Undergoing Surgery For Colon Cancer Research Articles

Erythrocyte deformability and aggregability in patients undergoing colon cancer surgery and effects of two infusions with omega-3 fatty acids.

An adequate erythrocyte function is vital for tissue oxygenation and wound healing. The erythrocyte membrane phospholipid composition plays an important role in erythrocyte function and administration of omega-3 fatty acids may provide a means to improve it. To investigate peri-operative erythrocyte function and effects of omega-3 fatty acidsMETHODS:Forty-four patients undergoing elective laparoscopic colon resection for non-metastasized cancer were randomized between intravenous omega-3 poly-unsaturated fatty acids (n-3 PUFAs) or placebo (saline). Peri-operative blood samples were analyzed with a Lorrca MaxSIS Ektacytometer and erythrocyte membrane phospholipids were determined with gas chromatography. Patient and operation characteristics were equal between groups. There was a significant increase in erythrocyte membrane eicosapentaenoic acid (EPA) but not docosahexaenoic acid (DHA) in the n-PUFA group. There were no significant differences in erythrocyte deformability but the aggregation index (AI) was significantly lower and the aggregation half time (T½) was significantly higher in the n-3 PUFA group. This study confirms rapid changes in erythrocyte membrane phospholipid composition after administration of intravenous n-3 PUFAs. Erythrocyte deformability parameters were not affected but erythrocyte aggregability was decreased in the n-3 PUFA group. Further investigation is necessary to gain more insights in the effects of n-3 PUFA and the postoperative inflammatory response on erythrocyte function.

Virtual spectral histopathology of colon cancer - biomedical applications of Raman spectroscopy and imaging

Colon cancer is one of the most commonly detected pathology and is the third worldwide cause of death in the US and Europe and ranks second with regard to the incidence of malignant tumors in population. Raman spectroscopy and imaging can be used for colon cancer detection and bioanalytical characterization of noncancerous and pathologically changed tissues. These studies included Raman spectroscopy measurement of not fixed and not stained tissues samples. Presented study included patients from Poland, who were ≥18 years of age and underwent colon cancer surgery. Outcomes were measured using confocal Raman microscope, spectroscopy results were compared with traditional histopathology analysis outcomes. DNA, lipids, proteins and carotenoids can be treated as biomarkers of cancerogenesis. Ratios: 751/1156 (DNA/Carotenoids), 1228/1332 (β-sheet/α-helix proteins conformation), 1586/1004 (Phosphorylated proteins/Proteins), 2854/2935 (Lipids/Proteins) can be used to differentiate noncancerous and cancerous human sigmoid colon mucosa based on Raman spectroscopy and imaging. We have proved that Raman spectroscopy and imaging are a powerful technique to distinguish between noncancerous and cancerous human sigmoid colon mucosa and to characterize biochemical composition of multilayer sigmoid colon tissues samples.

Risk factors of anastomotic leakage in colon cancer.

To analyze the risk factors for anastomosis leak in colon cancer surgery (CCS) in our environment, and developed a predictive equation for that risk. We performed a case-control study nested in a cohort of 576 consecutive patients undergoing colon cancer surgery with primary anastomosis, univariate statistical tests and univariate logistic regression for statistical analysis of associated factors with anastomosis leak in colon cancer surgery, and multivariate logistic regression for predicting that risk using a predictive equation associated with a ROC curve. We obtained a higher risk of anastomosis leak in patients whose operative time was longer than 180 minutes. The variables: preoperative transfusion, previous pathologies, nutritional status, approach, surgical technique or age do not influence the development of this complication. The equation found has a sensitivity of 64.1% and a specificity of 67.5%. Operation time longer than 180 minutes was the main risk factor for anastomosis leak. Our equation can hardly predict this risk. After further validation, our results may help the surgeon make a more individualized, safer decision regarding whether to perform an anastomosis or make a stoma.

