Fecal expression of Escherichia coli lysine decarboxylase (LdcC) is downregulated in E-cadherin negative lobular breast carcinoma.

Breast cancer is characterized by oncobiosis, the abnormal composition of the microbiome in neoplastic diseases. The biosynthetic capacity of the oncobiotic flora in breast cancer is suppressed, as suggested by metagenomic studies. The microbiome synthesizes a set of cytostatic and antimetastatic metabolites that are downregulated in breast cancer, including cadaverine, a microbiome metabolite with cytostatic properties. We set out to assess how the protein expression of constitutive lysine decarboxylase (LdcC), a key enzyme for cadaverine production, changes in the feces of human breast cancer patients (n = 35). We found that the fecal expression of Escherichia coli LdcC is downregulated in lobular cases as compared to invasive carcinoma of no special type (NST) cases. Lobular breast carcinoma is characterized by low or absent expression of E-cadherin. Fecal E. coli LdcC protein expression is downregulated in E-cadherin negative breast cancer cases as compared to positive ones. Receiver operating characteristic (ROC) analysis of LdcC expression in lobular and NST cases revealed that fecal E. coli LdcC protein expression might have predictive values. These data suggest that the oncobiotic transformation of the microbiome indeed leads to the downregulation of the production of cytostatic and antimetastatic metabolites. In E-cadherin negative lobular carcinoma that has a higher potential for metastasis formation, the protein levels of enzymes producing antimetastatic metabolites are downregulated. This finding represents a new route that renders lobular cases permissive for metastasis formation. Furthermore, our findings underline the role of oncobiosis in regulating metastasis formation in breast cancer.

Mesohepatectomy without hilar dissection in the treatment of malignant focal liver diseases.

BACKGROUND/AIMS: Mesohepatectomy is a method of surgical treatments for the centrally-located liver diseases. These operations were performed without hilar dissection by our modification and the results were evaluated. METHODOLOGY: Between 2000 and 2002 we performed eight modified mesohepatectomy in cases of central malignant tumors of the liver. Preoperative examinations were done by strict protocol. We performed the operation with CUSA US scalpel. On postoperative days 1, 3, 5 and 7, we monitored the patients' liver enzymes, bilirubin level and hemostasis factors. After recovering the patients received chemotherapy. Follow-up was done 3 and 6 months later. RESULTS: The time of operation and the blood consumption were significantly less with this modified technique comparing data found in the literature. The average tumor-free interval is 6.5 months, in five patients. CONCLUSIONS: On reflection of these data, we consider mesohepatectomy performed without hilar dissection to be a suitable method for the treatment of centrally-located tumors. Postoperative morbidity rate is of a similar degree to that of operations using prior dissection, and the advantageous effects of parenchyma sparing mesohepatectomy are retained.

Laparoscopic treatment of nonparasitic hepatic cysts.

BACKGROUND: We present our experience with laparoscopic deroofing of nonparasitic hepatic cysts. METHODS: Laparoscopic deroofing was performed due to a solitary hepatic cyst in 21 patients and polycystic liver in four patients. Laparoscopy was indicated when a cyst was larger than 5 cm (the general size of cysts was 6.9 cm) and caused complaints and was in a superficial position. In eight patients in whom the cyst was larger than 10 cm, omentoplasty was performed. RESULTS: Intraoperative complications were not detected. Two conversions were performed because of the deep position of the cyst. Postoperative bile leakage was detected in one case that was treated conservatively. The average hospital stay was 4.7 days. Relapse occurred in two patients (8%), but only one of them required a second operation. CONCLUSIONS: We recommend laparoscopic deroofing for treatment of nonparasitic liver cysts. This operation causes only slight discomfort for the patients, the intra- and postoperative morbidity is low, and relapses are rare.

Simple reconstructive method in cases of duodenum-preserving subtotal resection of the head of pancreas.

BACKGROUND/AIMS: Surgical treatment of chronic pancreatitis is either by ductal decompression, or resection of the pancreas. Among various resection operations the duodenum preserving resection of the head of pancreas is the newest surgical technique. This paper describes substances of our modified reconstructive method following resection of the pancreatic head, and the results of this procedure. METHODOLOGY: Duodenum preserving resection of the head of pancreas with a simple modified reconstruction was performed in 21 patients with chronic pancreatitis. Early and late results are herein evaluated. RESULTS: There was no mortality. The rate of complication was 28.5%. Considering late results, complete pain relief was achieved in 80% of patients. Body weight was unchanged in 50%, decreased in 15% and gained in 35% of patients. Progression of endocrine dysfunction (rate of diabetes mellitus and glucose tolerance impairment) was observed to a small degree two years (average follow-up) after the operation. CONCLUSION: Our procedure can be applied in the treatment of chronic pancreatitis, with low risk and relatively good late results.

Technique and results of duodenum-preserving resection of the head of the pancreas in the treatment of chronic pancreatitis.

