Vasileios Papadopoulos

Prognostic significance of mucinous component in colorectal carcinoma

BackgroundMany factors influence survival in colorectal cancer patients, one of them is the mucinous component of the tumour. Mucinous adenocarcinoma is characterized by the extracellular mucin of more than 50% of the tumour volume.MethodsFrom 1970 to 1999, 1160 patients were admitted to our clinic for colorectal cancer. They were divided into four groups according to mucinous character of the tumour, in two time periods of 15 years.ResultsThere was an increase in the incidence of mucinous tumours from 20.8 to 30.5% in the second period. These tumours were more advanced (Dukes’ C) and especially right sided (34.5% vs. 17.9%). Five-year survival was increased during the second period but was of a lesser degree in the mucinous group (51.5% vs. 65.5%).ConclusionsColorectal mucinous carcinomas present at a more advanced stage, predominantly in men, with higher right colon location rate, and a worse overall 5-year survival rate than the non-mucinous colorectal cancers.

Synchronous and metachronous colorectal carcinoma

BackgroundSynchronous and metachronous colorectal carcinoma have an incidence of 2–10%. The purpose of the study was to evaluate the clinical characteristics, the accuracy of diagnostic examinations and the survival of these patients.MethodsFrom 1970 to 1999, 1160 patients with colorectal cancer were admitted to our Department. During follow-up examination 50 patients (4.3%) were found to present with multiple primary colon cancers. Fifty-two per cent were synchronous and 48% metachronous tumours.ResultsThe overall 5-year survival of the patients was 45.87%. Mortality was 10% for multiple primaries, while in patients with single cancer was 4.1%. The overall 5-year survival of the patients with multiple primaries tumours was 46.67%.ConclusionsPatients with colorectal cancer must be fully studied endoscopically. There has been an improvement in survival in recent years due to better surgical techniques, the introduction of more sophisticated examination methods and the meticulous follow-up of patients at risk.

Colorectal cancer in patients over 70 years of age: determinants of outcome.

BackgroundThe aim of this study was to evaluate operative risk factors, the mortality, morbidity and survival in old patients with colorectal cancer.MethodsFrom 1160 patients with colorectal cancer, 398 patients aged 70 years or older, from 1970 to 2000, were followed-up. Dukes’ classification, differentiation, sex, anatomical site and survival were compared with patients <70 years old.ResultsLong-term results have been proved to be similar both in young and old patients. Relative survival rate for patients aged 70–95 (70.5%) were similar to those for patients less than 70 years old (71.6%) and also comparable between male (72.3%) and female (68%) patients.ConclusionsElderly patients have a lower capacity to react to postoperative complications, but the relative survival is similar to younger patients. Advanced age alone should not be used as a criterion to deny surgery for colorectal cancer.

Surgical treatment of haemorrhoids with the use of the circular stapler and open haemorrhoidectomy. A comparative study

Abstract The surgical treatment of haemorrhoids with the use of a circular stapler is a novel method. A comparative retrospective study of two groups of patients treated surgically for third- and fourth-degree haemorrhoids was conducted. Fifty patients (group A) underwent a surgical intervention with the circular stapler in the rectal mucosa 4 cm above the dentate line. In another group of 50 patients (group B), the standard open haemorrhoidectomy (Milligan-Morgan) was carried out. The new method (group A) compared with the standard haemorrhoidectomy (group B) was found to be less time consuming (mean time, 10±2 minutes vs. 35±5 minutes, p<0.001). The majority of patients (28) in group A experienced mild pain (VAS, 3–5) while pain for the majority of patients in group B was 5–7 on the VAS scale (p<0.01). The duration of postoperative hospitalisation was 1±1 days for the patients of group A and 5±2 days for the patients of group B (p<0.05). The early postoperative bleeding rate was 6% in group A and 12% in group B (p<0.01). None of the patients of group A developed incontinence and 6 (12%) patients in group B developed mild liquid incontinence during the first postoperative month. During the period of follow-up (12 months to 3 years, median length 18 months in outpatient visits), no patient in either group developed recurrence of haemorrhoids or rectal prolapse. In conclusion, the surgical treatment of haemorrhoids with the circular stapler seems to be an efficient alternative to the standard open haemorrhoidectomy when this is indicated.

