No abstract available.
Animals ; Bacteria* ; Carcinoma, Lewis Lung* ; Lactic Acid* ; Mice* ; Sarcoma 180* ; Sarcoma*

Colonic stenting has been suggested as an acceptable therapeutic option for the palliation of malignant colorectal obstruction or to achieve bowel decompression and preparation. It is effective as a bridge to surgery that is useful as an option to avoid emergency colostomy. However, it is associated with complications such as intestinal perforation, stent migration, bleeding, and failure of bowel decompression. Of all the complications, intestinal perforation and failure of bowel decompression are most serious and require surgical treatment. Here we report a case of abdominal compartment syndrome after stent insertion for obstructive colon cancer. The main causative factors for abdominal compartment syndrome were bowel distension associated with endoscopic gas inflation and failure to achieve bowel decompression.
Colon ; Colonic Neoplasms ; Colostomy ; Decompression ; Emergencies ; Hemorrhage ; Inflation, Economic ; Intestinal Perforation ; Intra-Abdominal Hypertension ; Stents

PURPOSE: Hepatoblastoma is the most common malignant liver tumor in children. The aim of this study was to review our results of hepatoblastoma treatment and to determine the role of surgical treatment in hepatoblastoma. METHODS: This is a retrospective clinical study. The medical records of patients with hepatoblastoma, treated between October 1994 and October 2009, were reviewed. The patients were classified according to the pretreatment extent of disease (PRETEXT) grouping system. The main outcome variable was survival. Secondary outcome variables were complete, partial and no response to chemotherapy and surgery, when indicated. RESULTS: Twenty-seven patients were treated during the observation period. Eighteen were males. Five were PRETEXT group I, 8 group II, 13 group III and 1 group IV. Complete excision was achieved in all patients except in one case that underwent liver transplantation (group IV). Median follow-up and survival rate were 2.3 years and 100%, 6.6 years and 75%, 5.8 years and 92%, 7.7 years and 100%, for groups I to IV, respectively. Twenty patients are currently considered to be in complete response status and three patients are receiving postoperative chemotherapy. Four patients died; the causes of death were cytomegalovirus hepatitis, bone marrow suppression during adjuvant chemotherapy, primarynonfunction after the transplantation for recurrent tumor and metachronous rectal cancer, respectively. CONCLUSION: Favorable long-term outcome could be expected for hepatoblastoma with complete tumor excision and adjuvant chemotherapy.
Bone Marrow ; Cause of Death ; Chemotherapy, Adjuvant ; Child ; Cytomegalovirus ; Follow-Up Studies ; Hepatitis ; Hepatoblastoma ; Humans ; Liver ; Liver Transplantation ; Male ; Medical Records ; Rectal Neoplasms ; Retrospective Studies ; Survival Rate ; Transplants

BACKGROUND: Primary liver tumors account for less than 2% of pediatric malignancies, and the best treatment is complete surgical excision. The aim of this study was to review the results of liver transplantation (LT) for primary hepatomas in children. METHODS: The medical records of patients who underwent LT for unresectable primary hepatoma between May 1996 and December 2009 were reviewed retrospectively. RESULTS: Seven of 130 patients (5.3%, M:F=4:3) underwent LT for unresectable hepatoma. The median age at transplantation was 9 years (range, 6 months-14 years). Two patients were transplanted for hepatitis B virus-associated hepatocellular carcinoma (HCC), 2 for hepatoblastoma, 1 for hemangioendothelioma, 1 for angiosarcoma, and 1 for intrahepatic cholangiocarcinoma after a Kasai operation for biliary atresia. There was no post-LT treatment except in patients with HCC who were taking immunoglobulin prophylaxis against hepatitis B. Four patients (2 HCC, 1 hepatoblastoma, 1 hemangioendothelioma) are now alive and well after 7.8, 7.2, 7.7, 6.3 years of follow-up, respectively. Three patients died after transplantation; 1 for the recurrent cholangiocarcinoma in the transplanted liver 1 year after the transplantation and 1 who underwent LT for the recurrent hepatoblastoma for the primary non-function 10 days after the transplantation. One patient died of metastatic angiosarcoma (bone) 2.5 years after LT. CONCLUSIONS: LT can be tried for unresectable primary hepatoma in children and, although limited, the outcome was successful in patients with HCC, hepatoblastoma, or hemangioendothelioma. Careful patient selection, based on the pre-transplant histological diagnosis, seems to be related to better outcome.
Biliary Atresia ; Carcinoma, Hepatocellular ; Child ; Cholangiocarcinoma ; Follow-Up Studies ; Hemangioendothelioma ; Hemangiosarcoma ; Hepatitis B ; Hepatoblastoma ; Humans ; Immunoglobulins ; Liver ; Liver Neoplasms ; Liver Transplantation ; Medical Records ; Patient Selection ; Transplants

