AN UNUSUAL CAUSE OF OBSTRUCTİVE JAUNDİCE: AN İSOLATED ULCERATİNG METASTASİS İN THE DUODENUM FROM COLON CANCER

H. ERDAL, O. GUL UTKU, İ. SHEN, M. ARHAN, M. İBİSH, Sh. DUMLU, S. UNAL

Gazi University, Ankara, TURKEY

Colon carcinoma is the third most frequent cancer worldwide. Regional lymph nodes, Liver,lungs and periton are the most common sites of colorectal cancer metastases.

Case. A 80-years-old male patient with a history of AJCC T3 N1 M0 (stage III) right colon adenocarcinoma underwent total colectomy.Adjuvant chemotherapy was given. A year later,patient presented with jaundice. On laboratory examination,Total bilirubin 17.6 mg/dl, direct bilirubin 12.6 mg/dl. Alkaline phosphatase 1337 IU/L (53-119), GGT 697 IU/L (0-50), ALT 94 IU/L (0-40), AST 177 IU/L (0-40), prothrombin time 14 seconds. Computed tomography (CT) revealed about 4 cm mass, adjacent to the head f pancreas can not be distinguished from the duodenum. Esophagogastroduodenoscopy was performed. Necrotic,ulcerating lesion surround the lumen in second part of duodenum was shown.Endoscope could be passed scarcely through the duodenum. Biopsies were obtain from the lesion. Histopathological examination revealed poor-differentiated adenocarcinoma. Immunostaining was positive for pankeratin (diffuse) and CK 20 (Focal), but negative for CDX2,CD117,CD34 and Cromogranin. The patient refused further evaluation or treatment and he subsequently died.

Discussion. The presenting clinical and radiological findings from an isolated metastasis to the duodenum may mimic primary duodenal or pancreas carcinoma. Isolated duodenum involvement is a rare metastasis of colon carcinoma. Our patient is the fourth case in the literature. Also previous cases presented ulcerating metastasis in the second portion of the duodenum from colon cancer. Lymphatics from the right colon drain primarily to the periduodenal lymph nodes. Mass effect or invasion of the duodenum itself occurs as a result of tumor seeding by this route. In presence of colon cancer history, clinicians should consider metastasis while patient admitted with the duodenal lesion

NEW ASPECTS OF DIAGNOSIS OF LARGE INTESTINE CANCER AND PRECANCER DISEASES

S.M. EYVAZOV

The Hospital of the Ministry of Internal Affairs, Baku, AZERBAIJAN

The investigation of mitotic regime was held on 25(62,5%), 30(72,5%), 37(74%) and 55(50%) patients with diagnoses ulcerative colitis, Chron’s disease of the large intestine, colonic polyp, adenocarcinoma of colon. During the ulcerative colitis, the cell has been characterized with normal mitotic activity. The firsts are superior in prophase and metaphase, the pathologic mitosis is less.

We observed relative increase of mitotic activity during the Chron’s disease, besides, the majority of cells are in metaphase. The increase of pathologic mitosis is defined.

During the polyposis of colon, it was seen that the disorder of mitotic regime was severe. Thus, it is characterized with increase of cell amounts in the metaphase, observation of more cells in pathologic mitosis, determination of their various types, occurrence of aneuploidy, the enlargement of division zones.

In adenocarcinoma of colon, in comparison with other phases, superiority of metaphase in the cells, increase of pathologic mitosis, occurrence of various mitotic activity, aneuploidy, 4, 8, 16, 24, and even more ploidy cells has been observed.

The mentioned mitotic regime disorders are very important to estimate the early diagnostics of neoplastic transformation, pre-tumor processes, as well as malignant tumors. Thus, the severe and serious disorders of mitotic regime (low-grade differentiated adenocarcinoma and undifferentiated adenocarcinoma) are resulted with unsatisfactory prognosis.

The investigation of the law of mitotic regime in the neoplasm of the large intestine is very important in the explanation of grounding mechanism of kinetic polulation of the cells. If explaining the population of tumor cells from division point of view, it shall be noted that the cells extracted from the mitotic cycle either pass to the further differential phase, or enter to the mitosis phase, or proliferates or remains in slience. Thus, cell populations are divided into 3 groups in this neoplasm, and are in close relation with each other: undifferentiated indivisible cells, undifferentiated proliferative cells, differentiated non-proliferated cells.

CAPABILITIES OF LASER TECHNOLOGY AND NEW TECHNOLOGIES IN THE COMPLEX TREATMENT OF PATIENTS WITH RECTAL POSTTRAUMATIC FISTULAS

A.V.GEYNITS, M.M.MAMEDOV, KH.N. MUSAEV, N.I. MAMEDOV

Scientific Surgical Center named after academician M.A. Topchubashov, Baku, AZERBAIJAN, State Research Center of Laser Medicine of FMBA, Moscow, RUSSIA

Objective of investigation: To improve the results of surgical treatment of post-traumatic rectal fistulas of various varying degrees of severity, by fistulectomy with the use of modern laser technology and new technologies.