Risk factors affecting hospital stay among patients undergoing colon cancer surgery: a prospective cohort study.

To identify and validate risk factors that contribute to prolonged length of hospital stay (LOS) in patients undergoing resection for colorectal cancer. This prospective cohort study included 1955 patients admitted to 22 hospitals for primary resection of colorectal cancer. Multivariate analyses were used to identify and validate risk factors, randomizing patients into a derivation and a validation cohort. Multiple correspondence and cluster analysis were performed to identify clinical subtypes based on LOS. The strongest independent predictors of prolonged LOS were postoperative reintervention, surgical site infection, open surgery, and distant metastasis. The multiple correspondence and cluster analysis provided three groups of patients in relation to prolonged LOS: patients with the longest LOS included the highest percentage of patients with open surgery, distant metastasis, deep surgical site infections, emergency admissions, additional diagnostic factors, and highly contaminated surgical sites. Patients with prolonged LOS (> 14days) were more likely to develop adverse outcomes within 30days after discharge. Patients undergoing resection of colorectal cancer cluster into different groups based on LOS of the index admission. Those with prolonged LOS were more likely to develop adverse outcomes within 30days after discharge. Some of the strongest independent predictors of prolonged LOS, such as surgical infections or open surgery, could be modified to reduce LOS and, in turn, other adverse outcomes. NCT02488161.

Upregulated Na+/H+-Exchange Protects Human Colon Cancer Tissue against Intracellular Acidification.

Increased metabolism accelerates local acid production in cancer tissue. The mechanisms eliminating acidic waste products from human colon cancer tissue represent promising therapeutic targets for pharmacological manipulation in order to improve prognosis for the increasing number of patients with colon cancer. We sampled biopsies of human colonic adenocarcinomas and matched normal colon tissue from patients undergoing colon cancer surgery. We measured steady-state intracellular pH and rates of net acid extrusion in freshly isolated human colonic crypts based on fluorescence microscopy. Net acid extrusion was almost entirely (>95%) Na+-dependent. The capacity for net acid extrusion was increased and steady-state intracellular pH elevated around 0.5 in crypts from colon cancer tissue compared with normal colon tissue irrespective of whether they were investigated in the presence or absence of CO2/HCO3–. The accelerated net acid extrusion from the human colon cancer tissue was sensitive to the Na+/H+-exchange inhibitor cariporide. We conclude that enhanced net acid extrusion via Na+/H+-exchange elevates intracellular pH in human colon cancer tissue.

Whole blood gene expression profiling in patients undergoing colon cancer surgery identifies differential expression of genes involved in immune surveillance, inflammation and carcinogenesis

Abstract Introduction Cancer surgery may represent a potential risk of enhanced growth and metastatic ability of residual cancer cells due to post-operative immune dysfunction. This study identifies changes in transcription of genes involved in immune surveillance, immune suppression and carcinogenesis in the post-operative period of laparoscopic colon-cancer surgery within an ERAS regime. Methods Patients undergoing elective, curatively intended laparoscopic surgery for colon cancer stage I-III UICC were included in the study. Patients followed standard of care in an ERAS setting. Whole blood gene expression profiling (WBGP) was performed on the day prior to surgery and 1, 2, 3 and 10–14 days after surgery. Samples were collected in Paxgene tubes and Labeled cDNA was fragmented and hybridized to Affymetrix GeneChip™ 2.0. Results were corrected for multiple hypothesis testing using the false discovery rate. Pathway analysis was performed through the Molecular Signature Database. Paired fold changes of gene expression were calculated for post-operative compared to pre-operative samples. A mixed effect model was used to test differential gene expression by repeated-measures ANOVA. Results WBGP of 33,804 genes at five timepoints in six patients showed 302 significantly differentially expressed genes between samples from the day prior to surgery and the day after surgery. Pathway gene enrichment analysis showed a downregulation of immunologically relevant pathways. There was a significant downregulation of genes involved in T-cell receptor signaling, antigen presentation and NK-cell activity after surgery. Furthermore, there was an upregulation of cytokines related to metastatic ability, growth and angiogenesis. Conclusion Whole blood gene expression profiling revealed dysregulation of genes involved in immune surveillance, inflammation and carcinogenesis, after laparoscopic colon cancer surgery.

