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Οι φυλετικές ορμόνες επηρεάζουν τη βιολογική συμπεριφορά του μελανώματος. Μετά την ανακάλυψη των οιστρογονικών υποδοχέων (ER) και ιδίως του υποδοχέα βήτα, η άποψη πως τα μελανώματα εκφράζουν χαμηλές συγκεντρώσεις ER αναθεωρήθηκε. Ο σκοπός της παρούσας μελέτης ήταν να διερευνήσει το βαθμό έκφρασης των ER στο πρωτοπαθές μελάνωμα αλλά και στο λεμφαδένα φρουρό αυτού που παριστά ένα σημαντικό σταθμό στη μεταστατική διαδικασία και να εκτιμήσει πιθανή συσχέτιση με την πρόγνωση και τη συνολική επιβίωση.Μέθοδος. Πραγματοποιήθηκε ανάλυση δεδομένων 60 ασθενών, μέσης ηλικίας 54,4 ± 14,5 ετών, με διάγνωση μελανώματος κατά την περίοδο 2001-2012. Όλοι οι ασθενείς υποβλήθηκαν σε βιοψία λεμφαδένα φρουρού, μετά την αναγνώρισή του με ραδιοϊσοτοπική λεμφαγγειογραφία. Εάν η ιστοπαθολογική εξέταση αναδείκνυε διήθηση του λεμφαδένα από το νεόπλασμα, διενεργείτο συμπληρωματικός λεμφαδενικός καθαρισμός, σε δεύτερο χρόνο. Με ανοσοϊστοχημική μέθοδο εκτιμήθηκε η έκφραση των οιστρογονικών υποδοχέων (ERα και ERβ) σε όλες τις δυνατές περιπτώσεις.Αποτελέσματα. Η έκφραση του ERα ήταν εξαιρετικά ασθενής, αναδεικνύοντας τον ERβ σαν τον επικρατούντα οιστρογονικό υποδοχέα, τόσο στον πρωτοπαθή όγκο, όσο και στο λεμφαδένα φρουρό. H εντονότερη ανοσοέκφραση του Μέθοδος. Πραγματοποιήθηκε ανάλυση δεδομένων 60 ασθενών, μέσης ηλικίας 54,4 ± 14,5 ετών, με διάγνωση μελανώματος κατά την περίοδο 2001-2012. Όλοι οι ασθενείς υποβλήθηκαν σε βιοψία λεμφαδένα φρουρού, μετά την αναγνώρισή του με ραδιοϊσοτοπική λεμφαγγειογραφία. Εάν η ιστοπαθολογική εξέταση αναδείκνυε διήθηση του λεμφαδένα από το νεόπλασμα, διενεργείτο συμπληρωματικός λεμφαδενικός καθαρισμός, σε δεύτερο χρόνο. Με ανοσοϊστοχημική μέθοδο εκτιμήθηκε η έκφραση των οιστρογονικών υποδοχέων (ERα και ERβ) σε όλες τις δυνατές περιπτώσεις.Αποτελέσματα. Η έκφραση του ERα ήταν εξαιρετικά ασθενής, αναδεικνύοντας τον ERβ σαν τον επικρατούντα οιστρογονικό υποδοχέα, τόσο στον πρωτοπαθή όγκο, όσο και στο λεμφαδένα φρουρό. H εντονότερη ανοσοέκφραση του ERβ καταδείχθηκε σε λεπτά, λιγότερο διηθητικά μελανώματα.με αρνητικούς λεμφαδένες φρουρούς. Επιπρόσθετα, η έκφραση του ERβ στον πρωτοπαθή όγκο σχετιζόταν σαφώς με το κυτταρικό μικροπεριβάλλον του, πιθανά επηρεάζοντας τη λεμφογενή διασπορά.Συμπέρασμα. Τα επίπεδα έκφρασης του ERβ είναι ελαττωμένα σταθερά σε επιθετικά μελανώματα, μεγάλου πάχους με μεταστατική νόσο στο λεμφαδένα φρουρό. Η αξιολόγησή τους υποδεικνύει έναν πιθανό δείκτη του μεταστατικού δυναμικού των μελανωμάτων και κατ’ επέκταση της πρόγνωσης της νόσου.

