Sarhan Sydney Saad

Co-expression of monocarboxylate transporter 1 (MCT1) and its chaperone (CD147) is associated with low survival in patients with gastrointestinal stromal tumors (GISTs)

Monocarboxylate transporters (MCTs) have been described to play an important role in cancer, but to date there are no reports on the significance of MCT expression in gastrointestinal stromal tumors (GISTs). The aim of the present work was to assess the value of MCT expression, as well as co-expression with the MCT chaperone CD147 in GISTs and evaluate their clinical-pathological significance. We analyzed the immunohistochemical expression of MCT1, MCT2, MCT4 and CD147 in a series of 64 GISTs molecularly characterized for KIT, PDGFRA and BRAF mutations. MCT1, MCT2 and MCT4 were highly expressed in GISTs. CD147 expression was associated with mutated KIT (p = 0.039), as well as a progressive increase in Fletcher’s Risk of Malignancy (p = 0.020). Importantly, co-expression of MCT1 with CD147 was associated with low patient’s overall survival (p = 0.037). These findings suggest that co-expression of MCT1 with its chaperone CD147 is involved in GISTs aggressiveness, pointing to a contribution of cancer cell metabolic adaptations in GIST development and/or progression.

Assessment of staging, prognosis and mortality of colorectal cancer by tumor markers: receptor erbB-2 and cadherins

PURPOSE To evaluate the prognostic significance and correlation with staging and degree of cell differentiation of the tumoral expression of the proteins c-erbB-2 and E-cadherin, in patients with colorectal adenocarcinoma. METHODS The study included 117 patients with an average age of 63.1 years and an average follow-up duration of 28.1 months. The disease-free interval, survival, incidence of recurrence and specific mortality were evaluated. c-erbB-2 anti-oncoprotein antibodies (Dako) were utilized via the streptavidin-biotin technique. Samples were considered to be positive for c-erbB-2 if 10% or more of the tumor cell membranes were stained. The anti-E-cadherin antibodies (Dako), evaluated this protein and is considered positive, if 50% or more of the cell membranes were stained. Statistical analysis was performed using Pearsons chi-squared test, Fishers exact test, Kaplan-Meiers estimator, the log-rank test and Wilcoxons test (Breslow version), setting the level of statistical significance at 5% (p<0.05). RESULTS 52 of 108 patients studied for c-erbB-2 were positive (48.1%), 47 of 93 patients studied for E-cadherin were negative (50.5%). These data do not express any correlation with TNM (tumor, node and metastasis) staging and the degree of cell differentiation or with the tumor recurrence rate. The disease-free interval among patients who were positive for c-erbB-2 and negative for E-cadherin was 68.0 months and did not differ from those with c-erbB-2 negative and E-cadherin positive (55.0 months--p = 0.5510). The average survival among patients positive for c-erbB-2 and negative for E-cadherin was 75 months without statistical significance difference with the other group (61 months--p = 0.5256). Specific mortality occurred in 20.0% of the cases and did not correlate with the expression of c-erbB-2 (p=0.446), E-cadherin (p=0.883). CONCLUSION The tumoral expression of c-erbB-2 and E-cadherin did not demonstrate a correlation with the staging and degree of cell differentiation, and it did not present prognostic value regarding disease recurrence, disease-free interval, survival and specific mortality among patients with colorectal adenocarcinoma.

Study on the prevalence of human papillomavirus in the anal canal of women with cervical intraepithelial neoplasia grade III

OBJECTIVE The objective was to evaluate the prevalence of human papillomavirus (HPV) in the anal canal of women with cervical intraepithelial neoplasia (CIN) grade III. STUDY DESIGN Two groups were compared. In group I (study group), 40 women who had undergone cervical biopsy with a histopathological result indicating CIN III were evaluated. Group II (control) consisted of 40 women with normal results from colposcopic examination and colpocytological tests. The women in group I who presented high-grade neoplasia in colpocytological tests underwent collection of material from the uterine cervix and anal canal for investigating HPV DNA using the Hybrid Capture II technique. Colposcopy and cervical biopsy were then performed. If CIN III was confirmed, HPV DNA was investigated in the material collected. In group II, colpocytological tests and colposcopy were performed and, if normal, the procedure was similar to that followed for group I, except that no biopsy was performed. RESULTS In group I, 39 women (97.5%) were positive for HPV in the uterine cervix and 14 women (35%) in the anal canal. In group II, only four women (10%) had a positive HPV test, for both the uterine cervix and the anal canal. CONCLUSIONS The prevalence of HPV in the anal canal of the women with CIN III was greater than in the women without CIN III.

