Ampullary cancer in a patient with familial adenomatous polyposis - a rare case report and current status of management.

Familial adenomatous polyposis (FAP) is an inherited autosomal dominant disorder. Extracolonic manifestations are seen quite often. As prophylactic colectomy has become a standard care in FAP patients, the concerns over the development of associated extracolonic malignancies have become more prevalent. The authors report a case of a patient with the history of subtotal colectomy because of FAP with the development of adenocarcinoma of papilla of Vater twenty-six years later. A radical procedure in form of proximal pancreaticoduodenectomy was indicated. Variable endoscopic surveillance protocols and treatment strategies have been proposed concerning the management of duodenal and periampullary lesions. In case of periampullary malignancies, the radical surgical resection offers the only chance for cure and the only option that may safeguard the long­term survival (Fig. 2, Ref. 30). Keywords: ampulla of Vater, bile duct, obstructive jaundice, pancreatoduodenectomy, periampullary tumors.

Endoscopic treatment of praecancerous colorectal lesions and early colorectal cancer.

Endoscopic mucosal resection or piece meal polypectomy are the methods of choice for the treatment of unifocal visualized lesion. Thermal ablative techniques are indicated for flat adenomas as a adjunct therapy after an imcomplete EMR or piece meal polypectomy. Photodynamic therapy using ALA photosensitisation is effective in the treatment of multifocal lesions and also in combination with EMR or thermal ablative techniques. At present, the "tailored suite" combination of these techniques for each patient, according to the character of the lesions, is considered to be the most effective treatment of precancerous lesions and early colorectal cancer (Tab. 1, Fig. 2, Ref. 16). Full Text (Free, PDF) www.bmj.sk.

Consideration of endoscopic retrograde cholangiopancreatography in cases of acute biliary pancreatitis.

AIM: The important question to be answered in all cases of ABP is whether or not a calculous biliary obstruction is still present. Answering this question conditions subsequent management, including the need for endoscopic retrograde cholangiopancreatography (ERCP). The aim of this study was to determine the relationship between persistent common bile duct stone (CBDS) and laboratory values, and dilation of bile duct in order to find possible significant associations in patients with acute biliary pancreatitis (ABP). METHODS: Retrospectively, statistical evaluation of a group of 76 patients with ABP who had received early ERCP. RESULTS: The prevalence of choledocholithiasis in patients > 70 years old was 54.2%, in patients < or = 70 years old it was 36.5%. Following cholecystectomy, CBDS was present in 81.8% of patients, p = 0.005. The probability of CBDS occurrence in patients > 70 years old with bile duct dilation was 81.3%; in the absence of bile duct dilation CBDS was not present, p < 0.001. The probability of CBDS occurrence in patients 70 years old with bile duct dilation was 57.7%, in the absence of bile duct dilation CBDS was present in 15.4%, p = 0.002. In patients with bile duct dilation predictive factors are as follows: bilirubin (Bi), after excluding patients with acute cholecystitis and cholangitis, p = 0.05; alanine aminotransferase (ALT) in patients 70 years old, p = 0.004; gamma-glutamyl transferase (GMT) in patients > 70 years old, p = 0.02. CONCLUSIONS: ERCP is indicated in patients with ABP if biliary obstruction is present and the presence of a ductal stone is suspected. From our results it is clear that the predictive parameter for choledocholithiasis is the dilation of the bile duct and previous cholecystectomy. In patients with bile duct dilation possible predictive factors are Bi, ALT, and GMT (Tab. 1, Fig. 8, Ref. 20).

Barrett's esophagus.

Patients with Barrett's esophagus have 30-40 times higher risk of developing adenocarcinoma of distal esophagus. Treatment of Barrett's esophagus without dysplasia is identical with treatment of gastroesophageal reflux disease. (Tab. 1, Ref. 5.).

Etiology, epidemiology and diagnosis of esophageal cancer.

The data from the National Cancer Registry in Slovakia showed 306 esophageal cancers in 1999 (288 men and 18 women). There has been a 5-fold increase in the incidence of esophageal cancer among men in the past 30 years as compared to women in whom no significant chance occurred. The reported 1999 raw incidence of esophageal cancer (per 100000) was 11.0 and 0.6 among men and women in Slovakia, respectively. (Tab. 1, Ref. 8.).

Laser and photodynamic therapy for esophageal cancer.

Esophageal cancer has a poor prognosis. The diagnosis in clinical practise is often made in advanced stages when curative treatment is impossible. Overall five year survival is reached only in 10% of patients and a palliative treatment is indicated in 60% of patients. From these patients one year survival could be observed in 55% and five year survival only in about 20% of patients. Progressive dysphagia is responsible for the poor quality of life. (Ref. 4.).

Endoscopic ultrasound in esophageal cancer.

The first prototype of an endoscopic ultrasound (EUS) was constructed in Japan in 1980. The evolution continued quickly and within the past ten years this method became available in routine practice. One of the most significant indications of EUS in esophagus are locoregional staging and posttherapeutic monitoring of the esophageal cancer. (Ref. 4.).

Palliative endoscopic therapy of esophageal cancer: self-expanding stents.

Esophageal cancer is the tenth most common malignancy. Recently, there has been an increase in the incidence of carcinoma of distal esophagus. Unfortunately, early esophageal cancer is commonly asymptomatic and inaccessible to examinstion during regular physical examination. Thus, high percentage of patients present with advanced disease at the time of diagnosis. Main symptom are nutritional deficiencies, dysphagia, pressure in the epigastrium and commonly, blood loss. (Tab. 1, Fig. 1, Ref. 4.).

[Peritoneal catheters in the treatment of continuous peritoneal dialysis (CAPD)]. / Peritoneálny katéter v liecbe kontinuálnou peritoneálnou dialýzou (CAPD).

Continual ambulatory dialysis (CAPD) is used during the last five years with increasing frequency in the treatment of patients with chronic renal failure. In some countries already a very high proportion of patients is treated by this method, e.g. in Great Britain about 50%. A decisive influence in the design of peritoneal catheters (PC) and improvement of the exchange system of bags with the dialyzatin fluid. The most important step in the development of the peritoneal catheter was the introduction of a dacron cuff in the intramural portion of the catheter by Tenckhoff. The cuff is a strong barrier against penetration of infection into the abdominal cavity via the subcutaneous tunnel. There are many modifications of the design of the intraperitoneal part, however, they are not of such fundamental importance for the function of the PC as the dacron cuff. As regards implantation of the PC, in addition to the surgical insertion the laparoscopic method is being enforced. A new method is leaving the external portion of the PC in subcutaneous tissue for 3-6 weeks, as recommended by Moncrief and Popovich. This method reduced the incidence of peritonitis after exteriorization of the PC.