Intra-abdominal desmoplastic small round cell tumor (DSRCT) is a highly malignant tumor of uncertain histogenesis. Here we report a case of DSRCT involving the stomach, initially misdiagnosed as gastric cancer. A 12-year-old boy presented with upper abdominal pain developed 1 month prior. On gastroscopy, a 7-cm mass was noted involving the esophago-gastric junction to the fundus, and positron emission tomography showed multiple hot uptakes suggesting distant metastasis. Gastroscopic biopsy showed poorly differentiated malignant cells. We diagnosed as stage IV gastric cancer and treated with 6 cycles of chemotherapy. Laparotomy revealed a huge gastric mass along with peritoneal disseminations. Palliative proximal gastrectomy was performed. Pathological examination revealed transmural involvement of DSRCT, and t(11;22)(p12;q12) was demonstrated on fluorescence in situ hybridization test. The chemotherapeutic regimen was changed and the patient underwent 8 additional cycles of post-operative chemotherapy. The patient is now alive and the residual tumor shows no significant changes after chemotherapy.
Abdominal Pain ; Biopsy ; Child ; Desmoplastic Small Round Cell Tumor ; Fluorescence ; Gastrectomy ; Gastroscopy ; Humans ; In Situ Hybridization ; Laparotomy ; Neoplasm Metastasis ; Neoplasm, Residual ; Positron-Emission Tomography ; Stomach ; Stomach Neoplasms

PURPOSE: Recently, non-operative conservative management or laparoscopic repair has been reported for the management of colonic perforation during colonoscopy. However, the preferred management strategy remains controversial. The purpose of the present study is to identify an appropriate strategy for the treatment of colon perforation during colonoscopy. METHODS: The medical records of patients who developed colon perforation during colonoscopy between May 2003 and November 2007 were retrospectively reviewed. The mechanism and site of perforation, the treatment administered, complications, and clinical outcomes were analyzed. RESULTS: In total, 16 perforations were evaluated. Of these, 11 developed during diagnostic colonoscopy and 5 during therapeutic colonoscopy. The most frequent perforation site was the sigmoid colon (12), followed by the transverse colon (2), the rectum (1), and unknown site (1). Six patients underwent surgery due to signs of diffuse peritonitis 10 were initially treated conservatively. Among the patients who underwent surgery, four underwent laparoscopic repair and two underwent open repair. Among the patients initially treated conservatively two patients required surgery due to clinical deterioration of peritonitis and rectovaginal fistula. These 2 patients underwent repair with proximal diverting stomas. CONCLUSIONS: Colon perforation associated with colonoscopy is a rare event, but raises serious complications. Selected patients with colonoscopic perforation may be treated conservatively, but if these patients fail to respond to such treatments, extensive surgical procedures may be warranted.
Colon ; Colon, Sigmoid ; Colon, Transverse ; Colonoscopy ; Humans ; Medical Records ; Peritonitis ; Rectovaginal Fistula ; Rectum ; Retrospective Studies

CD44 is a glycoprotein expressed in a wide variety of cell types. Recently expression of some alternatively-spliced variants of CD44 transcripts (CD44v) has been suggested to play a potential role in tumor metastasis and the detection of CD44v containing exon 6 to 11 may be helpful for the diagnosis of cancers. Expressions of CD44v containing exon 6 to 11 were investigated in 20 human colorectal cancer samples, peripheral blood leukocytes isolated from colorectal cancer patients, and 4 colorectal cancer cell lines using reverse transcription-polymerase chain reaction and Southern blot analysis. The standard form of CD44 transcripts was expressed in all samples tested. CD44v containing exon 6 to 11 was expressed in 18 cases of colorectal cancers (sensitivity = 90%), 3 out of 4 cell lines, and one normal tissue (specificity = 95%). These results suggest that the expression of CD44v containing exon 6 to 11 can be regarded as tumor specific and that this marker may be helpful for the early diagnosis of colon cancers, if specimens from the early stage are available.
Adenocarcinoma/*genetics ; Adult ; Aged ; Antigens, CD44/*genetics ; Base Sequence ; Blotting, Southern ; Colorectal Neoplasms/diagnosis/*genetics ; DNA Primers ; Electrophoresis, Agar Gel ; Feces/chemistry/cytology ; Female ; Gene Expression Regulation, Neoplastic/genetics ; Human ; Male ; Middle Age ; Molecular Sequence Data ; Polymerase Chain Reaction ; RNA Splicing/*physiology ; RNA, Messenger/analysis ; Tumor Cells, Cultured/*physiology ; Tumor Markers, Biological

