Colorectal cancer (CRC) is one of the most common malignancies worldwide. Patients with CRC may need chemotherapy (CTx) in a neoadjuvant, adjuvant or palliative setting through the course of the ...disease. Unfortunately, its effect is limited by chemoresistance and chemotoxicity. Novel more effective and non-toxic CTx regimens are needed to further improve CRC treatment outcomes. Thus, the present study was designed to test the hypothesis that non-toxic sulforaphane (SF) is effective against CRC and has additive effects in combination with conventional 5-fluorouracil, oxaliplatin and folinic acid (FOLFOX) CTx in vitro. Highly metastatic human colon cancer cells, CX-1, and fibroblasts were treated with FOLFOX + or - SF. Cell viability was assessed using an MTT assay. The level of apoptosis and the expression of apoptotic proteins were measured by TUNEL assay and quantitative PCR analysis. Aldehyde dehydrogenase isoform 1 (ALDH1) and multidrug resistance protein 2 (MRP2) levels were evaluated. The ability of cells to form spheroids was measured in three-dimensional cell culture. SF alone and in combination with FOLFOX effectively decreased the viability of the CX-1 cells, promoted apoptosis within the CX-1 cells, prevented cellular spheroid formation and decreased ALDH1 activity. However, SF promoted MRP2 expression and protein levels. In conclusion, SF together with conventional FOLFOX has additive anticancer effects against highly metastatic human CRC in vitro. Key words: sulforaphane, CRC, FOLFOX, CX-1, CTx
•Ileal diverticulum rarely causes pelvic abscess.•Pelvic abscess rarely causes thigh phlegmon.•Rupture of presacral abscess to extra-pelvic site carries high mortality.•Intrapelvic pathology has to ...be considered in patients with thigh phlegmon.
Ileal diverticula usually remain asymptomatic. If complicated, they may present as intra-abdominal or pelvic abscess. Abscess formation in the presacral space is very rare. The rupture of abscess and spread of pus to extra-pelvic sites through anatomical structures of the pelvis is extremely rare. It carries high mortality if not diagnosed on time.
We report a case of 52-year-old woman presented with thigh phlegmon and septic condition. The CT scan revealed free air in the left leg and pelvic presacral fluid collection descending to extra-pelvic direction through the greater sciatic notch. Moreover, ileal fistula to presacral abscess was suspected. Multiple incisions and fasciotomies were urgently performed to treat thigh phlegmon. Subsequently, laparotomy was carried out and ileal fistula was excised. Histological examination of the surgical specimen demonstrated that the fistula to presacral abscess has formed due to perforated ileal diverticulum. 3 years after the surgery the patient remains healthy without recurrence.
Rupture of presacral abscess to extra-pelvic site due to ileal diverticulum fistula is an extremely rare case, to our best knowledge, never reported in literature. Due to a rare occurrence and early septic complications if diagnosed late, this condition carries a high mortality rate.
Intrapelvic pathology must be considered in patients with thigh phlegmon in order to prevent complications and associated mortality.
Gastrinomas are rare neuroendocrine tumors characterized by the secretion of gastrin, which causes hyperchlorhydria, thereby producing the Zollinger-Ellison syndrome. In most cases this syndrome ...manifests as severe peptic ulcer disease. We are presenting an extremely rare clinical case of sporadic duodenal macrogastrinoma. The patient underwent investigation due to six-year history of epigastric pain, heartburn and episodic diarrhea. Endoscopy, endosonoscopy and histologic examination of biopsy specimens indicated the presence of duodenal gastrinoma with no signs of peptic ulcers. Pyloroduodenal segment including 3.5 cm macrogastrinoma was resected. This case is unique as duodenal gastrinomas are usually very small, up to 1 cm. During the follow up period we observed slowly decreasing hypergastrinemia. Somatostatin receptor scintigraphy, CT and upper GI endoscopy were performed to reveal the reasons, though did not find any abnormalities. 8 months of follow-up did not reveal any progression of the disease. The etiology of slowly decreasing hypergastrinemia remains unclear, controversial and is under investigation.
Background. Colorectal cancer is a major health problem. Approximately 25% of the patients present with liver metastases at initial diagnosis and more than 50% develop metastases in the course of ...illness. Over the last few decades, with improvements in therapy, the management of colorectal liver metastases has changed dramatically. In this review, we explore various current modalities of care, with surgical treatment ahead, for patients with colorectal liver metastases and present a brief report about the Vilnius University Hospital Santariskiu Clinics experience in the surgical treatment of metastatic liver disease.
