Postoperative results, pathologic outcome, and long-term patency rate of autologous vein reconstruction of the mesentericoportal axis after pancreatectomy.

PURPOSE: In advanced pancreatic cancer (PC), en-bloc vein resection and reconstruction (VR) is a curative option in oncologic pancreatectomy. However, few data about long-term patency rates after autologous venous reconstruction are available. We aimed to analyze whether early postoperative morbidity is increased by additional VR. Furthermore, pathologic outcomes and long-term patency rates after applying autologous vein material are examined. METHODS: Data on patients who underwent surgical resection for suspicious malignancy were collected prospectively. Early postoperative complications, as well as the circumferential resection margins were analyzed retrospectively. Patients with VR (VR+) were compared with patients without vein resection (VR-). Vein reconstruction was always performed by autologous vein replacement, followed by a 6-month application of Enoxaparin. Patency rates of the mesenteric vessels in long-term follow-up exams were determined by contrast-enhanced computed tomography (CT) every 3 months. RESULTS: Two hundred nineteen pancreatic resections for suspicious malignancy were performed. In 82 patients, VR occurred (37.4%). No significant differences between VR+ and VR- were observed concerning 30-day mortality and postoperative morbidity. R0 rate did not differ between the two groups. By applying autologous vein material, the average patency rate was 90%. CONCLUSION: In terms of tumor free resection margins, equal oncologic results can be achieved by additional vein resection. Because the patency rate is high in follow-up, and early postoperative complication rates are not increased in patients with VR+, vein resection and reconstruction should be performed if oncologically necessary. The application of autologous vein reconstruction followed by a 6-month enoxaparin treatment seems to yield favorable technical results.

Identification of Patients with Pancreatic Cancer by Electron Paramagnetic Resonance Spectroscopy of Fatty Acid Binding to Human Serum Albumin.

An effective biological marker for pancreatic adenocarcinoma (PAC) is not available so far. Here, we investigate how electron paramagnetic resonance (EPR) spectroscopy of spin-labeled fatty acid (FA) molecules binding to human serum albumin (HSA) in human serum is a suitable method for the identification of patients with PAC through detection of PAC-induced changes of FA binding to albumin. The functionality of HSA to bind FA is investigated in serum samples of 35 patients with PAC, 26 patients with benign pancreatic tumors (BPD), and 24 healthy individuals by continuous wave (CW) EPR spectroscopy by simply dissolving 16-DOXYL stearic acid as spin-labeled FA. It is found that FA binding to HSA in PAC is significantly modified when compared with healthy and BPD individuals. The PAC group could best be discriminated from the healthy group based on EPR characteristics at the loading ratio of 1:4 (HSA:FA), while patients with PAC and BPD are distinguishable at a loading ratio of 1:6. Using nanoscale distance measurements through double electron-electron resonance (DEER), it is found that the distribution of FAs in the HSA of one PAC patient is similar to that of FAs in healthy individuals. Combining all EPR spectroscopic data, this leads to a tentative molecular interpretation of only small changes in hydration at the protein's surface as origin of the detectable characteristics for PAC patients. Thus, EPR of FA/HSA binding is a simple and promising tool for clinical detection of patients with PAC and needs to be tested with larger ensembles of different patient groups.

Fatty Acid Binding to Human Serum Albumin in Blood Serum Characterized by EPR Spectroscopy.

One of the functions of Human Serum Albumin (HSA) is binding and transport of fatty acids. This ability could be altered by the presence of several blood components such as toxins or peptides - which in turn alters the functionality of the protein. We aim at characterizing HSA and its fatty acid binding in native serum environment. Native ligand binding and deviations from normal function can be monitored by electron paramagnetic resonance (EPR) spectroscopy using spin labeled fatty acids (FAs). Blood serum from healthy individuals is used to examine healthy HSA in its natural physiological conditions at different loading ratios of protein to FAs. Among the EPR spectroscopic parameters (like hyperfine coupling, line shape, rotational correlation time and population of different binding sites) the rotational correlation time is found to differ significantly between binding sites of the protein, especially at loading ratios of four FAs per HSA. Although differences are observed between individual samples, a general trend regarding the dynamics of healthy HSA at different loading ratios could be obtained and compared to a reference of purified commercially available HSA in buffer.

