APC, MYH, and the correlation genotype-phenotype in colorectal polyposis.

Background: Familial adenomatous polyposis (FAP) has been divided into two entities: classical (CFAP) and attenuated (AFAP). With the discovery of MYH associated polyposis (MAP) syndrome, the clinical differences have become unclear. The aim of our study was to investigate patients with polyposis treated in our institution for a correlation between genotype and phenotype.

Results of an aggressive surgical approach in the management of postoperative peritonitis.

Background: Treatment of postoperative peritonitis (POP) necessitates adequate control of the source of peritoneal contamination. For most patients, a surgical approach to this requires reoperation to restore intestinal continuity. The aim of this study was to audit our results for the surgical treatment of POP.

Lumboaortic and iliac lymphadenectomy for lymph node recurrence of colorectal cancer: prognostic value of the MSI phenotype.

Background: Some patients have isolated lumboaortic and/or iliac lymph node recurrences (ILNR) of colorectal cancer. Current guidelines recommend the use of chemotherapy. The aim of our study was to assess the carcinological results of lymphadenectomy for ILNR and to identify prognostic factors that may be used to select patients for this aggressive surgical approach.

Multiple stomas for recurrent life-threatening gastrointestinal bleeding: report of a case.

Acute lower gastrointestinal hemorrhage is an uncommon and severe symptom. The overall mortality rate ranges from 5 to 12 percent and can approach 40 percent for persistent or recurring bleedings. We report a case of a patient with severe recurrent lower bleeding in whom, despite several repeated explorations and a blind subtotal colectomy, no lesion could be found.

Long-term results of intersphincteric resection for low rectal cancer.

Introduction: In the treatment of very low rectal cancer, a distal resection margin of more than 1 cm can be obtained by partial internal sphincteric resection, allowing a sphincter preserving surgery. Thus, intersphincteric resection (ISR) has been proposed as an alternative to abdominoperineal resection for selected low rectal cancer.

Objective: The aim of our study was to assess the morbidity, mortality, and the long-term oncologic and functional results of ISR.

[Acinar cell carcinoma of the pancreas with predominant intraductal growth: report of a case].

Acinar cell carcinoma (ACC) of the pancreas accounts for approximately 1% of all exocrine pancreatic tumours. We report a rare form of ACC in a 66-year-old man. This tumour was revealed by epigastric pain and weight loss.

Implication of MYH in colorectal polyposis.

Objective: The aim of this study was to determine the frequency of MYH mutations in one large population of polyposis patients without APC mutation identified.

Summary Background Data: Familial adenomatous polyposis (FAP) is the most known inherited colorectal cancer syndrome. In 70% to 80% of polyposis patients, an APC mutation is found.

Coloanal sleeve anastomosis (Soave procedure): the ultimate treatment option for complex rectourinary fistulas.

Purpose: Acquired rectourinary fistulas represent a therapeutic challenge. Multiple previous unsuccessful procedures increase the difficulty of successful repair, leaving many patients with no option other than permanent urinary and/or fecal diversion. We report our experience with coloanal sleeve anastomosis (Soave procedure) as a salvage procedure for complex rectourinary fistulas.

The effect on morbidity of mesentery lengthening techniques and the use of a covering stoma after ileoanal pouch surgery.

Purpose: A tension-free anastomosis in a restorative proctocolectomy requires sufficient length of small-bowel mesentery. To ensure adequate length, it has been proposed that the superior mesenteric artery be divided and the right colon marginal vascular arcade be preserved. This study was designed to evaluate the influence of mesenteric lengthening techniques on the need for a stoma and on early outcomes after restorative proctocolectomy.

Palliative surgery for unresectable pancreatic and periampullary cancer: a reappraisal.