The relationship between chemokines CCL2, CCL3, and CCL4 with the tumor microenvironment and tumor-associated macrophage markers in colorectal cancer.

A complex network of chemokines can influence cancer progression with the recruitment and activation of hematopoietic cells, including macrophages to the supporting tumor stroma promoting carcinogenesis and metastasis. The aim of this study was to investigate the relation between tissue and plasma chemokine levels involved in macrophage recruitment with tumor-associated macrophage profile markers and clinicopathological features such as tumor-node-metastases stage, desmoplasia, tumor necrosis factor-α, and vascular endothelial growth factor plasma content. Plasma and tumor/healthy mucosa were obtained from Chilean patients undergoing colon cancer surgery. Chemokines were evaluated from tissue lysates (CCL2, CCL3, CCL4, CCL5, and CX3CL1) by Luminex. Statistical analysis was performed using Wilcoxon match-paired test ( p < 0.05). Macrophage markers (CD68, CD163, and iNOS) were evaluated by immunohistochemistry samples derived from colorectal cancer patients. Correlation analysis between chemokines and macrophage markers and clinicopathological features were performed using Spearman's test. Plasmatic levels of chemokines and inflammatory mediators' vascular endothelial growth factor and tumor necrosis factor-α were evaluated by Luminex. Tumor levels of CCL2 (mean ± standard deviation = 530.1 ± 613.9 pg/mg), CCL3 (102.7 ± 106.0 pg/mg), and CCL4 (64.98 ± 48.09 pg/mg) were higher than those found in healthy tissue (182.1 ± 116.5, 26.79 ± 22.40, and 27.06 ± 23.69 pg/mg, respectively p < 0.05). The tumor characterization allowed us to identify a positive correlation between CCL4 and the pro-tumor macrophages marker CD163 ( p = 0.0443), and a negative correlation of iNOS with desmoplastic reaction ( p = 0.0467). Moreover, we identified that tumors with immature desmoplasia have a higher CD163 density compared to those with a mature/intermediated stromal tissue ( p = 0.0288). Plasmatic CCL4 has shown a positive correlation with inflammatory mediators (tumor necrosis factor-α and vascular endothelial growth factor) that have previously been associated with poor prognosis in patients. In conclusion High expression of CCL4 in colon cancer could induce the infiltration of tumor-associated macrophages and specifically a pro-tumor macrophage profile (CD163+ cells). Moreover, plasmatic chemokines could be considered inflammatory mediators associated to CRC progression as well as tumor necrosis factor-α and vascular endothelial growth factor. These data reinforce the idea of chemokines as potential therapeutic targets or biomarker in CRC.

Evaluation of the feasibility of an "enhanced recovery after surgery" protocol for older patients undergoing colon cancer surgery.

Objectives: The aim of this study was to evaluate the feasibility of a protocol for enhanced recovery after surgery (ERAS) for colon cancer in older patients. Methods: One hundred and fifty-nine patients enrolled in the ERAS group of our previous clinical study were divided according to age into an older group (n = 31; ≥80 years old) and a younger group (n = 128; <80 years old). We compared the two groups for clinical outcomes, including surgical complications, re-admission rates, and the time to discharge, based on criteria for hospital discharge. Compliance with each ERAS element was compared between groups. Results: Concomitant diseases were present in all older patients (100%), but only in 57.8% of the younger group (P < 0.0001). The preoperative risk grade according to the American Society of Anesthesiologists classification was significantly higher in the older group than in the younger group. The postoperative surgical complications and re-admission rates were not significantly different between groups. Discharge criteria were met three days after the operation. The median length of hospital stay was slightly longer in the older group (9 days, range 5-15) than in the younger group (8 days, range 4-41; P = 0.061). Compliance above 80% was observed for 13 ERAS items in the older group and 14 ERAS items in the younger group; thus, compliance with the ERAS protocol was equally feasible in both groups. Conclusions: For older patients undergoing colon cancer surgery, an ERAS protocol might be feasible with a high implementation rate of the elements in the protocol.