The single-incision laparoscopic surgery technique has questionable advantages in colorectal surgery.

BACKGROUND: Laparoscopic procedures have increasingly been accepted as standard in surgical treatment of benign and malignant entities, resulting in a continuous evolution of operative techniques. Since one of the aims in laparoscopic colorectal surgery is to reduce access trauma, one possible way is to further reduce the surgical site by the single-incision laparoscopic surgery technique (SLS). One of the main criticisms concerning the use of SLS is its questionable benefit combined with its technical demands for the surgeon. These questions were addressed by comparing SLS versus conventional laparoscopic multitrocar surgery (LMS) in benign and malignant conditions with respect to technical operative parameters and early postoperative outcome of the patients. METHODS: Between 2010 and 2013, we performed SLS for colorectal disease. Of the 111 patients who underwent colorectal resection, 47 patients were operated by SLS and 31 using the LMS technique. The collected data for our patients were compared according to operating time, postoperative morbidity and mortality, pain score numeric rating scale on day 1 and day 5 postoperatively and postoperative hospital stay. To complement the pain scores, the required pain medication for adequate pain relief on these days was given. RESULTS: There was no significant difference in age, BMI or sex ratio between the two groups. The intraoperative and early postoperative course was comparable as well. Postoperative hospital stay was the only parameter with a significant difference, showing an advantage for SLS. CONCLUSION: SLS is a feasible surgical method and a technical option in laparoscopic colorectal surgery. However, we were not able to identify substantial advantages of SLS that would favor this technique.

Analysis of albumin fatty acid binding capacity in patients with benign and malignant colorectal diseases using electron spin resonance (ESR) spectroscopy.

INTRODUCTION: In colorectal cancer (CRC), no biological marker is known that could serve both as a marker for detection and prognosis. Electron spin resonance (ESR) spectroscopy of spin-labeled fatty acid (FA) molecules binding to human serum albumin is a suitable method for the detection of conformational changes and alterations of transport function of albumin through changes in its FA binding capabilities. OBJECTIVE: The aim of this study was to examine whether the FA binding to albumin is detectably and significantly altered in CRC patients when compared with patients having benign colorectal diseases. MATERIALS AND METHODS: One hundred four patients operatively or endoscopically treated for CRC, sigmoid diverticulitis, or a colorectal adenoma were examined before procedure. Albumin was analyzed by ESR with spin-labeled FA. A determination ratio (DR) was calculated from the measured ESR spectra as ratios of the fraction of FA that is tightly bound vs. the fractions that are loosely interacting with albumin or are unbound. RESULTS AND DISCUSSIONS: Patients with CRC showed significantly lower DR values (DR, -0.09 +/- 0.98 vs. 0.61 +/- 1.43) than patients with benign colorectal diseases, consistent with a change of conformation and transport function of albumin in CRC. Within the CRC group, with advanced tumor stage, the difference in DR values increased. ESR of FA binding to albumin thus seems to be suitable for detection of patients with CRC. Furthermore, a correlation with advanced tumor stage can be established. CONCLUSIONS: These results suggest that a further evaluation of the role of ESR in patients with all stages of CRC should take place. It should also be examined whether ESR might play a role in detecting CRC in a larger panel of patients.

Pancreatic carcinosarcoma. Case report of multimodal therapy and review of the literature.

