An International Registry of Peritoneal Carcinomatosis from Appendiceal Goblet Cell Carcinoma Treated with Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy

PURPOSE

Peritoneal carcinomatosis from appendiceal goblet cell carcinoma (A-GCC) is a rare and aggressive form of appendiceal tumor. Cytoreductive surgery (CRS) and hyperthermic intra peritoneal chemotherapy (HIPEC) was reported as an interesting alternative regarding survival compared to surgery without HIPEC and/or systemic chemotherapy. Our aim was to evaluate the impact of CRS and HIPEC for patients presenting A-GCC through an international registry.

METHODS

A prospective multicenter international database was retrospectively searched to identify all patients with A-GCC tumor and peritoneal metastases who underwent CRS and HIPEC through the Peritoneal Surface Oncology Group International (PSOGI). The post-operative complications, long-term results, and principal prognostic factors were analyzed.

RESULTS

The analysis included 83 patients. After a median follow-up of 47 months, the median overall survival (OS) was 34.6 months. The 3- and 5-year OS was 48.5% and 35.7%, respectively. Patients who underwent complete macroscopic CRS had a significantly better survival than those treated with incomplete CRS. The 5-year OS was 44% and 0% for patients who underwent complete, and incomplete CRS, respectively (HR 9.65, p < 0.001). Lymph node involvement and preoperative chemotherapy were also predictive of a worse prognosis. There were 3 postoperative deaths, and 30% of the patients had major complications.

CONCLUSION

CRS and HIPEC may increase long-term survival in selected patients with peritoneal metastases of A-GCC origin, especially when complete CRS is achieved. Ideally, randomized control trials or more retrospective data are needed to confirm CRS and HIPEC as the gold standard in this pathology.

The gradation of psychopathology: for better or for worse

Lately, there has been a growing interest in the dimensional concept of psychiatric diagnosis, along with a tendency to replace the categorical concept by the dimensional one. Before favouring either of these concepts, more light should be shed on the specifics of the categorical and dimensional approach to diagnosing mental disorders. A comparison of the main features of the categorical and dimensional concepts of psychiatric diagnosis has been made. The strengths of the categorical concept are weaknesses of the dimensional one, and vice versa. The clinical utility of the categorical concept over-rates the dimensional model, whereas the dimensional concept provides more information about the respective individual. Usefulness of the categorical concept is the major reason why it is going to stay as a cornerstone of psychiatric diagnostics.

PCR detection of helicobacter pylori genome in colonic mucosa: normal and malignant

BACKGROUND AND AIMS

The aim of this study was to detect Helicobacter pylori (H. pylori) in colorectal cancer tissue specimens and relate the possible role of this microorganism in the etiology of colorectal cancer.

PATIENTS AND METHODS

From February 2002 to April 2003 83 CRC patients (55 male, 28 female) and 40 control patients (19 male, 21 female) entered the prospective study. The biopsy samples of CRC tissue and normal mucosa were obtained during open surgery on CRC patients. In the control patients biopsy samples were taken during colonoscopy. Pathology confirmed adenocarcinoma in all the CRC patients. The existence of genetic material of H. pylori was determined by detection of the ureA gene by nested PCR. K-ras PCR was also performed on all patients.

RESULTS

H. pylori PCR was positive in 1 case (1.2%) of CRC in the tumour tissue and in all 5 samples (6.0%) of the normal colonic mucosa in the cancer patients. The control patients were PCR positive to H. pylori in 13 samples (32.5%). According to Chi-square test, there is no statistical correlation between H. pylori infection and CRC (x2 = 2.9395; p > 0.05) but there is a significant prevalence of H. pylori infection in controls compared to CRC (x2 = 15.5625; p < 0.01). The K-ras PCR showed gene mutations in 19 tumour tissues of CRC (31.6%) and in 2 cases (3.4%) of normal colonic mucosa of CRC patients . In controls K-ras PCR showed one gene mutation (3.0%). There is a significant statistical correlation between K-ras mutation and CRC (x2 = 16.0694; p < 0.01).

CONCLUSION

Our established PCR for H. pylori is feasible for CRC tissue as well. However, H. pylori is not considered to play an important role in the pathogenesis of CRC. The identification of K-ras mutations in routine PCR analysis correlates with the presence of CRC.

