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Glucose transporter-1 (GLUT-1): a potential marker of prognosis in rectal carcinoma?

The aim of the study is to evaluate the pattern and level of expression of glucose transporter-1 (GLUT-1) in rectal carcinoma in relation to outcome as a potential surrogate marker of tumour hypoxia. Formalin-fixed tumour sections from 43 patients with rectal carcinoma, who had undergone radical resection with curative intent, were immunohistochemically stained for GLUT-1. A mean of three sections per tumour (range 1–12) were examined. Each section was semiquantitatively scored; 0, no staining; 1, <10%; 2, 10–50%; 3, >50% and a score given for the whole section, the superficial (luminal) and deep (mural) part of the tumour. Staining was seen in 70% of tumours. Increased staining was noted adjacent to necrosis and ulceration. A diffuse and patchy pattern of staining, with and without colocalisation to necrosis was seen. Patients with high GLUT-1-expressing tumours (score 3 vs 0–2) had a significantly poorer overall survival (P=0.041), which was associated with poorer metastasis-free survival with no difference in local control. No significant correlation was seen with other prognostic factors. There was a strong correlation between the score for the superficial and deep parts of the tumour (r=0.81), but a significant relationship with outcome was only found in the deep part (P=0.003 vs P=0.46). In conclusion, increased GLUT-1 expression in rectal tumours was an adverse prognostic factor and is worth further evaluation as a predictive marker of response to therapy.

Primary anastomosis vs nonrestorative resection for perforated diverticulitis with peritonitis: a prematurely terminated randomized controlled trial

Aim  This randomized controlled trial (RCT) was performed to test the hypothesis that adverse event rates following primary anastomosis (PRA) are not inferior to those following nonrestorative colon resection for perforated diverticulitis with peritonitis.

Effects of preoperative chemoradiotherapy on anal sphincter functions and quality of life in rectal cancer patients

PurposeDeterioration of anorectal function after long-course preoperative chemoradiotherapy combined with surgery for rectal cancer is poorly defined. We conducted a prospective study to evaluate the acute and long term effects of preoperative chemoradiotherapy on anorectal function and quality of life of the patients.MethodsThere were 26 patients in surgery group and 31 patients in preoperative chemoradiotherapy group. Anorectal function and quality of life of the patients were assessed by anorectal manometry, incontinence score, quality of life questionnaire.ResultsSignificant lower resting pressures in both groups and lower maximal squeeze pressures in the preoperative chemoradiotherapy group were observed after postsurgical evaluations compared with the paired pretreatment ones. In the surgery group, both the Wexner continence score, FIQL score, and the rectoscopy score were comparable before and after surgery, whereas significant worsening in the Wexner score was observed in the preoperative chemoradiotherapy group postoperatively (P < 0.01). Significant reduction in anal canal resting pressures and squeeze pressures, Wexner score, and FIQL score were observed immediately after the completion of preoperative chemoradiotherapy. Significant lower maximal squeeze pressures and worsening of the Wexner scores were observed in the preoperative chemoradiotherapy group compared to the surgery group during the postoperative assessments (P < 0.05 and P < 0.01, respectively).ConclusionsBoth total mesorectal excision and preoperative chemoradiotherapy may adversely affect the anorectal function. Careful selection of the patients who will benefit from neoadjuvant therapy and identifying the patients with a high risk of developing functional problems may help to improve functional outcomes for the treatment of rectal cancer.

The efficacy of helical CT in the diagnosis of small bowel obstruction

OBJECTIVE To evaluate the usefulness and reliability of helical computed tomography (CT) for patients with small bowel obstruction. METHODS AND MATERIAL Helical CT findings of 41 patients were evaluated prospectively on the basis of the presence and the cause of obstruction, and the presence of strangulation. RESULTS In the determination of the cause of the obstruction sensitivity and specificity of CT were 84 and 90%, respectively. Of the 19 patients undergoing surgery, 6 had strangulation and were correctly identified by CT. CONCLUSION Helical CT is an accurate method in the detection of small bowel obstruction, especially for evaluating the cause and vascular complications of obstruction.