Highlights • Entero-vesical fistulas (EVFs) represent an uncommon complication of Crohn’s disease. • EVFs affects mostly men patients. • Conservative treatment improves symptoms but is associated with low rate of healing. • Surgical approach is usually necessary, establishing long-term remission., Background Entero-vesical fistula (EVF) is an abnormal link between the enteric lumen and the urinary bladder. Crohn's disease (CD) represents, nowadays, the most common cause in the formation of this fistula. Materials and methods The aim of this study was to describe the diagnostic and treating modalities applied in nine patients with CD and EVFs, the clinical/epidemiological features of this clinical entity and to perform a systemic review of the literature, concerning the diagnosis and treatment of this complication. Results The medical records of eight men and one woman (mean age 42 ± 12 years) with EVFs were analyzed. The terminal ileum and the ileocecal region were affected in three and six cases, respectively. The most common symptoms were pneumaturia, fecaluria, fever, urinary urgency and abdominal pain. The diagnosis was suspected by abdominal CT scan and by indirect findings of bladder infection in cystoscopy. MRI with concurrent cystography set the diagnosis in three patients. Colonoscopy was not helpful. Conservative treatment, including administration of antibiotics and immunosuppressive agents in all patients and anti-TNF-a agent (infliximab) in six patients, was ineffective. Surgical treatment was applied in seven cases (77.8%), including fistula repair in all patients, drainage of coexistent intraabdominal abscess in two, small bowel resection in four and ileocecectomy in two cases. Conclusion EFVs are uncommon but potentially dangerous complications of CD. Abdominal CT scan and cystoscopy are the most commonly used diagnostic modalities. Surgical treatment seems to be unavoidable in most cases, although medical treatment could also benefit a small cohort of patients.

Non-operative management (NOM) may be particularly challenging in patients receiving synchronous antithrombotic therapy (AT). The current study examined the feasibility of NOM in patients under AT who sustained blunt splenic or hepatic injuries.We analyzed the results of a 5-year (2010-2014) pre-decided treatment protocol, including 15 patients under AT who were treated for splenic and/or hepatic injuries at our institution. The antithrombotic therapy consisted of acenocoumarol 4 mg, acetylsalicylic acid 100 mg and clopidogrel 75 mg. Vitamin K (Vit K), Fresh frozen plasma (FFP) and Prothrombin Complex Concentrate (PCC) were transfused to patients receiving anticoagulant therapy, while platelets (PLTs) were given to patients under antiplatelet therapy if their level was excessively low. The organ injury grading scale, injury severity score (ISS), the need for blood transfusion and intensive care unit (ICU)/ high dependency unit (HDU) admission, morbidity, mortality and duration of hospital stay were also recorded.Ten patients fulfilled the criteria for NOM and were treated accordingly. No conversion to operative management (OM) was required (success rate 100%). Five patients were managed surgically due to hemodynamic instability and/or signs of peritonitis. Reversal of AT was attempted in all cases.Hemodynamically stable patients under AT with blunt hepatic or splenic injuries (grade ≤ III) and no signs of peritonitis, may be good candidates for NOM, despite their bleeding tendency. The type of AT does not seem to influence the final outcome. Reversal of AT should be stratified individually.Antithrombotic therapy, Hemodynamic stability, Non-operative management.La gestione non operatoria (NOM) può essere particolarmente difficile nei pazienti sottoposti a contemporaneo trattamento antitrombotico (AT). Con questo studio è stata esaminata la fattibilità di NOM in pazienti con AT che hanno subito lesioni epatiche o spleniche. Per questo abbiamo analizzato i risultati a 5 anni (2010- 2014) di un protocollo prospettico su 15 pazienti sotto trattamento AT, trattati per lesioni spleniche e / o epatiche presso il nostro istituto. La terapia antitrombotica consisteva in 4 mg di acenocumarolo, 100 mg di acido acetilsalicilico e 75 mg di clopidogrel. La vitamina K (Vit K), il plasma fresco congelato (FFP) e il concentrato di complesso protrombinico (PCC) sono stati trasfusi nei pazienti sottoposti a terapia anticoagulante, mentre piastrine (PLT) sono state somministrate a pazienti sottoposti a terapia antiaggregante se il loro livello era eccessivamente basso. Sono state inoltre registrate il grado delle lesioni organiche, il punteggio di gravità (ISS), la necessità di trasfusione di sangue e di trattamento in terapia intensiva (HDU) di grado elevato, la morbilità, la mortalità e la durata della degenza ospedaliera. I pazienti con adeguati criteri per NOM e trattati di conseguenza sono stati dieci. Non è stata necessaria alcuna conversione alla gestione operativa (OM) con un tasso di successo del 100%. Cinque pazienti sono stati gestiti chirurgicamente a causa di instabilità emodinamica e / o segni di peritonite. In tutti i casi è stata tentata la In tutti i casi è stata tentata l’interruzione dell’AT. Si conclude che i pazienti emodinamicamente stabili sotto AT con lesioni epatiche o spleniche (grado ≤ III) e senza segni di peritonite, possono essere buoni candidati per il NOM, nonostante la loro tendenza al sanguinamento. Il tipo di AT non sembra influenzare il risultato finale. L’interruzione del trattamento AT dovrebbe essere deciso caso per caso.

