Differential expression of genes implicated in liver lipid metabolism in broiler chickens differing in weight.

1. Lipid parameters and expression of ACACA, APOA1, CPT1A, FASN, FOXO1, LIPG, PPARα and SIRT1 genes involved in lipid metabolism were investigated in two groups of high (HW) and low (LW) weight broilers from the same strain.2. Blood cholesterol and liver triglyceride levels were significantly increased in HW chickens compared to LW broilers, while other parameters, i.e. blood triglyceride, blood HDL/LDL, liver cholesterol and total liver fat showed no significant changes in either group.3. The relative expression of ACACA, APOA1 and CPT1A genes was significantly lower in the liver tissues of HW broilers than in the LW group. The mRNA levels of these three genes showed a significant negative correlation with abdominal fat deposition and live weight of broilers. However, relative expression of FASN, FOXO1, LIPG, PPARα and SIRT1 hepatic genes did not differ among broilers.4. It was concluded that, of eight hepatic genes implicated in lipid metabolism, only the expression of three (ACACA, APOA1 and CPT1A) were significant for fat and leanness within the same strain of chicken. Since reducing body fat is a major goal in the broiler industry, these data can provide fresh insight into the molecular processes underlying the regulation of fat deposition in broilers.

Short- and long-term efficacy of intragastric air-filled balloon (Heliosphere® BAG) among obese patients.

BACKGROUND: Obesity is an increasing health problem worldwide. The intragastric balloon as a temporary endoscopic treatment of obesity can play an important role among the aforementioned group of obese individuals. It can also be used as a preoperative test before subjecting patients to restrictive bariatric surgery. Furthermore, the intragastric device may be applied to patients affected by severe obesity as a "bridge treatment" before they undergo major surgery in order to reduce chances of operation-related risks. To date, there are insufficient data in the literature on the long-term results of the intragastric balloon. METHODS: Our study includes an analysis of our experience with Heliosphere® BAG from 2006 through to 2010, concerning early weight loss and weight loss maintenance over at least 18 months since the device's removal. The 32 patients who completed the 6-month treatment had recorded a mean weight loss of 12.66 kg and a mean overweight loss of 24.37 % (SD, 12.74). RESULTS: A total of 16 patients are subjected to an 18-month follow-up. Their pretreatment and long-term body mass index (BMI) were calculated: 6 months later, when devices were removed, they showed a mean weight of 99.75 kg (SD, 17.90; p < 0.001) and a mean weight loss of 13.62 kg and 26.14 % (SD, 12.79). 18 months after removing Heliosphere® BAG, the 16 patients' mean BMI was 37.28 kg/m² (SD, 5.41; p = 0.004), with a mean weight of 103.56 kg (SD 17.25; p = 0.0125), and a mean weight loss of 9.8 kg or 18.2 % (SD, 12.07). CONCLUSIONS: Heliosphere® BAG enables modest short-term weight loss with little side effects, although mid/long-term follow-up may entail partial weight gain. We believe it can be considered a useful bridge treatment in bariatric surgery in order to reduce chances of preoperative risks.

[Emergencies in colorectal carcinoma: negative prognostic factor?]. / L'urgenza da carcinoma colorettale fattore prognostico negativo?

The authors analyze a consecutive series of 219 patients affected by complicated colorectal cancer who underwent surgery in emergency. In hospital mortality, 5-year survival and recurrence's incidence in 104 of these patients who underwent curative treatment are calculated and compared with a series of 701 patients who underwent elective surgical treatment. There was no significative statistical difference between emergency and elective group. At the multivariate analysis only the stage of the tumor was an independent prognostic factor.

[Functional complications of the lower urinary tract after curative exeresis for cancer of the rectum]. / Le complicanze funzionali delle basse vie urinarie dopo exeresi curativa per cancro del retto.

The aim of the study is to assess the incidence and the pathogenesis of urinary dysfunction in the surgical treatment of rectal cancer. A series of 219 patients, who underwent surgery for rectal cancer with normal urinary preoperative function, was submitted to a prospective follow-up for the urinary function. Symptomatic patients in the follow-up were studied by ultrasonography, cystomanometry and pressure-flow electromyography. In the immediate follow-up only 17 patients with urinary dysfunction were observed (14 at stage 2, 2 at stage 3 an1 at stage 4 according Saito classification). Six months later only 8 patients had urinary dysfunction. In 1 of these cases neurogenic bladder requiring catheterization was observed no significative correlation with staging, radiotherapy, size of tumor, surgical technique was observed. Worst functional results were observed in patients who underwent abdomino-perineal resections.

