High plasma CD40 ligand level is associated with more advanced stages and worse prognosis in colorectal cancer.

BACKGROUND: Colorectal cancer (CRC) is often associated with elevated platelet count (> 400 × 109/L), known as thrombocytosis. The role of CD40 ligand (CD40L), a member of the tumor necrosis factor family, is controversial in CRC. Circulating CD40L is higher in CRC, but its relationship with disease staging and local and distant metastasis is not clear. Although most of the circulating CD40L is produced by platelets, no previous study investigated its relationship with CRC-related thrombocytosis. AIM: To investigate the role of CD40L to predict the outcome of CRC and its relation to thrombocytosis. METHODS: A total of 106 CRC patients and 50 age and sex-matched control subjects were enrolled for the study. Anamnestic data including comorbidities and histopathological data were collected. Laboratory measurements were performed at the time of CRC diagnosis and 1.5 mo and at least 6 mo after the surgical removal of the tumor. Plasma CD40L and thrombopoietin were measured via enzyme-linked immunosorbent assay, while plasma interleukin-6 was measured via electrochemiluminescence immunoassay. Patient follow-ups were terminated on January 31, 2021. RESULTS: Plasma CD40L of CRC patients was tendentiously higher, while platelet count (P = 0.0479), interleukin-6 (P = 0.0002), and thrombopoietin (P = 0.0024) levels were significantly higher as opposed to the control subjects. Twelve of the 106 CRC patients (11.3%) had thrombocytosis. Significantly higher CD40L was found in the presence of distant metastases (P = 0.0055) and/or thrombocytosis (P = 0.0294). A connection was found between CD40L and platelet count (P = 0.0045), interleukin-6 (P = 0.0130), and thrombocytosis (P = 0.0155). CD40L was constant with the course of CRC, and all baseline differences persisted throughout the whole study. Both pre- and postoperative elevated platelet count, CD40L, and interleukin-6 level were associated with poor overall and disease-specific survival of patients. The negative effect of CD40L and interleukin-6 on patient survival remained even after the stratification by thrombocytosis. CONCLUSION: CD40L levels of CRC patients do not change with the course of the disease. The CD40L level is strongly correlated with platelet count, interleukin-6, thrombocytosis, and the presence of distant metastases.

Does diabetes affect paraneoplastic thrombocytosis in colorectal cancer?

BACKGROUND: A large variety of factors can affect colorectal cancer (CRC) survival, including type 2 diabetes mellitus (T2DM) and paraneoplastic thrombocytosis. Although several common factors play a role in their development and platelets are damaged in both diseases, the combined relationship of the three conditions was never investigated previously. METHODS: A prospective, real-life observational cohort study was conducted with the inclusion of 108 CRC patients and 166 voluntary non-CRC subjects. Plasma interleukin-6 and thrombopoietin levels were measured. RESULTS: Study participants were divided into cohorts based on the presence of T2DM. Platelet count (p < 0.0500) and interleukin-6 (p < 0.0100) level were significantly higher in the CRC groups. Thrombopoietin level was higher in the T2DM, CRC, and CRC + T2DM groups (p < 0.0500). Analysis of parameter changes over time and survival models revealed that neither platelet count, interleukin-6, nor thrombopoietin levels were affected by T2DM. Death of patients was associated with higher baseline platelet count (p = 0.0042) and interleukin-6 level (p < 0.0001). CONCLUSION: Although the independent, disease-worsening effect of paraneoplastic thrombocytosis and T2DM is known, the coexistence of the two did not further impair the survival of CRC patients, suggesting that T2DM has no significant effect over paraneoplastic thrombocytosis.

Petersen hernia, a rare type of hernia in our department / Petersen-hernia, egy ritka sérvtípus megjelenése osztályunkon

61 years old female with previous surgical history of Roux-en-Y gastric bypass (3 years ago) and earlier hysterectomy admitted to our surgical department with clinical and radiological signs of small intestinal obstruction. Urgent intervention had been performed with following findings: Petersen herniation of alimentary tract including the ­ biliopancreatic tract and the small bowel extending to the midpart of the terminal ileum. Viability of herniated intestinal tract had been confirmed, and reposition of herniated parts through the Petersen hernia had been done. Closure with non-absorbable running suture of the gap between the transverse colon and the mesenteriun of the alimentary limb had been performed. Patient was fit for discharge on the fifth postoperative day.