Comparison of different surgical repairs in the treatment of experimental duodenal injuries

BACKGROUND In this experimental study, we aimed to investigate the results of different surgical repair methods for delayed reconstruction of severe experimental duodenal defects. METHODS A large duodenal defect with irregular and tagged margins covering about 50% of the circumference was created in the second part of duodenum of male Wistar rats. The effectiveness of primary repair, jejunal serosal patch, Roux-en-Y duodenojejunostomy, or expanded polytetrafluoroethylene patch repair techniques were investigated on the basis of survival and histologic assessment. RESULTS No significant survival benefit was observed between jejunal serosal patch, Roux-en-Y duodenojejunostomy, or expanded polytetrafluoroethylene patch repair techniques. But these repair modalities were associated with better survival rates than no-treatment or primary repair techniques. Complete coverage of the expanded polytetrafluoroethylene grafts by neomucosa consisting of columnar epithelium with villus formation was observed in surviving rats about 16 weeks after surgery. CONCLUSIONS Expanded polytetrafluoroethylene patch can be used in the repair of experimental large duodenal defects, which can not be repaired primarily.

Incarcerated inferior lumbar (Petit's) hernia.

Petits hernia is an uncommon abdominal wall defect in the inferior lumbar triangle. Colonic incarceration through the inferior lumbar triangle, which causes mechanical obstructive symptoms, necessitates particular diagnostic and management strategy. We present a rare case of inferior lumbar hernia, leading to mechanical bowel obstruction, successfully treated with prosthetic mesh reinforcement repair.

Multivisceral resections for primary advanced rectal cancer.

Abstract Fixation of the locally advanced rectal tumor at the time of operation is an important prognostic variable. It may be difficult to determine whether fixation is caused by inflammatory adhesions or by direct tumor extension tethering the tumor to the surrounding pelvic structures. Extended en bloc removal of the locally advanced rectal cancer with involved adjacent organ(s) increases the resectability rate. We examined the perioperative mortality and morbidity and the prognosis of patients undergoing multivisceral resections for advanced primary rectal cancers. Of 83 patients with rectal cancers 20 (24%) had locally advanced tumors. Cases were divided into Gunderson-Sosin stages B3 and C3 and were further stratified into those with histologically confirmed carcinomatous invasion of the adjacent organ and those with inflammatory adhesions. Perioperative mortality was 5%. Only five patients (24%) showed histopathological confirmation of carcinomatous adhesion into adjacent organ(s)/structure(s). Histological confirmation of contiguous tumor spread was higher in C3 patients. There was no significant difference between patients with positive and negative histopathological confirmation of malignant spread in terms of survival rates. Multivisceral resections can be performed safely for locally advanced rectal cancers with acceptable mortality and morbidity rates. The presence of local tumor extension does not mean incurability, and sound surgical judgement should dictate that in the face of a tethered lesion one must extend the surgical intervention radically to resect any tumor en bloc.

Acute pancreatitis induced by magnetic-resonance-imaging contrast agent

We present a case of acute pancreatitis induced by magnetic-resonance-imaging (MRI) contrast agent. We suggest that the use of MRI with this agent early in acute pancreatitis should be reconsidered.

The prognostic impact of the log odds of positive lymph nodes in colon cancer.

This study aimed to investigate the prognostic impact of the log odds of positive lymph nodes (LODDS) in colon cancer.

Isolated mesosigmoidal hydatid cyst as an unusual cause of colonic obstruction: report of a case.

Abstract We report herein an unusual case of primary mesosigmoidal hydatid cyst that presented as acute left colonic obstruction mimicking sigmoid colon cancer. A 61-year-old man with a 3-day history of abdominal pain, distention, obstipation, vomiting, and fever was admitted to the emergency department of our hospital. Surgery was performed under a presumptive diagnosis of acute left colonic obstruction. The intraoperative findings were highly suggestive of sigmoid colonic carcinoma and Hartmanns procedure was performed. Histopathological examination of the pathological specimen revealed an isolated hydatid cyst embedded in mesosigmoid which had caused mechanical sigmoidal obstruction. Primary extrahepatic, intra-abdominal localization of a hydatid cyst is not unusual. Therefore, as a hydatid cyst may cause a wide variety of clinical syndromes, it should be kept in mind in the differential diagnosis of mechanical bowel obstruction, especially in endemic regions.