The role of nm23 gene in colorectal carcinogenesis.

The aim of this study was to investigate the correlation of immunohistochemical expression of nm23 gene in colorectal cancer cells with tumor stage according to Dukes, tumor differentiation, occurrence of distant metastases and patient survival. This retrospective study included 100 colorectal cancer patients who underwent surgical treatment. Both pathological and clinical data were analyzed according to sex, age, immunohistochemical expression of nm23, tumor stage, tumor differentiation, occurrence of distant metastases and patient survival. Overexpression of nm23 gene was related to both good tumor differentiation and Dukes' stage A, whereas no significant correlation was found between the occurrence of metastases and nm23 gene expression. There was no significant correlation between nm23 gene expression and 5-year survival of colorectal cancer patients either. Although the results of this study suggested that higher expression of nm23 gene correlated with an early stage of tumor and its good differentiation, this parameter cannot yet be taken as an independent and reliable prognostic indicator in colorectal cancer.

Percutaneous embolization of persistent low-output enterocutaneous fistulas.

OBJECTIVES: To present and retrospectively evaluate the technique of percutaneous embolization of chronic enterocutaneous fistulas (ECFs) using n-butyl-2-cyanoacrylate and Lipiodol under fluoroscopic guidance. METHODS: Six patients with a total of seven post-operative low-output ECFs of the large intestine were treated. After fistulography a hydrophilic guide wire and a catheter were advanced through the ECF into the intestine. After dilation of the bowel with saline and contrast medium, the catheter was withdrawn into the enteric orifice and glue together with Lipiodol was injected while simultaneously pulling the catheter. RESULTS: Complete closure of all seven fistulas was achieved. There were no peri-procedural complications. In one patient 1 month following embolization a low-output enteric discharge was observed, but the ECF spontaneously healed 5 days later. In one patient 18 months after the embolization a new perforation due to diverticulitis close to the embolization site occurred and resection of the sigmoid colon was performed. One patient needed reoperation due to a recurrence of rectal carcinoma. CONCLUSIONS: In our series of patients, the presented technique of percutaneous embolization proved to be efficacious and easy to perform. It may have potential as a first-line treatment of low-output ECFs but a prospective study with a larger series of patients and a longer follow-up is required.

Advantages of the spared surgical treatment of the spleen injuries in the clinical conditions.

BACKGROUND/AIMS: Aim of this study was to compare clinical, biochemical and hematological parameters of the patients after posttraumatic splenectomy, posttraumatic spleen preservation and auto transplantation and the control group of the patients. METHODOLOGY: The study included data on 169 patients treated at the University Surgery Department, University Hospital Split, from 1998 till 2006. There were 127 male, and 42 female patients, mean age was 40,3 years (range 15-74), 137 of the patients underwent surgery and 32 were treated without operation. A group of 29 patients, who underwent inguinal hernia repair, was the control group. RESULTS: Reduction in postoperative morbidity, hospital stays and blood products administration are achieved if the spleen is preserved. The values of Howell-Jolly bodies, CH50 complement particles, IgM antibodies, lymphocytes and monocites are reduced if the spleen is not preserved. CONCLUSION: No operative treatment and spleen preserving surgical procedures are superior to the splenectomy in the spleen trauma treatment. Splenectomy should be avoided whenever is possible.

Skip mediastinal nodal metastases in the IIIa/N2 non-small cell lung cancer.

INTRODUCTION: To study the incidence and characteristics of mediastinal nodal metastases without N1 nodal metastases (skip N2 metastases) in patients with resected pIII/A/N2 non-small cell lung cancer. METHODS: A total of 323 non-small cell lung cancer patients who underwent radical surgical resection with a systematic mediastinal nodal dissection in 4-year period (2000-2003) were retrospectively reviewed. The 85 patients (26%) at stage IIIA/N2 (pN2+) were grouped according to their skip metastases status. Patient data were statistically analyzed. RESULTS: Skip N2 metastases were found in 21 patients (25%) without N1 nodal involvement. The postoperative survival for skip N2 disease was almost the same as that for pN2 disease with N1 nodal involvement. The incidence of N2 metastases seemed to be more frequent in adenocarcinoma patients (p < 0.005), but skip N2 metastases were significantly higher (p < 0.001) in squamous cell carcinoma patients. Although skip metastases involved more often upper mediastinal lymph nodes and one station level, the difference was not found statistically significant (p < 0.227). Complication rate showed no difference between analyzed groups of patients. CONCLUSIONS: Sample mediastinal lymphadenectomy may not be appropriate in surgery for non-small cell lung cancer because skip metastases were found in 25% of patients without N1 nodal involvement.

