Plasma levels of angiostatin and endostatin remain unchanged for the first 3?weeks after colorectal cancer surgery

Introduction  

Angiostatin and endostatin are endogenous inhibitors of angiogenesis with anticancer effects. After minimally invasive colorectal resection (MICR), blood levels of the proangiogenic factors vascular endothelial growth factor (VEGF) and angiopoetin 2 (Ang-2) are elevated for 2–4 weeks. Also, postoperative human plasma from weeks 2 and 3 after MICR has been shown to stimulate endothelial cell proliferation and migration, which are critical to angiogenesis. This proangiogenic state may stimulate tumor growth early after MICR. Surgery’s impact on angiostatin and endostatin is unknown. This study’s purpose is to determine perioperative plasma levels of these two proteins in colorectal cancer (CRC) patients undergoing MICR.     

Minimally invasive colorectal resection is associated with a rapid and sustained decrease in plasma levels of epidermal growth factor (EGF) in the colon cancer setting

Background  

Epidermal growth factor (EGF) stimulates tumor growth directly via tumor cell EGF receptors or indirectly via its proangiogenic effects. This study’s purpose was to determine the impact of minimally invasive colorectal resection (MICR) on postoperative (postop) plasma EGF levels in the colorectal cancer (CRC) and benign disease settings and to see if preoperative (PreOp) EGF levels are altered in cancer patients.     

Minimally invasive colon resection for malignant colonic conditions is associated with a transient early increase in plasma sVEGFR1 and a decrease in sVEGFR2 levels after surgery

Introduction  

Plasma VEGF levels increase after minimally invasive colorectal resection (MICR) and remain elevated for 2–4 weeks. VEGF induces physiologic and pathologic angiogenesis by binding to endothelial cell (EC) bound VEGF-Receptor-1 (VEGFR1) and VEGFR2. Soluble forms of these receptors sequester plasma VEGF, decreasing the amount available to bind to EC-bound receptors. Ramifications of surgery-related plasma VEGF changes partially depend on plasma levels of sVEGFR1 and sVEGFR2. This study assessed perioperative sVEGFR1 and sVEGFR2 levels after MICR in patients with colorectal cancer.     

Plasma soluble vascular adhesion molecule-1 levels are persistently elevated during the first month after colorectal cancer resection

Introduction

Plasma from the second and third weeks after minimally invasive colorectal resection (MICR) has high levels of the proangiogenic proteins VEGF and angiopoietin 2 and also stimulates, in vitro, endothelial cell (EC) proliferation and migration, which are critical to wound and tumor angiogenesis. Soluble vascular cell adhesion molecule-1 (sVCAM-1) stimulates EC chemotaxis and angiogenesis. The impact of MICR on blood levels of sVCAM-1 is unknown. This study’s purpose was to determine plasma sVCAM-1 levels after MICR in colorectal cancer (CRC) patients.

Methods

Blood samples from 90 patients (26% rectal, 74% colon) were obtained preoperatively, on postoperative days (POD) 1 and 3, and at other points during the next 2?months. The late samples were bundled into 7-day time blocks. sVCAM-1 levels were determined in duplicate via ELISA and reported as ng/ml. Student’s t test was used for data analysis (significance, P?Results The mean incision length was 7.3?±?3.1?cm, and the conversion rate was 3%. Compared with preoperative (PreOp) levels (811.3?±?233.2), the mean plasma sVCAM-1 level was significantly higher on POD 1 (905.7?±?292.4, P?P?Conclusions MICR for CRC is associated with a persistent increase in plasma sVCAM-1 levels during the first month. This sustained increase may promote angiogenesis and stimulate the growth of residual tumor cells early after surgery.     

Minimally invasive colorectal resection for cancer is associated with a short-lived decrease in soluble Tie-2 receptor levels, which may transiently inhibit VEGF-mediated angiogenesis (via altered blood levels of free Ang-1 and Ang-2)

Background  

Angiopoetin- (Ang-) 1 inhibits and Ang-2 promotes VEGF-mediated angiogenesis via binding to endothelial cell-bound Tie-2 receptor (Tie-2). After minimally invasive colorectal resection (MICR), Ang-1 levels decrease and Ang-2 levels increase, which may stimulate angiogenesis in wounds and residual tumor foci. Soluble Tie-2 (sTie-2) modulates the effects of free Ang-1 and Ang-2 by binding to them. This study assessed perioperative MICR plasma sTie-2 levels.     

