Prognostic factors in gastric cancer evaluated by using Cox regression model.

OBJECTIVE: To identify the most relevant short-term predictor variables in gastric cancer removal. EXPERIMENTAL DESIGN: A retrospective survival analysis executed by using the Cox regression model; the follow-up period is included between 18 and 90 months. SETTING: A district general hospital surgery unit: "Divisione di Chirurgia Generale, Ospedale Civile di Urbino" (Marche, Italy). SUBJECTS: One hundred and twenty nine consecutive patients operated for gastric cancer. INTERVENTIONS: Surgery (total or subtotal gastrectomy). MAIN OUTCOME MEASURE: Survival times. RESULTS: Lymph node involvement (N) (p < 0.0001), cancer intraparietal extension (T) (p < 0.001) and the age of the patients (p < 0.05) have been recognized as significant prognostic factors. CONCLUSIONS: Results show that the short-term prognosis largely depends on both the earliness of the diagnosis and the age of the patients.

Comparison of colloidal bismuth subcitrate and metronidazole, both in combination with an H2-antagonist as therapy for Helicobacter pylori.

In this random study, the efficacy of either colloidal bismuth subcitrate (CBS) or metronidazole in combination with an H2-antagonist in the treatment of various gastric pathologies was evaluated, along with the trends in antibody levels. Among the 40 Helicobacter pylori-positive patients with various gastroduodenal pathologies who underwent chemotherapy, 27 were treated with CBS and 13 with metronidazole. H. pylori was eradicated in 48.14% of the patients treated with CBS and 53.8% of those treated with metronidazole. After therapy, no statistically significant or slight decrease in the serum levels of antibodies was found.

[Acute abdominal pain and appendicitis in childhood]. / Il dolore addominale acuto e l'appendicite nell'infanzia.

The diagnosis of acute appendicitis is still difficult to ascertain in children. However, a complete anamnesis, an accurate physical examination as well as a careful evaluation of other medical and surgical possibilities causing abdominal pain allow to arrive to a correct diagnosis in 80% of cases. Laboratory findings may be helpful but usually don't add further information. Each patient suspected to have appendicitis should be admitted to the hospital and kept under observation; if no improvement is registered during the following hours then a surgical exploration is needed. The surgeon, however, must be acquainted with the different medical affections causing abdominal pain in order to decide whether a laparotomy is required. The Authors report their experience in 426 patients submitted to appendectomy and stress the correlation between abdominal pain and intraoperative finding.

[A case report of Cushing's syndrome due to an adrenal carcinoma]. / Descrizione di un caso di sindrome di Cushing da carcinoma surrenalico.

A rare case of ACTH-independent Cushing's syndrome due to carcinoma is described. A thirty-year-old woman presented with systolic-diastolic hypertension, unsuccessfully treated for several months with ACE and beta-blockers. During this period physical changes such as centripetal obesity, rubeosis, and hair loss were observed. Elevated urinary and plasmatic cortisol levels were essential for the diagnosis. Alterations of the circadian rhythm with higher levels in the evening compared to the morning were registered. ACTH was found to be suppressed in several tests. Ultrasound and abdominal CT scan showed a mass involving the left adrenal gland. While waiting for surgery, the patient underwent ketoconazole therapy. The operation was carried out by bilateral chest laparotomy and consisted in a left adrenalectomy with regional lymphadenectomy. At 18 months from the operation the patient is in excellent health, the classic signs of Cushing's syndrome have disappeared and laboratory tests are normal.

[An apparently primary lymphoma of the testicle]. / Linfoma apparentemente primitivo del testicolo.

A case of apparently primary non-Hodgkin's lymphoma of the testis is described. The patient, in stage IVE at the diagnosis, was treated with left orchiectomy and chemotherapy (MACOP-B). The abdominal CT scan showed a retroperitoneal lymph node involvement with infiltration of the right kidney and liver. The patient died 6 months after onset of the disease due to its progressive course.

[Endoscopic treatment of postoperative external pancreatic fistula by means of papillotomy and naso-pancreatic drainage]. / Trattamento endoscopico di una fistola pancreatica esterna postoperatoria mediante papillotomia e drenaggio naso-pancreatico.

External pancreatic fistula is a common complication after pancreatic resection. We report a case successfully treated by endoscopic papillotomy and a naso-pancreatic tube.