Prognostic value of CA 19-9 level in resectable pancreatic adenocarcinoma.

The prognosis in patients with pancreatic cancer is poor and some authors describe it as a lethal disease. At the time of diagnosis only 14% of patients could be surgically treated and up to 30% of them die within 12 months. Therefore, further clinical investigations on preoperative patient qualification are needed. A total of 81 patients were included into the study. The CA 19-9 concentration was measured before surgery by an automated, commercially available enzyme immunoassay in Axsym analyzer (Abott Diagnostics Laboratory). A value of 37 U/ml was used as the upper limit of normal levels. Tumors were staged according to the Union Against Cancer (UICC) of 2004 and graded during the histological evaluation according to the G0-G4 scale. All patients were monitored every three month via outpatient clinic visits. In the case of missing visit we contacted the families to establish the cause. We assessed perioperative, 12 month, 2 year and 5 year survival. Twelve moth, 2 year and 5 year survival were assessed in the whole studied population and in the group of patients with the exception of these who died during the perioperative period. The total five year survival was 6%. The median time of survival was 467 days (range: 163 - 586 days). The perioperative period was survived by 91.4% patients, 12 months were survived by 71.6% patients, 2 years were survived by 35.8% patients, 5 years were survived by 6.2% patients. The serum Ca 19-9 level was above the normal limit in 80.5% patients. ROC curve analysis revealed that CA 19-9 level of more than 106 U/ml was linked to 2 year survival with 79.3% sensitivity and 74.5% specificity. Preoperative level of CA 19-9 below 106U/ml represents a predictive factor of 2- and 5-year survival, independent of other factors, such as lower size of the tumor, absence of metastases to lymph nodes, female gender of patients. After exclusion of the patients who died in the perioperative period, no relationship could have been disclosed between preoperative CA 19-9 levels and one year survival. The observation points to the chance that patients with higher levels of CA 19-9 harbour micrometastases, the development of which is sufficiently slow to allow for a one-year survival of the patients but which increase the risk of death after two and five years.

The importance of preoperative elevated serum levels of CEA and CA15-3 in patients with breast cancer in predicting its histological type.

It is not known whether in patients with breast cancer the occurrence of elevated serum tumour markers depends on its histological type. The aim of the study was to assess relationship between breast cancer histological type and the presence of increased serum levels of CEA and CA 15-3. The study population was 428 patients (all women, mean age 52.5 years), treated at The Department of Surgery of Wroclaw Medical University from 2005 to 2008 due to breast cancer. All of them had their preoperative CA 15-3 and CEA serum concentrations measured. According to the TNM system, 21% of patients were in stage I, 32.5% in stage II, 46.5% in stage III of the disease. In patients with ductal type of the cancer the elevated serum levels of CEA and CA 15-3 were observed in 48.7% and 42.2%, in lobular type in 42.4% and 52.5%, and in non-ductal/tubular types in 48.1% and 40.4% (p=N/S). Stepwise logistic regression analyses showed that ductal breast cancer is related to elevated CEA and normal CA 15-3 serum levels. The histological types of breast cancer are not significantly related to elevated serum levels of CEA and/or CA 15-3.

Surgical and endoscopic treatment of pancreatic pseudocysts.