Weekend Effect in Emergency Colon and Rectal Cancer Surgery: A Prospective Study Using Data From the Dutch ColoRectal Audit.

Background: It is unclear whether emergency weekend colon and rectal cancer surgery are associated with worse outcomes (ie, weekend effect) because previous studies mostly used administrative data, which may insufficiently adjust for case-mix. Materials and Methods: Prospectively collected data from the 2012-2015 Dutch ColoRectal Audit (n=5,224) was used to examine differences in 30-day mortality and severe complication and failure-to-rescue rates for emergency weekend (Saturday and Sunday) versus Monday surgery, stratified for colon and rectal cancer. Analyses were adjusted for age, sex, body mass index, Charlson comorbidity index, American Society of Anesthesiologists classification score, tumor stage, presence of metastasis, preoperative complication, additional resection for metastasis or locally advanced tumor, location primary colon tumor, type of rectal surgery (lower anterior resection or abdominal perineal resection), and type of neoadjuvant therapy (short-course radiotherapy or chemoradiotherapy). Results: A total of 5,052 patients undergoing colon cancer surgery and 172 undergoing rectal cancer surgery were included. Patients undergoing colon or rectal cancer surgery during weekends had significantly more preoperative tumor complications compared with those undergoing surgery on a weekday. Additionally, differences in year of surgery and location of primary tumor were found for colon cancer surgery. Emergency colon cancer surgery during the weekend was associated with increased 30-day mortality (odds ratio [OR], 1.66; 95% CI, 1.10-2.50) and severe complications (OR, 1.29; 95% CI, 1.03-1.63) compared with surgery on Monday. Estimates for emergency weekend rectal cancer surgery were similar but not statistically significant, likely explained by small numbers. Conclusions: Weekend emergency colon cancer surgery was associated with higher mortality and severe complication rates. More research is needed to understand which factors explain and contribute to these differences.

Distance to hospital is not a risk factor for emergency colon cancer surgery

PurposeThe purpose of this study is to see if the distance to a hospital performing colon cancer surgery is a risk factor for emergency surgical intervention and to determine the variability between defined but demographically divergent catchment areas.MethodsData on patients living in Västerbotten County who underwent colon cancer surgery between 2007 and 2010 were extracted from the Swedish Colorectal Cancer Register (SCRCR). Of the 436 registrations matching these criteria, 380 patients were used in the analysis, and their distance to the nearest hospital providing care for colorectal cancer (CRC) was estimated using Google Maps™. The correlations between the risk for emergency surgery and the distance to a hospital, gender, age, income level and hospital catchment area were analysed in uni- and multivariate models.ResultsDistance to the nearest hospital had no significant effect on the proportion of emergency operations for colon cancer. There was significant variability in risk for emergency surgery between hospital catchment areas, where the catchment areas of the university hospital and the most rural hospital had a higher proportion than the other local hospital catchment area (OR, 2.00 (p = 0.038) and OR, 2.97 (p = 0.005)). These results were still significant when analysed with multivariate logistic regression (OR, 2.13 (p = 0.026) and OR, 3.05 (p = 0.013)).ConclusionDistance to a hospital performing colon cancer surgery had no effect on the proportion of emergency surgeries. However, a variability between defined catchment areas was seen. Future studies will focus on possible factors behind this variability.