[Preoperative CEA: prognostic significance in colorectal carcinoma]. / CEA preoperatorio: significato prognostico nel carcinoma colo-rettale.

The prognostic meaning of preoperative CEA level and its relation to the other risk factors are still under debate. In 512 patients who underwent surgical treatment for colorectal cancer, CEA preoperative plasma level had been evaluated. The prognostic value of CEA was compared with other prognostic factors and the characteristics of the tumor. There was no significant ratio between CEA overexpression and stage, diameter, grading, ploidy, site and shape of the cancers. As regard as the long-term results are concerned, the patients with normal preoperative CEA levels had a better prognosis. In the Dukes B and C tumors, the level of CEA over the cut off point lets identify a group of patients with high risk whom more aggressive adjuvant therapies and follow up could be addressed to. This study suggests that CEA preoperative is an independent prognostic factor and may be useful in the therapeutic planning.

[Role of intensive follow-up in colorectal cancer surgery patients]. / Ruolo del follow-up intensivo nell'operato per carcinoma colo-rettale.

Authors analyze the role of follow-up after curative resection for colo-rectal cancer. In 129 patients (29.6%) a recurrence was observed, whilst in 6 (1.4%) a metachronous carcinoma was detected by endoscopy. Liver involvement was observed in 59 patients, lung metastasis in 18 and both liver and lung metastasis in 4. In 23 patients local recurrence (LR) was observed and in 25 both LR and liver metastasis were detected. 31 patients (24%) were submitted to surgery and 21 (16.2%) with curative purpose. As far as LR is concerned, 5 patients were operated (10%) with curative purpose and a 5 years survival of 40% was observed. Five years survival in 9 patients submitted to surgery with curative purpose (8.4%) for liver metastasis was 57.1%, whilst in 7 patients operated for lung metastasis (31.8%) it was 76%. All the 6 patients operated for metachronous carcinoma are still alive with a 2-5 years follow-up.

Local excision for rectal cancer.

BACKGROUND AND OBJECTIVES: The aim of this retrospective study is to evaluate the results of local excision (LE) for rectal cancer for curative purposes. METHODS: From 1969 to December 1997, a total of 456 operations were performed for surgical treatment of rectal carcinoma (262 males and 194 females, mean age 66 years). Twenty patients (4.1%) underwent LE (7 males and 13 females, median age 65 years). Patients were selected for LE if they met the following criteria during preoperative staging: tumors staged as T1-T2,N0,M0, grading G1 or G2, and accessible location. Types of LE performed were: 13 transanal excisions (Francillon's technique), 2 Mason surgeries, 2 endoscopic excisions, and 3 transanal endoscopic microsurgeries. RESULTS: There was no in-hospital mortality among LE patients. Thirteen tumors were T1 and 7 were T2; all 20 were adenocarcinoma, 14 G1 and 6 G2. There was no specific morbidity, and aspecific morbidity was minimal (5%). There were no local recurrences, but 2 patients (10%) had secondary lesions. Five-year overall survival following LE was 87.4%. Comparing T1 and T2 tumors treated with abdominoperineal resection (APR) and SSR (17 T1 and 42 T2, all adenocarcinoma), in-hospital mortality and specific morbidity were respectively 1.7% (P = 0.55) and 28% (P = 0.007). There were 5 (8.5%) local recurrences (P = 0.17) and 6 (10.2%) metastatic lesions. Five-year overall survival was similar to LE (88.3%; P = 0.76). CONCLUSIONS: LE for rectal carcinoma might only be successfully performed in selected patients with correct preoperative staging. In the LE cases reported five-year overall survival, local recurrence, and in-hospital mortality were similar to APR and SSR, while there was a statistically significant difference following LE in terms of specific morbidity.

[Current trends in the treatment of rectal carcinoma]. / Attuali orientamenti in tema di trattamento del carcinoma del retto.

Authors report their personal experience about 336 cases of curative surgery for rectal cancer. They describe technical surgical details universally accepted in Literature such as sharp total mesorectal excision, the extension of lymphadenectomy with high ligature of inferior mesenteritis artery while pelvic lymphadenectomy seems to be unuseful and burdened by high morbidity; finally they underline advantages offered by a colic pouch above all for lower incidence of anastomotic leakages. As adjuvant therapy is concerned, our actual tendency is a preoperative radiochemiotherapy of which we are still evaluating long-term results. Finally we analyzed correlations between cellular genetics and colo-rectal cancer.

[Serous cysts of the transverse mesocolon: a review of the literature in the light of 2 cases brought to our notice]. / Cisti sierose del mesocolon trasverso: revisione della letteratura alla luce di due casi giunti alla nostra osservazione.

