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Comparison of bacterial flora found in the peritoneal cavity and drains after intraabdominal surgery.

The aim of this study was to evaluate bacterial flora infecting during the surgical procedures the peritoneal cavity and drains which were used after the surgery in 40 patients who underwent surgery for colon and rectum tumors. Smears from the peritoneal cavity, liquid removed from the drain taken at 3-4 days after the surgery and smears from the drain taken at the end of drainage of each patient were examined for bacterial content. The comparison of bacterial flora found in the peritoneal cavity with bacteria found in drains showed that the frequency of isolation of anaerobes decreased in contrast to aerobes which were more often cultured over the time of drainage (p < 0.05). Bacteroides spp, enterococci, and strains of Enterobacteriaceae were most often isolated from the peritoneal cavity, but over the time of drainage the frequency of isolation of coagulase-negative staphylococci including MRCNS increased as well as the number of patients infected with enterococci, whereas anaerobes and strains of Enterobacteriaceae were rarely isolated.

Adult↗

[Disorder of thyroid function in patients with cancer of the gastrointestinal tract].

A quantitative assessment of T3 pool was performed in patients with malignant tumors of the esophagus, stomach, pancreatic head, rectum and colon as well as in patients with chronic gastritis, peptic ulcer and benign stomach tumors. A high T3 pool deficiency was noted in patients with malignant GIT tumors. It was assumed that such a deficiency was indicative of profound disorder of hormone supply of tissues which could be regarded as an endogenous factor of predisposition to the development of malignant neoplasms.

Digestive System Neoplasms↗

[Current developments in the field of endoscopy in the treatment of digestive system disorders].

A review is given of new developments of endoscopic treatment of diseases of the gastrointestinal tract. Endoscopic treatment is possible in patients with peptic stricture or inoperable tumors of the oesophagus, achalasia of the oesophagus, oesophageal varices, polyps and angiodysplasia of the large bowel, stomach and duodenum, choledocholithiasis and unresectable stenosing tumors of the bile ducts. In comparison with surgical therapy endoscopic treatment is relatively simple and has a much lower morbidity and mortality, especially in patients with an increased surgical risk.

Aged↗

Phase I-II study of ftorafur and methyl-CCNU in advanced colorectal cancer.

The combination of Ftorafur (NSC-148958) and methyl-CCNU (NSC-95441) was evaluated in 36 patients with advanced colorectal cancer. The principle toxicities encountered were myelosuppression, gastrointestinal, and neurological. There were no complete responses and only 5/34 (14.7%) patients achieved a partial response. Methyl-CCNU and Ftorafur does not appear to be an effective combination in advanced adenocarcinoma of the colon and rectum.

Adenocarcinoma↗

A3--a novel colon and pancreatic cancer reactive antibody from a primate phage library selected using intact tumour cells.

The identification of novel tumour-associated antigens (TAAs) is pivotal for progression in the fields of tumour immunotherapy and diagnosis. In the present study, we have developed, based on flow cytometric evaluation and use of a mini-library composed of specific antibody clones linked to different antibiotic resistance markers, methods for positive and subtractive selection of phage antibodies employing intact cells as the antigen source. An scFv phage library (2.7 x 10(7)) was constructed from a primate (Macaca fascicularis) immunised with pooled human colon carcinomas. This library was selected for 3 rounds by binding to Colo 205 colon adenocarcinoma cells and proteolytic elution followed by phage amplification. Several antibodies reactive with colon carcinomas and with restricted reactivity to a few epithelial normal tissues were identified by immunohistochemistry. One clone, A3 scFv, recognised an epitope that was homogeneously expressed in 11/11 of colon and 4/4 pancreatic carcinomas studied and in normal tissue restricted to subtypes of epithelia in the gastrointestinal tract. The A3 scFv had an apparent overall affinity approximately 100-fold higher than an A3 Fab, suggesting binding of scFv homodimers. The cell surface density of the A3 epitope, calculated on the basis of Fab binding, was exceptionally high, approaching 3 million per cell. We also demonstrate efficient T-cell-mediated killing of colon cancer cells coated with A3 scFv fused to the low MHC class II binding superantigen mutant SEA(D227A). The identified A3 molecule thus represents a TAA with properties that suggest its use for immunotherapy of colon and pancreatic cancer.