Ileostomy or colostomy for temporary decompression of colorectal anastomosis: systematic review and meta-analysis

PURPOSE The controversy regarding whether loop ileostomy or loop transverse colostomy is a better method for temporary decompression of colorectal anastomosis motivated this review. METHODS Five randomized trials were included, with 334 patients: 168 in the loop ileostomy group and 166 in the loop transverse colostomy group. The outcomes analyzed were: 1. Mortality; 2. Wound infection; 3. Time of stoma formation; 4. Time of stoma closure; 5. Time interval between stoma formation and closure; 6. Stoma prolapse; 7. Stoma retraction; 8. Parastomal hernia; 9. Parastomal fistula; 10. Stenosis; 11. Necrosis; 12. Skin irritation; 13. Ileus; 14. Bowel leakage; 15. Reoperation; 16. Patient adaptation; 17. Length of hospital stay; 18. Colorectal anastomotic dehiscence; 19. Incisional hernia; 20. Postoperative bowel obstruction. RESULTS Stoma prolapse was statistically significant (p = 0.00001), but with statistical heterogeneity; the sensitive analysis was applied, excluding the trials that included emergency surgery, and this showed: p = 0.02, with I2 = 0% for the heterogeneity test. CONCLUSIONS The outcomes reported were not statistically or clinically significant except for stoma prolapse. Better evidence for making the choice between loop ileostomy or loop colostomy requires large-scale randomized controlled trials.

Primary perineal posterior hernia: an abdominoperineal approach for mesh repair of the pelvic floor

Spontaneous development of perineal hernias is a very rare condition and many techniques have been described for repairing the floor defect. The authors describe the use of a combined approach in the surgical treatment of primary perineal hernias, by reconstructing the muscle pelvic floor and restoring the rectum to its sacral position with mesh repair. The case of one patient with a huge primary perineal hernia is reported, with clinical manifestations of progressive bulging in the buttock area, obstipation and fecal incontinence. Long-term follow-up has shown no recurrence of the condition and normal bowel function. It is concluded that primary perineal hernia can be repaired by a combined surgical approach, by using prosthetic material.

Analysis of the correlation between p53 and bcl-2 expression with staging and prognosis of the colorectal adenocarcinoma

PURPOSE To analyze the correlation between p53 and bcl-2 expression and colorectal adenocarcinoma staging and prognosis. METHODS This was a retrospective series of 125 colorectal adenocarcinoma patients (67 women and 58 men; ages 30-87 years) who underwent surgery with curative intent. The mean follow-up was 28.5 months (range: 2-96 months). TNM staging, tumor recurrence, survival and cancer-related mortality were analyzed. Immunoreactivity was evaluated using DO7 (Dako) for p53 and K492 (Dako) for bcl-2. Tumors with accumulation of staining for cytoplasmic bcl-2 or nuclear p53 in more than 10% of cells were considered positive. Statistical analysis utilized Pearson chi-squared, log-rank and Wilcoxon tests, and Kaplan-Meier survival estimation (significance level: p<0.05). RESULTS p53+ was found in 11.8% (14/118), bcl-2+ in 50% (58/116) and associated p53+/bcl-2+ in 6.4% (7/109) of the tumors. There was no significant correlation between expression of these biomarkers and TNM I, II, III and IV staging (p=0.385 for p53; p=0.461 for bcl-2). For tumor recurrence, p53+ was found in 9.5% (2/21), bcl-2+ in 50% (11/22), and associated p53+/bcl-2+ in 5.2% (1/19) of the tumors (p=0.714, p=1.000 and p=0.960, respectively). For survival analysis, p53+: 57 months (45.0-68.0), bcl-2+: 78 (37.0-89.0), and p53+/bcl-2+: 62 (56.0-68.0) (p=0.319). For cancer-related mortality, p53+: 8.3% (3/36), bcl-2+: 47.2% (17/36), and p53+/bcl-2+: 5.9% (2/36) of the patients (p=0.432, p=0.688 and p=0.907, respectively). CONCLUSION No correlation was found between tumor expression of p53 and bcl-2 and the TNM staging, recurrence, survival and cancer-related mortality in colorectal adenocarcinoma.

Rubber band ligation and infrared photocoagulation for the outpatient treatment of hemorrhoidal disease

PURPOSE To compare the results of rubber band ligation and infrared photocoagulation for the treatment of hemorrhoidal disease through the analysis of the incidence of complications after each treatment and respective success rate. METHODS Forty-eight patients with first, second or third degree hemorrhoidal disease were randomized to receive treatment with either rubber band ligation (n=23) or infrared photocoagulation (n=25). Each patient was assessed at 1 week and 4 week intervals after treatment. We compared the incidence of complications and efficiency of each treatment modality and Qui-square, Fishers Exact Test and Students t Test were used to statistical analysis. RESULTS Bleeding occured in eight (34,7%) patients treated with rubber band ligation and in four (16,0%) after infrared photocoagulation (p=0,243). Thirteen (52,0%) patients felt pain during infrared photocoagulation and 9 (39,1%) after rubber band ligation (p=0,546). After rubber band ligation, 14 (60,8%) required medication for pain relief. One patient (4,0%) required medication after infrared photocoagulation (p<0,001). Three (13,0%) patients treated with rubber band ligator and 1 (4,0%) treated with infrared photocoagulation had symptomatic mucosal ulcers. Perianal dermatitis occured in two (8,0%) patients treated with infrared photocoagulation and one patient (4,3%) was observed to have prolapsed thrombosed piles after rubber band ligation. One month after treatment, 17 of 23 patients treated with rubber band ligation (73,9%) and 18 of 25 patients treated with infrared photocoagulation were asymptomatic. Rubber band ligation treated bleeding and prolapse in 90,0% and 82,4% respectively. Infrared photocoagulation treats bleeding and prolapse in 93,7% and 87,5% respectively. Those differences are not significant. CONCLUSION Rubber band ligation causes significantly more pain than infrared photocoagulation during the first week after the procedures and their success rate are not different after four weeks of treatment.