Whole Blood Gene Expression Profiling in patients undergoing colon cancer surgery identifies differential expression of genes involved in immune surveillance, inflammation and carcinogenesis

IntroductionCancer surgery may represent a potential risk of enhanced growth and metastatic ability of residual cancer cells due to post-operative immune dysfunction. This study identifies changes in transcription of genes involved in immune surveillance, immune suppression and carcinogenesis in the post-operative period of laparoscopic colon-cancer surgery within an ERAS regime. MethodsPatients undergoing elective, curatively intended laparoscopic surgery for colon cancer stage I-III UICC were included in the study. Patients followed standard of care in an ERAS setting. Whole blood gene expression profiling (WBGP) was performed on the day prior to surgery and 1, 2, 3 and 10–14 days after surgery. Samples were collected in Paxgene tubes and Labeled cDNA was fragmented and hybridized to Affymetrix GeneChip™ 2.0.Results were corrected for multiple hypothesis testing using the false discovery rate. Pathway analysis was performed through the Molecular Signature Database. Paired fold changes of gene expression were calculated for post-operative compared to pre-operative samples. A mixed effect model was used to test differential gene expression by repeated-measures ANOVA. ResultsWBGP of 33,804 genes at five timepoints in six patients showed 302 significantly differentially expressed genes between samples from the day prior to surgery and the day after surgery. Pathway gene enrichment analysis showed a downregulation of immunologically relevant pathways. There was a significant downregulation of genes involved in T-cell receptor signaling, antigen presentation and NK-cell activity after surgery. Furthermore, there was an upregulation of cytokines related to metastatic ability, growth and angiogenesis. ConclusionWhole blood gene expression profiling revealed dysregulation of genes involved in immune surveillance, inflammation and carcinogenesis, after laparoscopic colon cancer surgery.

Hospital Teaching Status and Patients\u2019 Outcomes After Colon Cancer Surgery

Background and objectivesIt is increasingly accepted that quality of colon cancer surgery might be secured by combining volume standards with audit implementation. However, debate remains about other structural factors also influencing this quality, such as hospital teaching status. This study evaluates short-term outcomes after colon cancer surgery of patients treated in general, teaching or academic hospitals.MethodsAll patients (n = 23,593) registered in the Dutch Colorectal Audit undergoing colon cancer surgery between 2011 and 2014 were included. Patients were divided into groups based on teaching status of their hospital. Main outcome measures were serious complications, failure to rescue (FTR) and 30-day or in-hospital mortality. Multivariate logistic regression models on these outcome measures and with hospital teaching status as primary determinant were used, adjusted for case-mix, year of surgery and hospital volume.ResultsPatients treated in teaching and academic hospitals showed higher adjusted serious complication rates, compared to patients treated in general hospitals (odds ratio 1.25 95% CI [1.11–1.39] and OR 1.23 [1.05–1.46]). However, patients treated in teaching hospitals had lower adjusted FTR rates than patients treated in general hospitals (OR 0.63 [0.44–0.89]). However, for all outcomes there was considerable between-hospitals variation within each type of teaching status.ConclusionOn average, patients treated in general hospitals had lower serious complication rates, but patients treated in teaching hospitals had more favorable FTR rates. Given the hospital variation within each hospital teaching type, it is possible to deliver excellent care regardless of the hospital teaching type.

Dual-port vs. single-port laparoscopic colectomy for colon cancer

Dual-port laparoscopic colectomy (DPLC) has emerged as a surgical option that can overcome the technical limitations of single-port laparoscopic colectomy (SPLC). The aim of this study was to compare perioperative outcomes of DPLC and SPLC for colon cancer. This case-control study assessed 119 patients who underwent colon cancer surgery using DPLC (n = 66) and SPLC (n = 53). Propensity score matching resulted in 42 pairs of patients, equivalent in distribution of TNM stage and tumor size. Perioperative outcomes and postoperative complications were similar in the two groups, except for a tendency toward less blood loss in the DPLC group (50 ml vs. 100 ml, p = 0.087). Umbilical incision sites were significantly more common in the DPLC than in the SPLC group with left-sided colon cancer (94.4% vs. 66.7%, p = 0.032). In a subgroup of patients with stage II–IV tumors, there were no significant between-group differences in perioperative outcomes. These findings show that perioperative outcomes following colon cancer surgery with DPLC were not superior to those achieved with SPLC. DPLC may be associated with better cosmetic outcomes through greater use of an umbilical approach for left-sided colectomies.