Plasma from the second and third weeks after open colorectal resection for cancer stimulates in vitro endothelial cell growth,migration, and invasion

Introduction  

Angiogenesis is central to wound healing and tumor growth. Postoperative (postop) plasma from weeks 2 and 3 after minimally invasive colorectal resection (MICR) stimulates endothelial cell (EC) migration (MIG), invasion (INV), and proliferation (all vital to angiogenesis) compared with preoperative (preop) plasma results and may promote postop tumor growth. The purpose of this study was to determine whether plasma from open colorectal resection (OCR) patients has similar proangiogenic EC effects in vitro.     

Minimally invasive colon resection is associated with a transient increase in plasma sVEGFR1 levels and a decrease in sVEGFR2 levels during the early postoperative period

Introduction  Plasma vascular endothelial growth factor (VEGF) levels are elevated for 2–4 weeks after minimally invasive colorectal resection (MICR). VEGF induces wound and tumor angiogenesis by binding to endothelial cell (EC)-bound VEGF-receptor 1 (VEGFR1) and VEGFR2. Soluble receptors (sVEGFR1, sVEGFR2) sequester VEGF in the blood and decrease VEGF’s proangiogenic effect. The importance of the MICR-related VEGF changes depends on the effect of surgical procedures on sVEGFR1 and sVEGFR2; this study assessed levels of these proteins after MICR for benign indications. Methods  Blood samples were taken (n = 39) preoperatively (preop) and on postoperative days (POD) 1 and 3; in most cases a fourth sample was drawn between POD 7 and 30. sVEGFR1 and sVEGFR2 levels were measured via enzyme-linked immunosorbent assay (ELISA), which detects free and VEGF bound soluble receptor. Late samples were bundled into POD 7–13 and POD 14–30 time points. Results are reported as mean and standard deviation. The data was assessed with paired-samples t-test. Results  Preop, mean plasma sVEGFR2 level (9,203.7 ± 1,934.3 pg/ml) was significantly higher than the sVEGFR1 value (132.5 ± 126.2 pg/ml). sVEGFR2 levels were significantly lower on POD 1 (6,957.8 ± 1,947.7 pg/ml,) and POD 3 (7,085.6 ± 2,000.2 pg/ml), whereas sVEGFR1 levels were significantly higher on POD 1 (220.0 ± 132.8 pg/ml) and POD 3 (182.7 ± 102.1 pg/ml) versus preop results. No differences were found on POD 7–13 or 14–30. Conclusions  sVEGFR2 values decreased and sVEGFR1 levels increased early after MICR; due to its much higher baseline, the sVEGFR2 changes dominate. The net result is less VEGF bound to soluble receptor and more free plasma VEGF.     

Prostate-specific antigen test result interpretation when combined with risk factors for recommendation of biopsy: a survey of urologist’s practice patterns

Introduction  

Recent data have suggested historical cutoff levels for prostate cancer (PC) screening using a prostate-specific antigen (PSA) level ≤ 4 ng/ml may no longer be appropriate with cancer detected at lower levels, particularly in younger men. Our aim was to conduct a contemporary survey of urologist’s practice patterns toward PC detection, specifically focusing on factors determining the decision to recommend ultrasound-guided biopsy (TRUS-BX).     

Patient awareness of smoking as a risk factor for bladder cancer

Introduction  

Data on general population’s and bladder cancer patients’ perception of smoking as a risk factor for bladder cancer are limited. To determine urological patients’ awareness of smoking as a risk factor for bladder cancer.     

Trends in Contralateral Prophylactic Mastectomy for Unilateral Cancer: A Report From the National Cancer Data Base, 1998–2007

Background  

Several studies have reported an increased rate of contralateral prophylactic mastectomy (CPM) in patients with unilateral breast cancer. This study reports on CPM trends from the American College of Surgeon’s National Cancer Data Base (NCDB) diagnosed over a 10-year period.     

Treatment of ultralong-segment Barrett’s using focal and balloon-based radiofrequency ablation

Introduction  

Endoscopic radiofrequency ablation (ERFA) is being evaluated as definitive treatment for patients with Barrett’s esophagus (BE). Guidelines have yet to be developed for the application of this technology to patients with ultralong-segment BE (ULBE, ≥8 cm). This study reports a single institution’s experience with ERFA of ULBE.     

Laparoscopic Treatment of Obese Patients with Gastroesophageal Reflux Disease and Barrett’s Esophagus: a Prospective Study

Background  

Short-segment Barrett’s esophagus (SSBE) or long-segment Barrett’s esophagus (LSBE) is the consequence of chronic gastroesophageal reflux disease (GERD), which is frequently associated with obesity. Obesity is a significant risk factor for the development of GERD symptoms, erosive esophagitis, Barrett’s esophagus, and esophageal adenocarcinoma. Morbidly obese patients who submitted to gastric bypass have an incidence of GERD as high as 50% to 100% and Barrett’s esophagus reaches up to 9% of patients.     