Material and methods: 134 patients with post-traumatic rectal fistulas of different etiologies at the age from 8 to 83 were divided into two groups. The control group included 58 (43.3%) patients (35 males (60.3%), 23 females (39.7%) with post-traumatic fistula of the rectum, where treatment was carried out by the traditional method. The study group, consisting of 76 (56.7%) patients with post-traumatic fistulas of the rectum (46 males (60.5%), 30 female (39.5%), surgical interventions were performed with the use of modern laser technology with special tools and new technologies. In the study group one-stage surgical treatment was carried out in -30 (39.5%), and multistage surgical treatment in 46 (60.5%) patients. During the surgical operation, we used the carbon dioxide laser device “Lancet, 2” (Russia), with the wave length of 10.6 mcm, and up to 20 watts power, and a contact laser "Atkus-15" (Russia), which generates a wavelength of 0.81 mcm, and up to 15W of power. In the postoperative period all the patients of the study group underwent irrigation of the wound channel in the paraproctium by antiseptics and percutaneous and transdrainage laser illumination by the “NEEDLE” (Russia), with wavelength of 0.89 mcm and 20 mW of output power with 10-12 minute exposure within 10 -12 days. The illumination was carried out for postoperative decongestion, relieving of pain and improving the properties of the reparative tissues. The course of wound healing process and effectiveness of treatment were assessed by a clinical presentation with consideration of the terms of necrolysis, formation of granulations, beginning of epithelialization, terms of healing, as well as data of cytological and cytochemical studies of prints from the surface of wounds, identification of microflora. The average terms of necrolysis, appearance of granulations and beginning of epithelialization constituted 5.2, 6.3, 8.3 days. During cytological and cytochemical studies the number of decayed and dystrophic altered cells was two times less than in the control group. During the treatment of wounds by laser, wounds cleaned from necrotic tissues, covered with bright red granulation, edge epithelialization were observed boundary within 7-8 days. By comparing the direct results of surgical treatment in patients with “low” rectal fistulas, it can be noted that their number in the control group constitued 21.4%, and 10.0% in the main group. The complication rate in the control and main groups of patients with “high” located fistulas was 20.0% and 4.3% (p <0.05) respectively. Thus, the use of high-and low-intensity lasers may reduce the terms of necrolysis, speed up formation of granulation and epithelialization of purulent wounds in patients with post-traumatic anorectal fistulas and reduce the period of rehabilitation.

IMPORTANCE OF THE CONTRAST RENTGENOLOGY METHODS IN DIAGNOSTICS OF THE HIRSHPRUNG DISEASE IN CHILDREN

Ch.B. GULIYEV, R.Sh. POLUKHOV, L.O. ZEYNIYEV

Azerbaijan Medical University, Baku, AZERBAIJAN

Introduction: Innate agangleonar problem still lose urgency of the thick intestine in spite of being more than 100 year(s) histories of the Hirshprung disease from point of view diagnostics and cure of the illness. Simptom compleks triad organizes amounts the leader signs of the illness. These constipatons is congenital disease, durable meteorism in the belly and gifvary consists of part which have expanded in the form in the X-ray photography than/of being of the zone of the previous narrowing. So, the role of irrigography is non-substitutive time and correct diagnostics of the illness, in the defining of anatomical forms and elect cure tactics.

Material and methods: Let us immortalize the analysis 83 ill which address 15 and we have carried out the analysis 83 ill which address 15 the clinical this purpose in the department of child surgery of the medical centre in 11 last recent years from month. Persons which passed trough from inspection have been 65 boys and 18 girls. Adjoining patogmonik being discovered of the zone sign narrowing counted, agangleonar with methods of general inspection to all ill and retrograde irrigography inspection of the thick intestine have been carried out of its length the purpose of to learn influence to the clinical going away of the illness.

Discussion: Being in the result of carrying out inspections as the following of the meet frequency of the anatomic forms has been discovered. In 18 patients rectal form, (21. 6%), rectosigmoidal in 58 (69.8%), segmentar in 3 (3.6%), subtotal in 2 (2. 4%s) and total in 2 (2.4%) patients was registered. Aganglionar correlation dependence have been registered with stage of the illness between length of the zone. So, rectosigmoidal (56) and rectal (6) 62 shaped patients (74.7%) to clinic in the subkompensation stage, segmentar (3) and rectal (12) form in 15 patients (18%) in the compensation study, 6 other ill (7. 2%) have entered in decompensation study.

Result: So from results of the inspections carried out that irrigography methods adjoining choice applied with methods of other inspection as like diagnostic method in the children with Hirshprung disease.

Date: 2014-12-28; view: 728