This study aimed to reappraise short-term and long-term results of palliative biliary and gastric bypass surgery in patients with unresectable pancreatic head carcinoma found at explorative laparotomy. We retrospectively analyzed 83 consecutive patients whose pancreatic head carcinoma appeared unresectable at laparotomy (vascular involvement [57%], liver metastases [24%], distant metastatic lymph nodes [11%], peritoneal implants [8%]) and who underwent palliative surgical concomitant biliary and gastric bypass. Postoperative mortality and morbidity rates were 4.

Assessment of MRI and MRCP in diagnosis of biliary cystadenoma and cystadenocarcinoma.

Magnetic resonance imaging (MRI) and magnetic resonance cholangio-pancreatography (MRCP) features were analyzed in the diagnosis of seven surgically resected hepatobiliary cystic tumors with reference to histopathological data. Homogeneity, size, location, signal intensity, presence or absence of septa and/or nodules and MRCP features of the lesions were studied. Histological evidence demonstrated six biliary cystadenoma (BCA) including four pseudo-ovarian stroma (POS) and one biliary cystadenocarcinoma (BCAC).

Lymph node metastases of prostatic adenocarcinoma in the mesorectum in patients with adenocarcinoma or villous tumor of the rectum with collision phenomenon in a single lymph node: report of five cases.

Purpose: Lymph node involvement is the most important prognostic factor when staging patients with rectal cancer. Cancer originating from sites other than rectum rarely may metastasize to the mesorectum. We report five patients with metastatic prostatic carcinoma to mesorectal lymph nodes, with the "collision phenomenon" in one lymph node.

Malignant deciduoid mesothelioma: a diagnostic challenge.

Malignant deciduoid mesothelioma, a rare phenotype of epithelioid mesothelioma, arises more commonly from the peritoneum of young women, but it is also reported in the pleura of elderly people. We report a case of malignant deciduoid mesothelioma that occurred in a 41-year-old woman after cesarean section and was initially misdiagnosed as pseudotumoral deciduosis. Microscopically, the tumor was entirely composed of deciduoid areas, and only scattered tumor cells were positive for calretinin and keratin 5/6.

Colonic J-pouch-anal anastomosis for rectal cancer: a prospective, randomized study comparing handsewn vs. stapled anastomosis.

Purpose: Colonic J-pouch-anal anastomosis performed after complete proctectomy and total mesorectal excision for adenocarcinoma of the rectum can be handsewn or stapled. Stapling the coloanal anastomosis is believed to shorten operating time and reduce morbidity, but there are no randomized trials comparing the techniques.

Methods: Between January 1999 and May 2001, all patients with rectal adenocarcinoma requiring total mesorectal excision were randomized intraoperatively to handsewn or stapled anastomosis.

Ex vivo sentinel lymph node mapping in colorectal cancer.

Introduction: Sentinel lymph node mapping has been used in clinical work in malignant melanoma and breast cancer and shown an advantage over routine regional lymphadenectomy. The technique has been applied to colorectal cancer, but concerns over accuracy and high false-negative rates have restricted its use in the routine clinical setting. Most published series have used the in vivo technique and only three studies have been published in which the ex vivo technique was used.

Intensive systemic chemotherapy combined with surgery for metastatic colorectal cancer: results of a phase II study.

Purpose: To evaluate the efficacy and tolerability of the metastatic irinotecan plus oxaliplatin (MIROX) strategy (adjuvant FOLFOX-7 followed by FOLFIRI), in patients with resectable metastatic colorectal cancer.

Patients And Methods: Forty-seven patients with resectable metastases of colorectal cancer were prospectively enrolled onto this study. Treatment consisted of six cycles of leucovorin 400 mg/m(2), oxaliplatin 130 mg/m(2) in a 120-minute infusion, and fluorouracil (FU) 2,400 mg/m(2) in a 46-hour infusion, every 2 weeks (FOLFOX-7), followed by six cycles of leucovorin 400 mg/m(2), irinotecan 180 mg/m(2) in a 90-minute infusion, bolus FU 400 mg/m(2), and FU 2,400 mg/m(2) as a 46-hour infusion, every 2 weeks (FOLFIRI).

