Carcinoembryonic antigen immunoereactivity patterns and tumour morphologic parameters in patients with colorectal cancer

The cellular expression of carcinoembryonic antigen [CEA] was studied immunohistochemically in 98 colorectal cancer specimens. The tumours were categorized into three groups according to the predominant staining pattern, which was either apical [26 cases], cytoplasmic [47 cases] or stromal [25 cases]. A significant correlation was found between CEA immunoreactivity patterns and either, the histologic grading [P < 0.001], nuclear grading [P < 0.001], mucin synthesis [P < 0.01], blood and lymph vessels invasion [P < 0.01], lymph nodes metastases [P < 0.01] or the number of the lymph nodes involved [P < 0.01]. So, well-differentiated tumours generally showed an apical CEA pattern, poorly differentiated tumours showed a stromal CEA pattern, whereas most moderately differentiated tumours showed a cytoplasmic CEA pattern. No statistically significant correlation was noted between CEA immunoreactivity patterns and the age and sex of the patients, location or gross appearance of the tumours or Dukes' classification. However, an inverse relationship was noted between CEA staining patterns and the size of tumours. We conclude that CEA immunoreactivity patterns can provide more data that are relevant for the prognosis of colorectal cancer. However, we advise a longer follow-up of the patients to study the relation between CEA patterns and both tumour recurrence and survival of the patients

Cryosurgical drainage of hepatic abscess

Thirteen cases of hepatic abscess were diagnosed by CT examination. In 5 of them, CT-guided percutaneous catheter drainage failed to cure the condition-because of failure to drain a multilocular abscess in two cases, inability to drain thick pus in two cases and recurrence of the abscess in the fifth. All the 13 patients were operatively treated using the cryocone. There was no mortality among these patients. Two patients developed septicaemia which was successfully treated, white another two patients developed wound infection. No cases of subphrenic or subhepatic abscess or empyema were recorded. Follow-up for 3 months after surgery showed no evidence of abscess recurrence. The procedure is simple and requires no special skills and as it has proved to be very effective and relatively safe, we recommend its use for the treatment of hepatic abscess, if percutaneous drainage fails or if facilities or experience for percutaneous drainage are lacking. However, we advise management of more cases for proper evaluation of the procedure

Asymptomatic cholelithiasis concomitant with other abdominal surgical conditions: risk of additional cholecystectomy and fate of untreated gall stones

Forty-seven cases of asymptomatic cholelithiasis have been encountered during celiotomy for various abdominal conditions. Concomitant cholecystectomy was performed in 34 cases [72.3%], with operative cholangiography in 20 cases of them, while the common bile duct was explored with removal of stones in 4 cases. No mortality cases were recorded while, 3 patients [8.8%] developed wound sepsis and another 4 [11.8%] developed chest problems. No cases of subphrenic abscess, retained CED stones, biliary fistula or burst abdomen were encountered. Cholecystectomy was not performed in 13 cases [27.7%], because of failure to appreciate the presence of gall stones, unstable condition of the patients, short life expectancy or fear of spread of infection. One patient was lost to follow-up, while 10 patients [83.3%] developed various biliary problems within one year after the primary operation. Four of them developed acute cholecystitis with one in the early postoperative period. In another 5 cases, cholelithiasis became symptomatic with development of obstructive jaundice in one of them. The tenth patient developed acute haemorrhagic pancreatitis, however he died despite of early surgical intervention. We conclude that, if asymptomatic gall stones are encountered during celiotomy for other conditions, cholecystectomy should be carried out unless specific contraindications exist, as it adds minimal morbidity to the primary procedure. Left untreated, cholelithiasis becomes symptomatic in most patients and may cause serious biliary problems and this can lead to subsequent operation which may require a more extensive procedure producing a greater morbidity

Oesophagomyotomy with partial fundoplication for achalasia of the cardia

Twelve patients with achalasia of the cardia were surgically treated over a four-year period. The diagnosis was established through clinical, radiological and endoscopic findings, while oesophageal manometry was performed in 9 cases. All patients underwent oesophagomyotomy with; anterior partial fundoplication in 5 cases and posterior partial fundoplication in 7 cases. There were no peri-operative mortality or significant morbidity among these patients. One year after surgery, the outcome was excellent in 8 cases [66.7%] and good in 3 cases [25%] while, one patient with mega-oesophagus failed to improve and underwent oesophageal resection and colonic replacement. Postoperative radiological studies showed non-reflux of barium in the examined cases while, oesophageal manometry revealed the presence of a small high pressure zone in the 8 cases examined, that mostly prevented the reflux but did not cause postfundoplication oesophageal obstruction. Follow-up [mean +/- s.e was 2.4 +/- 0.2 years] revealed no cases of recurrent dysphagia or symptomatic gastro-oesophageal reflux. The success rate of this series was 91.7% and as the procedure is simple, needs no special skills and obviates the need for thoracotomy or to excise part of the oesophageal muscle, we recommend it as a primary management of achalasia of the cardia

Obstructive jaundice caused by intrabiliary rupture of hydatid cysts

Seventeen patients with obstructive jaundice due to intrabiliary rupture of hydatid cysts were surgically treated during a three-year period. The diagnosis, though suspected clinically was confirmed by ultrasonogrophy and established at operation. The principles of management are the surgical treatment of the cyst and drainage of the biliary tree. Endocystectomy and closure of the biliary communication were performed in all cases. The cyst cavity was externally drained in 13 cases [76.5%] and packed with omentum in 4 cases [23.5%]. The common bile duct was drained by a [T] tube in 5 cases [29.4%] by choledochoduodenostomy in 12 cases [70.6%]. Cholecystectomy was performed in 10 cases [58.8%]. Sixteen patients had an uneventual recovery, while one patient died 3 days after surgery because of septicaemia [the mortality rate was 5.9%]. One patient treated by [T] tube drainage of the CBD developed persistent biliary discharge after tube removal, while the other 4 developed recurrent obstructive jaundice within 4 months after surgery. All these patients required further surgery, where choledochoduodenostomy was performed in 3 cases and sphincteroplasty in the other two. In contrast, all survivors treated by choledochoduodenostomy did not develop recurrent biliary obstruction throughout the follow-up period [one year after surgery]. So, we conclude that, although intrabiliary rupture of hydatid cysts of the liver is a life-threatening problem due to the associated obstructive jaundice and cholangitis, it can be efficiently managed by prompt surgical intervention with establishment of permanent biliary drainage by a wide choledochoduodenostomy We also recommend routine cholecystectomy as a part of the operative procedure because of the high incidence of postoperative acute cholecystitis in such cases [5 out of 7; 71.4%, within 6 months after surgery]