Lys751Gln XPD and Arg399Gln XRCC1 in Romanians. Association with sporadic colorectal cancer risk and different stages of carcinomas.

BACKGROUND: DNA repair processes involved the removal of modified bases through the base excision repair (BER) pathway and removal of damaged nucleotides through the nucleotide excision repair (NER) pathways. METHODS: in order to determine the association between XPD(Lys751Gln) and XRCC1 (Arg399Gln) SNPs and the risk of CRC as well as tumor grade and stages in Romanians we genotyped using PCR-RFLP methods 150 patients (80 females and 70 males) and 162 controls (100 females and 62 males). RESULTS: The risk (odds ratio - OR) to develop sporadic CRC was 3.02 (p=0.02) and 3.49 (p=0.001), respectively, in association with the homozygous Gln751 Gln751-XPD and Gln399 Gln399-XRCC1 genotypes. Higher risk for carriers of the Gln751 Gln751 - Arg399 Arg399 (OR 4.19, p=0.027),Gln399 Gln399 - Lys751 Lys751 (OR 3.21, p=0.013),Gln399 Gln399 - Lys751 Gln751 (OR 4.5, p=0.05),Lys751 Gln751 - Arg399 Gln399 (OR 3.94, p 0.001) combined genotypes was observed. The lowest risk was observed in carriers of Lys751 Lys751-Arg399 Arg399 genotypes (OR0.24, p 0.001). 2.24-fold (p=0.05) and 3.75-fold (p=0.004)increased risk (OR) for carriers of the Lys751Gln or Arg399Gln variants to be on stage pT2 and pT4, respectively. Patients carriers of Lys751Gln or Arg399Gln variants had 7.7-fold(p=0.002) and 18.94-fold (p 0.001) increased risk (OR) to develop sporadic CRC in stage D. CONCLUSIONS: XPD and XRCC1 variants affect the risk for sporadic CRC in Romanians, seem to be associated with more aggressive forms of sporadic CRC and may be prognostic factors in patients with advanced CRC.

[Non-ulcerous duodenal perforations: a clinical analysis of 23 cases]. / Perforatiile neulceroase ale duodenului: analiza a 23 de cazuri.

Non-ulcerous duodenal perforations are a rare and seldom studied pathology. The present retrospective study analyses a group of 23 patients, over a 10 year period (Jan 1st 2000 - Dec 31st 2009) with this pathology. The most frequent etiology was iatrogenic (52.17 % after ERCP and 17.39% after upper gastrointestinal endoscopy). Other rare etiologies included were tumoral perforations, penetrating wounds, and ingestion of foreign bodies. The lesions vary from millimetric perforations to total necrosis of the wall of a duodenal segment and are often associated with other complex lesions. The overall mortality was 52.17%, a little lower for the post ERCP injuries (40%). Usually the iatrogenic lesions are diagnosed earlier (ex. 54.54% of the post ERCP lesions undergo surgery during the first 24 h), probably increasing the chance of surviving. 43.47% of cases undergo surgery in the condition of severe sepsis, with multiple organ failure, thus aggravating the prognosis. Sometimes the patient required multiple interventions (with a maximum of 8 in our group). In 26% of the cases the primary intervention was just paraduodenal and/or retroperitoneal drainage, suture of the duodenum (6 cases - 26%), usually under the protection of a gastro-enteroanastomosis (4 cases - 17.39%), suture of the duodenum around a decompression tube (26%), sometimes suture of the duodenum with a jejunal serous patch or duodeno-jejunal anastomosis. The bile drainage and the jejunostomy were associated sometimes. The procedures in this pathology have a significant morbidity, with a high rate of reinterventions (30.4%).

[Correlation between C677T and A1298C mutations of the MTHFR gene and therapeutic prognostic elements in colorectal cancer]. / Relatia mutatiilor C677T si A1298C ale genei MTHFR cu elemente de prognostic terapeutic in cancerul colorectal.