Methods. The Medline / PubMed literature database was searched for articles on the topics of colorectal liver metastases, including criteria of surgical resectability, chemotherapy, adjunctive and locoregional therapies. Also, results of the surgical treatment of liver metastases at the Vilnius University Hospital Santariskiu Clinics were analysed.
Results. Globally, surgical liver resection for colorectal liver metastases remains the only regular curative treatment with the 5-year survival rates reported as 20–50%. With improvements in therapy, resectability criteria are expanding. Hepatic metastases are primarily resectable in 15–25% cases only. Up to 25% of patients with initially non-resectable metastases become amenable to a potentially curative operation after interdisciplinary treatment involving preoperative chemotherapy, portal vein embolization or ligation, few-stage hepatectomy, and / or locally ablative procedures. We observed good and optimistic survival results in the Vilnius University Hospital Santariskiu Clinics patient population after liver resection: 1-, 2- and 3-year survival was 86.9%, 63.5% and 42.3%, respectively.
Conclusions. Over the last ten years, liver surgery has changed dramatically. A thorough selection of patients with colorectal liver metastases in a multidisciplinary team may improve treatment results significantly. Surgical treatment results for liver metastases at the Vilnius University Hospital Santariskiu Clinics are good.
Keywords: colorectal liver metastases, liver resection, ablation, chemotherapy, portal vein embolisation
Vilniaus krašto išvaržų registras Strupas, Kęstutis; Šimčikas, Dainius; Lipnickas, Vytautas ...
Lietuvos chirurgija,
01/2008, Letnik:
6, Številka:
3
Journal Article
Recenzirano
Odprti dostop
Kęstutis Strupas1, Dainius Šimčikas1, Vytautas Lipnickas1, Juozas Stanaitis2, Audrius Gradauskas31 Vilniaus universiteto ligoninė Santariškių klinikos, Medicinos fakulteto Chirurgijos klinika, ...Santariškių g. 2, LT-08661 Vilnius2 Vilniaus greitosios pagalbos universitetinės ligoninės Bendrosios chirurgijos centras,Šiltnamių g. 29, LT-04130 Vilnius3 Vilniaus miesto universitetinė ligoninė, Antakalnio g. 57, VilniusEl paštas: kestas.strupas@mf.vu.lt
Kirkšninė išvarža yra dažna patologija, kelianti didžiules socialines ir ekonomines problemas. Išvaržų chirurgijoje šiuo metu vienos aktualiausių yra lėtinio skausmo ir gyvenimo kokybės pokyčių po išvaržų operacijų temos. Problemas mėginama spręsti remiantis klinikinių tyrimų ir metaanalizių rezultatais. Viena iš priemonių tam tikriems tiriamųjų skaičiams gauti yra registrų kūrimas. Ar verta kurti išvaržų registrą Lietuvoje? Danijos chirurgai teigia, kad nacionalinių kirkšninių išvaržų duomenų bazių kūrimas gerina bendrus rezultatus ir dėl didelio įtrauktų pacientų skaičiaus leidžia atlikti specifinių pogrupių ar komplikacijų analizes, kurioms neužtektų duomenų iš pavienių gydymo centrų. Nacionalinis bendradarbiavimas yra svarbus daugiacentriams tyrimams atlikti ir tolesniems gydymo rezultatams gerinti. Lietuvoje sistemingai pateiktų duomenų apie atliktas išvaržų operacijas beveik nėra. 2004 m. buvo bandyta įkurti Lietuvos išvaržų registrą, tačiau gauta tik 44,79% duomenų apie 2001–2003 metais Lietuvoje atliktas išvaržų operacijas. Todėl kuriamas mažesnis regioninis Vilniaus krašto išvaržų registras. Atlikus apklausą apie 2006 metais darytas pilvo sienos išvaržų operacijas Vilniaus krašte, gauta 74,58% duomenų. 20% laparoskopinių operacijų gydant kirkšnines išvaržas yra pažangus modernių technologijų diegimo rodiklis. Pasaulinė praktika rodo, kad išvaržų registrai yra būtini, nes registras yra paprasta, nebrangi priemonė, kuri suteikia galimybę stebėti ir tobulinti išvaržų chirurgiją nacionaliniu lygmeniu ir palengvina atlikti didelės apimties tyrimus. Norint įsteigti profesionalų išvaržų registrą reikia tai daryti valstybės mastu, sukuriant sistemą, skiriant tam lėšų. Lietuvoje šiuo metu išvaržų chirurgijos rezultatus sistemina tik pavieniai asmenys ar ligoninės. Nesant sąlygų kurti registrą Lietuvos mastu, galima pradėti nuo mažesnio registro, įkurto asmeninėmis arba regiono pastangomis, tačiau jo funkcionavimui palaikyti reikia valstybės paramos ir finansavimo.
