Abstract. Colorectal cancer patients may succumb to their disease because of local recurrence or formation of metastasis. To develop a prognostic tool for these fatal types of progression, 23 patients with colorectal carcinoma were included in this study for the detection at the time of surgery of the incidence of K-ras, B-raf and p53 mutations, the phosphorylation status of Erk and the expression of cystatin-like metastasis-associated protein (CMAP) in tumor, mucosa and liver samples. Polymerase chain reaction-restriction fragment length polymorphism and PCR-SSCP were used to detect the respective mutations. The results of these assays were complemented by sequencing the K-ras, B-raf and p53 mutations. A multiplex RT-PCR assay was used to detect the CMAP mRNA levels and the phosphorylation status of Erk in tumor samples was assessed by Western blot using a phospho-specific Erk antibody. The carcinomas were classified as stages T4 (70%), T3 (17%), T2 (9%) and T1 (4%) and thus represent a group of advanced colorectal carcinomas. The carcinomas (8 out of 23, 39.1%) were mutated in K-ras codons 12 or 13 and two patients had a B-raf (V599) mutation in their tumor. Of 22 tumors, 11 (50%) were positive for pErk, indicating the activation of the RAS/RAF/ERK signaling pathway. Of the 23 tumors, 13 (65.5%) showed an increased CMAP RNA level. Notably, 10 of these 13 patients have already died and two developed liver metastasis. Mutations in p53 were found in only 6 patients (26%), with 6 being detected in carcinoma, 1 in mucosa and 1 in liver tissue. These alterations were classified as non-sense (n=1), mis-sense (n=2) and frame-shift mutations (n=1) as well as intron polymorphisms (n=5). There was a significant correlation between Erk activation and K-ras codon 12 mutation (p=0.016), but not between K-ras codon 13 or B-raf mutations and Erk activation. Furthermore, there was a significant correlation of each positive marker with tumor stage (p=0.001).

According to the literature, the development of metallosis after hip arthroplasty occurs in approximately 5% of patients. Metallic debris in the joint results in massive local and systemic release of cytokines. Excision of the pelvic pseudotumor, as well as revision surgery, is mandatory if there is evidence of osteolysis and loosening of the endoprosthesis. Imaging diagnostics, including magnetic resonance and computed tomography, are crucial for the preoperative planning of surgical intervention.

INTRODUCTION: Laparoscopic resections in colorectal cancer gain an increasing popularity. Sentinel lymph node mapping in colorectal cancer and its advantages in daily practice are still subject of discussion. In laparoscopic operations, the procedure has same technical difficulties, although provides definite advantages in staging and estimating the extent of lymph dissection. MATERIALS AND METHODS: We present techniques for intraoperative sentinel lymph nodes mapping in colorectal cancer and their detection with surgical gamma probe in laparoscopic resection, which are used in our clinic, and the initial results from them. RESULTS: The initial results show that sentinel lymph nodes mapping with radionuclides and their detection with surgical gamma probe are technically feasible in laparoscopic resections for colorectal cancer. The method has additional possibilities for the surgeon for estimating of the lymph drainage and precise staging in laparoscopic operation. CONCLUSION: Nevertheless the contradictory opinions for application of sentinel lymph nodes mapping in colorectal cancer, the method provides certain advantages in improving staging. In laparoscopic operations, although having some difficulties, it could be used, as it offers additional facilitation for the surgeon in estimating the lymph drainage in condition of decreased tactile sensation.