Surgery stimulates an intense systemic inflammatory response which might increase postoperative morbidity. Corticosteroids may reduce this inflammatory reaction. The purpose of this study was to investigate any possible effect on postoperative morbidity and recovery after administrating methylprednisolone in super-obese patients undergoing open surgery. Sixty super-obese patients with BMI ≥50 kg/m2 (mean 57.48 ± 7.33), mean age of 39 ± 9 years, who underwent an open bariatric procedure, were enrolled. Thirty patients (group A) were allocated to a preoperative single dose of 30 mg/kg (ideal body weight) methylprednisolone versus placebo (group B, 30 patients). Endpoints included assessment of IL-6 and CRP; evaluation of postoperative pulmonary function, pain management, nausea, and vomiting; and documentation of postoperative complications. Significant improvement in spirometry parameters and arterial blood gas analysis, in the first and third postoperative days, was observed in the methylprednisolone group. IL-6 and CRP levels were significantly lower in that group. Administration of methylprednisolone was associated with less postoperative pain, nausea, and vomiting, with no statistical difference in septic complications. Preoperative administration of a single high dose of methylprednisolone in super-obese patients undergoing open surgery inhibits the inflammatory signaling cascade, lessens the systemic inflammatory response, and results in fewer pulmonary complications and better patient recovery.

Background The non-operative management (NOM) of abdominal injuries has gained wide acceptance over the last few decades. The present study evaluated the efficacy of NOM in blunt abdominal trauma (BAT) at a regional Hellenic hospital. Methods We analyzed the results of a pre-decided treatment protocol, which was applied to all patients hospitalized for BAT, from 2008 to 2015. The protocol proposed NOM in hemodynamically stable patients with no signs of peritonitis. The demographic characteristics, type of injury, injured organ(s), type of management (operative vs. non-operative), Injury Severity Score (ISS), morbidity, mortality rates, and health costs were evaluated. Results One hundred and forty-six patients hospitalized for BAT at our department were included. Among them, 49 were operated and 97 were subjected to NOM. Although ISS was significantly higher in the surgical group, the severity of injuries in liver, spleen, and kidneys was not different between the two groups. Surprisingly, no case subjected to NOM required a conversion to operative management, which may probably be because of the strict inclusion criteria for NOM. Conclusion Patients with hemodynamic stability and normal physical examination may be non-operatively treated, independent of the grade of injury, in highly selective cases. ISS score is an independent risk factor for surgical treatment.