Incomplete operative removal of colorectal liver metastases followed by chemotherapy decreases survival in comparison to chemotherapy alone

Metastatic colorectal carcinoma (CRC) has an inevitable fatal outcome except in a small percentage of selected patients, approximately 10-20%, with good prognosis after successful complete operative removal of the liver metastases. In patients not eligible for surgical resection of the liver metastases, chemotherapy is currently the only widely available treatment option. Controversy still exists about the criteria for operability of CRC liver metastases, and some patients, still undergo ineffective, i.e. unnecessary surgery. The aim of this paper is to analyse and compare the overall survival (OS) and time to progression (TTP) in patients who underwent incomplete removal of liver CRC metastases followed by chemotherapy, and patients treated with chemotherapy alone. Seventy-three patients with CRC liver metastases underwent incomplete operative removal of the metastases followed by FOLFIRI (Cohort A - 27 patients) or with FOLFIRI alone (Cohort B - 46 patients). Patients received FOLFIRI until progression. FOLFOX4 was used as second line chemotherapy. The median OS in Cohort A was 8 months, the median TTP was 5 months, and the response rate was 44%; the median OS in Cohort B was 19 months, the median TTP was 8m, and the response rate was 39%. There was a significant difference in OS and in TTP (p < 0.01) in favour of the chemotherapy alone group (B). Patients undergoing incomplete removal of the liver metastases had shorter survival and TTP in comparison with patients treated with chemotherapy alone.

Radioimmunodetection of colorectal carcinoma

BACKGROUND/AIMS

The aim of the study is detection of the recurrences and metastases of colorectal carcinomas using 111In-labeled antibodies B72.3.

METHODOLOGY

Fourteen patients underwent planar immunoscintigraphy and/or tomoscintigraphy.

RESULTS

With tomography in comparison to planar scintigraphy, we can access better distinction of tumor and estimation of its size. Other imaging methods (computed tomography, ultrasonography) have an advantage in detection of liver metastases, while immunoscintigraphy is more specific for the assessment of malignant abdominal tumors and extrahepatic metastases.

CONCLUSIONS

The first results point out that Oncoscint CR-103 can be useful in diagnosis of recurrences and metastases of colorectal carcinoma, viability assessment after radiotherapy and in the choice of the adequate surgical treatment in dependence of the spread of the disease.

Role of autologous fibrin tissue adhesive in abdominal surgery

Fibrin tissue adhesive (FTA) is an agent developed for achieving better hemostasis and adhesion of living tissue. FTA appears to have no tissue toxicity, promotes a firm seal in seconds to minutes, is reabsorbed in days to weeks following application, and appears to promote local tissue growth and repair. It can be used in various surgical procedures. It has been used preoperatively, perioperatively and postoperatively in abdominal surgical procedures. There were no side effects. Improvement of surgical hemostasis was obvious in all patients. Anastomotic leakages were closed in a shorter time without surgical intervention. Sero-lymphatic drainage after surgical procedures that include extensive lymph node dissections was less. Use of FTA in treatment of fistula in ano was successful. The data would indicate that use of FTA may be a good alternative in solving various conditions in every day clinical practice, although a bigger randomized series, and longer follow up is needed.

Psychiatrists in times of ethnonationalism

OBJECTIVE

My goal was to determine the function served by ethnopsychological writings of prominent Croatian and Serbian psychiatrists, published between 1990 and 1998, when fierce interethnic strife between their communities occurred.

METHOD

These writings, which deal with the national character of the Croats and Serbs, were analysed.

RESULTS

The writings have served the function of detachment.

CONCLUSION

Croatian and Serbian psychiatrists have been affected by ethnonationalist sentiments that have prevailed in their communities, and have shown bias in stereotyping each others' population.

Post release adjustment of day and inpatients

A comparison was made of the post-release adjustment of patients who were treated in the day hospital and those by the inpatient service. The patients diagnosed as schizophrenics, psychopaths and neurotics, living with their families, who were able to work prior to hospitalization were chosen for samples. In addition, the patients of the two samples were matched with regard to age, the number of hospitalizations and the length of the last one. The day hospital sample consisted of 85 patients and the inpatient sample of 92. Four aspects of social adjustment during the 18 months after discharge were particularly stressed: rehospitalization, working ability, interpersonal relations and role functioning in the family. No significant difference between day and full-time patients with regard to these aspects of post-release adjustment were revealed.

Patients discharged against medical advice from a lock-and-key psychiatric institution

Over half of patients discharged a.m.a. from the psychiatric department of the Neuro-Psychiatric clinic in Sarajevo leave within the first two weeks of hospitalization. Over the same period only 8% of patients leave the department w.m.a. On the average patients discharged a.m.a. belong to the age group younger than patients discharged w.m.a. This difference is less marked when a correction is made by diagnostic groups. In a significantly greater number of cases patients discharged a.m.a. are of a higher educational level than patients discharged w.m.a. (p less than .0001). 2. In patients discharged a.m.a. personality disturbances and tentamen suicidii are diagnosed in significantly greater number of cases (p less than .0001 and p less than .0001) than in the patients discharged w.m.a. A comparison of patients in the experimental group (a.m.a.) with patients in the control group (w.m.a.) from the aspect of factors stimulating or initiating discharges a.m.a. has shown that for patients leaving a.m.a. the situation of the closed psychiatric ward is more trying and that it causes in them a concealed or open revolt. 3. The declared motives of discharges a.m.a. have confirmed the above finding. 4. No difference has been established as to the number of readmissions and the adjustment level between patients discharged w.m.a. and those discharged a.m.a.