135 research outputs found
Biopsija resektabilnih jetrnih zasevkov raka debelega črevesa in danke
No full textNo abstract.Ni abstrakta
Kako preprečiti jetrno odpoved pri resekciji jeter zaradi zasevkov raka debelega črevesa in danke?
No full textVpliv debelosti na izhod zdravljenja po laparoskopski resekciji jeter
No full textnamen raziskovalne naloge je opredeliti kratkoročne operacijske izide po laparoskopski resekciji jeter pri debelih bolnikih ter jih primerjati z bolniki z normalno in čezmerno telesno težo
Biopsija resektabilnih jetrnih zasevkov raka debelega črevesa in danke : odgovor avtorja
No full textThe prognostic value of biological markers in patients undergoing liver resection of colorectal metastases
No full textIzhodišče/cilji: Prizadevanja za prenos temeljnega znanja o bioloških označevalcih (BO) v klinično uporabo se nadaljujejo. Namen raziskave je bilo ugotoviti, ali lahko BO dopolnijo napovedno vrednost kliničnega točkovnega sistema tveganja (CRS) po zdravljenju jetrnih zasevkov raka debelega črevesa in danke (RDČD).
Metode: Opravili smo retrospektivni pregled prospektivno vodene, računalniško podprte jetrne datoteke. Bolniki, izbrani za analizo, so bili zdravljeni na Oddelku za abdominalno in splošno kirurgijo Univerzitetnega kliničnega centra Maribor zaradi zasevkov RDČD s potencialno kurativno resekcijo jeter v obdobju od 1996 do 2011. Pri vseh bolnikih je bila s histopatološkim pregledom potrjena in postavljena dokončna diagnoza zasevkov adenokarcinoma RDČD v jetrih. Vključno s CRS smo skupaj analizirali 14 rutinsko razpoložljivih kliničnih dejavnikov tveganja. Izražanje p53, Ki-67 in timidilat-sintaze (TS) smo določali z imunohistokemijo na tkivnih mrežah. Izražanje p53 in Ki-67 smo ocenjevali s točkovanjem odstotka pozitivno obarvanih jeder malignih celic. Vzorec je bil ocenjen kot pozitiven na p53 in Ki-67, če je bilo obarvanih več kot 50 % tumorskih celic. Izražanje TS smo ocenjevali po intenziteti obarvanja citoplazme malignih celic. Intenzivnost obarvanja TS je bila določena z vizualno stopenjsko lestvico od 0 do 3. Stopnji 0 in 1 sta predstavljali nizko, stopnji 2 in 3 pa visoko intenzivnost obarvanja. Rezultate smo primerjali z aktualnim preživetjem, preživetjem brez bolezni ter preživetjem brez jetrne bolezni.
Rezultati: Izmed 406 bolnikov jih je 98 (24 %) izpolnjevalo kriterije vključitve. Mediani čas sledenja preživelih bolnikov je bil 103 mesece (razpon 61–195 mesecev). Vsi bolniki so imeli CRS v razponu od 0 do 4, nihče ni imel CRS 5. Skupaj se je obarvalo pozitivno 52 (53 %) zasevkov na protein p53 in 27 (28 %) zasevkov na protein Ki-67. Intenziteta imunohistokemijskega barvanja za TS je bila nizka pri 29 (30 %) in visoka pri 69 (70 %) vzorcev. Statistična analiza s testom hi-kvadrat je razkrila korelacijo med prekomerno izraženim p53 in visokim CRS (P = 0,058). Aktualno petletno in pričakovano desetletno preživetje bolnikov je bilo 34,5 % oziroma 24,3 %, z medianim preživetjem 36 mesecev. Čeprav so bili vsi bolniki zdravljeni s potencialno kurativno resekcijo R0, se je pri 72 (73 % ) bolezen ponovila. Pri 20 izmed 72 bolnikov (28 %) je bila ponovitev bolezni omejena samo na jetra, pri 20 bolnikih (28 %) je bila prisotna izključno zunaj jeter, pri 32 (44 %) pa so bili zasevki prisotni tako v jetrih kakor tudi zunaj njih. Po multivariatni analizi je ostal samo visok CRS negativni napovedni dejavnik preživetja (P = 0,018), kazalec zgodnje ponovitve bolezni (P = 0,010) in hkrati tudi kazalec zgodnje ponovitve jetrne bolezni (P = 0,003). Med BO je po multivariatni analizi ostal pozitivni napovedni dejavnik preživetja samo prekomerno izraženi Ki-67 (P = 0,038).
