Coexistence of perineural invasion and lymph node metastases is a poor prognostic factor in patients with locally advanced rectal cancer after preoperative chemoradiotherapy followed by radical resection and adjuvant chemotherapy

To determine the role of lymph node metastases [ypN] and perineural invasion [PNI] in patients with locally advanced rectal cancer [LARC]. Eighty-eight LARC patients receiving preoperative chemoradiotherapy from April 2006 to November 2011 were enrolled in this study. Univariate and multivariate analyses were conducted to determine the association between clinicopathologic features and clinical outcome. The presence of ypN [p = 0.011] and PNI [p = 0.032] was a significant adverse prognostic factor for disease-free survival [DFS]. High histologic grade [p = 0.015], PNI+ [p = 0.043] and ypN+ [p = 0.041] were adverse prognostic factors for overall survival [OS]. Positive PNI was significantly associated with a higher risk of distant failure [odds ratio = 6.09; 95% CI: 1.57-27.05; p = 0.008]. Moreover, patients with a coexistence of ypN+ and PNI+ had the significantly worst DFS [p < 0.001] and OS rates [p < 0.001] compared with other phenotypes. The presence of either PNI or ypN was a significant prognostic factor for predicting poor survival rates in LARC patients, especially those with a coexistence of both factors. Accordingly, we recommend an intensive follow-up and therapeutic programs for LARC patients with simultaneous PNI+ and ypN+

Intramural duodenal hematoma and hemoperitoneum in anticoagulant therapy following upper gastrointestinal endoscopy

To report the unusual occurrence of intramural duodenal hematoma in a case on anticoagulant therapy, presenting as a complication of gastrointestinal endoscopy. A 74-year-old female patient developed nausea, vomiting and abdominal pain, and subsequently hypovolemic shock, 2 days after fiberoptic upper gastrointestinal endoscopy. The patient's international normalized ratio value was 2.7. A computed tomographic scan of the abdomen demonstrated duodenal wall thickening with intramural hematoma, as well as hematoma in the pararenal space and pelvic cavity. The patient was treated by conservative treatment that included correction of clotting abnormalities, blood transfusion, nasogastric decompression, hydration, and parenteral nutrition support. She resumed oral intake after 10 days of support treatment, recovering uneventfully. This case shows the possibility of development of an intramural duodenal hematoma in patients on anticoagulant therapy, without biopsies being taken