Mesenteric cyst is one of the rarest tumours, with about 820 cases reported since 1507. Ultrasound and TC are the most valuable modalities for diagnosis of mesenteric cyst. Surgical resection is the treatment of choice. The authors report two cases of mesenteric cyst of the transverse mesocolon preoperatively diagnosed by ultrasonography and computed tomography (CT). A surgical enucleation was performed.

[Surgical therapy of right colon cancer]. / La terapia chirurgica del cancro del colon destro.

The debate about the management of frequent advanced right colon cancer is still opened: the opportunity of extended resections when the surrounding organs or tissues are infiltrated, the lymphadenectomy extension and its role, the possibility of identifying prognostic factors that could be useful to decide adjuvant therapy, the definition of the role of laparoscopy. Considering these problems, we have reviewed a series of 159 operations performed by the Institute of Clinical Surgery of the University of Trieste from 1980. 112 of these operations had a curative goal. The reconstruction of intestinal continuity was carried out manually in 28 cases and with mechanical stapler in 78. As far as the curative resection are concerned, in 89 of them an extended lymphadenectomy was performed (D3), while in 18 cases the lymphadenectomy was limited to the lymph nodes of first and second level due to the general bed conditions of the patient. 27 of the curative exeresis were performed in patients with T4 tumor infiltrating the nearby tissues. Referring to Dukes' classification, 8 were included in stage A, 59 in stage B and 40 in stage C, while as far as the depth of wall infiltration is concerned 2 were categorized as T1, 9 as T2, 69 as T3 and 27 as T4. The overall operative mortality was of 5 patients, the overall morbidity of 14%, that specific of 4.6%. The final incidence of local recurrences was 13.8% for Dukes A cancers, 10.9% for Dukes B and 120.5% for Dukes C (p = 0.0614). Half of the recurrences (50%) occurred in patients with a cancer infiltrating the nearby tissues. The 5 year survival rate for patients with Dukes A lesions was 100%, for patients with Dukes B lesions 73.4% and for Dukes C 52.3% (p = 0.00510). With Cox' multivariate analysis only the stage disease, T and grading showed a significative correlation with the survival rate. Our experience, therefore, suggests the execution of an exeresis with lymphadenectomy D3 in each cases where the local site of the lesion and the general conditions of the patients allow it and an extended exeresis where possible from a technical point of view and when the lymph nodes are involved.

[Gastric leiomyoblastoma. (Review of the literature in the light of a case)]. / Leiomioblastoma gastrico. (Revisione della letteratura alla luce di un caso giunto alla nostra osservazione).

Gastric leiomyoblastoma is a rare benign neoplasm, arising from the smooth muscle cell, that may become malignant. The most important symptoms are epigastric pain, sideropenic anaemia and upper GI bleeding, but frequently the diagnostic iter is difficult and definitive diagnosis is made only with histology after laparotomy. A personal case is reported and Literature data are reviewed; stress being laid on the uncertain biological evolution that influence mostly the choice of therapy.

[Role of curative local excision in rectal cancer]. / Ruolo delle escissioni locali con intento curativo nella chirurgia del cancro del retto.

The aim of this retrospective study is to evaluate the results of local excision (LE) for rectal cancer for curative purposes. From 1969 to December 1997, a total of 456 operations were performed for surgical treatment of rectal carcinoma (262 males and 194 females, mean age 66 years). 20 patients (4.1%) underwent LE, 7 males and 13 females, median age 65 years. Patients were selected for LE if they met the following criteria during preoperative staging: tumors staged as T1-T2, N0, M0, grading G1 or G2, achievable location. As far as the type of LE is concerned, 13 transanal excisions (Francillon technique), 2 Mason, 2 endoscopic excisions and 3 TEM were performed. Among patients who underwent LE there was no operative mortality. 13 tumors were T1 and 7 were T2; pathologic findings included 20 adenocarcinoma, 14 G1 and 6 G2. There was no postoperative specific morbidity, while aspecific morbidity was minimal (5%). There were no local recurrences but 2 patients (10%) had secondary lesions. Five year overall survival following LE was 87.4%. Comparing T1 and T2 tumors after APR and SSR (17 T1 and 42 T2, all adenocarcinoma), operative mortality and specific morbidity were respectively 1.7% (p = 0.55) and 28% (p = 0.007). There were 5 (8.5%) local recurrences (p = 0.17) and 6 (10.2%) metastatic lesions. Five year overall survival was similar to LE (88.3%; p = 0.76). In conclusion the authors stress the importance that IE for rectal carcinoma must be performed only in selected patients provided there is correct preoperative staging. In these cases five year overall survival, local recurrence and operative mortality were similar to APR and SSR, while there was a statistically significative difference following LE in terms of specific morbidity.

