A combined laparoscopic and endoscopic approach for the removal of a gastric foreign body. A case report and review of the literature.

BACKGROUND AND AIM: Foreign bodies that are ingested and will not pass spontaneously through the gastrointestinal tract, need to be removed either endoscopically or surgically. Surgery will be required when endoscopy alone fails to retrieve the foreign body. In this study, we aimed to present our experience with an combined minimal invasive approach for the removal of a gastric foreign body and to review the medical literature on the complexities related to its management. METHODS: We report a successful technique represented by a combined laparoscopic and endoscopic approach for the retrieval of a gastric foreign body. A 51 year old male patient, with a longstanding psychiatric history, who ingested a folded bank card with suicidal purpose, had the foreign body removed using this combined minimal invasive approach. RESULTS: The operating time was 150 minutes, there was no blood loss and no perioperative complications. The patient fulfilled the discharge criteria on the 3rd postoperative day DISCUSSION : The approach for ingested foreign bodies should be considered for each patient independently, depending on the characteristics, location and existence of complications of the retained object. CONCLUSION: This combined minimal invasive technique is safe and feasible, with excellent results for the retrieval of large, non-malleable gastric foreign bodies. KEY WORDS: Endoscopy, Foreign body, Laparoscopy, Removal.

Predictors of 1-year postoperative mortality in radical colon cancer surgery.

AIM: The aim of this study was to determine the impact of patient, tumor and surgery-related parameters on 1-year postoperative mortality in a cohort of patients operated in a single tertiary center. MATERIALS AND METHODS: The study included 605 patients diagnosed with colon cancer between January 2013 and December 2015 that underwent radical surgery in a tertiary center. Patient demographics, comorbidities, preoperative biological parameters alongside with tumor and surgery-related factors were prospectively recorded and then analyzed in relation 1-year postoperative mortality. RESULTS: One-year mortality rate in the study group was 10.9%. Independent risk factors in relation to 1-year mortality were advanced TNM stage (OR 3.10, 1.10 - 8.75 95% CI ), emergency surgery (OR 1.91, 1.11 - 3.74 95% CI ), location of the tumor in the ascending colon (OR 2.17, 1.32 - 3.57 95% CI ), multiorgan resections (OR 2.07, 1.15 - 3.74 95% CI), age over 63 years (OR 2.05, 1.16 - 3.62 95% CI) and the history of alcohol consumption (OR 2.058, 1.17 - 3.61 95% CI ). DISCUSSION: Postoperative complications are still being reported in colon cancer surgery, despite technological progress and constant research in the field. So far, factors that influence postoperative mortality have been mostly studied up to 30 days postoperatively. According to some recent papers, reporting 30-day mortality data can underestimate accurate communication of postoperative adverse events. Thus, 1-year mortality in colon cancer surgery could be a better indicator of the impact on surgery on postoperative period of this patients and factors that influence it should be well known. KEY WORDS: Surveillance, Colon cancer, 1-year mortality.

Solitary Langerhans histiocytosis of the orbit: case report and review of the literature.

Langerhans cell histiocytosis (LCH), previously known as "histiocytosis X", is a clinical entity characterized by abnormal proliferation of Langerhans cells, which exert a mass effect. Orbital involvement due to LCH is rare as a unifocal disease, seldom occurring outside the pediatric population. We report a case of a 21-year-old man with solitary LCH of the orbit depicted by magnetic resonance imaging (MRI) and diagnosed by histopathological examination.

Keratoacanthoma of the conjunctiva - case report and review of the literature.

INTRODUCTION: Keratoacanthoma (KA) is a relatively common, benign, rapidly growing and self-limiting squamous proliferation, which appears most frequently on the sun-exposed skin. The nature of KA and its relationship to squamous cell carcinoma (SCC) still represent one of the major debates in dermatopathology, as it is the truthfulness of such a diagnosis outside the skin. However, the tumor is now known to originate from the pilosebaceous units of the skin or from ectopic sebaceous glands of squamous mucous membranes, and to differentiate onto follicular isthmus÷infundibulum-like epithelium. CASE PRESENTATION: A 71-year-old man presented with a sore and red right eye, which on slit-lamp biomicroscopical examination revealed a dome-shaped lesion at the temporal inferior conjunctival limbus. After a thorough histopathological examination, a diagnosis of KA has been made, both after the initial tumor excision and after the relatively rapid recurrence. After the second intervention, no recurrence was observed over five years of follow-up, confirming the diagnosis. CONCLUSIONS: The peculiarity of the case stands in his exceptional rarity, being to our knowledge the first conjunctival KA reported in our country. In the light of current knowledge, the peculiar limbal location of all the conjunctival KAs reported in the literature raised the question of the possible role of limbal stem cells in the histogenesis of these tumors, similar to the pilosebaceous ones. The treatment of conjunctival KA remains the complete excision of the tumor, as it allows histopathological evaluation of the entire tumor and the exclusion of a KA-like SCCs or KAs with SCC component.

Raman spectroscopy as a detection and analysis tool for in vitro specific targeting of pancreatic cancer cells by EGF-conjugated, single-walled carbon nanotubes.

Single-walled carbon nanotubes (SWCNTs) were covalently linked to epidermal growth factor (EGF) proteins through an esterification process that was found to be responsible for the docking of SWCNTs on the human pancreatic cancer cells (PANC-1) surface, thus providing a mechanism for the enhanced delivery and internalization of the nanotubes. Micro Raman spectroscopy and enzyme-linked immunosorbent assay were used to evaluate the delivery process and kinetics of the SWCNTs. In vitro studies indicated that the delivery kinetics of SWCNT-EGF conjugates, at a concentration of 85 µg ml(-1), to the PANC-1 cell surfaces was significant in the first 30 min of incubation, but reached a plateau with time in accordance with the establishment of equilibrium between the association and the dissociation of EGF with the cell receptors. SWCNT-EGF conjugates could act as strong thermal ablation agents and could induce higher percentages of cellular death compared with the nontargeted SWCNTs alone.