PURPOSE: The York-Mason operation has been used as local therapy for benign rectal tumors not easily excised with a conventional transanal excision and for T1 rectal cancers having a low risk of lymph-node metastasis. This study evaluated whether a York-Mason operation could be an alternative therapy for selected patients with T2 or T3 rectal cancers. METHODS: From February 2004 to March 2008, 11 patients with T2 or T3 rectal cancer, who refused rectal excision due to fear of abdominal surgery itself and perioperative side effects or unwillingness to have a permanent stoma, underwent a York-Mason operation. The data on the patients were analyzed retrospectively. RESULTS: The distance from the anal verge to the tumor was 5 cm (median, 2-8 cm), and the tumor size was 3 cm (median, 1.5-4 cm). Histological examination revealed a pathological tumor (pT) stage 2 in eight patients, stage pT3 in one patient, and stage pTx in two patients. The distance from the resection margin to the tumor was 0.3 cm (median, 0.1-0.5 cm). Six patients (55%) had incomplete tumor excision. Radiotherapy was performed in one patient preoperatively and in eight postoperatively. Postoperative morbidity occurred in four patients (36%). During a median of 38.2 months, two patients (18%) developed local recurrence and liver metastasis. Postoperative mortality, which was not related to the procedure, occurred in one patient (9%). CONCLUSION: The York-Mason operation could be considered as an alternative therapy for selected T2 or T3 rectal cancer patients who refuse rectal excision.
Humans ; Liver ; Neoplasm Metastasis ; Rectal Neoplasms ; Recurrence ; Retrospective Studies

One of the most frequently used flaps for coverage of sacral skin and soft-tissue defects is the gluteus maximus musculocutaneous flap. These authors encountered two cases of sacral pressure sore, for which reconstructive surgery was performed, using the hatchet-shaped gluteus maximus musculocutaneous flap - a modified flap type. We report on our experience in treatment of these two cases, with an excellent outcome.
Myocutaneous Flap* ; Pressure Ulcer* ; Sacrum ; Skin

PURPOSE: Clostridium difficile (C. difficile)-associated colitis, a known complication of colon and rectal surgery, can increase perioperative morbidity and mortality, leading to increased hospital stay and costs. Several contributing factors, including advanced age, mechanical bowel preparation, and antibiotics, have been implicated in this condition. The purpose of this study was to determine the clinical features of and factors responsible for C. difficile-associated colitis after colorectal cancer surgery. METHODS: The medical records of patients who had undergone elective resection for colorectal cancer from January 2008 to April 2010 were reviewed. Cases that involved procedures such as transanal excision, stoma creation, or emergency operation were excluded from the analysis. RESULTS: Resection with primary anastomosis was performed in 219 patients with colorectal cancer. The rate of postoperative C. difficile-associated colitis was 6.8% in the entire study population. Preoperative metallic stent insertion (P = 0.017) and aged sixty and older (> or = 60, P = 0.025) were identified as risk factors for postoperative C. difficile-associated colitis. There were no significant differences in variables such as preoperative oral non-absorbable antibiotics, site of operation, operation procedure, and duration of prophylactic antibiotics. CONCLUSION: Among the potential causative factors of postoperative C. difficile-associated colitis, preoperative metallic stent insertion and aged sixty and older were identified as risk factors on the basis of our data. Strategies to prevent C. difficile infection should be carried out in patients who have undergone preoperative insertion of a metallic stent and are aged sixty and older years.
Aged ; Anti-Bacterial Agents ; Clostridium ; Clostridium difficile ; Colitis ; Colon ; Colorectal Neoplasms ; Emergencies ; Humans ; Length of Stay ; Medical Records ; Risk Factors ; Stents