Reikšminiai žodžiai: išvarža, registras, Vilniaus kraštas
The Vilnius region hernia database
Kęstutis Strupas1, Dainius Šimčikas1, Vytautas Lipnickas1, Juozas Stanaitis2, Audrius Gradauskas31 Vilnius University Hospital Santariškių Klinikos, Clinic of Surgery, Faculty of Medicine, Santariškių str. 2, LT-08661 Vilnius, Lithuania2 Vilnius University Emergency Hospital, Center of General Surgery,Šiltnamių str. 29, LT-04130 Vilnius, Lithuania3 Vilnius City University Hospital, Antakalnio str. 57 Vilnius, LithuaniaE-mail: kestas.strupas@mf.vu.lt
Inguinal hernia is a common disease which causes significant social and economical problems. Postoperative chronic pain and the quality of life are the main issues in hernia repair. These issues are being solved using the results of trials and metaanalysis. Databases are one of the possibilities to obtain the required number of patients. Is it worth creating such database in Lithuania? According to Danish surgeons, establishment of nationwide groin hernia databases leads to the general improvement of the outcomes and, due to the large number of patients, allows an analysis of specific subgroups or complications which otherwise could not be obtained from single centres. Nationwide collaboration is important for multi-centre research and the further improvement of outcomes. There is almost no database regarding hernia operations in Lithuania. In 2004, there was an attempt to compile the Lithuanian Hernia Database; however, only 44.79% of the data on hernia operations in 2001–2003 was obtained. As a result, a smaller database for the Vilnius region is in progress. A survey of abdominal wall hernias performed in 2006 in the Vilnius region comprised 74.58% of the data. 20% of the operations were done laparoscopically. This number indicates an advanced use of modern technology. Worldwide medical practice shows that hernia databases are necessary as it is a simple, inexpensive tool that has the potential to monitor and improve hernia surgery on a national level and to facilitate large-scale prospective studies. To compile an efficient professional hernia database, it is necessary to do it on a national level, creating a system and allotting money specifically for that purpose. At present, in Lithuania hernia repair data are analysed only by individual surgeons or on a hospital level. If resources for the national database are not available, it is possible to compile a smaller database which relies on individual or regional efforts, but recieves national financial and other support.
Keywords: hernia, database, Vilnius region
INTRODUCTIONIleal diverticula usually remain asymptomatic. If complicated, they may present as intra-abdominal or pelvic abscess. Abscess formation in the presacral space is very rare. The rupture of ...abscess and spread of pus to extra-pelvic sites through anatomical structures of the pelvis is extremely rare. It carries high mortality if not diagnosed on time. CASE PRESENTATIONWe report a case of 52-year-old woman presented with thigh phlegmon and septic condition. The CT scan revealed free air in the left leg and pelvic presacral fluid collection descending to extra-pelvic direction through the greater sciatic notch. Moreover, ileal fistula to presacral abscess was suspected. Multiple incisions and fasciotomies were urgently performed to treat thigh phlegmon. Subsequently, laparotomy was carried out and ileal fistula was excised. Histological examination of the surgical specimen demonstrated that the fistula to presacral abscess has formed due to perforated ileal diverticulum. 3 years after the surgery the patient remains healthy without recurrence. DISCUSSIONRupture of presacral abscess to extra-pelvic site due to ileal diverticulum fistula is an extremely rare case, to our best knowledge, never reported in literature. Due to a rare occurrence and early septic complications if diagnosed late, this condition carries a high mortality rate. CONCLUSIONIntrapelvic pathology must be considered in patients with thigh phlegmon in order to prevent complications and associated mortality.
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