Preferência do paciente no rastreamento do câncer colorretal: uma comparação entre colonografia por tomografia computadorizada e colonoscopia

OBJETIVO: Avaliar o grau de aceitacao do paciente submetido a colonografia por tomografia computadorizada (CTC) em comparacao com a colonoscopia, quando realizadas para rastreamento de doenca colorretal. MATERIAIS E METODOS: Cinquenta pacientes com suspeita de doenca colorretal foram submetidos a CTC e colonoscopia. Questionarios foram aplicados antes e apos a realizacao da CTC e apos a colonoscopia. Graduou-se o desconforto esperado e experimentado antes e apos a realizacao da CTC e da colonoscopia, bem como a preferencia do paciente por exame. RESULTADOS: Em relacao a CTC, antes de iniciar o exame 18% dos pacientes afirmaram esperar pouco desconforto, 78%, desconforto moderado e 4%, muito desconforto. Apos a realizacao do exame, 72% dos pacientes relataram pouco desconforto, 26%, desconforto moderado e apenas um (2%) dos pacientes referiu muito desconforto. Apos a realizacao da colonoscopia, 86% dos pacientes relataram preferencia pela CTC. O grau de distensao colonica e a quantidade de fluido residual nao influenciaram na preferencia dos pacientes. CONCLUSAO: Os pacientes preferiram a CTC a colonoscopia, nao havendo relacao estatistica com o grau de distensao colonica na CTC e a eficiencia do preparo intestinal.

Metalloproteinase-1, metalloproteinase-7, and p53 immunoexpression and their correlation with clinicopathological prognostic factors in colorectal adenocarcinoma.

AIM The aim of this study was to analyze the immunoexpression of metalloproteinase-1, metalloproteinase-7, and p53 in colorectal adenocarcinoma, and to correlate this with clinicopathological prognostic factors. MATERIAL AND METHODS Formalin-fixed paraffin-embedded tumor tissue from 82 patients was analyzed by means of immunohistochemistry, using the streptavidin-biotin method and the tissue microarray technique. Protein tissue expression was correlated with the variables of the degree of cell differentiation, stage, relapse-free survival, recurrence, survival, and specific mortality. RESULTS All of the tumors were positive for metalloproteinase-1, while 50 (61%) were positive for metalloproteinase-7, and 32 (39%) were negative for the latter. For p53, 70 (85.4%) of the tumors were positive and 12 (14.6%) were negative. Correlation of the marker expressions separately and in conjunction did not produce any statistically significant data. CONCLUSION The immunoexpression of metalloproteinase-1, metalloproteinase-7, and p53 did not correlate with recurrence, mortality, relapse-free survival, survival, degree of cell differentiation, or staging of colorectal cancer.

Estudo clínico comparativo entre anastomose colocólica com anel anastomótico biofragmentável e com sutura manual não absorvível

The use of suture in anastomosis presents some theoretical disadvantages that they would be avoided by using sutureless intestinal anastomosis. The biofragmentable ring idealized by Hardy et al.(1985), is composed by polyglycolic acid and barium sulfate. It is constituted by two identical components that are coupled, not returning to the original position after its occlusion. This ring suffers desintegration in 2 to 3 weeks, and is eliminated with evacuation. This device allows a sutureless anastomosis by the compression of intestinal walls. The purpose of this prospective and randomized study was to compare the clinical and endoscopic results in eletive and low risk colonic anastomosis accomplished with biofragmentable anastomosis ring and with non absorbable suture. MATERIAL: Thirty-six patients were stratified in two groups of 18 that were denominated Group I (biofragmentable anastomosis ring) and Group II (non absorbable suture). The average age for Group I was 36 years and for Group II was 42. The most frequent surgical indication in both groups was reconstruction of the intestinal flow after colostomy. All patients were submitted to biochemical blood tests, nutritional and surgical risk evaluation. The statistical analysis used for comparison between groups demonstrated that they were homogeneous. RESULTS: Comparative analysis of the intraoperative period parameters revealed that the anastomosis with biofragmentable anastomosis ring is faster ant there are no significant differences regarding intraoperative complications rate, period of ileus, time to reintroduce the oral diet, mortality and long term folloow-up. The incidence of anastomotic leak was higher in the Group I . The endoscopic analysis demonstrate no difference because there was the same results for both groups . There was a significant higher incidence of exposed suture in suture anastomosis when compared to biofragmentable anastomosis ring. CONCLUSIONS: It can be concluded that the biofragmentable anastomosis ring allowed the accomplishment of colon anastomosis more quickly, and regarding clinical complications, similar to the use of non absorbable suture. This anastomosis method presented the inconvenience of determining higher incidence of anastomotic leak while as advantage it established presence of exposed suture in the anastomosis in smaller percentage.