Successful emergency endovascular aortic repair for intratumoral hemorrhage in extensive retroperitoneal mass of testicular origin.

BACKGROUND: Metastatic germ cell cancer of the testis is characterized by favorable prognosis since effective treatment methods are available even in cases of extensive disease. Retroperitoneal masses frequently encroach major blood vessels requiring a vascular intervention usually performed in association with the post-chemotherapy retroperitoneal lymph node dissection (RPLND). Reported clinical case describes a successful pre-treatment endovascular surgery for abdominal aortic rupture allowing for full-dose systemic chemotherapy administration, and subsequent radical surgical intervention at primary tumor site as well as metastatic retroperitoneal lymph node dissection including the reconstruction of inferior caval vein. CASE PRESENTATION: Patient presented with left-sided testicular tumor and voluminous retroperitoneal mass with vascular involvement. Soon after the patient had been admitted for the first cycle of cisplatin-based chemotherapy, computed tomographic angiography (CTA) revealed a dorsal aortic wall rupture with active extravasation and irregular pseudoaneurysmatic dilatation of the aorta below the leak area. Retroperitoneal intratumoral hemorrhage associated with the bilateral iliac venous thrombosis required an endovascular repair procedure of infrarenal abdominal aorta. CONCLUSIONS: Following the successful endovascular aortic repair 3 cycles of BEP (bleomycin, etoposide, cisplatin) regimen were administered with subsequent delayed left radical orchiectomy and RPLND associated with vena cava inferior (VCI) resection. Reconstruction of VCI was originally not deemed necessary as collateral blood flow appeared sufficient, however, intraoperative complications resulted in the need for unilateral VCI reconstruction, using the interposed bypass between right common iliac vein and infrarenal segment of VCI. Histopathologic examination of the attained specimen detected no vital cancer structures. The patient remains disease-free 18 months after the RPLND.

Impact of the anatomical location and the number of metastatic lymph nodes on gastric cancer patient´s survival.

BACKGROUND: The most serious problem in surgical treatment of gastric cancer includes the area of resection and the extent of lymphadenectomy. The extent of gastric resection is determined by the extent of tumor affection. The aim of radical surgical intervention is to achieve microscopically clear resection line, since R0 resection is the main criterion for the patient´s prognosis. Curative surgical resection for gastric cancer includes the lymph nodes dissection. In the treatment of gastric cancer, there are two views on the importance of lymphadenectomy. The Far East considers that operation improves the survival and the Europe considers that surgery is not curative, but it determines the staging and prognosis. There is also a difference in staging systems. The one from East is importance based on the anatomical location of affected lymph nodes, the second from Europe is based on the number of positive lymph nodes. MATERIALS AND METHODS: This work is a retrospective observational study. In the study cohort, comparing the survival of patients according to different classification systems, depending on the N-stage of disease, 119 patients with gastric adenocarcinoma in clinical stage I to III, i.e. without metastasis, who underwent a radical surgical resection with D2 lymphadenectomy, were enrolled. For the evaluation of the survival versus the time after operation, we used Kaplan‒Meier method. To evaluate the correlation between the survival rate and the explanatory variables, Cox regression and Kendall correlation coefficient were used. RESULTS: The median survival, according to different classification systems, depending on the N-stage of the disease, was significantly correlated with the survival for the 6th and 7th editions of TNM classification system for the Japanese classification system, for N-ratio classification system).The new finding was differentiation of patients in groups N1 vs N2 under the 6th TNM classification (HR=0.910249), also a little differentiation in groups N1 vs N2 according to the classification of N-ratio (HR=0.8750926) and equally a poor differentiation in the survival in groups N2 vs N3 according to the 7th TNM classification (HR=0.881797).The strongest correlation reached the Japanese classification system, but not significantly different from the 6th TNM classification system. In the 7th edition of TNM classification system, we then found the weakest correlation with the survival time, but not significantly different from the previous two. CONCLUSION: Our retrospective study confirmed the strongest correlation between the patient´s prognosis and the anatomic localization of the affected lymph nodes. This correlation was not statistically significant compared to the correlation between patient´s prognosis and the number of positive lymph nodes. It leads us to the conclusion that both classification systems are comparable and the difference is statistically insignificant (Tab. 4, Fig. 8, Ref. 16).

