Local recurrence after 'standard' abdominoperineal resection: do we really need ELAPE?

Introduction Low rectal cancers requiring abdominoperineal resection tend to have a worse prognosis than higher tumours, which may be treated by anterior resection. One of the reasons for this may be inadequate local surgery, in particular the narrow waist of the resection specimen of a standard abdominoperineal resection may be associated with a high positive circumferential resection margin. The extralevator abdominoperineal excision (ELAPE) aims to improve the R0 resection rate but carries significant morbidity. We examined our own results of standard abdominoperineal resection to assess the need for a change of policy. Methods We operformed a retrospective analysis of consecutive standard abdominoperineal resections for rectal cancer in a single centre from June 2002 to December 2011. Results A total of 102 patients underwent standard abdominoperineal resection with curative intent; 19 had no preoperative treatment, 42 had short course radiotherapy, 9 had long course radiotherapy and 32 had neoadjuvant chemotherapy followed by long course chemoradiotherapy. In 17/102(16.6%), there was a positive circumferential resection margin. Over a median follow up of 32 months, 20 patients developed recurrence of any type. Local recurrence occurred in five patients (two of which also had distant recurrence), of whom two had a positive circumferential resection margin (P = 0.10). Actuarial two-year local only recurrence was 3.4% and any recurrence was 17.7%. Overall five-year cancer specific survival was 77%. Conclusions In this series we found low rates of local recurrence after standard abdominoperineal resection even with a circumferential margin rate positivity of 16.6%.Performing an ELAPE in selected cases may improve these results further but is not necessarily required for all patients.

Laparoscopic management of terminal ileal volvulus caused by Meckel's diverticulum.

Complications from a Meckel's diverticulum include diverticulitis, bleeding, intussusception, bowel obstruction, a volvulus, a vesicodiverticular fistula, perforation or very rarely as a tumour. We report a case where a Meckel's diverticulum presented with a terminal ileal volvulus in a 32-year-old man without the presence of a typical vitelline band or axial torsion of the diverticulum causing the volvulus. It was successfully managed laparoscopically.

Receptor of advanced glycation end products (RAGE) positively regulates CD36 expression and reactive oxygen species production in human monocytes in diabetes.

INTRODUCTION: Advanced glycation end products (AGEs) engagement of a monocyte surface receptor (RAGE) induces atherosclerosis. AGEs also act as CD36 ligands. We studied reactive oxygen species (ROS) and CD36 expression after siRNA inhibition of RAGE expression in human monocytes. METHODS: We isolated monocytes from: a) 10 type 2 diabetics, and b) 5 age- and sex-matched healthy individuals. CD36 expression and ROS production were evaluated before and after RAGE knockdown. RESULTS: After incubation of monocytes with AGE + bovine serum albumin (BSA), CD36 expression and intracellular ROS increased significantly in all groups. In RAGE-knockdown monocytes, AGE-induced CD36 expression and ROS generation were also significantly inhibited. CONCLUSIONS: Blocking RAGE expression using siRNA in human monocytes led to a significant inhibition of CD36 expression and ROS production, suggesting a positive interaction between RAGE, CD36 expression and ROS generation in monocytes.

Advanced glycosylation end products and nutrition--a possible relation with diabetic atherosclerosis and how to prevent it.

Advanced glycosylation end product (AGE) levels are elevated in diabetic patients and may contribute to the excessive cardiovascular disease in this population, promoting oxidant stress and chronic vascular inflammation. AGEs in people with diabetes mellitus are formed mainly by protein and lipid glucosylation in an environment of chronic hyperglycemia and also by prolonged thermal food processing (diet derived AGEs). This brief review summarizes current literature about food derived AGEs and their relationship with diabetic vascular disease and supports the importance of low AGE diet as an essential preventive or therapeutic intervention against atheromatosis progress.

Knee dislocations and their management. A report of 16 cases.

We retrospectively studied the outcome of 16 knee dislocations. 11 patients had surgical treatment, 4 were managed nonoperatively and 1 patient died. In the elderly the outcome was poor, regardless of the type of treatment. Only 3 adolescents obtained excellent results and 2 young adults had good results after surgical repair of the knee. Concurrent arterial and nerve damage increased the morbidity.

[A case of multifocal neurinoma of the femoral nerve associated with chronic myeloblastic dysplasia]. / Un cas de neurinome étagé ancien du nerf crural, associé à une dysplasie myéloblastique chronique.

A large multiple lobulated painless mass in the inguinal fossa, was investigated and removed, in a 58 years old patient with undiagnosed chronic myelodysplasia. The patient was initially referred to the urologic clinics for recurrent bleeding from the urinary tract, when the above mentioned and few smaller masses were palpated on the anterior aspect of the thigh. Clinical, laboratory and imaging investigation revealed enlargement of the spleen and the liver accompanied by relatively large and well separated tumors under the inguinal ligament extending to the upper thigh. From clinical history the patient had recurrent episodes of spontaneous bleeding from the nose and the bladder. He underwent open biopsy under general anesthesia where the inguinal tumor was found to be well encapsulated, firmly attached to a branch of the femoral nerve and loosely connected with the next mass that had similar characteristics. Intraoperative decision was made to excise the entire lesion which consisted of thirteen lobules of varying size, connected to each other as a chain. Histological examination revealed multifocal ancient neurilemona from a sensory branch of the femoral nerve. Further investigation of the patient for the episodes of hemorrhage and the enlargement of the spleen and the liver gave the diagnosis of chronic myelodysplasia. The patient was doing well one year after the excision of the tumor, and had an area with hypoesthesia above the knee. The concurrence of the two distinct neoplasms is discussed.