Role of insulin-like growth factor-1 in colon cancerogenesis: a case-control study.

BACKGROUND: Our aim was to establish whether individuals who developed colon cancer have elevated blood levels of insulin-like growth factor-1 (IGF-1). METHODS: This was a case/control study in which 52 patients with colon cancer and a corresponding control group were investigated. Data on age, weight, height, and sex of subjects were recorded and levels of IGF-1 and growth hormone, as well as insulin and C-peptide levels, were measured in the morning before eating, 90 min after breakfast and again 90 min after lunch. RESULTS: We found significantly higher levels of IGF-1 in blood of colon cancer patients compared to the control group. No differences in the levels of growth hormone, insulin and C-peptide in blood were found between colon cancer patients and the control group. It was found that the increase of IGF-1 level was followed by a 3.15-fold increased risk for developing colon cancer. There were no differences in the levels of IGF-1 in blood in all three measurements in the group of colon cancer patients, whereas differences were found in the control group. We found differences in the levels of insulin and C-peptide in blood in all three measurements in both groups of patients. No differences were found in the levels of growth hormone in blood in all three measurements in both groups of patients. CONCLUSIONS: The results of this study suggest a positive correlation between the increased levels of IGF-1 and colon cancer and are thus consistent with the hypothesis that the level of IGF-1 plays an important role in the development of colon cancer.

Injuries from Antitank mines in Southern Croatia.

OBJECTIVE: Antitank mines inflict devastating injuries that are usually fatal. The objective of this retrospective study was to analyze antitank mine casualties in South Croatia during the period from 1991 to 1995. METHODS: Mechanism, degree of injury according to Abbreviated Injury Scale and Injury Severity Score, as well as surgical treatment were analyzed. FINDINGS: Of 464 mine victims, 42 (9.0%) patients sustained antitank mine injuries, and 12 of these were fatal (29%). Abbreviated Injury Scale of the antitank mine injuries was 5.3 +/- 10.6. Military personnel were injured in 29 cases, and civilians were injured in 13 cases. CONCLUSION: Although injuries from antitank mines were ravaging, and frequently fatal, a significant number of patients survived.

Insulin increase in colon cancerogenesis: a case-control study.

BACKGROUND: Our aim was to establish whether individuals who develop colon cancer have elevated blood insulin concentrations. METHODS: This was a case-control study in which 56 normoglycemic patients with colon cancer and a corresponding control group were investigated at the Clinical Hospital Split from April 1998 to April 1999. Data on age, weight, height, and sex of examinees were recorded and concentrations of glucose, insulin, and C-peptide were measured first in the morning before breakfast and again 90 min after breakfast. RESULTS: In the male group of colon cancer patients, we found statistically significant higher blood insulin concentrations 90 min after breakfast (median 34.7 mIU/L, range 3.3-162.6 mIU/L) in comparison to male control group (median 20.7 mIU/L, range 3.1-122.1 mIU/L) (p=0.044). Concentration of C-peptide in blood 90 min after breakfast (median 3.28 nmol/L, range 0.38-6.1 nmol/L) was higher in the male group of colon cancer patients than in male control group (median 1.68 nmol/L, range 0.26-4.26 nmol/L) (p=0.001). No difference was found in concentrations of insulin, C-peptide, and glucose in blood measured in the morning before breakfast between the male group of colon cancer patients and male control group. Ratio of insulin 90 min after breakfast with respect to insulin in the morning before breakfast was higher in the male group of colon cancer patients (median 4.65, range 0.83-22.1) than in male control group (median 1.78, range 0.38-8.75) (p=0.005). Ratio of C-peptide 90 min after breakfast with respect to fasting C-peptide was higher in the male group of colon cancer patients (median 3.22, range 0.74-11.9) than in male control group (median 1.42, range 0.54-6.0) (p=0.001). Women with colon cancer also had statistically significant higher ratio of insulin and C-peptide with respect to female control group. In the female group of colon cancer patients, median for ratio of C-peptide was 2.42 (range 0.43-8.87), while in female control group it was 1.19 (range 0.62-15.4) (p=0.025). Median for ratio of insulin in the female group of colon cancer patients was 4.23 (range 0.25-8.54), while in female control group it was 1.17 (range 0.29-26.89) (p=0.007). CONCLUSIONS: There was a higher increase of insulin 90 min after breakfast in the group of patients with colon cancer than in control group.