Gastrointestinal stromal tumours. Our experience ten years later.

AIM: To analyze GISTs behaviour observing their clinical evolution and outline the best approach to this neoplasia. MATERIAL OF STUDY: In a period between December 1999 and October 2009 came to our observation, at the Institute of General Surgery, 37 patients with GIST. We conducted a retrospective study evaluating the anatomo-pathological aspects, the clinical situation and the tumour characteristics of the 37 patients with GIST. RESULTS: The 37 patients included 21 women (57%) and 16 men (43%), the mean age was 67 years. GISTs originated from the stomach (27), jejunum (5), ileum (3), anus (1) and transverse mesocolon (1), the symptom most frequently found was acute anaemia and in 5 cases the diagnosis was occasional; 36 patients underwent surgical treatment. Based on tumor size, mitotic count, presence of areas of necrosis and/or haemorrhage, GISTs were classified according to the categories of potential high-grade malignancy (13 pts), intermediate grade (8 pts), low grade (16 pts). DISCUSSION: According to international literature, surgery remains the cornerstone of treatment for patients with primary resectable GIST without evidence of metastasis and should also be utilized when surgery has minimal risk of morbidity for the patient. The goal of surgery is complete surgical resection with negative margins (R0). The follow-up for some patients is still ongoing; only 10 patients underwent to adjuvant therapy with Imatinib. CONCLUSIONS: In the last decade, GISTs have become an emblematic example of the possibility of pharmacologically interfering with the molecular mechanisms of carcinogenesis.

Adenocarcinoma arising in an elderly patient's large ileal duplication.

Bowel duplications are rare congenital anomalies commonly found in pediatric patients; few cases may remain undetected until adulthood. Malignant carcinomatous changes are rare complications in intestinal duplications. An 88-year-old female patient was referred to our surgical unit with the diagnosis of a large abdominal mass. An explorative laparotomy was performed, revealing a large (22 × 11 cm) neoplasm strictly connected to the lowest ileal segment and completely filling the pelvis. Definitive histology revealed a moderately differentiated adenocarcinoma developing in a duplication of the terminal ileum. The hypothesis of a gastrointestinal duplication should be evaluated in the differential diagnosis of large, complex, indeterminate masses located in or near the bowel; the possibility of neoplasm within the duplication should be considered.

Adenosine signaling contributes to ethanol-induced fatty liver in mice.

Fatty liver is commonly associated with alcohol ingestion and abuse. While the molecular pathogenesis of these fatty changes is well understood, the biochemical and pharmacological mechanisms by which ethanol stimulates these molecular changes remain unknown. During ethanol metabolism, adenosine is generated by the enzyme ecto-5'-nucleotidase, and adenosine production and adenosine receptor activation are known to play critical roles in the development of hepatic fibrosis. We therefore investigated whether adenosine and its receptors play a role in the development of alcohol-induced fatty liver. WT mice fed ethanol on the Lieber-DeCarli diet developed hepatic steatosis, including increased hepatic triglyceride content, while mice lacking ecto-5'-nucleotidase or adenosine A1 or A2B receptors were protected from developing fatty liver. Similar protection was also seen in WT mice treated with either an adenosine A1 or A2B receptor antagonist. Steatotic livers demonstrated increased expression of genes involved in fatty acid synthesis, which was prevented by blockade of adenosine A1 receptors, and decreased expression of genes involved in fatty acid metabolism, which was prevented by blockade of adenosine A2B receptors. In vitro studies supported roles for adenosine A1 receptors in promoting fatty acid synthesis and for A2B receptors in decreasing fatty acid metabolism. These results indicate that adenosine generated by ethanol metabolism plays an important role in ethanol-induced hepatic steatosis via both A1 and A2B receptors and suggest that targeting adenosine receptors may be effective in the prevention of alcohol-induced fatty liver.

Jejuno-jejunal invagination due to intestinal melanoma.