Concurrent appendiceal and umbilical endometriosis: a case report and review of the literature

IntroductionEndometriosis affects 3 to 10 percent of women of reproductive age. Most of the time it involves the pelvis; however, sites of endometriosis have been reported almost anywhere in the body. Appendiceal and primary umbilical endometriosis are considered rare loci, making accurate diagnosis elusive. Here we present the case of a 46-year-old woman with concurrent appendiceal and umbilical endometriosis.Case presentationA 46-year-old Greek woman presented with a large mass in the lower abdomen adhering to the surrounding organs. She reported recurrent lower abdominal and pelvic pain and the presence of a dark-blue hard nodule at the umbilicus. She had no previous medical, surgical or gynecological history. Her physical examination and laboratory test results were without any significant findings. The laparotomy revealed a fibromatose uterus adhering to the rectum and a urinary cyst and a palpable mass in the vermiform appendix. A hysterectomy and an appendectomy were performed. The umbilical mass was also excised. Pathology revealed endometriosis of the umbilicus and the appendix. The postoperative period was uneventful and she was discharged.ConclusionsEndometriosis, although rare, should always be considered in women of reproductive age, presenting with cyclic pain. The diagnosis is, most of the time, difficult and requires a high degree of clinical suspicion. The clinical doctor should be aware that endometriosis can sometimes be multifocal, thus a thorough investigation is required in all cases.

Surgical Management of a Giant Adrenal Pseudocyst: A Case Report and Review of the Literature in the Last Decade

Adrenal pseudocysts are rare entities and occurred in the 5th and the 6th decades of life. They are discovered accidentally, while appearing with nonspecific clinical and imaging findings. We report a case of a 28-year-old woman presented in our Emergency Department complaining about upper abdomen pain. Computed tomography revealed a hypodense cystic lesion containing hyperdense material. The size of a mass was 11. 7 × 9.3 × 6.6 cm in diameter close to the pancreas, but the origin was from the left adrenal gland. The mass was excised with surgical laparotomy. Giant adrenal pseudocysts are rare entities. Final diagnosis usually confirmed with the pathology examination. Management of such adrenal lesions depends on the unique characteristics, the surgeons experience, and local resources.

Primary malignant melanoma of the ascending colon

Malignant gastrointestinal melanoma is usually a metastatic lesion. We report the case of a 67-year-old female patient who presented with intermittent abdominal pain, fever, rigor and diarrhoea. CT scan of the abdomen revealed a large mass at the right iliac fossa with features concerning for intra-abdominal abscess. Exploratory laparotomy confirmed the preoperative diagnosis of abscess, and a right hemicolectomy was performed. Histopathological examination of the surgical specimen was indicative of malignant melanoma, and immunohistochemical examination showed positivity to S100 protein, Melan-A, HMB-45 and vimentin. A series of postoperative clinical, laboratory and imaging examinations revealed no suspicious lesions in the skin, eye, leptomeninges or other sites. Therefore, the diagnosis of primary colonic melanoma was confirmed. Only 36 additional cases of primary colonic melanoma have been reported to date. These rare neoplasms are challenging to diagnose and usually require a multidisciplinary treatment approach, including surgery, chemotherapy and possibly immunotherapy or radiotherapy.

Stoma prolapse handmade repair under local anesthesia with variation of Altemeier method in severe patients: a case report and review of the literature

Abstract Stoma prolapse represents one of the most common late complications, occurring in 1–16%. Final rate depends on systematic follow up of the patient and the primary technique. A 49-year-old male patient presented in the Emergency Department, complaining about stoma prolapse, pain and stoma care difficulties. On admission, his colostomy protruded ~20 cm from the skin. The symptoms were local pain and psychological stress. The prolapse was repaired successfully with a simple revision procedure under local anesthesia, by resecting the prolapsed part of the bowel and reconstruction of stoma. Prolapsed part of the colon is removed and the remaining end of the colon is fixated to the abdominal wall. Colorectal surgeons must familiarize with management of stoma complications. Stoma revision under local anesthesia is an alternative and safe method.

Condylomata acuminata within perianal fistulae tracts: report of two cases

The commonest sights of appearance of condylomata acuminata are in the genital and anal regions. Herein we present two cases of condylomata within perianal fistulae tracts, resulting in recurrence in one case and a malignant-like tumour in the second. To our knowledge, these are the first cases reported in the literature.

Acute appendicitis perforating into the bladder mimicking cystitis

Perforation of the appendix can lead to periappendiceal abscess or diffuse peritonitis. The major reason for appendiceal perforation is delay in diagnosis and treatment. We report this rare case of perforated appendix into the bladder, which caused acute abdomen. We also present a review of the literature. The patient underwent an emergency operation in which the appendicitis was found to have perforated into the bladder and produced symptoms that mimicked cystitis. The terminal ileum and the cecum were seriously inflamed. The patient underwent a limited right hemicolectomy, closure of the bladder with a serosal patch, closure of the transverse colon and an end‐ileostomy. Differential diagnosis of acute appendicitis especially in women is very difficult because the surgeon must always consider and look for many other conditions that can mimic appendicitis. From a management viewpoint, the various diagnoses can be divided into those that require surgery and those that do not. The present case was an uncommon case of acute appendicitis where, unfortunately, its primary symptoms and laboratory data had led to the wrong diagnosis of cystitis, which did not require surgery.