No abstract

The success of transplantation depends on multiple factors, but the establishment of immune tolerant milieu is of critical importance. Hepatic environment consists of different cellular populations with prominent capacity to tolerate a huge range of antigens. Among them, regulatory T cells (Tregs) play an important role. They control the strength of immune reactions against non-self antigens and were shown to have an impact on the establishment of immune tolerance in the post-transplantation period. Furthermore, they impact a particular state after transplantation – operational tolerance. The abundant data show that Tregs might be manipulated, which suggests their further implementation as a treatment strategy. Tregs are also a very attractive target as a biomarker in the monitoring of post-transplantation period. Here, we review the particular role of Tregs among the broad spectrum of immune tolerance mechanisms of the liver in the light of the current directions of medical research.

Aim: To assess the eff ect of the factor 'hepatic metastatic disease' on long-term outcomes in patients with colorectal cancer. Materials and methods: We analysed retrospectively 200 randomly selected patients. Forty-two of them were excluded from the study for diff erent reasons so the study contingent was 158 patients over a period of 23 years. All were diagnosed and treated in the Lozenetz University Hospital, in the Department of General Surgery. 125 of the patients were diagnosed with colorectal cancer without distant metastases and 33 of the patients had liver metastases as a result of colorectal carcinoma. The statistical analysis was performed using SPSS 19 IMB, with a level of signifi cance of P < 0.05 at which the null hypothesis is rejected. We also used descriptive analysis, Kaplan-Meier estimator, Log-Rank Test and LifeTable statistics models. Results: The median survival for patients without metastases was 160 months, and the median was 102 months. The median survival for patients with liver metastases was 28 months and the median was 21 months. One-year survival for patients without metastases was 92% versus 69% in patients with liver metastases. Conclusion: Average, annual and median survivals are infl uenced statistically signifi cantly by the presence of liver metastases compared to overall survival and that of patients without metastatic colorectal cancer. Liver metastatic disease is a proven factor aff ecting long-term prognosis and survival in patients with colorectal cancer.

Gynecomastia is a benign enlargement of the male breast, secondary to gland proliferation and is a common problem among the male population. Treatment is primarily surgical. The most common intra-and postoperative complication is bleeding, followed by seroma, infection, insufficient results, inverted nipple and nipple necrosis. The embolism is one of the non-specific complications. A 24-year-old male was presented to the Surgery Department with a diagnosis unilateral gynecomastia. The operation proceeded without complication and around 10 hours later, the patient complained of weakness in all four limbs, later nausea, and vomiting and after full cardiopulmonary resuscitation, the patient died. The main reason for the patient's death was concluded to be a postoperative pulmonary thromboembolism and fat embolism was discovered. In addition, there was a papillary carcinoma of the thyroid, which was missed before. We reported that unilateral gynecomastia associated with papillary carcinoma of the thyroid detected rarely at autopsy and fat embolism after surgery for gynecomastia is a rare complication.