The use of European Randomized study of Screening for Prostate Cancer calculator as a diagnostic tool for prostate biopsy indication.

BACKGROUND: It is a well-known fact, that too many men are having prostate biopsy performed with negative biopsy results. The decision to undertake prostate biopsy is usually based on prostate specific antigen (PSA) level and digital rectal examination (DRE). A risk-based strategy may reduce the numbers of unnecessary prostate biopsies. METHODS: Retrospective statistical analysis of data from 195 men undergoing their initial prostate biopsy from 1.1.2015 to 31.12.2015 based on elevated PSA ≥ 4.0 ng/ml and/or abnormal DRE were included. Subsequent risk stratification using the European Randomized study of Screening for Prostate Cancer calculator (ERSPC) was used with the intent to calculate the accuracy of ERSPC with the aim to avoid unnecessary (negative) prostate biopsies. RESULTS: The specific values of sensitivity and specificity in this cohort were 94.34 % and 24.72 %. In direct comparison of PSA and ERSPC calculator, the differences between sensitivity, specificity, negative predictive value and false omission rate as negative were statistically insignificant, but the positive predictive value was on the edge of statistical significance (p = 0.054), slightly in favor for ERSPC calculator. CONCLUSION: PSA still remains the single most predictive factor for identifying men with an increased risk of prostate cancer to be detected on prostate biopsy, but using other risk factors included in ERSPC can considerably reduce the numbers of unnecessary biopsies on initial screening (Tab. 4, Fig. 2, Ref. 23).

Clinical Management and Outcome in Extreme Retroperitoneal Growing Teratoma Syndrome of Testicular Origin - Clinical Management and Effect of the Treatment.

BACKGROUND: Growing teratoma syndrome (GTS) is an uncommon clinical finding in patients treated for testicular cancer. It is diagnosed during or after chemotherapy as an expanding tumour mass not responding to the treatment while the serum tumour markers are within the normal range. Pathological evaluation of resected tissue confirms the structures of benign mature teratoma. CASE: Authors report a case of metastatic germ cell testicular cancer treated with 2 lines of chemotherapy and everolimus, that had finally been subjected for the resection of voluminous metastatic masses. We give a brief overview of current records concerning clinical management of GTS, and support the major role of surgical treatment in GTS. RESULTS: Patient with metastatic mixed germ cell tumour of testis underwent a radical orchiectomy and completed the 1st line treatment with BEP (bleomycin, etoposide, cisplatin) regimen. Radiographic restaging showed considerable disease progression to the retroperitoneum and supraclavicular lymph nodes. Second-line treatment with VIP (etoposide, ifosfamide, cisplatin) did not reverse the progression and the patient was consulted at our institute. Following the enrolment to the clinical study with everolimus, the patient exhibited continual metastatic growth in contrast to serum markers decrease. GTS was confirmed after resection of enormous retroperitoneal tumour mass, as well as from the specimen obtained from the subsequent supraclavicular and hepatal metastasectomy. The patient attained complete remission and has been closely observed over the last 31 months since the last surgery. CONCLUSION: GTS is resistant to chemotherapy and radiation and complete surgical resection results in excellent disease control. Clinicians should be aware of this infrequent presentation of testicular tumours, to ensure the timely diagnosis and the appropriate surgical removal without any delay. Despite the great extent and vital vasculature encasement, surgery may be feasible and successful, as we report in our case, consistently with the published data.

Lymphoma transformation of tumor infiltrating lymphocytes observed in testicular patient­derived xenograft models.