Surgical treatment of chronic pancreatitis is either by ductal decompression or resection of the pancreas. Among various resection operations the duodenum preserving resection of the head of the pancreas is the newest surgical technique. At the 2nd Dept. of Surgery of Debrecen Medical University duodenum preserving resection of the head of the pancreas with simple modified reconstruction was performed in 22 patients with chronic pancreatitis. The authors evaluate the early and late results: there was no mortality. The rate of complication was 27.2%. Considering late results complete relief of pain was found in about 80% of patients. The authors suggest that this type of resection can be well applied in the treatment of chronic pancreatitis with low risk and relatively good late results.

The role of different tumor markers in the early diagnosis and prognosis of pancreatic carcinoma and chronic pancreatitis.

The examination of tumor markers in the diagnosis and in the evaluation of progression of tumors has got an increasing significance. The serum level changements of three tumor markers (CEA, CA 19-9, CA 125) were examined before and after the operation in 94 patients operated for pancreatic carcinoma (PC) and chronic pancreatitis (CP) between March 1994 and December 1996 at the 2nd Dept. of Surgery of Debrecen Medical University. From the patients 62 were operated for carcinoma, in 19 cases the tumor was resectable, 43 patients had palliative operation. In 32 patients ductal decompression was performed because of CP. The authors evaluate the serum level changements of the three tumor markers examined in three groups of patients before and after the operation. In conclusion CA 19-9 is the most sensitive marker of PC, the sensitivity was 77.4%, the specificity was 87.5%. CEA and CA 125 are not as sensitive markers of PC as CA 19-9, while CEA and CA 125 serum levels are both increased in half of the patients with chronic pancreatitis.

Surgical treatment of pancreatic head and periampullary tumors.

The aim of this study was the comparison of the postoperative results of standard Whipple pancreatoduodenectomy (WP), pylorus preserving pancreatoduodenectomy (PPPD) and palliative bypass operation performed for treatment of pancreatic head and periampullary tumors. In the period from Jan. 1992 to 1996 106 patients had tumors located in the head of pancreas and 21 patients had periampullary tumors. The diagnosis was established by ERCP, transabdominal ultrasonography and computer tomography. We assessed the morbidity, mortality, prognostical data of the surgery of pancreatic head and periampullary tumors. Tumor markers such as CEA, CA 19-9 and CA 125 were also studied. The operability rate was 26% in case of pancreatic head tumors and 69% in peri ampullary tumors. The mortality rate was 6%. Postoperative complications were in 23 patients(18.1%). There was no significant difference between the survival of WP and PPPD group, but we found much better survival in patients with periampullary tumor. After palliative operation the survival rate was 6.1 months in case of pancreatic head carcinoma and 11 months in case of periampullary tumors. Our data provided many evidences about the advantage of PPPD in the patients with malignant periampullary and pancreas head tumors and the long-term results and quality of life is much better after PPPD.

Monitoring of gastric acidity following ductal decompression surgery for chronic pancreatitis.

The accepted decompression methods of chronic pancreatitis are the longitudinal pancreaticogastrostomy and the conventional pancreaticojejunostomy. The aim of the present study was to estimate the effect of these types of drainage operations on gastric acidity and to evaluate the clinical results. Between Jan. 1992 to 1996 56 patients with chronic pancreatitis were selected into the investigation who were operated in our clinic. A 24 hour gastric monitoring was taken on every patient before and 6 weeks after the operation. Following a complete postoperative check up we found that both types of operations are effective for pain relief (71%). Retrospectively 83% of the patients had no digestive problems due to pancreatic enzyme substitution. According to our statistical evaluation of 24 hour gastric pH monitoring test no alteration was detected in gastric pH in both groups pre- and postoperatively. On the basis of pH measuring and evaluated data we consider that pancreaticogastrostomy is a good operation choice to relieve intractable pain in selected patients with chronic pancreatitis associated with duct dilatation.

Effect of glucagon and somatostatin on pancreatic secretion in dogs.

The authors investigated the effects of glucagon and a somatostatin preparation (Stilamin) on the secretion volume and on the secreted and absorbed enzyme levels of the pancreas. Four groups of dogs with an artificial pancreatic fistula were given a single intravenous injection of glucagon (group I, n = 8), intravenous drip-infusion of glucagon (group II, n = 8), intravenous drip-infusion of somatostatin (group III, n = 10) and intravenous drip-infusion of the carrier fluid, physiological sodium-chloride (control, group IV, n = 5), respectively. Pancreatic juices were collected and volume, pH, bicarbonate, amilase, lipase, trypsin and protein contents were determined. Serum amilase and lipase levels before and at the termination of the experiment were also measured. Intravenous drip-infusion of both Glucagon and Stilamin decreased pancreatic secretion, Stilamin being more effective than Glucagon. On the other hand, a single i.v. injection of Glucagon resulted in an increased secretion. The authors suggest that based on the observed inhibitory effect on pancreatic secretion, both glucagon and somatostatin could be used to reduce postoperative complications of pancreatic operations in the clinical practice.