Cutaneous melanoma is one of the most studied neoplastic lesions in biology and clinical oncology. It has been well documented that this type of neoplasm presents a high metastatic rate, and is able to involve nearly every tissue. Non-cutaneous melanoma represents an unusual pattern of melanoma, and the small intestine is an uncommon anatomic localization. Herein we report an extremely rare clinical case of a young woman affected by a bleeding jejunal melanoma, whose early clinical presentation was an intestinal invagination.

Alteration of adenosine receptors in patients with chronic obstructive pulmonary disease.

RATIONALE: Chronic obstructive pulmonary disease (COPD) is the fourth leading cause of mortality worldwide. Adenosine is an inflammatory regulator that acts through four distinct receptors to mediate pro- and antiinflammatory effects. OBJECTIVES: The primary aim of this study was to investigate the expression, affinity, and density of adenosine receptors in peripheral lung parenchyma from age-matched smokers with COPD (n = 14) and smokers with normal lung function (control group; n = 20). METHODS: Adenosine receptors were analyzed by immunohistochemistry and saturation binding assays using typical antagonist radioligands. RESULTS: A(1), A(2A), A(2B), and A(3) receptors were expressed in different cells in peripheral lung parenchyma. The affinity of A(1), A(2A), and A(3) receptors was significantly decreased in patients with COPD compared with the control group (K(D)[A(1)] = 3.15 +/- 0.19 vs. 1.70 +/- 0.14 nM; K(D)[A(2A)] = 7.88 +/- 0.68 vs. 1.87 +/- 0.09 nM; K(D)[A(3)] = 9.34 +/- 0.27 vs. 4.41 +/- 0.25 nM; p < 0.01), whereas their density was increased (Bmax[A(1)] = 53 +/- 4 vs. 32 +/- 3 fmol/mg protein; Bmax[A(2A)] = 852 +/- 50 vs. 302 +/- 12 fmol/mg protein; Bmax[A(3)] = 2,078 +/- 108 vs. 770 +/- 34 fmol/mg protein; p < 0.01). The affinity of A(2B) receptors was not altered, but the density was significantly decreased in patients with COPD compared with the control group (Bmax = 66 +/- 5 vs. 189 +/- 16 fmol/mg protein; p < 0.01). A significant correlation was found between the affinity and density of the adenosine receptors and the FEV(1)/FVC ratio. CONCLUSIONS: This is the first report showing the presence of adenosine receptors in lung parenchyma in subjects with COPD compared with control smokers. These novel findings strengthen the hypothesis of a potential role played by adenosine receptors in the pathogenesis of COPD.

[Long stapled haemorrhoidectomy versus Milligan-Morgan procedure: short- and long-term results of a randomised, controlled, prospective trial]. / Emorroidectomia secondo Longo vs Milligan-Morgan: risultati a breve e lungo termine di uno studio prospettico, randomizzato, controllato. Analisi costo-beneficio.

The aim of this study was to assess the short- and long-term results of treatment for haemorrhoids by prospectively comparing two techniques, namely, stapled rectal prolapse mucosectomy according to Longo and open hemorrhoidectomy. One hundred consecutive patients were randomised to stapled (50 patients) or manual hemorrhoidectomy (50 patients). We analysed postoperative pain, preoperative and postoperative anorectal function, intraoperative and postoperative complications, time needed to return to work and to normal social activities, and costs. Long-term follow data were obtained by means of an outpatient visit. The operative time of the stapled technique was less than that of open haemorrhoidectomy (22 vs 35 minutes). Two cases of early postoperative bleeding occurred after the stapled technique. The mean pain score on a visual scale was significantly less in patients undergoing the stapled technique. In addition, the time needed to return to work and to normal social activities was significantly less after the stapled technique, which, however, proved to be a more expensive procedure. Stapled mucosectomy of the prolapsed rectal mucosa is a safe, rapid, and relatively painless technique, which has a low incidence of complications. It can be performed in a day surgery unit. Patient satisfaction, early return to normal activities and good long-term results counterbalance the high cost of the procedure.