Testicular germ cell tumors (TGCTs) are highly sensitive to cisplatin­based chemotherapy. Nevertheless, there are metastatic tumors that do not completely respond to front­line chemotherapy. For these tumors, surgical resection of residual masses is necessary to achieve long­term disease control. Resected tissues represent valuable clinical material, which may be used for the engraftment into immunocompromised mice to produce patient­derived xenografts (PDXs). They typically maintain similarities to the parental tumors and therefore serve as more realistic preclinical models. Moreover, a correlation between PDX treatment outcomes and clinical response to chemotherapy has been previously described. The aim of the present study was to establish and characterize TGCT patient­derived xenografts. These originated from retroperitoneal lymph node metastases infiltrated with TGCTs following previous cisplatin­based chemotherapy, in order to analyze novel treatment options for cisplatin­resistant testicular tumors. We generated two testicular patient­derived xenograft models in SCID beige male mice. Immunohistochemical analyses demonstrated that histological characteristics of the primary tumor were not retained, and transformation into lymphoma, and eventually plasmocytoma, was observed. A potential explanation for the lymphoma transformation observed in PDXs may include tumor­infiltrating lymphocytes (TILs) in xenografted samples of patients, which are transformed following engraftment into immunodeficient recipient mice. Based on these data, we indicated that lymphomagenesis prevention and terminal differentiation represent new challenges in the establishment of PDX models derived from patients with germ cell tumors.

The Chest Wall Tumor as a Rare Clinical Presentation of Hepatocellular Carcinoma Metastasis.

BACKGROUND: Extrahepatic metastatic spread of hepatocellular carcinoma is present at the time of diagnosis in 5-15% of hepatocellular carcinoma patients. The most common site of metastastic spread is the lungs, bones, lymph nodes. Isolated chest wall localization is extremely rare. CASE: We report a 58-year-old patient with large, synchronous chest wall hepatocellular carcinoma metastasis with solitary primary hepatocellular carcinoma. He underwent a radical, surgical en bloc metastasectomy and subsequent anatomic liver resection. Removal of this metastasis further led to aggressive dissemination to different sites during the course of the disease and subsequently the patient was treated with antiangiogenic therapy and, after failure, with systemic chemotherapy. Combined multimodality treatment in this case led to overall survival of 22-months. We suggest that the initial huge presentation of chest wall metastasis and consecutive aggressive dissemination after surgical removal could be explained by the biological process called "tumor self-seeding" by circulating tumor cells. CONCLUSION: The chest wall hepatocellular carcinoma metastasis is a rare entity associated with poor prognosis. Radical surgical approach is limited to a minority of patients and may be justified for the treatment of extrahepatic metastases on a case by case basis.Key words: hepatocellular carcinoma - chest wall metastasis - metastasectomy - ciculating tumor cells.

Morbidity, mortality and long term survival in patients with vascular resection in pancreatic cancer - single center experience.

Although venous resection in pancreatic cancer is widely used method, recently published data about its safety and survival benefit showed conflicting results. A retrospective case matched study was performed to compare the results of patients who underwent venous resection to those with no venous resection during radical surgery in pancreatic cancer.From January 2010 to December 2015, 297 pancreatic resections due to pancreatic tumor were performed in the National Cancer Institute (NCI). Fifty-three patients with venous resection were identified and enrolled into the study and matched with 66 patients without vascular resection during radical resection of pancreatic head/body cancer. Both groups matched for age, ASA score, need for preoperative biliary drainage and clinical staging of the tumor. Morbidity was determined according Clavien and Dindo classification [1] and was similar in both groups of patients (p = 0.48). Thirty day postoperative mortality was also equal in both groups 5.6 vs 4.5% (p > 0.99) and long term survival was with no significant difference. Median overall survival was 18.8 vs 20.7 months (p = 0.33) for patients with/without venous resection.Therefore we consider venous resection in pancreatic cancer safe procedure with equal morbidity and perioperative mortality as in patients with no need for vascular resection and with the same long term survival if R0 resection is achieved.

CXCR4-SDF-1 interaction potentially mediates trafficking of circulating tumor cells in primary breast cancer.