Amino Acid Sequence↗

What is the best surgical treatment for anorectal melanoma?

BACKGROUND AND AIMS: This study compared outcome following the two common surgical procedures for anorectal melanoma: wide local excision and abdominal perineal resection. We also examined the utility of endoluminal ultrasound to guide therapy. PATIENTS AND METHODS: Records of 19 patients surgically treated at our institution were studied. In addition to type of surgical procedure, we noted age, metastatic disease spread, sphincter involvement, tumor size and thickness, and mode of diagnosis. Survival after diagnosis and after recurrence of disease were also recorded. Ultrasound was used in seven, with the lesion delineated in six (all had therapy guided by the ultrasound). Regarding surgery ten had wide local excision, seven had abdominal perineal resection, and two had other procedures. RESULTS: The most common sites of recurrence were distant in 31.6% and regional lymph nodes in 26.3%. Mean survival after recurrence was 13 months (range 5-29). Two patients who had wide local excision are disease free and alive 135 and 29 months after diagnosis. Neither surgical treatment conferred obvious benefit on survival. CONCLUSION: Ultrasound can guide management by delineating lesions amendable to wide local excision. Since the mortality rate is high, wide local excision offers the advantage of avoiding a permanent colostomy and should be considered the procedure of choice when excision is feasible.

Adult↗

Tumor cell dissemination in colon cancer does not predict extrahepatic recurrence in patients undergoing surgery for hepatic metastases.

Patients undergoing resection of hepatic metastases of colorectal cancer have a high risk of extrahepatic recurrence, most likely caused by early tumor cell dissemination or the manipulation of liver tumors during surgical resection. Using immunocytochemistry, we studied 47 patients for cytokeratin (CK)-positive (+) cells in: a) bone marrow (BM) samples to determine whether tumor cell dissemination had already occurred before surgery; and b) blood samples directly taken from the hepatic vein before and during surgery of liver metastases. In addition, normal and malignant liver tissues were evaluated for markers known to be involved in tumor progression and metastasis [urokinase plasminogen activator (uPA), Her-2/neu, epidermal growth factor receptor (EGF-R)] using sandwich enzyme immunoassays. CK+ cells were detected in the BM of 26/47 patients (55%), in blood samples of 14/47 patients (30%) before surgery and 11/47 patients (23%) during surgery with a median detection rate of 1 (range, 1-14) CK+ cell per 4x10(6) MNC. No CK+ cells were found in 15/47 patients (32%) in any sample studied. Tumor tissue was obtained from 32/47 patients and normal liver tissue from 24/32 patients. While no differences were found for EGF-R and Her-2/neu, a 9-fold higher expression of uPA could be demonstrated in tumor tissue of 20/32 patients (63%) compared to normal liver tissue. When all obtained results were correlated with clinical outcome, neither the detection of CK+ cells nor the expression pattern in the tumor tissue, or the combination of both, was predictive for extrahepatic recurrence or overall survival after a mean observation time of 43 months (range, 26-54 months). Although uPa is overexpressed in liver metastases of colorectal cancer, and dissemination of CK+ cells during surgery of these metastases is a frequent event in colon cancer, these findings do not predict extrahepatic recurrence. Further characterization of single cells, especially those spread during surgery, will help to identify those patients with an increased risk of later relapse.

Adenocarcinoma↗

[Second primary malignant neoplasms in patients treated in the Otolaryngology Clinic AM of Lodz in the years 1981-1989].