The MTHFR gene polymorphism may influence the risk of developing sporadic CRC. The aim of this study is to assess the relationship between the mutations of this gene and certain aspects of the surgical practice: the tumoral resectability, the tumoral recurrence and the disease-free interval. 69 patients with sporadic colorectal cancer that underwent surgery at the 3rd Surgery Department of Cluj-Napoca between October 2003-May 2005 were randomly selected. The correlations between the C677T, A1298C mutations and the prognostic factors mentioned above were analyzed. The results show that the C677T mutation increases the risk of non-resectability (OR = 3.5, p = 0.099), while the A1298C mutation does not (OR = 1.1). For the A1298C mutation there is a major risk of recurrence (OR = 3,063), but in the group with C677T mutation there is only a small increase of the risk, non-significant statistically (OR = 1,196). Both the groups with the C677T mutation and the "wild" genotype 1298AA have more precocious recurrences then the other groups, so a shorter disease-free interval (HR = 0.9458 respectively 3.1070). The patients with the A1298C mutations have more often non-resectable recurrences. In conclusion, the mutations of the MTHFR gene are a prognostic factor for the treatment and evolution of patients with CRC.

[Management of colorectal resections for treatment of neoplastic intestinal occlusions. Experience of surgery clinic No III, Cluj-Napoca]. / Managementul rezectiilor colorectale în tratamentul ocluziilor intestinale neoplazice. Experienta Clinicii Chirurgie III Cluj-Napoca.

PURPOSE: We analyzed the clinical results of different techniques of resection for malignant colorectal (primary or staged) obstruction. METHODS: The subjects of this retrospective nonrandomized clinical study were 165 patients with malignant colorectal occlusion who underwent surgery treatment in our Department between 2002-2006. Patients with peritonitis or treated by means of permanent colostomy, palliative anastomosis, primary Hartman resection and rectal excision were excluded. RESULTS: Patients with large bowel obstruction caused by obstructive malignant colorectal lesions underwent either one-stage primary resection with anastomosis (77 patients) or staged interventions (88 patients). There were no differences in age, sex, comorbidities, tumor staging, serum preoperative levels of hemoglobin and proteins between the two groups of patients defined by the different surgical techniques. Regarding mortality and morbidity following surgical treatment for large bowel obstruction no significant difference among the two groups (p > 0.05) or the fistula rate (p = 0.435) was obtained. Moreover, results showed a higher incidence of mortality (11.8% vs 7.8%), morbidity (13.6 vs 10.4) and increased hospitalization period (p = 0.03) among the patients that undergone series resections. CONCLUSIONS: One stage primary resections with anastomosis of the large bowel can be performed safely in case of emergency whenever patient comorbidities and local conditions do not stand as major restrictions.

[Laparoscopic antireflux surgery--long-term results]. / Montaje antireflux efectuate pe cale laparoscopica--rezultate pe termen lung.

METHOD AND MATERIAL: Between 1995 and 2005 a number of 98 antireflux laparoscopic procedures have been performed. The patients have answered to a 7 point questionnaire regarding the disappearance of specific gastro-esophageal symptoms, the necessity of medical adjuvant treatment as well as regarding the measure in which surgery brought a real subjective improvement. The average follow-up was 57 months (4.7 years). RESULTS: 43 laparoscopic patients have answered the questions. 10 patients had dysphagia, most of which had a spontaneous remission. Only 3 of those patients needed an endoscopic dilatation. Bloating was still possible for 33 of the patients. Retrosternal pain remained present for 14 patients. Intestinal transit disorders have showed up in 11 cases. Reflux persisted at a variable degree in 12 patients. Only 7 patients continue to follow a systematic drug treatment. 35 patients consider that the surgery has brought an improvement of their disease.