BACKGROUND: Cytokines are involved in cancer invasion and metastasis. Circulating tumor cells (CTCs) play key role in tumor dissemination and are an independent survival predictor in breast cancer patients. The aim of this study was to assess correlation between CTCs and plasma cytokines in primary breast cancer (PBC) patients. METHODS: This study included 147 chemotherapy naïve PBC patients. Peripheral blood mononuclear cells (PBMC) were depleted of hematopoetic cells using RossetteSep™ negative selection kit. RNA extracted from CD45-depleted PBMC was interrogated for expression of EMT (Twist1, Snail1, Slug, Zeb1) and epithelial (Ck19) gene transcripts by qRT-PCR. The concentrations of 51 plasma cytokines were measured using multiplex bead arrays. RESULTS: CTCs were detected in 25.2% patients. CTCs exhibiting only epithelial markers (CTC_EP) and only EMT markers (CTC_EMT) were present evenly in 11.6% patients, while CTCs co-expressing both markers were detected in 2.0% patients. Patients with presence of CTC_EP in peripheral blood had significantly elevated levels of plasma IFN-α2, IL-3, MCP-3, ß-NGF, SCF, SCGF-ß, TNF-ß and SDF-1 compared to patients without CTC_EP. CTC_EP exhibited overexpression of SDF-1 receptor and CXCR4, but not other corresponding cytokine receptor, and in multivariate analysis SDF-1 was independently associated with CTC_EP. There was an inverse correlation between CTC_EMT and plasma cytokines CTACK, ß-NGF and TRAIL, while presence of either subtype of CTCs was associated with increased level of TGF-ß2. CONCLUSION: Using cytokine profiling, we identified cytokines associated with CTCs subpopulations in peripheral blood of PBC. Our data suggest that CXCR4-SDF-1 axis is involved in mobilization and trafficking of epithelial CTCs.

Relationship between circulating tumor cells and epithelial to mesenchymal transition in early breast cancer.

BACKGROUND: Circulating tumor cells (CTCs) play a crucial role in tumor dissemination and are an independent survival predictor in breast cancer (BC) patients. Epithelial to mesenchymal transition (EMT) is involved in cancer invasion and metastasis. The aim of this study was to assess correlation between CTCs and expression of EMT transcription factors TWIST1 and SLUG in breast tumor tissue. METHODS: This study included 102 early BC patients treated by primary surgery. Peripheral blood mononuclear cells (PBMC) were depleted of hematopoietic cells using RossetteSep™ negative selection kit. RNA extracted from CD45-depleted PBMC was interrogated for expression of EMT (TWIST1, SNAIL1, SLUG, FOXC2 and ZEB1) and epithelial (KRT19) gene transcripts by qRT-PCR. Expression of TWIST1 and SLUG in surgical specimens was evaluated by immunohistochemistry and quantified by multiplicative score. RESULTS: CTCs were detected in 24.5 % patients. CTCs exhibiting only epithelial markers were present in 8.8 % patients, whereas CTCs with only EMT markers were observed in 12.8 % of pts and CTCs co-expressing both markers were detected in 2.9 % pts. We observed lack of correlation between CTCs and expression of TWIST1 and SLUG in breast cancer cells or cancer associated stroma. Lack of correlation was observed for epithelial CTCs as well as for CTCs with EMT. CONCLUSIONS: In this translational study, we showed a lack of association between CTCs and expression of EMT-inducing transcription factors, TWIST1 and SLUG, in breast tumor tissue. Despite the fact that EMT is involved in cancer invasion and metastasis our results suggest, that expression of EMT proteins in unselected tumor tissue is not surrogate marker of CTCs with either mesenchymal or epithelial features.

[Rare complication after stapled hemorrhoidectomy]. / Raritná komplikácia po staplerovej hemoroidektómii.

Statistics show that more than half of the population suffers from hemorrhoids at different clinical stages. Only a small percentage of them (5 to 10%) require surgical treatment. The gold standard is open hemorrhoidectomy (most commonly Milligan-Morgan operation). Circular stapled hemorrhoidopexy by Longo is an alternative to conventional hemorrhoidectomy. The main advantages of this procedure are: less postoperative pain, earlier return to work and to social life. The complication rate is similar to open hemorrhoidectomy. This method, however, also brings new kinds of complications, some of them potentially life-threatening. Our case report presents one of these rare complications.

Portomesenteric vein gas and pneumatosis intestinalis--a rare complication after neoadjuvant radiochemotherapy in oesophageal cancer.