The incidence of multiple primary malignant tumours in 913 patients treated during 9 years for malignant neoplasms was investigated. In 24 (2.63%) cases second primary malignant neoplasm was diagnosed, mostly (in 19 cases-2.1%) it was correlated to cancer of larynx. In 18 cases (75% of all multiple tumours) neoplasms were metachronous, in 5-synchronous, and in one case--it was multifocal neoplasm (in both tonsils). In 3 patients three separate primary neoplasms were observed.

Adult↗

Amphicrine cells, dysplasias, and neoplasias.

The existence of epithelial cells displaying synchronous features of exocrine and endocrine differentiation has been well established. Sporadic descriptions of neoplasms comprising or including such cells have also been recorded. The authors investigated eight carcinomas (lung, two; stomach, two; colon, one; appendix, one; esophagus, one; and pancreas, one). By conventional light microscopy, all eight neoplasms appeared as moderately to well-differentiated adenocarcinomas. Mucosubstance stains showed positive material within well-defined lumina and as intracytoplasmic droplets. Argyrophil stains were positive in seven of the eight neoplasms. The esophageal tumor was a predominantly solid carcinoma; it compromised small to intermediate cells with focal mucosubstance positivity and squamous pearls. By electron microscopy, all these carcinomas including cells displaying variable complements of neurosecretory granules, which were concentrated in the basal pole or in cytoplasmic processes. The granule population was often heterogeneous. The pancreatic carcinoma also showed typical zymogen granules. In all cases, many of the neoplastic cells had true lumina or intracytoplasmic lumina, as well as arrays of filaments; secretory granules were also observed in cells with true or intracytoplasmic lumina. Immunohistochemical studies revealed in all cases either serotonin or one of a spectrum of neuropeptides. Five tumors contained more than one immunoreactive material. The authors conclude that synchronous exocrine and endocrine differentiation may be comparatively frequent in a spectrum of tumors that may be properly termed "amphicrine" carcinomas. This demonstrable heterogeneity of malignant cell populations, however variably expressed, may prove to have considerable significance in the diagnosis and management of these neoplasms.

Adenocarcinoma↗

Expression of transforming growth factor alpha messenger RNA in the normal and neoplastic gastro-intestinal tract.

The presence of TGF alpha mRNA has been reported previously to occur in primary colon cancers. We report the expression of the normal 4.5 kb TGF alpha transcript in the mucosa of the normal human gastro-intestinal tract from oesophagus through to colon. The highest levels of human TGF alpha mRNA occurred in the duodenum but significant levels were present in all of the mucosa. Similarly, in the rat gastro-intestinal tract, TGF alpha transcripts were detected in the lower gastro-intestinal tract mucosa. The relative abundance of the TGF alpha mRNA appeared to decrease in distal regions of the gastro-intestinal tract. The level of the TGF alpha mRNA was similar in both the normal and the neoplastic colon tissue. Similarly, in 2 patients with carcinomas, the TGF alpha mRNA was expressed at similar levels in the tumour and in adjacent mucosa. Although TGF alpha mRNA is associated with transformed cells from the gastro-intestinal tract, the presence of this mRNA at equivalent concentrations in normal mucosa suggests that over-production of TGF alpha is not an essential feature of carcinomas in the gastro-intestinal tract.

Animals↗

Distribution of adenosine deaminase binding protein in normal and malignant tissues of the gastrointestinal tract studied by monoclonal antibodies.

A mouse monoclonal antibody V-715 was raised against fresh colon cancer tissues. Biochemical analysis elucidated that the antigen defined was adenosine deaminase binding protein (ADBP). In colon cancer cell lines, V-715 was positive in 8 out of 16 differentiated cancers and in 2 out of 8 poorly differentiated cancers. In frozen sections, ADBP was expressed in 17 out of 33 differentiated colon cancers, but none of 4 poorly differentiated colon cancers. In normal colon, the expression was observed in epithelium. In gastric cancers, ADBP was expressed in 10 out of 15 differentiated cancers, but weakly or only heterogenously expressed in 2 out of 8 poorly differentiated cancers. In normal gastric mucosa, ADBP was mainly detected in the foveolar epithelium, but was weakly or not expressed in the deep gastric glands. Carcinoid tumors and malignant lymphoma of the stomach did not express ADBP. These results suggest that ADBP may act as a marker of enterocytic differentiation in normal and neoplastic gastrointestinal cells, and might be exploitable in clinical and pathological diagnosis of gastrointestinal cancers.

