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1.
Br J Biomed Sci ; 70(2): 47-50, 2013.
Article in English | MEDLINE | ID: mdl-23888604

ABSTRACT

Carcinoembryonic antigen (CEA), a marker for colorectal adenocarcinoma, can monitor disease progression and treatment response. This study aims to determine the accuracy of CEA in the detection and resectability of colorectal liver metastases. Patients with primary colorectal cancer were divided into three groups: resectable hepatic metastases (group 1), unresectable metastases (group 2), and disease-free cases (group 3). The CEA concentration was recorded pre- and post-hepatectomy in group 1 and on radiological confirmation of disease state in the other groups. It was expressed as median (95% confidence interval [CI]), with predictors of concentration determined. Group 1 (n=141) had pre-operative CEA of 8.9 (4.6-13.1), with 38.1% of patients being normal. Maximum tumour diameter correlated with CEA level (r=0.41, P<0.0001). Post-hepatectomy CEA was 2.3 (1.9-2.7; P<0.0001), with 81.1% of patients being normal. Group 2 (n=158) had CEA of 20.6 (9.4-31.9). Group 3 (n=361) had CEA of 2.0 (1.8-2.2). Sensitivity of CEA pre- and post-hepatectomy was 61.2% and 69.3%, respectively, while specificity was 79.8% for both groups. Concentration was elevated in hepatic colorectal metastases but is not a marker of resectability. A CEA reduction post-resection indicates that it may be used as an indicator of treatment response, while CEA is increased by tumour burden and lesion size.


Subject(s)
Adenocarcinoma/diagnosis , Carcinoembryonic Antigen/blood , Colorectal Neoplasms/diagnosis , Liver Neoplasms/diagnosis , Adenocarcinoma/blood , Adenocarcinoma/secondary , Adenocarcinoma/surgery , Adult , Biomarkers, Tumor/blood , Colorectal Neoplasms/metabolism , Colorectal Neoplasms/pathology , Colorectal Neoplasms/surgery , Databases, Factual , Female , Hepatectomy , Humans , Liver Neoplasms/blood , Liver Neoplasms/secondary , Liver Neoplasms/surgery , Male , Neoplasm Recurrence, Local/blood , Neoplasm Recurrence, Local/diagnosis , Neoplasm Staging , Retrospective Studies
2.
Eur J Surg Oncol ; 38(12): 1184-8, 2012 Dec.
Article in English | MEDLINE | ID: mdl-22883963

ABSTRACT

BACKGROUND: Since 2002, Positron Emission Tomography (PET-CT) has been considered to be an essential pre-operative investigation in the management of colorectal liver metastases (CRLM) in our institution. This study aimed to compare characteristics of hepatic metastases on PET-CT with post-operative histological findings and pathology of the primary tumour. METHODS: All patients with CRLM, who underwent surgical intervention from 2002 to 2008, were reviewed. PET-CT and pathology reports of hepatic resections and original colorectal resections were retrieved. Patient demographics, colorectal staging, number of metastases and their maximum diameter from both PET-CT and pathology reports were recorded. Values were expressed as mean (±SD). RESULTS: 141 patients were identified. The maximum diameter on PET-CT (4.2 ± 2.6) was similar to pathology (4.8 ± 3.6; p = 0.39), with significant correlation (r = 0.72, p < 0.0001). The number of lesions on PET-CT (1.6 ± 1.0) was similar to pathology (1.7 ± 1.3; p = 0.43) with significant correlation (r = 0.80, p < 0.0001). Mean SUV max was 9.22 (±4.39), with no correlation to lesion diameter (r = 0.25, p = 0.045), but significantly increased with decreasing differentiation (p = 0.01). CONCLUSIONS: PET-CT scanning accurately detected the number of lesions and their maximum diameter, with radiological evidence of poorer differentiation. Further studies of non-surgical patients are required to assess its overall accuracy.


Subject(s)
Colectomy , Colorectal Neoplasms/diagnostic imaging , Fluorodeoxyglucose F18 , Hepatectomy , Liver Neoplasms/diagnostic imaging , Neoplasm Staging/methods , Positron-Emission Tomography/methods , Colorectal Neoplasms/pathology , Colorectal Neoplasms/surgery , Female , Follow-Up Studies , Humans , Liver Neoplasms/secondary , Liver Neoplasms/surgery , Male , Middle Aged , Predictive Value of Tests , Preoperative Period , Radiopharmaceuticals , Reproducibility of Results , Retrospective Studies
3.
Ulster Med J ; 79(2): 70-5, 2010 May.
Article in English | MEDLINE | ID: mdl-21116422