大腸癌周術期発症の肺血栓塞栓症診断に可溶性フィブリンモノマー複合体（SFMC）測定が有用であった1例

大腸癌周術期発症の肺血栓塞栓症診断に可溶性フィブリンモノマー複合体（SFMC）測定が有用であった1例

Melanosis coli in patients with colon cancer.

IntroductionMelanosis coli is a benign lesion affecting the mucosa of the large intestine. There is a relationship between the presence of melanosis and anthraquinone laxative use. Melanosis coli is also observed in patients with colon cancer, but there is doubt whether these two conditions are related.AimTo analyze the correlation between melanosis and colon cancer.Material and methodsWe analyzed retrospectively 436 patients undergoing colon cancer surgery. There were 246 women and 190 men. Patients were divided into three age groups: under 50 years, between 51 and 65 years, and over 66 years. We analyzed sections of the cancer and intestinal mucosa from the tumor’s proximal (2–5 cm) and distal (8–10 cm) zone.ResultsMelanosis coli was present in 52 patients, which represents 11.9% of patients with colon cancer. More often it was present in women. The most common location of melanosis and colon cancer was the terminal part of the large intestine. In patients below 50 years of age in both sexes melanosis coli did not occur. In men, melanosis was more common in the age group over 66 years. Intensity of pigmentation was higher in the tumor’s distal zone.ConclusionsThe incidence of melanosis coli increases with age, similar to that of colon cancer. Melanosis was not present inside tumors, in almost half of the cases it was not present in the proximal zone, and the degree of pigmentation increased in distal zone. The cause-effect relationship between melanosis coli and colon cancer remains uncertain.

Safety and efficacy of an "enhanced recovery after surgery" protocol for patients undergoing colon cancer surgery: a multi-institutional controlled study.

The aim of this multi-institutional study was to prospectively evaluate the safety and efficacy of an enhanced recovery after surgery (ERAS) protocol for colonic surgery. The subjects of this study were 320 patients with an American Society of Anesthesiologists (ASA) grade I or II physical status. Patients underwent elective open or laparoscopic colonic resection or high anterior resection between April 2011 and January 2014 at one of six institutions. Three hospitals implemented an ERAS protocol (n=159), and three administered conventional care (n=161). The primary outcome measure was the surgical complication rate. Most operations, irrespective of group, were performed laparoscopically. The incidence of a surgical complication was 17.0% in the ERAS group vs. 16.1% in the conventional group (P=0.842), in which several non-surgical complications also arose. Oral food intake was implemented earlier for the ERAS group vs. the conventional group, after a median (range) of 1 (1-31) vs. 3 (1-9) days for the ERAS vs. conventional care groups, respectively (P<0.001). The median length of postoperative hospital stay was reduced by 5.5days for the ERAS group, being 8.5 (5-41) vs. 14 (7-56) days for the ERAS vs. conventional care groups, respectively (P<0.001). This multi-institutional controlled study clearly demonstrated that an ERAS protocol was efficient, without increasing the complication risk.

Results of colon cancer surgery in patients over 75 years old.