Zaključki: Razkrili smo korelacijo med prekomerno izraženim p53 in visokim CRS. Najpomembnejša ugotovitev dela je identifikacija prekomernega izražanja Ki-67 kot ugodnega napovednega dejavnika aktualnega preživetja po radikalni resekciji jetrnih zasevkov RDČD. TS ni dodala nobene klinične informacije. Samo CRS napoveduje neodvisno izid zdravljenja.Background/Aims: There is an ongoing effort to translate basic knowledge about biological markers (BM) into clinical use. The aim of this study was to assess whether BM can provide additional prognostic information to that supplied by clinical risk score (CRS) for colorectal liver metastases (CRLM).
Methods: A retrospective review of a prospectively maintained database was conducted. Patients selected for this study were treated between 1996 and 2011 with potentially curative liver surgery at the Department of Abdominal and General Surgery, University Medical Center – Maribor. The diagnosis of CRLM was confirmed by histopathology. A total of 14 routinely available clinical variables were analysed, including a CRS. p53, Ki-67, and thymidylate synthase (TS) were assayed using immunohistochemical technique on tissue microarrays. Expressions of p53 and Ki-67 were evaluated by scoring the percentage of positively stained nuclei of the malignant cells. Specimens were considered positive for p53 and Ki-67 when more than 50% of tumor cells were stained. For TS, the intensity of cytoplasm staining of the malignant cells was studied. Definition of the TS staining intensity was based on a visual grading scale of 0-3. Intensity levels 0 and 1 were grouped together as representing low intensity staininglevels 2 and 3 were grouped as representing intermediate or high-intensity staining. The endpoints of the study were actual survival, disease-free survival and hepatic disease-free survival.
Results: A total of 98 (24%) of 406 patients met the inclusion criteria. The median follow-up in surviving patients was 103 months (range: 65-195 months). All patients were found to have a CRS within the range of 0-4no patient had a CRS of 5. A total of 52 (53%) metastases stained positive for p53 protein and 27 (28%) stained positive for Ki-67 protein. Immunostaining for TS was low in 29 (30%) and high in 69 (70%). Chi-squared analysis revealed a relationship between p53 protein positive staining and high CRS (P = 0.058). The actual 5-year and actuarial 10-year survival of patients were 34.5% and 24.3%, respectively, with median survival of 36 months. Although all patients underwent a potentially curative resection, 72 (73%) of them subsequently developed recurrent disease. The pattern of recurrence was as follows: in 20 (28%) patients, recurrence was confined to the liverin 20 (28%) patients, recurrence was confined to an extrahepatic location only, and in 32 (44%) patients, intra- and extrahepatic metastases were present. Following multivariate analysis, only high CRS remained an independent negative prognostic predictor for survival (P = 0.018), indicator of early recurrence of disease (P = 0.010) as well as an indicator of early hepatic recurrence of disease (P = 0.003). Of the BM investigated, only Ki-67 overexpression was identified as a positive predictor of survival on multivariate analysis (P = 0.038).
Conclusions: In CRLM a correlation between p53 protein overexpression and high CRS is established. The most important finding of the present study is the identification of Ki-67 overexpression as a positive predictor of survival. TS expression provides no clinical information. Only high CRS remaines an independent negative prognostic predictor
Life threatening bleeding from duodenal ulcer after Roux-en-Y gastric bypass: Case report and review of the literature
No full textHepatocelični rak - možnost resekcije jeter
No full textLiver resection (LR) has remained the main form of therapy for solitary hepatocellular cancer (HCC) in patients with preserved functional liver reserves and in good general condition. Advanced imaging has contributed to a better selection of patients. Liver surgery has advanced as there are many techniques of liver tissue transection useful and different instruments are available, which enable faster and more accurate surgery in the bloodless operating field. Improved surgical technique, maintenance of low central venous pressure and advancement in patient postoperative care have provided that mortality rates after liver surgery in selected series lowered as far as to 0%. The Barcelona Clinic Liver Cancer (BCLC) classification apart from disease control also offers recommendations with regard to therapy selection. It limits surgical therapy only to patients with early stage liver cancer. The purpose of this article is to research whether at present time it is perhaps better to perform radioiodine therapy with acceptable short- and long-term results even in patients with HCC, where there are numerous and large tumours present, macroscopically invading the veins.Resekcija jeter (RJ) je ostala glavna oblika terapije pri solitarnem hepatoceličnem raku (HCC), pri bolnikih z ohranjeno funkcijsko rezervo jeter in v primernem splošnem stanju. Izpopolnjene slikovne preiskave so pripomogle k boljši izbiri bolnikov. Kirurgija jeter je napredovala: uporabne so številne tehnike transekcije jetrnega tkiva; dosegljive so različne naprave, ki omogočajo hitrejše in natančnejše operiranje v brezkrvnem operativnem polju. Izboljšana kirurška tehnika, vzdrževanje nizkega centralnega venskega pritiska in napredek pri negi bolnika po operaciji so omogočili, da se je smrtnost po operaciji jeter v izbranih serijah znižala celo do 0%. Barcelona Clinic Liver Cancer (BCLC) klasifikacija poleg zamejitve bolezni, nudi priporočila tudi glede izbora terapije. Kirurško terapijo omejuje zgolj na bolnike z zgodnjim stadijem raka. Namen tega prispevka je raziskati, ali je v sedanjem času mogoče RJ opraviti s sprejemljivimi kratko- in dolgoročnimi rezultati tudi pri bolnikih s takšnim HCC, pri katerem so prisotni številni in veliki tumorji, ki makroskopsko vdirajo v žile
Extreme small bowel resection in malrotation with acute midgut volvulus in a 3-year old boy: a case report: Obsežna resekcija tankega črevesa pri malrotaciji z akutnim volvulusom pri tri letnem dečku: prikaz primera
No full textPurpose: Malrotation with midgut volvulus is a rare congenital anomaly that generally presents acutely in the neonatal period, with bilious vomiting, and requires surgical intervention. It is rarely observed beyond the first year of life, when the diagnosis can be difficult because of intermittent symptoms and vague clinical findings, which can subsequently delay appropriate treatment. Chronic volvulus associated with malrotation has the potential to turn into acute vascular congestion and arterial insufficiency secondary to torsion of the superior mesenteric vessels. Early diagnosis and surgical treatment are essential to prevent progression to transmural bowel infarction.