Portomesenteric vein gas and pneumatosis intestinalis is most commonly caused by mesenteric ischemia and bowel necrosis but may have a variety of other causes. The etiology is multifactorial and the clinical presentation is variable. The diagnosis is based on a combination of clinical suspicion and radiographic findings. The finding of hepatic portal venous gas alone is not an indication for emergent exploration. We report portomesenteric venous gas as a rare complication after neoadjuvant radiochemotherapy of the oesophageal cancer (Fig. 3, Ref. 12).

Specific aspects of acute pancreatitis.

Acute pancreatitis (AP) is still a disease with a significant mortality rate, mainly concerning the severe forms of this disease. Mortality in acute pancreatitis has 2 peaks. The first peak is caused by systemic inflammatory response syndrome (SIRS), which takes place in the first week of the disease. Sepsis is responsible for a second peak. It begins 1 to 3 weeks after the onset of acute pancreatitis and is caused by pancreatic superinfection. Sepsis as a result of infected pancreatic necrosis is the most serious complication in late phase of severe acute pancreatitis (SAP) and contributes to the high mortality rate of this disease. This complication is thought to be a result of the bacterial translocation from the gastrointestinal tract. The damage of the microvessels and the subsequent onset of systemic cascade reactions plays also an important role during acute pancreatitis. Recent experimental data suggest also the role of nervous system in etiopathogenesis of acute pancreatitis. We assume that the diagnostic and treatment strategy can not improve without a thorough knowledge of the physiology and patophysiology of acute pancreatitis. Therefore the aim of this paper is to highlight certain specific situations of high importance that are activated in the human organism during acute pancreatitis (Ref. 100).

Enterovesical fistulas in Crohn's disease.

BACKGROUND: Crohn's disease is a chronic inflammatory disease of the bowel, that may affects the urinary system. Although fistula formation has been reported in up to 35% patients suffering from Crohn's disease, urinary fistulas affect only 2 to 8% patients. PATIENTS AND METHODS: Authors have done a retrospective study with the aim to investigate the incidence of enterovesical fistulas in patients admitted due to Crohn's disease to the IInd Department of Surgery of the Comenius University Medical School and Department of Surgery of University Hospital Nitra during 10 years long period. RESULTS: The overall incidence of enterovesical fistulas in our clinical material was 6.83%. All patiens underwent elective surgery. There were no serious postoperative complication. A two stage approach was necessary due to severe inflammation in one patient. Severity of inflammation decreased later on, after treatment with anti TNF *, which allowed subsequent elective surgery. CONCLUSION: Authors consider elective surgery as a treatment of choice in the managenet of enterovesical fistulas in Crohn's disease. Surgery is effective and safe (Fig. 2, Ref. 3). Full Text (Free, PDF) www.bmj.sk.

Septic complications of acute pancreatitis.

Acute pancreatitis (AP) is a potentially lethal disease. There are numerous studies published on acute pancreatitis. This article presents the results of research of many scientists in the field of acute pancreatitis. The main aim of this article is to present the possible septic complications of acute pancreatitis, its diagnostic and treatment modalities. Early morbidity and mortality are the result of activation of mediators with failure of circulation and other organ systems. The overall mortality of patients with acute necrotising pancreatitis is in the range of 10-15 %. Secondary pancreatic infection and sepsis develop in 40-70 % of patients with 80 % mortality. Pancreatic infection is caused by bacterial contamination of pancreatic necrosis. Infection is usually recorded in the second week of the disease in 24 % and in 71 % during the fourth week of the disease. The incidence of secondary infection and sepsis correlates with the extent of pancreatic necrosis. The prevention of infection and sepsis by systemic administration of antibiotics is considered a principal step in the therapy of acute pancreatitis (Ref 62).

Cystic renal cell carcinoma--rare clinical finding. Radiographic variations of tumor/cyst appearance and further diagnostic work-up.

