INTRODUCTIONGastrointestinal angiosarcomas are rare and represent less than 1% of all gastrointestinal tract malignancies, with most occurring in the stomach and small intestine. Occurrence in the ...colorectal segments is considered extremely rare. Case Report. We describe the case of a 61-year-old male with multiple primary angiosarcomas of the colon who presented with fever and abdominal pain. The patient was initially hospitalized and treated as having an infectious disease. A multislice computed tomography (MSCT) scan revealed multiple soft tissue tumors in the region of the left iliopsoas and gluteus medius muscles. After developing hematochezia, a colonoscopy was performed which found an ulcerated tumor in the sigmoid colon. The small tissue biopsy taken during the procedure presented diagnostic difficulties and was given a preliminary diagnosis of gastrointestinal stromal tumor (GIST). Examination of the resected colon segment and surrounding fat tissue revealed four separate tumors. Microscopically, the tumors were composed of solid sheets of spindle and epithelioid neoplastic cells with prominent nucleoli and numerous mitotic figures and immunohistochemically positive for ERG, CD31, CD34, vimentin, and CD117, while negative for CK7, CK20, CD20, CD3, CD45, TTF-1, PAN-CK, ALK, Mpox, S-100, and DOG1, leading to the final diagnosis of multiple colonic angiosarcomas. The patient's condition declined rapidly and he passed away from multiple organ failures 60 days after initial hospitalization. CONCLUSIONBoth clinical and pathological diagnoses of colorectal angiosarcoma are challenging. Patients are present with nonspecific symptoms leading to mismanagement and late diagnosis. A definitive pathological diagnosis relies on immunohistochemical staining for endothelial markers. Misdiagnosis as poorly differentiated adenocarcinoma or GIST is possible in limited tissue biopsies.
Between January 1st 1990 and December 31st 1999, 24 patients affected by Klatskin tumor underwent operation in our department of surgery. According to Bismuth's classification, there were 0 (0%) type ...I, 5 (21%) type II, 6 (25%) type IIIa, 4 (17%) type IIIb and 9 (37%) type IV tumors. Five patients (21%) were treated by curative resection (group I) while in 14 patients (58%) palliative surgical procedure was performed (group II). In 5 cases (21%) the extension of malignancy did not allowed any procedure (group III). Curative resection for malignant tumors of the hepatic duct bifurcation included wide tumor excision and bile duct resection at the liver hilum (with wedge hepatic resection in one patient) and creation of biliary-enteric anastomosis. Palliative surgical procedure included stent insertion. Jaundice was completely relieved in all patients undergoing resection, since 3 patients (21%) after stenting hadn't satisfactory biliary drainage. There was 1 (20%) perioperative death in the group 1, while in group 2, 5 patients (36%) died postoperatively. In this series, the mean postoperative survival of all patients was 16 months. The mean postoperative survival of patients undergoing localized tumor resection with curative intent was 38 months, in contrast to 10 months for those undergoing operative stent insertion. in addition, only 1 patient from group III, in whom only exploratory surgery were performed survived 7 months, while other 4 patients died in the hospital. This retrospective review suggests that aggressive surgical treatment could improve survival and quality of life in patients suffering from Klatskin tumor.
Spontaneous bacterial peritonitis is one of the most common complications attending the onset of ascites in patients with liver cirrhosis. The aim of this study was to demonstrate whether it is ...possible, on the basis of ascitic fluid polymorphonuclear cell count in patients with liver cirrhosis and spontaneous bacterial peritonitis, to determine the optimal duration of cefotaxime therapy, as the most frequently applied empirical therapy, and possibly anticipate the disease recurrence.
In 16 patients with alcoholic liver cirrhosis and confirmed diagnosis of spontaneous bacterial peritonitis, cefotaxime therapy was administered 2g t.i.d. during 5 days. Before the therapy, at 48 hours, 5 days and 15-20 days after the cefotaxime therapy was started, in all patients with spontaneous bacterial peritonitis diagnostic abdominal paracentesis was performed, each time determining the ascitic fluid polymorphonuclear cell count together with microbiological analysis.
In the course of the "primary" spontaneous bacterial peritonitis attack, 3 patients died (18.8%). In 4 patients the recurrence of spontaneous bacterial peritonitis was observed within 15-20 days after therapy was discontinued. Two patients died during the therapy of spontaneous bacterial peritonitis recurrence. After 48 hours of therapy, 11 patients with the "primary" spontaneous bacterial peritonitis attack were without any symptoms (68.8%). Out of these 11, 10 patients (62.5%) had the ascitic fluid polymorphonuclear cell count lower than 250/mm3. After 5 days of therapy, 12 patients (75%) were free of symptoms, and the number of ascitic fluid polymorphonuclear cell count < 250/mm3 was still found in 10 (62.5%) patients. No association between the presence of symptoms 48 hours after the therapy and the recurrence of spontaneous bacterial peritonitis was established. A significant association was found between the ascitic fluid polymorphonuclear cell count determined 48 hours after the therapy and the recurrence of spontaneous bacterial peritonitis. A recurrence occurred in only 1 patient with the number of ascitic fluid polymorphonuclear cell count < 250/mm3, 48 hours after the therapy was started. A recurrence of spontaneous bacterial peritonitis occurred in all the patients who had an ascitic fluid PMN cell count > or = 250/mm3, 48 hours after the therapy was started.