Patient: Male, 70 • Male, 84 Final Diagnosis: Appendiceal mucocele and pseudomyxoma peritonei Symptoms: — Medication: — Clinical Procedure: — Specialty: Surgery Objective: Rare disease Background: Mucocele of the appendix is an uncommon cystic lesion characterized by distension of the appendiceal lumen with mucus. Most commonly, it is the result of epithelial proliferation, but it can also be caused by inflammation or obstruction of the appendix. When an underlying mucinous cystadenocarcinoma exists, spontaneous or iatrogenic rupture of the mucocele can lead to mucinous intraperitoneal ascites, a syndrome known as pseudomyxoma peritonei. Case Report: We report 2 cases that represent the clinical extremities of this heterogeneous disease; an asymptomatic mucocele of the appendix in a 70-year-old female and a case of pseudomyxoma peritonei in an 84-year-old male. Subsequently, we review the current literature focusing to the optimal management of both conditions. Conclusions: Mucocele of the appendix is a rare disease, usually diagnosed on histopathologic examination of appendectomized specimens. Due to the existing potential for malignant transformation and pseudomyxoma peritonei caused by rupture of the mucocele, extensive preoperative evaluation and thorough intraoperative gastrointestinal and peritoneal examination is required.

Introduction: Neutrophil gelatinase-associated lipocalin (NGAL) has been identified as a biomarker of acute kidney injury (AKI) that could contribute to early diagnosis and effective management of AKI. The purpose of this study was to evaluate NGAL as a predictive marker of AKI in patients with clinically severe obesity (BMI >50) who underwent biliopancreatic diversion surgery. Patients and Methods: We prospectively studied 23 patients with clinically severe obesity who underwent biliopancreatic bypass surgery. NGAL was measured using chemiluminescent microparticle immunoassay in three urine samples collected from each patient before surgery (first sample), 2-6 h after surgery (second sample) and on the first postoperative day (third sample). Results: Renal function was evaluated using serum creatinine values, which were 0.91 ± 0.26 mg/dl before surgery, 0.87 ± 0.31 mg/dl immediately after surgery and 0.92 ± 0.62 mg/dl on the fifth postoperative day. During the immediate postoperative period, AKI was observed in 2 patients, one of whom required renal replacement therapy with hemodialysis. In both patients, urine NGAL increased within the first postoperative hours before the values of serum creatinine increased. Conclusion: Urine NGAL in patients with clinically severe obesity, which was surgically treated, might be a potential biomarker of early AKI detection. Further research is required in order to confirm these results observed in a small number of patients who developed postoperative AKI and make recommendations for predictive NGAL values in patients who underwent bariatric surgery.

Selective IgM deficiency is a rare type of dysgammaglobulinemia characterized by low levels of serum IgM and repeated multisystemic infections. Yersiniosis is a food-borne disease that has become more prevalent recently due to human transmission via the fecal-oral route and its occurrence in farm animals. No clinically obvious development of Yersiniosis in patients with selective IgM deficiency has been described so far. The present report describes a patient with selective IgM deficiency who presented with repeated microbial infections and terminal ileitis due to Yersinia infestation.

BACKGROUND: To validate a new practical Sepsis Severity Score for patients with complicated intra-abdominal infections (cIAIs) including the clinical conditions at the admission (severe sepsis/septic shock), the origin of the cIAIs, the delay in source control, the setting of acquisition and any risk factors such as age and immunosuppression. ----- METHODS: The WISS study (WSES cIAIs Score Study) is a multicenter observational study underwent in 132 medical institutions worldwide during a four-month study period (October 2014-February 2015). Four thousand five hundred thirty-three patients with a mean age of 51.2 years (range 18-99) were enrolled in the WISS study. ----- RESULTS: Univariate analysis has shown that all factors that were previously included in the WSES Sepsis Severity Score were highly statistically significant between those who died and those who survived (p

Computed tomography (CT) imaging is the most appropriate diagnostic tool to confirm suspected left colonic diverticulitis. However, the utility of CT imaging goes beyond accurate diagnosis of diverticulitis; the grade of severity on CT imaging may drive treatment planning of patients presenting with acute diverticulitis. The appropriate management of left colon acute diverticulitis remains still debated because of the vast spectrum of clinical presentations and different approaches to treatment proposed. The authors present a new simple classification system based on both CT scan results driving decisions making management of acute diverticulitis that may be universally accepted for day to day practice.