CONTEXT: Carcinosarcoma (malignant mixed tumor) is a rare variant of a pancreatic neoplasm having a dismal prognosis; very few clinical data and treatment options have been published. Unlike adenocarcinoma of the pancreas, there is nothing specific in the literature for this variant regarding postoperative treatment with chemotherapeutic agents. CASE REPORT: We report the case of a 61-year-old woman presenting with anemia. Examination revealed a mass in the pancreatic head and she underwent a partial pancreaticoduodenectomy. Histopathological examination revealed a pancreatic neoplasm with both adenomatous as well as sarcomatous characteristics. Postoperatively, the patient was treated with gemcitabine and was in a good health for 9 months. Three follow-up CT scans were done, showing complete remission. Eleven months postoperatively, the patient died from a recurrence. CONCLUSION: Carcinosarcoma of the pancreas is a very rare disease having a dismal prognosis. In addition to reviewing the literature on this entity, we present the first published case where gemcitabine was administered as a treatment modality in combination with surgery.

Simultaneous ectopic adrenocorticotropic hormone syndrome and adrenal metastasis of a medullary thyroid carcinoma causing paraneoplastic Cushing's syndrome.

Medullary thyroid carcinomas (MTC) constitute about 5 to 7 % of thyroid neoplasms. They originate from parafollicular C-cells which can secrete adrenocorticotropic hormone (ACTH) and/or corticotropin-releasing factor (CRF) in abnormally high concentrations, potentially causing paraneoplastic Cushing's Syndrome (CS). We report on a 42-year-old male patient with a ten year history of metastatic medullary thyroid carcinoma suffering from paraneoplastic Cushing's Syndrome caused by ectopic hypersecretion of ACTH and a simultaneous Cortisol producing adrenal metastasis.

Epiploic appendagitis--clinical characteristics of an uncommon surgical diagnosis.

BACKGROUND: Epiploic appendagitis (EA) is a rare cause of focal abdominal pain in otherwise healthy patients with mild or absent secondary signs of abdominal pathology. It can mimick diverticulitis or appendicitis on clinical exam. The diagnosis of EA is very infrequent, due in part to low or absent awareness among general surgeons. The objective of this work was to review the authors' experience and describe the clinical presentation of EA. METHODS: All patients diagnosed with EA between January 2004 and December 2006 at an urban surgical emergency room were retrospectively reviewed by two authors in order to share the authors' experience with this rare diagnosis. The operations were performed by two surgeons. Pathological examinations of specimens were performed by a single pathologist. A review of clinical presentation is additionally undertaken. RESULTS: Ten patients (3 females and 7 males, average age: 44.6 years, range: 27-76 years) were diagnosed with symptomatic EA. Abdominal pain was the leading symptom, the pain being localized in the left (8 patients, 80 %) and right (2 patients, 20%) lower quadrant. All patients were afebrile, and with the exception of one patient, nausea, vomiting, and diarrhea were not present. CRP was slightly increased (mean: 1.2 mg/DL) in three patients (33%). Computed tomography findings specific for EA were present in five patients. Treatment was laparoscopic excision (n = 8), excision via conventional laparotomy (n = 1) and conservative therapy (n = 1). CONCLUSION: In patients with localized, sharp, acute abdominal pain not associated with other symptoms such as nausea, vomiting, fever or atypical laboratory values, the diagnosis of EA should be considered. Although infrequent up to date, with the increase of primary abdominal CT scans and ultrasound EA may well be diagnosed more frequently in the future.

Serum calcitonin negative medullary thyroid carcinoma.

BACKGROUND: Medullary thyroid carcinomas (MTC) constitute about 5 to 7% of thyroid neoplasms. They originate from parafollicular C cells which produce Calcitonin, a hormone which has an impact on calcium metabolism and represents the biochemical activity of MTC. In rare cases pre-operative serum calcitonin can be negative. CASE PRESENTATION: We report on a 73-year-old female patient with a rare case of a serum calcitonin negative medullary thyroid carcinoma who suffered fulminant post-operative course and died of multiple metastasis. CONCLUSION: This case shows that in very rare cases MTCs do not secrete calcitonin making diagnosis and tumour follow-up difficult. To this date, only few reports describing this combination of circumstances were found in the English literature.