Case report: We present the case of a 3-year-old boy with a 1-year history of recurrent abdominal pain and intermittent vomiting, which was evaluated many times at other institutions without a definitive diagnosis. Finally, the boy was referred as an emergency, with signs of an acute abdomen and septic shock. Upon urgent laparotomy, midgut volvulus caused by malrotation with extensive intestinal necrosis was found, which necessitated an extreme resection of the small bowel. The postoperative course was uneventful, and presently, 1 year after the operation, the boy is on total parenteral nutrition, thrives normally, eats regular food, and has no diarrhea or signs of liver failure. Although there is some impairment in his quality of life, he can practice almost completely normal daily activities for a child of his age.
Conclusion: In this article, we discuss the diagnostic pitfalls that can occur when symptoms of midgut malrotation develop beyond the neonatal period, the difficulties of management in an emergency setting, and therapeutic options for the patient after massive small bowel resection.Obsežna resekcija tankega črevesa pri malrotaciji z akutnim volvulusom pri tri letnem dečku: prikaz primera
Namen: Malrotacija z volvulusom tankega črevesa je zelo redka prirojena anomalija, ki se z bruhanjem žolčne vsebine največkrat pokaže kot akutno stanje v neonatalnem obdobju in potrebuje takojšnje kirurško ukrepanje. Redkeje se simptomi pojavijo šele po prvem letu starosti, ko je zaradi neznačilne klinične slike težko postaviti pravilno diagnozo, zaradi česar lahko s pravočasnim zdravljenjem zamudimo. Kronični volvulus, ki je povezan z malrotacijo, se lahko zaradi torzije zgornjih mezenteričnih žil vsak trenutek poslabša, tako da nastane akutna venska kongestija in arterijska insuficienca. Samo takojšnja diagnoza in kirurško ukrepanje lahko preprečita odmrtje celotne stene prizadetega dela črevesa.
Poročilo o primeru: Predstavljamo primer tri letnega dečka, ki je imel eno leto trajajoče težave v smislu ponavljajočih se bolečin v trebuhu in bruhanja, zaradi česar je bil fantek večkrat obravnavan v drugi zdravstveni ustanovi, vendar brez dokončne diagnoze. Nazadnje je bil deček z znaki akutnega abdomna in septičnega šoka nujno premeščen v našo ustanovo. Naredili smo urgentno laparotomijo in naleteli na volvulus zaradi malrotacije, z znatno nekrozo tankega črevesa, zaradi česar je bila potrebna obsežna resekcija prizadetega dela prebavne cevi. Po operaciji ni bilo zapletov in trenutno - eno leto po posegu - je deček na totalni parenteralni prehrani, raste primerno, uživa navadno hrano, drisk nima, prav tako ne znakov nezadostnega delovanja jeter. Čeprav je kvaliteta njegovega življenja nekoliko okrnjena, lahko skoraj nemoteno izvaja vsakodnevne aktivnosti in tako ne zaostaja za svojimi vrstniki.
Zaključek: V prispevku razpravljamo o pasteh pri diagnostiki malrotacije, ki so prisotne v primeru, če se simptomi tega redkega obolenja izjemoma pojavijo šele v otroštvu, o težavah pri zdravljenju, s katerimi smo soočeni ob razvoju akutnega abdomna in o terapevtskih možnostih pri bolniku po obsežni resekciji tankega črevesa
Factors affecting the morbidity and mortality of diverting stoma closure: retrospective cohort analysis of twelve-year period
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