Not long ago surgery was the only way to treat pancreatic pseudocysts that would not resolve spontaneously. Nowadays minimally invasive methods are gaining popularity, such as percutaneous drainage, endoscopic cystogastrostomy or cystoduodenostomy, and endoscopic transpapillary drainage. The aim of this study was to evaluate these methods in comparison with conventional surgery for pancreatic pseudocysts. From March 1997 to July 2000 we treated at the 2nd Dep. of Surgery, Wroclaw Medical University, 52 patients with pancreatic pseudocysts. 30 patients were treated surgically, 15 endoscopically, and 7 medically. For endoscopic treatment we chose patients with "mature" pseudocysts, with a distinct capsule on ultrasonography, adherent to the posterior wall of the stomach, clinically sterile, at least 5-15 cms in diameter. The endoscopic criterion was the appearance of the cyst bulging into the stomach. Surgical treatment was applicable for those patients who had no positive evidence of a direct contact of the pseudocyst and the stomach, those with cysts infected, multiple or filled with dense fluid. The observed complications (infection of the cyst and bleeding) are typically reported for the treatment of pancreatic pseudocysts. The single complication in the form of an inflammatory tumor of the pancreas was probably due to undiagnosed pancreatic necrosis. There was zero mortality in our group. In our opinion endoscopic cystogastrostomy with a double pigtail stent is a valuable alternative to conventional surgery and in selected cases can be the method of choice for the treatment of pancreatic pseudocysts. Conventional surgical methods of treatment still remain valid. They are often less hazardous as they allow full visual evaluation of the cyst and its neighbourhood (for the signs of necrosis). Surgical drainage provides secure anastomosis of the cyst with the GI tract and hemostasis, which may be vital in some cases.

[Evaluation of the results of treatment of cancer of the large intestine based on our clinical data]. / Hodnocení výsledku lécby rakoviny tlustého streva na základe vlastního materiálu.

Results of the treatment of 225 patients operated between 1991-1995 on the colorectal carcinoma in the II Clinic of Surgery, Medical Academy Wroclaw are evaluated. The analysis of the own material covers the tumor site, age of the patients, histologic grade and clinical stage according to Dukes. The type of surgical procedure--curative or palliative and the evaluation of the survival, death and recurrence rate is presented. Curative procedures were possible only in approximately 60% of cases. The Dukes stage C and D was established in 55.5% of the operated patients. Authors believe that such a significant number of advanced cases was the reason of so poor results. In conclusion they suggest to introduce screening tests for early detection of colorectal carcinoma.

Cysteine peptidase inhibitors and activator(s) in urine of patients with colorectal cancer.

The total activity of cysteine peptidase inhibitors and activator(s) was determined in the samples of urine received from colorectal cancer patients. Patients with peptic ulcer and healthy volunteers agreed to be a control group. The studies revealed a marked difference between the values of the determined parameters for the patients with colorectal cancer and those for the control group. Determination of cysteine peptidase inhibitors in patient's urine is proposed as a new diagnostic procedure.

[Late results of esophageal prostheses created from intestinal grafts]. / Pozdní výsledky jícnových protéz ze strevních stepu.

During the last 30 years, 280 retrosternal esophageal replacements from stem intestinal grafts were performed at GIT Surgery Clinic AM in Wroclav. Both clinical and auxiliary investigations showed the small intestine grafts have been of the best function as to the food passage. In esophagi made from the large intestine, the following and mostly frequent changes occur: the dilatations of their lumina, the stop of food passage and inflammatory changes varying in both the degree and extent. Inflammatory changes as well as ulcers are rather difficult to detect by radiology. Through the last years, the Second Clinic of General Surgery AM in Wroclav provides endoscopy of artificial esophagi. Being sophisticated, this approach is of benefit in early determining pathologic changes in the esophageal wall, the collection of contents for biochemical tests, tissue biopsies for histology and the initiation of appropriate therapy.

[Circulating immune complexes in chronic thrombocytopenic purpura in adults before and after splenectomy]. / Krazace kompleksy immunologiczne w przewleklej maloplytkowosci samoistnej doroslych przed i po splenektomii.

Circulating immune complexes (cic) were determined by means of the immunoenzymatic method in a group of 16 adults with immune thrombocytopenic purpura (ITP) before and after splenectomy. The recurrence of immune thrombocytopenic purpura after splenectomy was observed in 9 patients, in 6 out of them there co-existed non-specific inflammatory process and cic were present in the serum. In 7 patients in whom the number of thrombocytes after splenectomy was normal, no circulating immune complexes were found. A significant decrease in the medium level of IgM after splenectomy should be attributed rather to splenectomy than to the consuming of IgM in the formation of circulating complexes. The role of circulating complexes in the pathogenesis of ITP in adults still remains not fully solved, but the authors' experience suggests that non-specific inflammatory processes may lead to their appearance.