ABSTRACT

INTRODUCTION: Pancreatic cancer has a poor prognosis with <5% alive at 5 years, despite active surgical treatment. The study aim was to review patients undergoing pancreatic resection and assess the effect of clinical and pathological parameters on survival. PATIENTS AND METHODS: All patients who had undergone radical pancreatic surgery, January 1996 to December 2008, were identified from the unit database. Additional information was retrieved from the patient records. The demographic, clinical, and pathological records were recorded using Microsoft Excel. Survival was assessed using Kaplan-Meier and predictors of survival determined by multinominal logistic regression and log rank test. RESULTS: 126 patients were identified from the database. The majority (106) had a Whipple's procedure, 14 had a distal pancreatectomy and 6 had local periampullary excision. The average age of the Whipple's group of patients was 61.7 years (± 11.7) with most procedures performed for malignancy (n=100). Survival was worse with adenocarcinoma compared to all other pathologies (p=0.013), while periampullary tumours had a better prognosis compared to other locations (p=0.019). Survival decreased with poorer differentiation (p=0.001), increasing pT (p<0.001) and pN stage (p<0.001). Survival was worse with perineural (p=0.04) or lymphovascular invasion (p=0.05). A microscopic postive resection margin (R1) was associated with a worse survival (p=0.007). Tumour differentiation (p=0.001) and positive nodal status (p<0.001) were found to be independent predictors of mortality. CONCLUSION: Tumour differentiation and nodal status are important predictors of outcome. A positive resection margin is associated with a poorer survival.


Subject(s)
Adenocarcinoma/surgery , Endocrine Gland Neoplasms/surgery , Pancreatectomy , Pancreatic Neoplasms/surgery , Adenocarcinoma/mortality , Adenocarcinoma/pathology , Adenocarcinoma/secondary , Adult , Aged , Aged, 80 and over , Endocrine Gland Neoplasms/mortality , Endocrine Gland Neoplasms/pathology , Female , Humans , Kaplan-Meier Estimate , Logistic Models , Lymphatic Metastasis , Male , Middle Aged , Pancreatic Neoplasms/mortality , Pancreatic Neoplasms/pathology , Prognosis , Retrospective Studies , Survival Rate , Treatment Outcome
4.
Ulster Med J ; 69(2): 106-11, 2000 Nov.
Article in English | MEDLINE | ID: mdl-11196720

ABSTRACT

BACKGROUND: Several views are expressed by surgeons on biliary complications following laparoscopic cholecystectomy as follow: most are caused by trainees; complications occur in the presence of difficult anatomy/pathology; injuries occur more proximally than at open cholecystectomy; most injuries are recognised immediately and most can be managed non-operatively. The aim of our study was to determine if these views are substantiated in clinical practice. METHODS: The mode of presentation, management and outcome of thirty-two patients referred to a hepatobiliary unit over a seven year period were analysed. RESULTS: In 72% of cases the initial operator was a consultant. Five of the 32 complications (16%) occurred in the presence of difficult anatomy/pathology. Two patients had proximal biliary tree injuries, the only mortalities (two) occurring in this group. Only 41% of injuries were detected immediately; 87% required surgical intervention, hepaticojejunostomy being the most common procedure performed (75%). CONCLUSION: Our study shows that the majority of bile duct injuries are not caused by trainees, do not occur because of unusual anatomy/pathology, do not occur in the proximal biliary tree and are not recognised at the time of operation. Most injuries ultimately require major reconstructive surgery for definitive management.


Subject(s)
Biliary Tract Diseases/etiology , Cholecystectomy, Laparoscopic/adverse effects , Biliary Tract Diseases/epidemiology , Female , Health Knowledge, Attitudes, Practice , Humans , Ireland/epidemiology , Male , Middle Aged
5.
Ann Surg ; 222(2): 186-92, 1995 Aug.
Article in English | MEDLINE | ID: mdl-7639585

ABSTRACT

BACKGROUND/AIMS: Esophageal mucosal blood flow is a dynamic phenomenon that is altered by luminal content that probably represents an important intrinsic method of defense. This study investigated the role played by endogenous nitric oxide in the regulation of esophageal mucosal blood flow at rest and in response to luminal capsaicin, a specific stimulant for visceral afferent nerves, as well as calcitonin gene-related peptide, and the bile salt deoxycholate. METHODS: The L-arginine analog L-NAME was used to block nitric oxide synthesis. Radiolabeled microspheres were used to measure blood flow in a well-characterized rabbit model. Phenylephrine was used to mimic the hemodynamic effects of L-NAME to show the specificity of positive findings. RESULTS: Administration of L-NAME led to a significant reduction in mucosal blood flow at rest, an effect that was not shared by phenylephrine. The blood flow responses to luminal capsaicin, intra-arterial calcitonin gene-related peptide (CGRP), and luminal deoxycholate, however, were not diminished in the presence of L-NAME. CONCLUSIONS: Although nitric oxide may play a role in the maintenance of normal resting esophageal mucosal blood flow, the reactive responses to luminal capsaicin, luminal deoxycholate, and intra-arterial CGRP are not nitric oxide dependent.