By monitoring the ascitic fluid PMN cell count it seems to be possible to determine the efficacy and optimal duration of cefotaxime therapy in patients with spontaneous bacterial peritonitis when it is of most importance that the number of ascitic fluid PMN cell count should decrease below 250/mm3 during the therapy.
Cilj ovoga istraživanja bio je usporediti vrijeme cijeljenja prijeloma dijafize humerusa pri liječenju s dva različita dizajna intramedularnog čavla: antegradni ukotvljeni intramedularni čavao s ...dodatnim ukotvljenim neutralizacijskim vijcima i bez njih. Retrospektivna studija obuhvatila je 51 bolesnika liječenog antegradnim humeralnim intramedularnim čavlima između siječnja 2015. i prosinca 2017. godine. Kriteriji uključenja u studiju bili su prijelomi proksimalne i srednje trećine dijafize humerusa. Pedeset i jedan bolesnik je ispunio kriterije uključenja: 23 bolesnika su liječena antegradnim intramedularnim čavlom s dodatnim ukotvljenim neutralizacijskim vijcima kroz mjesto prijeloma (skupina A), a 28 bolesnika je liječeno antegradnim intramedularnim čavlom bez dodatnih ukotvljenih neutralizacijskih vijaka (skupina B). Analizirana je medicinska dokumentacija i radiološke slike učinjene prije i poslije operacije. Radiološko cijeljenje prijeloma definirano je kao kortikalno premošćivanje najmanje tri od četiri korteksa u dvoprofilnim radiografima, s nestankom frakturne pukotine. Nije bilo značajne razlike u vremenu cijeljenja prijeloma između skupina (p>0,05). Prema našim spoznajama, ovo je prva studija o liječenju
prijeloma humerusa antegradnim intramedularnim čavlom s dodatnim ukotvljenim neutralizacijskim vijcima kroz mjesto prijeloma. Hipotetsku prednost redukcije prijelomne pukotine s dodatnim ukotvljenim neutralizacijskim vijcima u svrhu poticanja cijeljenja nije potvrdila ova prva klinička studija.
Cilj istraživanja bio je analizirati dijagnostičku točnost (osjetljivost i specifičnost) Fenyö-Lindbergove i Teicherove bodovne ljestvice u postavljanju dijagnoze akutne upale crvuljka u ženskoj ...populaciji u urbanom okruženju. U studiju je prospektivno uključeno 130 bolesnica primljenih u hitnoj službi s bolovima u trbuhu i sumnjom na akutni apendicitis. Rezultati i parametri valjanosti izračunati su i uspoređeni s obzirom na konačnu dijagnozu. Za vrijednosti Fenyö-Lindbergova zbira -17 ili manje nađena je osjetljivost od 84,5%, specifičnost od 55,6%, pozitivna prediktivna vrijednost (PPV) od 87,9% i negativna prediktivna vrijednost (NPV) od 48,4%. Za vrijednosti istoga zbira većeg ili jednakog -2 utvrđena je osjetljivost od 59,2%, specifičnost od 77,8%, PPV od 91% i NPV od 33,3%. Usporedba krivulja ROC za Fenyö-Lindbergov zbir pokazala je da je najbolja pojedinačna granična vrijednost u proučavanoj populaciji u svrhu diskriminacije akutne upale crvuljka -15. Za Teicherov zbir vrijednosti veće od -3 pokazale su osjetljivost od 89,3%, specifičnost od 22,2%, PPV od 81,4% i NPV od 35,3%. U zaključku, Fenyö-Lindbergov zbir se može koristiti kao dodatni alat u isključivanju upale crvuljka i izbjegavanju nepotrebnih operacija. Teicherov zbir može pomoći u prepoznavanju bolesnica s akutnom upalom crvuljka. Niti jedan zbir se ne može koristiti kao jedino sredstvo za indiciranje ili nepoduzimanje operacije akutne upale crvuljka u svim slučajevima.
Bodovni sustav može biti koristan u isticanju važnih kliničkih znakova i simptoma u pojedinim skupinama bolesnika.
