The common cause of metastatic cervical lymphadenopathy is the spread from primary tumours in the head and neck region. However, in unusual cases, a primary site in head and neck region cannot be located. This calls for a complete clinical and radiological examination, focusing on the organs or areas where there is a high chance of an existing primary tumour. Sometimes, lymphatic metastases do not first develop in the lymph nodes nearest to the tumour. This is known as skip metastases. Тhe careful evaluation of these metastatic regional nodes is essential for appropriate treatment and to achieve the best outcome for the patient.
INTRODUCTION: Nowadays colorectal cancer (CRC) incidence rate increases in the Western world. The lack of effective screening programs results in diagnosis of advanced cases in our country. Combination of hematogenic, peritoneal or systemic CRC dissemination with present or potential complications from local disease is not an exception. The decision for palliative resection is not easy and is a matter of balance between potential risks of operative intervention and advances due to local tumour resection. Positive aspects of the laparoscopic approach are important in planning of these interventions. The aim of this study is to assess the indications for laparoscopic palliative large bowel resections in the literature available and to share our own experience. PATIENTS AND METHODS: During a two-year period, in the HPB and General Surgery Clinic, Acibadem City Clinic, Tokuda Hospital of Sofia, six laparoscopic palliative colon resections were performed. In the all cases, multiple liver metastases were diagnosed without possibility of liver resection. The early perioperative results were analyzed. RESULTS: Four left colon resections were performed with primary anastomosis due to high-level large bowel obstruction and two right colectomies were done for primary tumour bleeding. Three patients were over 77 years old and presented with comorbidity. Average hospital stay was 5,6 days. No perioperative complications were observed. CONCLUSION: Minimal surgical trauma, short recovery period and well-defined indications are important features in the process of planning of palliative large bowel resections in patients with disseminated CRC. The objective is to reduce risks of complications connected with primary tumour and to assure a good patient's quality of life.
The paper explores a hybrid page layout (HPL), combining the advantages of NSM and PAX. The design defines a continuum between NSM and PAX supporting both e cient scans minimizing cache faults and e cient insertions and updates. Our evaluation shows that HPL fills the PAX-NSM performance gap.
РезюмеТуморното метастазиране, включващо няколко последователни стъпки, започвайки от инвазия на раковите клетки в околните тъкани, е ключовият фактор, който компрометира прогнозата на раково болните пациенти и отговаря за 90% от смъртността. 2/3 от диагностицираните пациенти са с локално авансирал процес и/ или метастатична болест (стадий III или IV). Проучването на молекулярни и клетъчни механизми, водещи до формирането и метастазирането на плоскоклетъчния карцином от ларингеален произход, би било от клинична полза за разработването на молекулярна таргетна терапия. На базата на обширен литературен обзор акцентът е поставен върху следните гени -TP53, CDKN2A -exons 1,2,3 and PIK3CA -exons 9, 20, като потенциални отговорници за повишаване метастатичния потенциал на плосколетъчния карцином от ларингеален произход. Изследването на генетично сродство между карцином и метастаза би имало теоретичен принос към опознаването на генотипа и мутационния статус на плоскоклетъчните карциноми на глава и шия, чийто практически потенциал се изразява като прогностична стойност за преживяемостта на онкоболните и подобряване на терапевтичния алгоритъм при диагностицирани пациенти. Ключови думи: плоскоклетъчен карцином на глава и шия, метастазиране, генотип, мутационен статус, таргетна терапия, прогностична стойност. Специфични аспекти в проучването на онкогенезата и метастазирането на ларингеален плоскоклетъчен карциномSpecific aspects of researching the oncogenesis and metastatasing potential of laringeal squamous cell carcinoma.
INTRODUCTION: Laparoscopic abdominoperineal resection (LAPR) as a minimally invasive approach for the treatment of large rectal cancer is widely used. It has been proven to be technically feasible and safe with fewer complications and faster postoperative recovery than the open procedure. Our aim was to evaluate LAPR safety and feasibility as compared to the open procedure in large low rectal cancer. PATIENTS AND METHODS: A total of 34 low rectal cancer patients who underwent open APR (OAPR) were matched with 42 patients who underwent LAPR in a one-to-one fashion between 2011 and 2014 in the Division of General Surgery, Kaspela University Hospital of Plovdiv. RESULTS: Intraoperative parameters of LAPR were better than those of OAPR as followed: mean operation time (121.8±47.8 min versus 152.1±49.2 min), mean operative blood loss (82±30.0 mL versus 120±35.0 mL), mean total number of retrieved lymph nodes (12±1 versus 12±1.4), and percentage of surgical complications (12.3% versus 15.1%). Laparoscopically treated patients showed significantly shorter postoperative analgesia (2.1±0.7 days versus 3.7±0.6 days), earlier first flatus (36.3±7.9 hours versus 48.5±9.2 hours), shorter urinary drainage (3.8±3.4 days versus 5.8±1.3 days), and shorter hospital stay (6.2±1 days versus 8±2.0 days). Local recurrence rate during a three-year period (in 3 versus 4 patients) and metachronous liver metastasis (in 5 versus 6 patients) were less common after LAPR than after OAPR. CONCLUSION: The risks of APR-specific surgical complications such as perineal wound infection and parastomal hernia were comparable between the laparoscopic and open surgery groups. There were no significant differences regarding local recurrence and metachronous liver metastasis between these groups. Complication and locoregional recurrence rates in low large rectal cancer patients after laparoscopic and open were quite similar.
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