym wycięciu żołądka z powodu raka. Celem doniesienia jest przedstawienie chorego, u którego w 1989 r. w II Klinice Chirurgii Ogólnej i Gastroenterologicznej, po całkowitej resekcji żołądka z powodu raka, wykonano zespolenie przełykowo-dwunastnicze sposobem „koniec do końca”. Warunki anatomiczne pozwalające na zespolenie przełyku z dwunastnicą „koniec do końca” występują niezwykle rzadko. W piśmiennictwie spotyka się pojedyncze przypadki. W niniejszej pracy przedstawiono piśmiennictwo dotyczące problemów związanych z całkowitym wycięciem żołądka. Abstract