直肠癌术后左锁骨上淋巴结转移1例

1病例患者,男,51岁,因＂排脓便伴大便不尽感半月＂入院,既往健康,无家族遗传病史。肠镜及盆腔MRI提示：直肠占位,位于腹膜反折附近;腹部及胸部CT未提示肝、肺转移。予全系膜切除直肠癌根治（Dixon）术,术后病理：直肠腺癌,中至低分化,部分为黏液腺癌,直径3.5cm;浸润至浆膜层;两切缘及两吻合口阴性;直肠外膜（11/12）及肠系膜根部（1/1）淋巴结阳性;pT3N2Mx。

腹茧症1例临床诊断体会

腹茧症是一种临床临床上较为少见的腹膜病变,从前人们亦称之为局限性小肠外膜包绕症、特发性硬化性腹膜炎、慢性纤维性包裹性腹膜炎、小肠禁锢症等。由于临床极为罕见,诊断方面又缺乏特异性,故术前诊断相当困难,误诊率非常之高[1],此病一般是在术中确诊。我院2013年09月诊治腹茧症1例,现分析报道如下。1临床资料患者,女性,56岁,1年前行脾破裂、脾脏切除术,术后恢复良好,入院36小时前出现腹部胀痛,肛门排气、排便不畅,

Study on Outer Membrane Protein Patterns of Escherichia coli O38,O53 and O75 Isolated from Chickens

[Objective] This study aimed to investigate the outer membrane protein （OMP） patterns of Escherichia coli 038, 053 and 075 isolates from chickens. [Method] Eight pathogenic E. coil isolates with various serotypes were used as experimental materials to extract OMP by using supersonic schizolysis method and Sarcosyl. After SDS-PAGE electrophoresis, OMP patterns of the extracted products were determined based on the OMP model diagram. [Result] OMP of eight E. coil isolates with three serotypes were divided into three patterns, to be specific, 2 075 isolates respectively belonged to OMP-I and OMP-II pattern, 1 053 isolate belonged to OMP-II pattern, and 5 038 isolates belonged to OMP-I and OMP-III pattern. [Conclusion] Experimental results showed that E. coli isolates with the same serotype may belong to completely different OMP patterns, while serologically unrelated isolates may belong to the same OMP pattern. OMP of E. coil isolates with the same serotype may generate genetic differentiation; in addition, OMP of E. coli isolates with different serotypes may have different genetic correlation.

Primary multiple extragastrointestinal stromal tumors of the omentum with different mutations of c-kit gene

The author reports a very rare case of sporadic primary multiple extragastrointestinal stromal tumors (EGISTs) of the omentum associated with different mutations of the exon 11 of the c-kit gene in a 75-year-old man with gastric cancer. During an operation for the cancer, two solid tumors (10 mm and 8 mm) were found in the omentum. Both tumors consisted of cellular spindle cells. Mitotic figures were two and three per 50 high power fields. The tumor cells were positive for KIT, CD34 and vimentin, but negative for desmin, S100 protein, α-smooth muscle actin and p53 protein. Ki67 labeling was 2% and 3%. The larger EGIST showed a deletion of codons 552-558 of exon 11 of the c-kit gene, while the smaller EGIST had a point mutation at codon 559 (GTT←GAT) in exon 11 of the c-kit gene. Exons 9, 13, and 17 of the c-kit gene, and exons 12 and 18 of the platelet derived growth factor receptor α genes showed no mutations. The case shows that sporadic multiple EGISTs can occur in the omentum.

Complete peritonectomy and intraperitoneal chemotherapy for recurrent rectal cancer with peritoneal metastasis

A 68-year-old man underwent laparoscopic low anterior resection for rectal carcinoma in December 2006.Nearly 19 mo after the operation,he developed recurrent rectal cancer with peritoneal metastasis. In September 2008,he subsequently underwent a laparotomy with a peritonectomy,omentectomy, splenectomy,and a Hartmann procedure.Hyperthermic intraperitoneal oxaliplatin 750 mg was administered. The patient was discharged with no postoperative complications and has been well with postoperative FOLFOX chemotherapy.

Double ischemic ileal stenosis secondary to mesenteric injury after blunt abdominal trauma

The authors describe a rare case in which blunt abdominal trauma resulted in mesenteric injury with delayed double ischemic ileal stenosis. Abdominal computed tomography demonstrated stenotic ileal loop with mural thickening. At surgery, a double stenotic bowel loop was found adjacent to a healed defect in the mesentery. Histological examination of the two resected segments showed fibrotic and ischemic lesions within the mesentery. Ischemic intestinal stenosis from mesenteric injury should be considered in the differential diagnosis in patients suffering from intestinal occlusion with a history of blunt abdominal trauma.

Successful endoscopic treatment of biliary stricture following mesenteric tear caused by blunt abdominal trauma

Biliary duct injuries are frequently iatrogenic, being associated with surgery for gallbladder stones. However, blunt abdominal trauma such as a motor vehicle crash is a rare cause of extrahepatic biliary stricture. A few reports have been published on biliary strictures treated with endoscopic therapy. In the present study, we describe a suprapancreatic biliary stricture associated with mesenteric tear following road traffic accident. We performed endoscopic stent placement, which was successful in relieving the biliary stricture.