Adenocarcinoma↗

Long-term outcome after ampullectomy for ampullary lesions associated with familial adenomatous polyposis.

PURPOSE: Up to 90 percent of patients with familial adenomatous polyposis develop adenomas in the upper gastrointestinal tract. Besides pancreaticoduodenectomy, which remains indicated in duodenal and ampullary cancer, less aggressive surgical procedure (such as ampullectomy) must be evaluated in selected patients with familial adenomatous polyposis patients presenting low-risk benign duodenal adenomas. METHODS: From 1995 to 2000, we performed a retrospective, observational study, which included eight patients (5 females) with familial adenomatous polyposis underwent ampullectomy (with frozen sections) for presumed benign polyposis lesions. Six patients had an ileal pouch-anal anastomosis performed 2 to 27 years before ampullectomy. The remaining two patients had ampullectomy during the same operation than ileal pouch-anal anastomosis. RESULTS: No patient died postoperatively. Mean hospital stay was 15 +/- 6.5 (range, 10-21) days. There was one major complication (pancreatic fistula), which was treated conservatively. Final pathologic examination of the specimens revealed that three patients had a severe dysplasia. Mean follow-up of the patients was 58 +/- 37 (range, 24-119) months. During endoscopic follow-up, although all the patients underwent endoscopic resection of duodenal polyps, none presented recurrence at the ampullectomy site. CONCLUSIONS: Ampullectomy could be safely proposed in selected familial adenomatous polyposis patients. Our low morbidity and the absence of recurrence after almost five years of follow-up suggests that such conservative treatment could be proposed before pancreaticoduodenectomy in patients with high-risk ampullary adenomas without invasive carcinoma.

Adenoma↗

Clinicopathologic analysis of early ampullary cancers with a focus on the feasibility of ampullectomy.

OBJECTIVE: The purpose of this study was to evaluate whether ampullectomy can substitute for pancreatoduodenectomy (PD) in early ampullary cancer by clinicopathologic study. SUMMARY BACKGROUND DATA: Although ampullectomy has been attempted in early ampullary cancer (pTis, pT1), the indication and extent of resection have not been established. METHODS: Of 201 patients who had undergone PD for ampullary cancer between 1986 and 2002, 67 patients with a histologic diagnosis of pTis (n = 5) or pT1 (n = 62) cancer were analyzed retrospectively. Pathologic PD specimens were reviewed to analyze the cancer spread pattern, and medical records were reviewed for clinical outcomes. RESULTS: The 5-year survival rate of the 66 patients with early ampullary cancer (excluding one mortality) was 83.7%. Recurrence was confirmed in 12 patients (18.2%) and all died because of the recurrence. Pathologic review showed that 22 patients (32.8%) had at least one risk factor for failure after ampullectomy: lymph node metastasis (n = 6, 9.0%), perineural invasion (n = 1), or mucosal tumor infiltration along the CBD or P-duct (n = 15, 22.4%). Mean lengths of invasion into the CBD or the P-duct beyond the sphincter of Oddi were 7.7 mm (range, 1-25 mm) or 6.3 mm (range, 2-18 mm), respectively. Moreover, these risk factors were not correlated with tumor size, histologic grade, or the gross morphology of the primary tumor, although pTis cancer or pT1 cancer sized 1.0 cm or less was found to be least associated with risk factors. CONCLUSIONS: Ampullectomy for early ampullary cancer should not be considered an alternative operation to PD because of the high possibility of recurrence. PD should be preferably performed for adequate radical resection, even in early ampullary cancer, and ampullectomy should be reserved for those who have pTis or pT1 cancer sized 1.0 cm or less with high operative risk.

Adult↗