OBJECTIVES: To review the cases of cystic renal cell carcinoma and multilocular cystic nephroma, point out the radiographic variations and define further diagnostic work-up. MATERIALS AND METHODS: Between 2003 and 2005 5 patients with suspected cystic renal cell carcinoma were treated surgically (1 pt underwent radical nephrectomy, 1 pt laparoscopic cyst decortication, 3 pts ablation), 2 patients with multilocular cystic nephroma underwent ultrasound guided biopsy. RESULTS: Histopathologic examination confirmed cystic renal cell carcinoma (CRCC) T1aNOM0 Fuhrman grade 1 in 3 cases, T1bN0M0 Fuhrman grade 2 in one case. One patient with suspected tumor inside the cyst wall who underwent laparoscopic cyst decortication was excluded (final histology confirmed organized hematoma in the cyst wall). Biopsy in 2 patients with multilocular cystic nephroma did not confirm the presence of malignant cells. The mean tumor size was 4.2 cm (range 3.7 to 5.5) for CRCC and 4.7 cm (range 4 to 4.5 cm) for multilocular cystic nephroma. All 4 cases of CRCC were clear cell type. CONCLUSION: In conclusion according to the data described and from our study, tumor/cyst co-existence requires further surgical exploration in group 2, 3, 4. Small cystic renal cell carcinomas up to 4 cm in diameter have usually favourable pathology and prognosis, which offers the minimally invasive nephron-sparing treatment options such as excision, ablation or partial nephrectomy (Fig. 9, Ref. 18).

Retroperitoneoscopic approach in the treatment of symptomatic renal cysts.

INTRODUCTION AND OBJECTIVE: The authors present the results and follow up of patients with simple parenchymal and peripelvic cysts who underwent retroperitoneoscopic cyst decortication. MATERIAL AND METHODS: The records of 19 patients who underwent 3/4-port retroperitoneoscopic cyst decortication between January 1999 and January 2004 were retrospectively reviewed. All patients admitted to the hospital were symptomatic, the most common presenting syptoms were flank pain (19p) and hematuria (6p). The cyst size ranged from 8 to 15cm (mean size 10cm). 10 cysts were located on the right kidney and 9 cysts on the left kidney. The mean age of patients was 51 years. 16 patients had a simple parenchymal cyst corresponding to Bosniak type I (8 patients underwent cyst aspiration and sclerotherapy with 96 % alcohol in past), 2 patients had peripelvic cyst corresponding to Bosniak type II and 1 patient had a parenchymal cyst Bosniak type II. RESULTS: Retroperitoneoscopic renal cyst decortication was successfully performed in all patients, no conversion was needed. The mean operative time was 70 min (50-90 min) in patients with parenchymal and peripelvic cysts. The mean operative blood loss was 70 ml (50-130 ml) and the mean lenght of hospital stay was 3 days (2-5 days). The follow up ranged from 6 to 48 months and during that period were all patients asymptomatic, with no signs of recurrence. CONCLUSIONS: Retroperitoneoscopic cyst decortication is a safe and effective operative procedure in the treatment of symptomatic renal cysts with the minimal complication rate and excellent results (Tab. 2, Fig. 3, Ref. 30).

The correlation of procalcitonin serum levels with the presence of biliary obstruction.

INTRODUCTION: There is still no general agreement as to which patients suffering from attacks of acute biliary pancreatitis should undergo emergent endoscopic retrograde cholangiopancreatography (ERCP) with subsequent endoscopic intervention (endoscopic papilotomy, stent placement etc.). Many authors have described large differences in Procalcitonin (PTC) serum levels in patients suffering from biliary pancreatitis as opposed to patients whose acute pancreatitis is based on toxic etiology. Therefore, we have investigated the correlation of Procalcitonin serum levels with the presence of biliary obstruction in patients undergoing ERCP examination. MATERIAL AND METHODS: From 1.8.2004 to 31.3.2005, 97 patients undergoing ERCP were enrolled into the study. Blood samples were taken from each patient just before their ERCP examinations, and PCT serum levels were subsequently correlated to ERCP findings. RESULTS: ERCP examinations were completed in 90 out of 97 patients. Bile ducts obstructions were confirmed in 61 out of 90 patients and the mean serum level of PTC was 0.078 ng/ml. In the remaining 29 patients ERCP revealed normal findings and the mean PCT value was 0.069 ng/ml. There was no statistical correlation between PCT serum levels and the presence of biliary obstruction on ERCP findings. CONCLUSION: The measurement of PCT serum levels is of no help in the identification of patients, who should undergo emergent ERCP due to acute biliary pancreatitis (Tab. 1, Fig. 1, Ref. 6).