Colon cancer is the second most frequent cause of death in both genders. Survival has increased since 1980, although this increase has been lower in patients ≥75 years old. We analyzed the results of surgical treatment for this pathology in this group of patients. This retrospective, observational and descriptive study analyzed data relating to 315 patients undergoing colon cancer surgery between January 2010 and December 2011. Surgical results (surgical procedure, mean postoperative stay, isolated lymph nodes, postoperative morbidity and mortality) were compared between patients who were <75 and ≥75 years old. Statistical significance was observed in the percentages of hypertension (P = 0.001), cardiovascular disease (P = 0.006) and bronchopathy (P = 0.005) for the older group. No differences were found between the groups regarding surgical results, except higher postoperative morbidity and mortality in the ≥75 years old age group (P = 0.02 and P = 0.03, respectively). In the multivariate analysis, the factors associated with postoperative morbidity were age and preoperative albumin levels (P < 0.05). Cancer-specific survival (CSS) was lower in older patients (P < 0.05). The multivariate analysis of survival determined that age and tumour stage are independent predictive factors (P = 0.004 and P = 0.039, respectively), unlike American Society of Anesthesiologists score. Age does not influence the surgical results after colon cancer resection but is associated with increased postoperative morbidity and mortality. CSS is lower in patients who are ≥75 years old.

Effects of anaesthesia on proliferation, invasion and apoptosis of LoVo colon cancer cells in vitro

Tumour cell proliferation, invasion and apoptosis are crucial steps in tumour metastasis. We evaluated the effect of serum from patients undergoing colon cancer surgery receiving thoracic epidural and propofol anaesthesia on colon cancer cell biology. Patients were randomly assigned to receive propofol anaesthesia with a concomitant thoracic epidural (PEA, n = 20) or sevoflurane anaesthesia with opioid analgesia (SGA, n = 20). Venous blood was obtained before induction of anaesthesia and 24 hours postoperatively. The LoVo colon cancer cells were cultured with patient serum from both groups and the effects on proliferation, invasion and apoptosis were measured. Twenty-four hours after surgery, the absorbance value of LoVo cells at 10% serum concentration from PEA was decreased when compared with SGA (0.302 (0.026) vs 0.391 (0.066), p = 0.005). The inhibitory rate of LoVo cells at 10% serum concentration from PEA was higher than that from SGA (p = 0.004) 24 h after surgery. The number of invasive LoVo cells at 10% serum concentration from PEA was reduced when compared with SGA (44 (4) vs 62 (4), p < 0.001). Exposure of LoVo cells to postoperative serum from patients receiving PEA led to a higher luminescence ratio (apoptosis) than those receiving SGA (0.36 (0.04) vs 0.27 (0.05), p < 0.001). Serum from patients receiving PEA for colon cancer surgery inhibited proliferation and invasion of LoVo cells and induced apoptosis in vitro more than that from patients receiving SGA. Anaesthetic technique might influence the serum milieu in a way that affects cancer cell biology and, thereby, tumour metastastasis.

Acute community-acquired meningoencephalitis with Morganella morganii – a case report / Meningoencefalită acută comunitară cu Morganella morganii – prezentare de caz

Abstract Morganella morganii (M. morganii) is a Gram-negative aerobic and facultative anaerobic rod, belonging to the Enterobacteriaceae family. This pathogen is uncommon in community-acquired infections, most often being found in postoperative nosocomial and urinary tract infections. Infection of the central nervous system with this pathogen is rare. We present the case of a 66-year-old patient who underwent colon cancer surgery, chemotherapy and radiotherapy, had left iliac anus, type 2 diabetes and developed acute meningoencephalitis caused by M. morganii. Cerebrospinal fluid examination revealed increased number of polymorphonuclear neutrophils, modified biochemistry and AmpC beta-lactamase producing M. morganii strain. After initiation of antibiotic treatment, initially with empirical therapy represented by meropenem and vancomycin, afterwards adjusted to meropenem and ciprofloxacin, according to the stain’s susceptibility to antimicrobials the patient’s evolution was favourable, in spite of the existence of two immune suppressing conditions.

The effect of perioperative smoking in patients undergoing colon cancer surgery on health expenditure

The effect of perioperative smoking in patients undergoing colon cancer surgery on health expenditure