Long-term experience with intraoperative microrecording during DBS neurosurgery in STN and GPi

Background  

Intraoperative microelectrode recording (MER) for targeting during deep brain stimulation (DBS) procedures has been evaluated over a period of 4 years, in 57 consecutive patients with Parkinson’s disease, who received DBS in the subthalamic nucleus (STN-DBS), and 28 consecutive patients with either dystonia (23) or Parkinson’s disease (five), in whom the internal segment of the globus pallidus (GPi-DBS) was targeted.     

Intestinal Cancer Risk in Crohn’s Disease: A Meta-Analysis

Aim of the study  

To clarify the intestinal cancer risk in Crohn’s disease (CD).     

Urinary tract dysfunction in Parkinson’s disease: a review

Introduction  

Parkinson’s disease is an extrapyramidal neurological disorder. Although motor symptoms are a predominant feature of the condition, non-motor symptoms have also been recognized. Urinary symptoms are frequently present in patients affected with Parkinson’s disease (PD). Symptoms such as urgency, frequency, nocturia and urge incontinence significantly impact the patient’s quality of life. We discuss the urinary dysfunction seen in patients with Parkinson’s disease and consider the pathophysiology, important differentials, the investigations and management options for such patients.     

Endoscopic bilateral adrenalectomy in patients with ectopic Cushing’s syndrome

Background  

Bilateral adrenalectomy (BLA) is a treatment option to alleviate symptoms in patients with ectopic Cushing’s syndrome (ECS) for whom surgical treatment of the responsible nonpituitary tumor is not possible. ECS patients have an increased risk for complications, because of high cortisol levels, poor clinical condition, and metabolic disturbances. This study aims to evaluate the safety and long-term efficacy of endoscopic BLA for ECS.     

Surgical outcomes of laparoscopic adrenalectomy for patients with Cushing’s and subclinical Cushing’s syndrome: a single center experience

Objective  

We retrospectively examined the outcome of patients who underwent laparoscopic adrenalectomy for Cushing’s/subclinical Cushing’s syndrome in our single institute.     

Diabetes Mellitus Affects Response to Neoadjuvant Chemoradiotherapy in the Management of Rectal Cancer

Introduction  

Although diabetic patients with rectal cancer have poorer outcomes than their nondiabetic counterparts, few studies have looked at diabetics’ response to therapy as an explanation for this disparity. This study compares the neoadjuvant chemoradiotherapy (CRT) response in diabetic and nondiabetic patients with locally advanced rectal cancers.     

Influence of learning curve on short-term results after laparoscopic resection for rectal cancer

Background  Technical difficulties have been encountered in laparoscopic surgery for the treatment of rectal cancer. There are fewer studies about the learning curve for laparoscopic rectal resection. Methods  Between June 1995 and August 2007, 200 patients who were scheduled to undergo laparoscopic rectal resection for rectal cancer were enrolled in the study. Each surgeon’s operative experience was divided into three groups: 1–20 cases, 21–40 cases, and 41 or more cases. Furthermore, patients were divided chronologically into four groups of 50 patients each. This report describes the association between the learning curves (surgeon’s experience and team’s experience) and short-term outcomes such as operating time, complication rate, and hospital stay in the case of laparoscopic resection for rectal cancer. We also analyzed how the learning curve influences several postoperative outcomes compared with other clinical factors. Results  The team’s experience was not associated with short-term results except for surgical site infection (SSI). On the other hand, surgeon’s experience was associated with mean operating time and SSI rate. The endpoints of the learning curve for reducing mean operating time and SSI rate were defined as 40 and 20 cases of laparoscopic rectal resection. In contrast, anastomotic leakage was not associated with surgeon’s experience and showed the greatest correlation with total mesorectal excision (TME). Conclusion  Surgeon’s learning improved operating time and SSI. On the other hand, low level of anastomosis accompanied with TME was strongly related with leakage, and the association between leakage and surgeon’s learning was not clearly demonstrated.     

Routine Evaluation of the Distal Colon Remnant Before Hartmann’s Reversal is Not Necessary in Asymptomatic Patients

Background  

Reversal of Hartmann’s is a common surgical procedure. Routine preoperative evaluation of the distal colonic/rectal remnant (DCRR) with contrast and/or endoscopic studies is frequently performed despite lack of evidence to support this practice. We hypothesize that asymptomatic patients can safely undergo Hartmann’s reversal without preoperative DCRR evaluation.