The clinical value of the procalcitonin in prediction of severity and outcome in acute pancreatitis.

BACKGROUND/AIMS: Early identification of patients with severe forms of acute pancreatitis (AP) and subsequent management of these high risk patients are the most important aims in order to decrease mortality from AP. Procalcitonin (PCT) as a marker for systemic inflammation appears to be a useful marker for early identification of severe forms. METHODOLOGY: 101 patients with confirmed AP have been admitted to department of general surgery. PCT values were measured in each patient on admission and after 12 hours. PCT levels were correlated to the disease's course and prognosis. Results are given through PPV and NPV. Immunoluminometric assay (BRAHMS Diagnostica) was used for measurement. RESULTS: PPV and NPV for prediction of disease's course were better for PCT than for CRP PPV 64.7% versus 36% and NPV 82,6% versus 79.6% and for prediction of fatal outcome PCT reached 75% and 100% for cut off value 5 ng/ml. CONCLUSIONS: PCT seems to be a useful screening parameter for detecting severe AP and for identifying the patients who need ICU treatment, ATB covering and who can benefit from the novel therapies.

CEA and relapse after the operation of colorectal carcinoma.

BACKGROUND: Relapses have an important meaning in relation to the curative surgical intervention. In RO resections according to UICC classification, the local relapses were classified as the most important factor for survival. Without any doubts the most important of these tumor-biological prognostic factors in patients with colorectal carcinoma is the carcino-embryonal antigen. Up to now, the unquestionable importance of the determination of serum levels of CEA for the detection of relapses is most often described. MATERIAL AND METHODS: This study is retrospective, not randomized. Analyzed were medical records and data of patients, who underwent the surgery of colorectal carcinoma at IInd Department of Surgery, University Hospital, Faculty of Medicine, Comenius University, Bratislava, in period from January 1st, 1986 to December 31st, 1995. In our analysis we evaluate the age and gender of patients, date of the surgery and type of the surgery from the point of acuteness, as well as radicality, staging of the disease, levels of the serum CEA. Serum levels of carcino-embryonal antigen before operation were determined and evaluated. In patients, who remaind in the monitoring at our department we examine CEA in regular intervals. RESULTS: From our group of patients, in 28 patients the relapse of the disease was determined here. Before the first operation, the preoperative level of CEA was examined in 15 patients and in 13 patients it was not. From 15 patients with examined CEA level, 7 patients (46.7%) had increased and 9 patients (53.3%) normal level. In twenty-seven patients CEA level was examined to reveal a relapse. One patient was diagnosed during the acute surgery and CEA was not determined prior this operation. From the remaining 27 patients, CEA level was positive in 20 patients (74.1%) and 7 patients had normal levels (25.9%). From these 7 patients with normal CEA level, in 5 cases it was locoregional relapse and 2 patients have distant metastases. From all patients, in whom the relapse was determined at our department, in 13 patients locoregional relapse was detected and in 15 patients distant metastases were diagnosed. CONCLUSION: Due to the sensitivity of serum level of CEA for detection of relapses, which is higher compared to the primary tumor and also to found lead time 4 months we think the postoperative regular determination of CEA in patients after the curative resection is appropriate. Earlier determination of less progressive relapse is definitely important, although the current long-term survival after the surgery for relapses is not optimistic. Development of surgical procedures as well as alternative treatment can bring better results in less developed relapse of the disease. (Ref. 28.).

[Prevention of venous thromboembolism in general and laparoscopic surgery]. / Prevencia venózneho tromboembolizmu vo vseobecnej a laparoskopickej chirurgii.

Pulmonary embolism and thromboembolic attacks remain the most frequent cause of mortality in patients after general surgery or laparoscopy. The authors review the risk factors, indication of prophylaxis of thromboembolism and the currently used modes of prophylaxis. The so-called low-molecular-weight heparins (LMWH) are the most frequently used modes of prophylaxis. The algorithm of prevention and doses of LMWH used in general surgery and laparoscopy are presented. (Tab. 5, Ref. 17.)