HighlightsIntestinal malrotation and midgut volvulus in adulthood are rare events.Reports of recurrence among adults are very scarce. The rate of recurrence and optimal surgical management are yet to be determined.Bowel fixation procedures may be considered in Ladd procedures for adult midgut volvulus in order to reduce recurrence.
Introduction: Approximately 20% - 30% of histological lymph node-negative patients with colorectal cancer relapse at five years after surgical treatment. This recurrence is likely due to occult nodal disease undetected by standard histopathological practice which has implications in terms of the clinical management of patients.Material and Methods: Lymph nodes were collected from colectomy specimens. A central section from each lymph node was histologically examined following haematoxylin-eosin staining and the remaining tissue was subjected to OSNA - one step nucleic acid amplification analysis.Results: A total of 1046 lymph nodes from 59 pN0 patients were assessed. Of these, 753 lymph nodes were examined by both methods. The median number of lymph nodes assessed with OSNA - one step nucleic acid amplification was 12 (IQR: 7;16). Among pN0 patients, 17 had OSNA - one step nucleic acid amplification-positive lymph nodes, resulting in a positive molecular staging rate of 28.8% (95% CI: 17.8 - 42.1). Among these patients, 12 (70.59%) were molecular-staged as pN1 and 5 (29.41%) were molecular staged as pN2. The tumour burden of lymph nodes assessed with OSNA - one step nucleic acid amplification ranged from 270 to 17 000 cytokeratin 19 mRNA copies/μL. Most of these patients (88.2%) were found to have lymph nodes with micrometastases only (250 - 4999 copies/μL).Discussion: We provide the results from the first study of the use of the OSNA - one step nucleic acid amplification assay in colorectal cancer patients in Portugal. Our results are in-line with other international studies, showing the improvement on patients’ staging by molecular examination of lymph nodes.Conclusion: In our study, 28.8% of patients with histologically negative lymph nodes were found to have metastatic lymph nodes using OSNA - one step nucleic acid molecular assessment. OSNA - one step nucleic acid assay allows a more accurate staging of patients with colorectal cancer and standardizes lymph node assessment.
O liposarcoma (LPS) é um tumor mesenquimatoso maligno do tecido adiposo. A sua localização no mesentério é rara. Homem, 64 anos, enviado à consulta após colonoscopia de rastreio ter revelado um lipoma da parede do sigmoide. Realizou Tomografia computorizada abdominopelvico (TC AP): ~ confirmou lipoma e “…no mesentério jejuno-ileal - massa sólida, suspeita de GIST ou tumor neuroendócrino”. PET-DOTANOC mostrou: “fraca expressão de recetores da somatostatina na lesão”. O doente foi submetido a enterectomia segmentar. A histologia revelou “liposarcoma bem diferenciado do mesoíleon”. O caso foi discutido em reunião multidisciplinar e decidida vigilância. Posteriormente, foi realizada ressecção endoscópica do lipoma da sigmóidea. Segundo a literatura, a ressecção cirúrgica completa representa a única opção curativa. Liposarcoma is a malignant mesenchymal tumor of adipose tissue. It has a rare incidence at the intestinal mesentery. We present a case of 64-year-old man sent for consultation, due to an incidental finding in a colonoscopy - sigmoidal wall lipoma. CT AP performed shown: lipidic lesion already known and “… in the jejuno-ileal mesentery - solid mass, suspected of GIST or neuroendocrine tumor. PET-DOTANOC showed: "weak expression of somatostatin receptors in the lesion". Patient underwent segmental enterectomy. Histology revealed "well differentiated liposarcoma from the mesentery of the ileon". Subsequently was performed endoscopic resection of the lipoma. The case was discussed in a multidisciplinary meeting and decided follow-up. According to the literature, a complete surgical resection represents the single option for cure.
Background: Colon cancer is a frequent diagnosis worldwide affecting both men and women. Lynch syndrome in an autosomal dominant inheritable condition, accountable for 5 to 7% of colon cancer, as well as other malignancies.
<b><i>Introduction:</i></b> Home parenteral nutrition (HPN) and/or home parenteral hydration (HPH) are the gold-standard treatment for patients with long-term intestinal failure (IF). The authors aimed to assess the impact of HPN/HPH on nutritional status and survival of long-term IF patients, as well as HPN/HPH-related complications. <b><i>Methods:</i></b> This was a retrospective study including IF patients under HPN/HPH followed in a single large tertiary Portuguese hospital. The data collected included demographics, underlying conditions, anatomical characteristics, type and duration of parenteral support, IF functional, pathophysiological, and clinical classifications, body mass index (BMI) at the beginning and end of follow-up, complications/hospitalizations, current patient status (deceased, alive with HPN/HPH, and alive without HPN/HPH), and cause of death. Survival after HPN/HPH beginning, until death or August 2021, was recorded in months. <b><i>Results:</i></b> Overall 13 patients were included (53.9% female, mean age 63.46 years), and 84.6% of patients presented type III IF and 15.4% type II. Short bowel syndrome caused 76.9% of IF. Nine patients received HPN and 4 HPH. Eight patients (61.5%) were underweight at the beginning of HPN/HPH. At the end of follow-up, 4 patients were alive without HPN/HPH, 4 maintained HPN/HPH, and 5 died. All patients improved their BMI (mean initial BMI 18.9 vs. 23.5 at the end, <i>p</i> < 0.001). Eight patients (61.5%) were hospitalized due to catheter-related complications, mainly infectious (mean hospitalization episodes 2.25, mean hospital stay of 24.5 days). No deaths were related to HPN/HPH. <b><i>Conclusion:</i></b> HPN/HPH significantly improved IF patients’ BMI. HPN/HPH-related hospitalizations were common, however causing no deaths, reinforcing that HPN/HPH is an adequate and safe therapy for long-term IF patients.
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