[Extended resection in locally advanced colon cancer]. / Gli interventi allargati nella chirurgia del cancro del colon localmente avanzato.

Colorectal malignant tumors with a mono o multivisceral involvement have a poor prognosis and surgery is the only treatment with a hope to be curative. Aggressive surgical management of locally advanced colo-rectal cancer seems to be justified by good oncological results. At the Institute of Clinica Chirurgica of the University of Trieste 58 extended resections were performed for advanced tumors of colon and rectum. The specific morbidity rate was 24% for standard and 24.1% for extended resections. Operative morality was 15.2%; hystological specimen confirmed in 31 cases neoplastic infiltration of contigous structures. The 5 year survival rate was 38.5% in right colonic tumors and 53.3% in left colonic tumors. The literature favors an aggressive approach when the tumor adhesions are suspected. The excision of adjacent organs, whether or not they are microscopically involved by the tumor, is necessary to avoid leaving potentially curable disease The authors, analyzing their results, have also reported good results by management including resection of the colon and contigous organs if involved. Palliative therapy must be performed only if liver metastases are detected or in those cases when primary resection is not thecnically feable or in patients not able to tolerate the procedure.

[Colonic diverticulosis complicated with perforation. Analysis of several prognosis variables and criteria for emergency surgery]. / La malattia diverticolare del colon complicata da perforazione. Analisi di alcune variabili prognostiche e criteri di scelta chirurgica in urgenza.

The aim of this study was to analyse the clinical course, surgical strategy and results in patients with perforated large bowel diverticulitis. Over a 15-year period ending in January 1997, 25 patients (13 males and 12 females; mean age 64.1 years) underwent operation for perforation of acute diverticulitis. Depending on the symptoms, the spreading of the peritonitis and the patient general state, different surgical techniques were performed: primary resection and anastomosis with and without defunctioning colostomy (5), primary left hemicolectomy (1), Hartmann's resection (13), Mikulicz's procedure (4), suture and drainage with diverting colostomy (2). The overall mortality was 16%, while morbidity rate was 44%; these results were strictly related to the severity of clinical manifestations and peritoneal contamination. Therefore it must be stressed that a good surgical timing is essential. Our experience and literature data show that primary resection and anastomosis with and without colostomy have good results when the patient is fit, the sepsis is localized and satisfactory bowel preparation is achievable. By contrast, purulent and faecal peritonitis are still usually best treated by Hartamnn's procedure. Finally, it is submitted to surgeons's experience to choose, at any situation, the best procedure regarding age and general state, local findings and extent of peritonitis.

[Spigelio's hernia: presentation of 2 clinical cases and review of the literature]. / L'ernia di Spigelio: presentazione di 2 casi clinici e revisione della letteratura.

The authors present two cases of Spigelian hernia. The patients underwent surgery, in one case with urgency modality. They repaired surgically both hernias, by a plastic of the abdominal wall. Neither postoperative mortality, nor morbidity have been observed. On follow-up, they didn't observe any relapse. Nevertheless the extreme rarity of the Spigelian hernia, the authors believe that this pathology must be considered among the different causes of the partial intestinal obstruction or acute abdomen. The diagnosis can be performed both by the simple clinical examination and by instrumental devices. Ultrasonography seems to be the most specific and the less invasive one. Recently laparoscopic approach has been emphasized; it allows to reach the diagnosis and to treat the hernia at the same time. However the authors remark that traditional surgery remains the most effective treatment.

[DNA ploidy and cell kinetics in cancer of the rectum]. / DNA-ploidia e cinetica cellulare nel cancro del retto.

The pathological assessment of rectal cancer remained essentially unchanged for 50 years and it is based mainly on Dukes' classification and histological granding. Alternative methods of classifications have also been developed but, actually, Dukes'taging is the most important prognostic factor. The limit of Dukes' classification is the incomplete discrimination between high risk and low risk patients into the same stages. The measurements of cellular DNA content by flow cytometry is emerging as a prognostic aid in many human tumours. Authors analyze on the basis of their experience on 116 curative operations for the cancer of the rectum, the relationship between tumour's features, CEA, symptoms, recurrences, survival, type of operation and DNA flow cytometry. In 100 cases they studied the percentage of cells in "s" phase. (SPF). Samples of flow-cytometry were prepared using paraffin-embedded tumour blocks. The authors didn't find any statistically significant relation among pathological features, staging, ploidy and SPF. Recurrences rate was 16.6% in diploid tumours and 23% in no diploid (p = 0.3). In SPF < 25% it was 18.2% (p = 0.5). 5-year survival was worse in aneuploid patients (p = 0.06). Using Cox' multivariate regression analysis, ploidy has not independent prognostic significance. In conclusion authors consider ploidy a prognostic factor in rectal cancer, but not independent. However, authors conclude that flow cytometry could help in early staging of the disease, especially in preoperative diagnosis. Flow cytometry has a prognostic significance with informations on tumoral biology and could contribute to select patients for adjuvant therapy or different surgical techniques.