Cytoplasmic phospholipase A2 alpha overexpression in stromal cells is correlated with angiogenesis in human colorectal cancer.

In colorectal cancer, cyclooxygenase-2 (COX-2) overexpression in stromal cells induces angiogenesis through EP2 prostaglandin E2 receptor signaling. Cytoplasmic phospholipase A2 (PLA2) alpha preferentially hydrolyses arachidonic acid, which is the limiting substrate for prostaglandin production, from membrane phospholipids. We therefore investigated a possible relationship between cytoplasmic PLA2 and COX-2 overexpression in stromal cells, angiogenesis and microsatellite instability in 48 human colorectal adenocarcinomas.

Long-term outcome of familial adenomatous polyposis patients after restorative coloproctectomy.

Background: Restorative proctocolectomy (RPC) eliminates the risk of colorectal adenocarcinoma in familial adenomatous polyposis (FAP) patients, but desmoid tumors, duodenal, and ileal adenomas can still develop. Our aim was to assess the long-term outcome of FAP patients after RPC.

Patients And Methods: FAP patients who had RPC between 1983 and 1990 were contacted for interview and upper gastrointestinal (GI) and ileal pouch endoscopy.

Completion pancreatectomy for postoperative peritonitis after pancreaticoduodenectomy: early and late outcome.

Hypothesis: Completion pancreatectomy in patients with pancreatic leakage associated with postoperative peritonitis after pancreaticoduodenectomy is a viable salvage procedure.

Design: Retrospective analysis from a cohort of consecutive patients admitted between January 1, 1989, and December 31, 1999, for postoperative peritonitis originating from pancreaticojejunostomy leakage.

Setting: Tertiary referral center with surgical intensive care unit specializing in the treatment of intra-abdominal sepsis.

Functional results after the Orr-Loygue transabdominal rectopexy for complete rectal prolapse.

Purpose: The aim of this study was to assess functional results after Orr-Loygue transabdominal rectopexy for complete rectal prolapse.

Methods: Thirty-one consecutive patients operated on for complete rectal prolapse between 1995 and 1998 were evaluated preoperatively and postoperatively with regard to anal incontinence, constipation, evacuation difficulties, and overall satisfaction with a standardized questionnaire. Anal continence assessment was based on a clinical scoring system.

ABCB4 gene mutation-associated cholelithiasis in adults.

Background & Aims: We recently put forward arguments in favor of ABCB4 gene (adenosine triphosphate-binding cassette, subfamily B, member 4) defects as a risk factor for symptomatic cholelithiasis in adults. In this study, we characterized ABCB4 gene mutations in a series of patients with symptomatic cholelithiasis to determine the genetic basis and the clinical phenotype of ABCB4 gene mutation-associated cholelithiasis.

Methods: We analyzed the entire ABCB4 gene coding sequences in a first group of 32 patients who had a clinical history compatible with the syndrome previously described, in a second group of 28 patients who presented with a classic gallstone disease that justified a cholecystectomy, and in a third group of 33 patients without a history of cholelithiasis.

Methods and results of sphincter-preserving surgery for rectal cancer.

Background: Sphincter preservation is the goal in the treatment of rectal cancer and should be considered in all patients with an intact sphincter. Sphincter preservation for tumors of the upper rectum is easily achieved, but surgical management of cancer of the mid and lower third of the rectum continues to evolve. Several recent advances may influence future treatment strategies.

Colonic J-pouch-anal anastomosis for rectal cancer.

Purpose: The purpose of this article is to review the different aspects of the colonic J-pouch reconstruction with special focus on functional results and complications.

Methods: A MEDLINE search from 1965 to the present with manual search for older articles was used as the basis of this review.

Results: Rectal reconstruction using a colonic J-pouch-anal anastomosis after excision of extraperitoneal cancers can be performed with acceptable morbidity and good functional results.