[Clinical aspects with prognostic value in gastric cancer--analysis of 468 cases with gastric adenocarcinoma]. / Aspecte clinice cu implicatie prognostica în cancerul gastric--analiza a 468 cazuri de adenocarcinom gastric.

The aim of this study is to assess clinico-pathological parameters and find out the correlation between them and their possible prognostic value. We made a retrospective analysis of a group of 468 patients with gastric adenocarcinoma which were operated in the 3rd Surgical Clinic--Cluj Napoca--01.01.1998-31.12.2003. The median age was 62 years. Patients in pTNM 0 stage were significantly younger than the rest of patients, with an average of 7.5 years. The male/female ratio was 1.7:1, this ratio being significantly higher in cases with proximal gastric cancers. There was not found any significant correlation between the interval : onset of symptoms and surgery, and pTNM stage. The most frequent signs and symptoms were epigastric pain, weight loss, indigestion, fatigue, pallor and loss of appetite, each of them were found in more than 40% patients. Multivariate analysis of symptoms showed that weight loss (p=0.00638) was independently correlated to advanced pTNM stages. The number of signs and symptoms was significantly correlated to advanced pTNM stages (p=0.000026). This significant group of patients studied has maintained characteristics encountered in populations with higher incidence of gastric adenocarcinoma, men being more frequently affected, distal localization and intestinal histologic type being encountered more frequently.

[Morbidity and mortality in gastric cancer surgery--analysis of 468 cases with gastric adenocarcinoma]. / Morbiditate si mortalitate în chirurgia cancerului gastric--analiza a 468 cazuri de adenocarcinom gastric.

The aim of this study is to evaluate the morbidity and mortality in the surgical treatment of gastric cancer and the factors that could influencing them. We made a retrospective analysis of a group of 468 patients with gastric adenocarcinoma which have been operated in the 3RD Surgical Clinic-Cluj Napoca--01.01.1998-31.12.2003. We analyzed parameters related to patient, pTNM stage and type of treatment. Morbidity was significantly higher in these circumstances: elder patients, cases with lower serum levels of hemoglobin and total proteins, after Billroth II procedures; we found no significant differences of morbidity depending on gender, pTNM stage, type of intervention: simple or multiorgan resection, subtotal or total gastrectomy, radical or palliative procedure or only exploratory laparotomy, presence or absence of splenectomy or caudal pancreatectomy, D1 or D2 lymphadenectomy (in radical procedures), palliative resection or gastrojejunal bypass. Elder patients and male patients have had a mortality significantly higher; we found no significant differences of mortality depending on serum levels of hemoglobin and total proteins, pTNM stage, type of intervention: simple or multiorgan resection, subtotal or total gastrectomy, radical or palliative procedure or only exploratory laparotomy, presence or absence of splenectomy or caudal pancreatectomy, D1 or D2 lymphadenectomy (in radical procedures), type of restoring of the digestive continuity after subtotal gastrectomy, palliative resection or gastrojejunal bypass.

[Radiofrequency ablation of liver tumors: technique and preliminary results]. / Ablatia cu radiofrecventa a tumorilor hepatice: tehnica si rezultate preliminare.

Radiofrequency ablation is a therapeutic method more and more applied for unresectable liver tumors; the purpose of this study is to evaluate its advantages and disadvantages. A series of 14 cases with liver tumors was treated by radiofrequency ablation; in 5 cases (35.7%) a hepatic resection was associated. Laboratory data, complications, morbidity, mortality and survival were noted. Mean age was 57.4 years (40-70) for this series consisting of 8 women and 6 men. The mean number of tumors treated per patient was 2.2; the mean total tumoral diameter was 7.2 cm. There were no major technique related complications, nor perioperative mortality. Mean global survival was 507.4 days; one year mean global survival was 64.2% (9 cases) and two years mean global survival was 28.5% (4 cases). We presented the technique of radiofrequency ablation applied for liver tumors and our experience because it is less known and used in our country and there is a tendency to treat liver tumors by this mean.