The Use of Autologous Subcutaneous Fat Tissue to Embolize an Infected Iliac Artery Pseudoaneurysm.

We describe a patient with a fistula between small bowel and a polyester patch of the common iliac artery. After emergency treatment with an endograft, the patch was replaced by a venous patch. Within 3-week a symptomatic pseudoaneurysm developed. It was decided to embolize the pseudoaneurysm using autologous subcutaneous fat, followed by a femoro-femoral crossover bypass using an allograft. Using this technique, the pseudoaneurysm was successfully excluded. This case shows that subcutaneous fat tissue can be used as an autologous embolic material, also in larger vessel pathology and in cases of ongoing infection, where regular embolization material cannot be used.

Late onset acute occlusion of the subclavian artery after clavicle fracture.

Vascular injuries after a clavicle fracture are rare. The treatment remains, if possible, conservative. In case of life-threatening bleeding or limb ischemia, endovascular treatment is the treatment of choice. In this case report, we describe a patient who suffered a clavicle fracture five years before and now presented with acute invalidating claudication caused by an acute occlusion superimposed on a brachial artery stenosis. After unsuccessful thrombolytic therapy a surgical exploration of the brachial artery was performed.

Outcome of colonic surgery in elderly patients with colon cancer.

Introduction. Colonic cancer is one of the most commonly diagnosed malignancies and most often occurs in patients aged 65 years or older. Aim. To evaluate the outcome of colonic surgery in the elderly in our hospital and to compare five-year survival rates between the younger and elderly patients. Methods. 207 consecutive patients underwent surgery for colon cancer. Patients were separated in patients younger than 75 and older than 75 years. Results. Elderly patients presented significantly more (P < .05) as a surgical emergency, had a longer duration of admission and were more often admitted to the ICU (P < .01). Also, elderly patients had significant more co-morbidities, especially cardiovascular pathology (P < .01). Post-operative complications were seen more often in the elderly, although no significant difference was seen in anastomotic leakage. The five-year survival rate in the younger group was 62% compared with 36% in the elderly (P < .05). DFS was 61% in the younger patients compared with 32% in the elderly (P < .05). Conclusion. Curative resection of colonic carcinoma in the elderly is well tolerated and age alone should not be an indication for less aggressive therapy. However, the type and number of co-morbidities influence post-operative mortality and morbidity.

Micro-metastases in stages I and II colon cancer are a predictor of the development of distant metastases and worse disease-free survival.

Approximately 30% of the patients with Dukes A/B colon carcinoma will develop loco-regional recurrence or distant metastases. The aim of this study was to evaluate if patients with micro-metastases are at higher risk for developing distant metastases and therefore a worse disease-free survival and overall survival. In the period January 2000-January 2002, 137 patients underwent curative surgery for colon cancer. When patients had a Dukes A/B colon carcinoma, additional staining and sectioning on the harvested lymph nodes were performed retrospectively. Lymph nodes were examined using 4 multilevel sections at 250-microm intervals and stained with Pan-Cytokeratin. There were 11 patients with a Dukes A and 61 patients with a Dukes B colon carcinoma. Twenty-two patients developed metastases in time (group I) whereas 50 patients did not (group II). After additional staining and sectioning 41% of the patients of group I and 16% of the patients of group II showed micro-metastases (p<0.05). The 5-year overall survival rate in the group with micro-metastases was 62% against 79% in the group without micro-metastases. The disease-free survival (DFS) was 51% and 72% (p<0.05), respectively. Patients with micro-metastases develop significant more distant metastases in time and have a significant worse DFS.

Melanoma of the rectum: a rare entity.

A 41-year-old man presented with a 6-mo history of changed defecation and rectal bleeding. A 3-cm polypoid tumor of the lower rectum was found at rectosigmoidoscopy, which proved to be a leiomyosarcoma upon biopsy. Dissemination studies did not show any metastases. He was underwent to an abdomino-perineal resection (APR). Histopathology of the specimen showed a melanoma (S-100 stain positive). Two years after the resection, metastases in the abdomen and right lung were found. He died one and half years later. Primary anorectal melanoma is a rare and very aggressive disorder. According to current data, one should always perform a S-100 stain when anorectal sarcoma is suspected. A positive S-100 stain suggests the tumour to be most likely a melanoma. Subsequently, thorough dissemination studies need to be performed. Depending on the outcome of the dissemination studies, a surgical resection has to be performed. Nowadays, a sphincter-saving local excision combined with adjuvant loco-regional radiotherapy should be preferred in case of small tumors. The same loco-regional control is achieved with less "loss of function" compared to non-sphincter saving surgery. Only in the case of large and obstructing tumors an abdomino-perineal resection is the treatment of choice.

Ex vivo sentinel lymph node "mapping" in colorectal cancer.

BACKGROUND: The purpose of this study was to evaluate the feasibility and reliability of ex vivo sentinel lymph node mapping in patients with colorectal cancer. METHODS: In the period January-June 2006, 44 consecutive patients underwent curative surgery for colorectal cancer. In patients with colon and rectal cancer, 0.5-2 ml of Patent Blue Dye was injected submucosally. The injection sites where then gently massaged for 5 min. RESULTS: In 96% of the patients with colon cancer and 94% of the patients with rectal cancer, at least one sentinel lymph node was found. There were no patients with a false negative sentinel node. The sensitivity was 100% with a negative predictive value of 100%. In 19% of the patients with colon cancer and 18% of the patients with rectal cancer the sentinel node was the exclusive site of lymph node metastases. After additional sectioning and staining, 7 of the 23 patients (30%) with a Dukes B colorectal cancer were upstaged. CONCLUSION: The technique of ex vivo sentinel lymph node mapping is technically feasible with high sensitivity, high negative predictive value and a high rate of upstaging. The next step is to investigate, if detection of micro-metastases is associated with decreased survival and/or increased local recurrence rates.