U Klinici za onkologiju i nuklearnu medicine KBC “Sestre milosrdnice” u suradnji sa IAEA i ESTRO-m proveli smo ispitivanje o primjeni preoperativne radioterapije i kemoterapije u bolesnika s ...uznapredovalim karcinomom rektuma. U ispitivanje smo uključili petnaest bolesnika koji su zadovoljili uključne kriterije i potpisali informirani pristanak. Bolesnici su randomizirani u dvije skupine: skupina 1: standardni neoadjuvantni pristup (kemoterapija 5-FU / leucovorin konkomitantno uz radioterapiju (45-50 Gy u 25 frakcija); skupina 2: kemoterapija 5-FU / leukovorin uz radioterapiju (25 Gy u 5x). Glavni cilj bio je utvrditi stopu resektabilnosti nakon provedene neoadjuvantne terapije te odrediti postotak lokalne kontrole i ukupnog preživljenja.
Cilj ove studije bio je prikazati epidemiološke, kliničke i endoskopske karakteristike akutnog krvarenja iz gornjeg pro-bavnog sustava s naglaskom na krvarenje iz peptičkog vrijeda. U studiju je bilo ...uključeno 2198 bolesnika koji su pregledani u hitnoj službi naše ustanove zbog akutnog krvarenja iz gornjeg probavnog sustava u razdoblju od siječnja 2009. do prosin-ca 2012. godine. Svim bolesnicima je učinjena hitna gastroskopija unutar 24 sata od prijma, a u 842 bolesnika kod kojih je dokazana peptička ulkusna bolest nastavljeno je kliničko praćenje. Kumulativna incidencija krvarenja je bila 126/100.000 u razdoblju od 5 godina. Dva od pet bolesnika su imali krvareći peptički vrijed; ukupno 440 (52,3%) bolesnika je imalo krva-reći želučani vrijed, 356 (42,3%) duodenalni vrijed, 17 (2%) želučani i duodenalni vrijed, a 29 (3,5%) krvareći vrijed na gastroenteralnoj anastomozi. Srednja dob bolesnika je bila 65,9 godina. Većina bolesnika je uzimala lijekove koji suprimi-raju citoprotektivne funkcije želučane i duodenalne sluznice (57%). Recidiv krvarenja zabilježen je u 77 (9,7%) bolesnika, a 47 (5,9%) je zahtijevalo kiruršku intervenciju. Smrtnost kroz 30 dana je bila 5,2%, a 10% bolesnika je umrlo zbog krvarenja i pratećih komorbiditeta. Krvarenje iz peptičkog vrijeda je najčešći uzrok krvarenja iz gornjeg probavnog sustava, a obilje-ženo je značajnom stopom recidiva krvarenja i smrtnosti.
BACKGROUNDFamilial adenomatous polyposis (FAP) is an autosomal dominantly inherited syndrome characterized by the development of numerous polyps in the colon and rectum. If left untreated, the ...affected patients inevitably develop colon cancer by the age of 40 years. A resection of the colon (colectomy) or of the colon and rectum (proctocolectomy) is needed to minimize the risk of cancer. CASE PRESENTATIONWe report a case of FAP through three generations of a single family, in which the grandmother and granddaughter underwent total colectomy with ileoanal anastomosis and did not develop colon cancer, while the son underwent subtotal colectomy with ileorectal anastomosis and developed recurrent rectal cancer. Data regarding timely surgery, surveillance, and chemoprevention are discussed. CONCLUSIONThe FAP phenotype determines the type of treatment. In severe polyposis, proctocolectomy with ileoanal anastomosis seems to be the optimal method for minimizing the risk of cancer development. This case report advocates complete rectal removal, especially in cases of poor patient compliance with colonoscopic surveillance.
Primarni liposarkomi mezenterija su rijetki, osobito ako su miješanog histološkog izgleda. Prognoza pacijenta ovisi o najagresivnijem histološkom tipu liposarkoma. Prikazujemo slučaj 77. godišnjeg ...muškarca s anamnezom spororastućeg volumena abdomena tijekom 3 godine. Dijagnoza ogromne intra-abdominalne mase suspektne na liposarkom potvrđena je CT-om i ultrazvukom. Pacijentu su resecirane 24 tumorske mase koje su zajedno težile 23.5 kg. Histološka dijagnoza je bila miješani tip liposarkoma mezenterija. Iako je ovaj tip tumora rijedak, tumorsko tkivo treba pomno preuzeti i pregledati histološki kako bi se postavila ispravna zaključna dijagnoza. Pronalazak nepovoljnog tipa liposarkoma je važan zbog točne prognoze i daljnjeg liječenja pacijenta. Prema našim saznanjima, ovo je najveći opisani liposarkom mezenterija miješanog tipa u engleskoj literaturi.
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