Assessment of the Value of Preoperative Serum Levels of CA 242 and CEA in the Staging and Postoperative Survival of Colorectal Adenocarcinoma Patients

Introduction

CEA is the most frequently used tumor marker in colorectal cancer. There may be an improvement in its efficacy when used in association with CA 242.

Aim

The purpose of this study was to evaluate the efficacy of preoperative serum levels of the tumor markers CA 242 and CEA in the staging and postoperative follow-up of colorectal adenocarcinoma patients.

Patients and Methods

Of a series of 134 patients with colorectal adenocarcinomas 90 underwent radical surgery and 44 palliative surgery. The control group consisted of 22 organ donors. The cutoff serum levels utilized were 5 ng/mL for CEA and 20 U/mL for CA 242. The mortality during follow-up was recorded in order to determine the duration of survival. The data were submitted to statistical analysis using diagnostic tests, the chi-square test, survival analysis (Kaplan and Meier) and ROC curves. A significance level of p ≤ 0.05 was applied.

Results

The sensitivity of CEA in Dukes’ stages A, B, C and D was 27.8%, 32.4%, 32.1% and 66.7%, respectively. The sensitivity of CA 242 was 11.1%, 16.2%, 30.8% and 50%. When both markers were combined, the sensitivity was 33.3%, 48.6%, 40.7% and 72.5%. In the group of patients who underwent radical surgery the mean survival was 60.47 months for those with high preoperative CEA levels, 52.22 months for those with high preoperative CA 242 levels, and 44.80 months for those with elevated levels of both markers. There was a statistically significant difference in survival between patients undergoing radical surgery with elevated CA 242 levels, especially when CEA was also elevated, and patients without elevated CA 242.

Conclusion

Preoperative serum levels of CA 242 showed less efficacy than CEA levels for the staging of colorectal adenocarcinoma patients. Elevated preoperative serum levels of CA 242 alone were related to poor survival, especially in association with high levels of CEA.

[Computer-assisted image processing for quantifying histopathologic variables in the healing of colonic anastomosis in dogs]

BACKGROUND

The authors present the experimental results of the computerized quantifying of tissular structures involved in the reparative process of colonic anastomosis performed by manual suture and biofragmentable ring. The quantified variables in this study were: oedema fluid, myofiber tissue, blood vessel and cellular nuclei.

MATERIAL AND METHODS

An image processing software developed at Laboratório de Informática Dedicado à Odontologia (LIDO) was utilized to quantifying the pathognomonic alterations in the inflammatory process in colonic anastomosis performed in 14 dogs. The results were compared to those obtained through traditional way diagnosis by two pathologists in view of counterproof measures. The criteria for these diagnoses were defined in levels represented by absent, light, moderate and intensive which were compared to analysis performed by the computer.

RESULTS

There was significant statistical difference between two techniques: the biofragmentable ring technique exhibited low oedema fluid, organized myofiber tissue and higher number of alongated cellular nuclei in relation to manual suture technique.

CONCLUSION

The analysis of histometric variables through computational image processing was considered efficient and powerful to quantify the main tissular inflammatory and reparative changing.

[Comparative experimental study of colocolic anastomosis with manual suture and biofragmentable ring]

BACKGROUND

The authors undertook an experimental trial, in order to compare one layer interrupted sutured large bowel anastomosis with that of biofragmentable anastomotic ring (BAR). This device creates an inverted serosa-to-serosa anastomosis. It is designed to fragment after hydrolysis and it is passed within the faeces after healing of the anastomosis. Fourteen dogs were operated on, having been performed 28 anastomoses, 14 with conventional way and 14 with the BAR, both in the same bowel, on alternate sequence and 10cm from each other.

MATERIAL AND METHODS

Performing time, technical difficulties, postoperative complications and the healing anastomotic quality were studied. Histological examination was done not only by traditional technique but also by using computerized program, in order to measure the amount of inflammatory infiltration at the anastomosis site.

RESULTS

All dogs tolerated the operation well and postoperative period was uneventful. At laparotomy, after an average time of 33 days, perianastomotic adherence was mostly noted in the sutured anastomosis. Anastomotic index had no significant difference in both methods, but inflammatory change was mostly detected in sutured anastomosis, on which the amount of edema infiltration was significantly higher.

CONCLUSIONS

Based on these results, the authors conclude that the BAR anastomosis appears to be a safe alternative, uniform, more rapid and easy technique, with better healing. No difference in the clinical results was noted.

Prospective randomized comparison of pefloxacin and ampicillin plus gentamicin in the treatment of bacteriologically proven biliary tract infections

One hundred and eighty-nine patients with acute cholecystitis or cholangitis requiring antibacterial therapy and surgery were randomly allocated in a prospective open study to receive either iv or oral pefloxacin (800 mg per day) or a combination of iv or oral ampicillin (4 g per day) and gentamicin (240 mg per day im). Ninety-two patients had to be withdrawn from the efficacy analysis, mainly because of negative baseline culture, but occasionally because of isolation of bacteria resistant to the study drugs. In the 97 evaluable patients (90 with cholecystitis and 7 with cholangitis) the clinical cure rates were excellent and similar for both groups: 49/50 (98%) for pefloxacin and 45/47 (95.7%) for the combination; the respective bacteriological success rates were 100% and 91.5%. Three patients in the pefloxacin group and six patients in the ampicillin-gentamicin group reported mild and transient side effects.