Lumboaortic and iliac lymphadenectomy: what is the role today?

PURPOSE: The aim of this study was to evaluate the roles of the lymphadenectomy in the surgical treatment of rectal cancer. METHODS: On the basis of our experience of 252 curative operations for rectal cancer, we analyze survival and recurrence in relation to the lymph node involvement and to the level of the lymph nodes where the metastases are located. All patients underwent a lymphadenectomy with high ligation of the inferior mesenteric artery and removal of the lumboaortic lymph nodes from the left renal vein to the aortic bifurcation. Pelvic lymphadenectomy was performed in 16 cases. RESULTS: Five-year survival was 70.6 percent in patients with no lymph node involvement, 68.2 percent in patients with pararectal lymph nodes N+, 25 percent in patients with involvement of intermediate lymph nodes, and 30 percent in patients with involvement of lumboaortic lymph nodes. In no case was there involvement of the hypogastric lymph nodes. On the basis of our experience and from results in the literature, we consider an upward extended lymphadenectomy with high ligation of the inferior mesenteric artery is warranted since it enables the tumor to be staged accurately and may lead to survival even in cases of advanced lymph node involvement.

[Conservative surgery in rectal cancer]. / La chirurgia conservativa del cancro del retto.

The Authors analyse their experience about 387 cases operated for rectal cancer. The choice of the operation was not related to tumour's features, but was related to the location of the neoplasia. The safety margin of rectal resection was reduced up to a minimum of 2 cm. in lower tumours, where it was not possible to meet this condition an abdomino-perineal resection was performed. A lumbo-aortic lymphadenectomy with high ligature of inferior mesenteric artery was always performed; in 17 cases it was extended to the pelvic nodes. In all the patients the whole mesorectum was removed and a wide pelvic dissection was performed to avoid the so called cone effect. Since 1991 all the B2-C patients undergo preoperative radiotherapy. Recurrence rate and survival are similar both after abdomino-perineal and sphincter-saving resections. Among the different risk factors, the Authors have found a statistically significant relation only with the stage. The Authors, therefore, conclude that sphincter-saving resection is the best surgical procedure because of the god quality of life. They stress the importance of a lumboarotic lymphadenectomy with high ligature of inferior mesenteric artery. As far as the complementary therapy is concerned, the discussion is still open, especially about the timing and the choice of the adjuvant treatment.

[Low anterior resection in the curative surgical treatment of rectal cancer]. / La resezione anteriore bassa nel trattamento chirurgico curativo del cancro del retto.

Abdominoperineal resection for rectal cancer are being performed with decreasing frequency in favour of sphincter-saving resections. It remains to be demonstrated that sphincter preservation has not resulted in compromised local disease control and survival. For this purpose 342 patients with rectal carcinoma have been studied. A curative resection has been carried out in 232. Sphincter-saving procedure was performed whenever possible: the length of margin of resection was at least 2 cm. The operation were: 71 abdominoperineal excisions (AP), 147 anterior resections (AR), 14 transanal excisions. The thirty-days mortality was 7 patients (9.9%) for AP and 5 (3.4%) for AR. Local recurrence was: AP 10 cases (15.6%), AR 16 cases (11.3%); for tumors 4-8 cm from anal verge recurrence was 17.1% for AP, 16.2% for AR. Concerning staging, local recurrence was more common in the Dukes C stage (24.3%) than in the Dukes B (10.2%) or in the Dukes A (3.8%). 5 years survival after AP was 62.2 percent and after AR 67.9 percent. Concluding, in our experience, there was no relationship between local recurrence or survival and type of curative surgery (AP or AR). Local recurrence and survival were only related to tumor stage: lateral tumor extension in these advanced and aggressive lesions appears to be the major determinant of local recurrence. Further investigations are necessary to determine whether the addition of adjuvant radiotherapy or of extended abdomino-iliac lymphadenectomy should be able to improve the results.