Colon cancer during the coronavirus pandemic ­ recovery from COVID-19 pneumonia of an elderly woman with multiple co-morbidities / Vastagbéldaganat a koronavírusjárvány idején - idos, multimorbid nobeteg COVID-19-tüdogyulladásának gyógyulása: (A COVID­19-pandémia orvosszakmai kérdései)

COVID-19, caused by the new coronavirus, can lead to acute respiratory failure or even sepsis. Patients with multiple co-morbidities are more likely to develop these severe forms of the disease. The aim of this report is to highlight cases the analysis of which might help discover factors that influence the course and mortality of COVID-19 pneumonia. The past medical history of our elderly patient (75-year-old female) includes rectum resection with intraoperative cardiac arrest and successful resuscitation. In January 2020, the patient was diagnosed with adenocarcinoma of the ascending colon and concomittant pulmonary embolism. Following 6 weeks of therapeutic dose low-molecular-weight heparin (LMWH) treatment, the cancerous colonic section was resected. The patient arrested intraoperatively but was successfully resuscitated. On post-operative day 15, the patient developed arterial anastomosis bleed, which necessitated acute right-sided hemicolectomy. Post-operatively she became pyrexial and COVID-19 was confirmed, but later became apyrexial with symptomatic treatment. Subsequently, the patient developed partial anastomosis insufficiency, which resolved with conservative management. Following three negative SARS-CoV-2 tests, she was successfully discharged from hospital. It is worthy of note that due to the active anastomosis bleed the angiotensin-converting enzyme (ACE)-inhibitor treatment was stopped, and later the patient got infected with SARS-CoV-2. A long-lasting LMWH therapy was performed. The timely management of colorectal carcinoms remains important even during an epidemic. The appropriate treatment of these patients during the pandemic presents a great challenge for all doctors, but, as shown in our case report, surgical treatment of even those with multiple co-morbidities can be successful. Orv Hetil. 2020; 161(25): 1059-1062.

[The occurrence and impact on survival of type 2 diabetes mellitus and thrombocytosis in colorectal cancer, before and after the surgical resection of the primary tumor]. / Colorectalis daganatokban a 2-es típusú cukorbetegség és a thrombocytosis elofordulása, a túlélésre gyakorolt hatásuk, a primer tumor mutéti eltávolítása elott és után.

INTRODUCTION: The relationship between platelets and metastatic tumor cells is an ongoing research area. Pre- and postoperative thrombocytosis are suggested predictive survival markers. Colorectal cancer and type 2 diabetes are characterized by various changes to platelets. The occurrence of colorectal cancer is more frequent in diabetes. AIM: Our aim was to determine the occurrence of type 2 diabetes in colorectal cancer patients, who attended the Semmelweis University 2nd Department of Internal Medicine's Oncology Department in the last three years. Further goals included the evaluation of anamnestic, pre- and postoperative laboratory data, and whether diabetes can be a significant survival factor. METHOD: A retrospective study was conducted with 86 randomly selected colorectal cancer patients' preoperative (86 patients) and paired postoperative (66, who were operable) data. Patients were monitored no later than September 30, 2017 or until their death. RESULTS: Preoperatively, elevated (over 400 Giga/L) platelet counts were present in 22.1% of the patients (323.5 ± 128.63 Giga/L, mean ± SD) which decreased to 10.6% postoperatively (χ2: p = 0.0351; 289.2 ± 82.45 Giga/L, p = 0.0232). Negative correlation was found between platelet counts and overall survival (R: -0.35, p = 0.0085). One third of the patients had diabetes. Laboratory results (i.e., blood counts, creatinine) between diabetic and non-diabetic patients were not significant. Diabetes is a significant five-fold postoperative risk factor for shorter overall survival (relative risk: 5.1612, p = 0.0165). Average survival was 30.6 ± 26.78 months. CONCLUSION: Persistent consequential postoperative thrombocytosis may indicate shorter survival time. Our observations suggest elevated platelet counts and type 2 diabetes as prognostic markers for survival at the recognition of colorectal tumors. Orv Hetil. 2018; 159(19): 756-767.

PEG fixation of an upside-down stomach using a flexible endoscope: case report and review of the literature.

INTRODUCTION: Upside-down stomach usually is asymptomatic in adults, but sometimes it can cause regurgitation, vomiting, and weight loss. This condition has an incidence increasing with age thus increasing the risk of surgical intervention. CASE REPORT: A 90-year-old man was admitted with dysphagia, postprandial regurgitation, and an 18 kg weight loss in the past year. Gastroscopy revealed a significantly dilated, cranky esophagus and an upside-down stomach. The diagnosis was confirmed by a barium swallow and computed tomography. The stomach was repositioned with a gastroscope using insufflation and an α-loop maneuver under fluoroscopic guidance. A percutaneous endoscopic gastrostomy tube was then inserted to fix the stomach. The patient was discharged on the first postinterventional day. He gained 6 kg in the next 2 months. DISCUSSION: High-risk patients with upside-down stomach can be managed by endoscopic repositioning of the stomach and percutaneous endoscopic gastrostomy fixation. This is a useful alternative therapeutic intervention. There have been 14 similar cases being reported in the literature.