Detection of metastatic cancer cells in mesentery of colorectal cancer patients

AIM To detect the existence of isolated cancer cells in the mesentery of colorectum(named as Metastasis V), and investigate its clinical significance in colorectal cancer(CRC) patients.METHODS Sixty-three CRC patients who received radical excision between January 2012 and September 2015 were included. All the patients underwent laparoscopyassisted radical colorectomy or proctectomy [with complete mesocolic excision(CME) or total mesorectal excision(TME)] with R0 dissections at the Department of Gastrointestinal Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology. The location and size of the primary lesions were recorded immediately after the tumor was removed, with the surrounding mesenterium completely separated along the intestinal wall. Each dissected mesentery sample was analyzed for hematoxylin-eosin staining and immunohistochemistry using cytokeratin 19 antibody. Image Pro Plus Software 6.0(Media Cybernetics, CA, United States) was usedto semi-quantitatively measure the concentration of the cytokeratin 19 immunohistochemistry. The correlation between metastasis found in mesentery and clinicopathological characteristics was examined. The prognosis of patients was also evaluated by preoperative serum CEA level.RESULTS Metastasis V was detected in 14 of 63(22.2%) CRC patients who underwent laparoscopy-assisted radical colorectomy or proctectomy(with CME or TME) with R0 dissection in our hospital between January 2012 and September 2015. There was no significant difference in age, gender, tumor size, and tumor location in patients with Metastasis V(P > 0.05). Metastasis V was more likely to occur in poorly differentiated tumor(5/11; 45.5%) than moderately(8/46; 17.4%) and welldifferentiated one(1/6; 16.7%). The Metastasis V in N2 stage(9/14; 64.3%) was more frequent that in the N0 stage(3/35; 8.6%) or N1 stages(2/14; 14.3%). In addition, Metastasis V was positively related to the tumor invasive depth(T1:0/1, 0%; T2:1/12, 8.3%; T3:7/39, 17.9%; T4:6/11, 54.5%). Furthermore, preoperative serum CEA level in Metastasis V-positive patients was significantly higher than in Metastasis V-negative patients(4.27 ng/m L vs 3.00 ng/m L).CONCLUSION Metastasis V might be associated with a poor prognosis of CRC patients.

Accumulation of ciprofloxacin and lomefloxacinin fluoroquinolone-resistant strains of Escherichia coli

Objective To evaluate the role of outer membrane protein (Omp) F-deficiency and active efflux in the accumulation of hydrophilic fluoroquinolones ciprofloxacin (CPLX) and lomefloxacin (LMLX) in resistant E. coli strains. Methods Fluoroquinolone accumulation in bacteria and the effect of active efflux were measured by a fluorescence method. The outer membrane proteins of the bacteria were analysed by sodium dodecyl sulfate-polyacrylamide gel electrophoresis (SDS-PAGE). E. coli strains in this study included control strains JF701 and JF703 that are OmpC- or OmpF-deficient mutants of E. coli K-12, respectively, and the fluoroquinolone susceptible strain the fluoroquinolone susceptible strain of Escherichia coli (Ecs) and its in vitroselected resistant strains R2 and R256, and the clinical resistant isolates R5 and R6. Results The steady-state accumulation concentration of each drug in Ecs appeared to be the same as in JF701, while in the OmpF- deficient strain JF703, it was 1/5 CPLX or 1/2 LMLX lower than that in JF701, but JF703 was still susceptible to fluoroquinolones. On the other hand, compared with susceptible strains, a 2- to 10-fold decrease in the accumulation of each drug was found in the resistant strains except R2, in which the accumulation was slightly higher than in JF703. After the addition of 2,4-dinitrophenol (DNP), accumulation of each drug increased, especially in resistant strains, indicating that the function of the active efflux (pump) system in these bacteria had been enhanced dramatically. Furthermore, both OmpF and OmpC in Ecs, OmpF-deficiency in R2 and R256 and OmpC-deficiency in R5 and R6 were observed.Conclusion The decreased accumulation of hydrophilic fluoroquinolones in E. coli involved OmpF-deficiency and active efflux (pump), and the latter may be an important factor.

Intestinal autotransplantation

Most abdominal neoplasms involving the root of the superior mesenteric artery and/or celiac artery are difficult to manage with conventional operative techniques because of limited intestinal ischemia times and poor accessibility to the tumor region.Ex vivo surgery followed by intestinal autotransplantation(IATx)is a relatively novel surgical strategy to offer chances for complete resection in such hopeless circumstances.This review aims to assess potential surgical indications,operative techniques and clinical outcomes after IATx.Currently the main indications reported for IATx broadly include pancreatic,mesenteric and retroperitoneal neoplasms closely involving the superior mesenteric vessels.The preliminary results show that radical resection can be effectively achieved in carefully selective patients.Although perioperative morbidity and mortality are relatively high,there are several long-term survivors,particularly after complete resection of benign and low-grade tumor.Early tumor recurrence,however,remains a major problem in patients with high-grade tumor,particularly pancreatic ductal carcinoma.In conclusion,IATx allows patients with selected abdominal neoplasms involving themajormesenteric vessels to be completely resected.However,this aggressive approach is associated with a considerable operative risk,and should only be performed at experienced centers.Additional and adjunctive treatment therapies are required to improve the efficacy of this treatment.

Impact of anaesthetic technique on survival in colon cancer:a review of the literature

An oncological surgical resection is the mainstay of treatment for potentially curable colon cancer.At the time of surgery,a large fraction of patients do harbour—although not visibly—minimal residual disease at the time of surgery.The immunosuppression that accompanies surgery may have an effect on disease recurrence and survival.Regional or neuraxial anaesthetic techniques like epidural anaesthesia may suppress immune function less than opioid analgesia,by reducing stress response and significantly reducing exposure to opioids.Consistent with this hypothesis,regional anaesthetic techniques have been associated with lower recurrence rates in breast cancer and prostate cancer.Results for colon cancer,however,are contradictory.In this review of the literature we describe all studies addressing the association of the use of epidural anaesthesia and survival in colon cancer surgery.