Subject(s)
Calcitonin Gene-Related Peptide/pharmacology , Capsaicin/pharmacology , Deoxycholic Acid/pharmacology , Esophagus/blood supply , Nitric Oxide/physiology , Administration, Topical , Animals , Arginine/analogs & derivatives , Arginine/pharmacology , Calcitonin Gene-Related Peptide/administration & dosage , Capsaicin/administration & dosage , Deoxycholic Acid/administration & dosage , Esophagus/drug effects , Esophagus/innervation , Hyperemia/chemically induced , Hyperemia/physiopathology , Infusions, Intra-Arterial , Male , Microspheres , Mucous Membrane , NG-Nitroarginine Methyl Ester , Neurons, Afferent/drug effects , Nitric Oxide/antagonists & inhibitors , Phenylephrine/pharmacology , Rabbits , Regional Blood Flow/drug effects
6.
Surgery ; 116(2): 409-17; discussion 417-8, 1994 Aug.
Article in English | MEDLINE | ID: mdl-7519367

ABSTRACT

BACKGROUND: Esophageal mucosal blood flow is a dynamic phenomenon dependent on luminal content. Reactive hyperemia, likely a factor in mucosal protection, follows luminal exposure to noxious substances, including bile. The mediators of this response are unknown, although the likelihood is that visceral afferent nerves play a major role. The purpose of this study was to determine whether substance P, calcitonin gene-related peptide (CGRP), or adenosine could mediate this reactive blood flow response. METHODS: Esophageal mucosal blood flow was studied in a rabbit model with the radiolabeled microsphere technique. The effect of intraarterial infusion of CGRP and substance P and intravenous adenosine was studied. Subsequently, the hyperemic response to luminal deoxycholate was measured in the presence of antagonists to CGRP, substance P, and adenosine. Immunohistochemical studies were performed to determine the distribution of CGRP and substance P in the esophagus. RESULTS: CGRP proved to be a potent stimulus to mucosal blood flow. The presence of a CGRP antagonist reduced mucosal blood flow at baseline and after exposure to deoxycholate. Antagonists to substance P and adenosine had no effect on baseline and deoxycholate-stimulated blood flow. CONCLUSIONS: CGRP is likely a major mediator involved in the regulation of esophageal mucosal blood flow.


Subject(s)
Calcitonin Gene-Related Peptide/physiology , Esophagus/blood supply , Animals , Calcitonin Gene-Related Peptide/analysis , Calcitonin Gene-Related Peptide/pharmacology , Immunohistochemistry , Male , Mucous Membrane/blood supply , Peptide Fragments/pharmacology , Rabbits , Regional Blood Flow/drug effects , Substance P/analysis , Substance P/pharmacology , Theophylline/pharmacology
7.
Circ Shock ; 43(3): 103-6, 1994 Jul.
Article in English | MEDLINE | ID: mdl-7850929

ABSTRACT

The objective of this study was to determine if nitric oxide mediates the effects of exogenously administered adenosine on peripheral blood flow. An intravenous infusion of adenosine (1.0 mumol/kg/min) into male New Zealand white rabbits caused an increase in blood flow, measured using radiolabeled microspheres, throughout the gastrointestinal tract, as well as in the heart and kidneys. Prior administration of nitro-L-arginine methyl ester (L-NAME) 10 mg/kg i.v. completely blocked the hyperemic effect of adenosine on all organs studied. Administration of L-arginine (300 mg/kg bolus and 50 mg/kg/min infusion) together with L-NAME restored the hyperemic effect of adenosine. This phenomenon was specified to the L-arginine/nitric oxide pathway in that a similar pressor response induced by phenylephrine (1.5 micrograms/kg/min) did not block the effects of adenosine. We conclude that the peripheral vasodilator response to intravenously administered adenosine in the rabbit is mediated by nitric oxide.


Subject(s)
Adenosine/pharmacology , Blood Circulation/drug effects , Digestive System/blood supply , Nitric Oxide/physiology , Adenosine/administration & dosage , Animals , Arginine/analogs & derivatives , Arginine/pharmacology , Infusions, Intravenous , Microspheres , NG-Nitroarginine Methyl Ester , Phenylephrine/pharmacology , Rabbits , Regional Blood Flow/drug effects , Vasodilator Agents/pharmacology
8.
Ulster Med J ; 61(1): 8-11, 1992 Apr.
Article in English | MEDLINE | ID: mdl-1535744

ABSTRACT

Fifty-five consecutive unselected patients were submitted for laparoscopic cholecystectomy, and the procedure completed laparoscopically in fifty cases. The outcome is presented with particular reference to the duration of surgery, postoperative pain and nausea, the length of hospital stay and the time taken to recover normal activities. This technique is shown to have major advantages over conventional gallbladder surgery for the majority of patients.


Subject(s)
Cholecystectomy , Gallbladder Diseases/surgery , Laparoscopy , Adult , Aged , Female , Hospitals, District , Humans , Length of Stay , Male , Middle Aged , Northern Ireland , Postoperative Complications , Treatment Outcome
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