Epidemiological and experimental evidence indicates chronic inflammation as a risk factor for colorectal cancer. We investigated whether IL-1B -511C>T (rs16944), IL-1B +3954C>T (rs1143634) and IL1-RN +2018T>C (rs419598) cytokine polymorphisms are correlated with colorectal cancer. Blood samples were obtained from 377 Romanian subjects: 144 patients with sporadic colorectal cancer and 233 healthy controls. Polymorphisms were analyzed by allelic discrimination TaqMan PCR assays with specific probes. The results of our study showed that IL-1RN +2018T>C polymorphism is associated with colorectal cancer. We found that there was a significant difference in the frequency of CC genotype between patients with colorectal cancer and the control group (OR 2.42, 95 % CI: 1.06-5.53, p = 0,034) when TT genotype was used as reference. Furthermore, in a stratified analysis, a positive association was found only for IL-1RN +2018CC genotype, that was limited to early I and II stages (OR 2.72, 95 % CI: 1.05-7.03, p = 0,033). We did not find any association between any of the IL-1B polymorphisms and colorectal cancer. In conclusion this study found that IL-1RN +2018T>C polymorphism is associated with colorectal cancer, mainly for localized disease.
Background The incidence of the highly morbid and potentially lethal gangrenous cholecystitis was reportedly increased during the COVID-19 pandemic. The aim of the ChoCO-W study was to compare the clinical findings and outcomes of acute cholecystitis in patients who had COVID-19 disease with those who did not. Methods Data were prospectively collected over 6 months (October 1, 2020, to April 30, 2021) with 1-month follow-up. In October 2020, Delta variant of SARS CoV-2 was isolated for the first time. Demographic and clinical data were analyzed and reported according to the STROBE guidelines. Baseline characteristics and clinical outcomes of patients who had COVID-19 were compared with those who did not. Results A total of 2893 patients, from 42 countries, 218 centers, involved, with a median age of 61.3 (SD: 17.39) years were prospectively enrolled in this study; 1481 (51%) patients were males. One hundred and eighty (6.9%) patients were COVID-19 positive, while 2412 (93.1%) were negative. Concomitant preexisting diseases including cardiovascular diseases (p < 0.0001), diabetes (p < 0.0001), and severe chronic obstructive airway disease (p = 0.005) were significantly more frequent in the COVID-19 group. Markers of sepsis severity including ARDS (p < 0.0001), PIPAS score (p < 0.0001), WSES sepsis score (p < 0.0001), qSOFA (p < 0.0001), and Tokyo classification of severity of acute cholecystitis (p < 0.0001) were significantly higher in the COVID-19 group. The COVID-19 group had significantly higher postoperative complications (32.2% compared with 11.7%, p < 0.0001), longer mean hospital stay (13.21 compared with 6.51 days, p < 0.0001), and mortality rate (13.4% compared with 1.7%, p < 0.0001). The incidence of gangrenous cholecystitis was doubled in the COVID-19 group (40.7% compared with 22.3%). The mean wall thickness of the gallbladder was significantly higher in the COVID-19 group [6.32 (SD: 2.44) mm compared with 5.4 (SD: 3.45) mm; p < 0.0001]. Conclusions The incidence of gangrenous cholecystitis is higher in COVID patients compared with non-COVID patients admitted to the emergency department with acute cholecystitis. Gangrenous cholecystitis in COVID patients is associated with high-grade Clavien-Dindo postoperative complications, longer hospital stay and higher mortality rate. The open cholecystectomy rate is higher in COVID compared with non -COVID patients. It is recommended to delay the surgical treatment in COVID patients, when it is possible, to decrease morbidity and mortality rates. COVID-19 infection and gangrenous cholecystistis are not absolute contraindications to perform laparoscopic cholecystectomy, in a case by case evaluation, in expert hands. Graphical abstract
Dear Editor, Colocutaneous fistulas are very rare, account for 1%-4% of the total number of fistulas complicating diverticular diseases, and may be caused by percutaneous drainage of diverticular abscesses without subsequent resection (1). They are more likely to occur in a patient who has undergone resection and primary anastomosis. In this letter, we report a case of a patient with a fistula connecting the sigmoid colon with left iliac fossa skin as a complication of sigmoid diverticulitis.A 45-year-old male was admitted to our department for cutaneous fistula formation and seropurulent secretion in the fistulous opening. Initially, the patient with complicated colon diverticular disease had been admitted to another hospital 3 months previously with an abscess in the left iliac fossa, and its drainage was performed. Postoperative evolution was unfavorable with fistula formation in the scar (Figure 1). Physical examination indicated the presence of a postoperative scar with signs of inflammation and at the lower pole of the postoperative scar, a fistulous orifice with a diameter of 0.2-0.3 cm discharging the seropurulent fluid.Fistulography of the left iliac fossa emphasized opacification of the sigmoid loop with inflammatory changes and incomplete lumen stenosis over a distance of approximately 10 cm.Abdomen and pelvis computed tomography (CT) revealed infiltration with inflammatory aspect of subcutaneous fat in the anterior and left abdominal wall. At the lower pole of the postoperative scar, inflammatory process spread in the intrapelvic region without extending to the left iliac muscle, but with no cleavage plane toward the ileal loops. It also revealed the presence of fluid and air bubbles in the abdominal wall muscles (Figure 2).During surgical intervention, we found inflammatory process in the left iliac fossa involving the side of the sigmoid colon, anterior abdominal wall, and greater omentum. Releasing the sigmoid loop was difficult. A fistulous orifice with a diameter of 0.4 0.5 cm, thickened wall, and irregular edges was identified. Sigmoidectomy with end-to-end colorectal anastomosis was performed as a one-step procedure.Postoperative specimen consisted of a 25-cm sigmoid segment, which contained three perforated diverticula (when it 248
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