Prognostic significance of tumor DNA content in carcinoma of the hepatic duct confluence.

Carcinoma of hepatic duct confluence was characterized by Klatskin, as a small, relatively slow-growing and sharply localized tumor. Sixty consecutive patients with carcinoma of the hepatic duct confluence were surgically resected in our Department between January 1984 and December 1996. All histological section of each patient included in the study were reviewed. The nuclear content was measured. Twenty-nine patient (48%) had diploid tumors and 31 (51%) were found to have aneuploid tumors. Survival of patients with a diploid tumor was significantly longer than those with aneuploid tumors. Our results indicate that DNA ploidy is an important, prognostic factor of carcinoma of the hepatic duct confluence.

Experimental use of a pedicle gallbladder graft for the repair of large duodenal defects.

The use of a gallbladder patch to cover duodenal wall defects was attempted on 36 dogs. This defect was surgically induced on the second part of the duodenum. All the dogs survived and had an uneventful postoperative course. The healing of the defect was satisfactory and the structure and thickness of the graft remained unchanged This method could be a suitable alternative in the treatment of large duodenal defects, especially in the presence of other intra-abdominal injuries, and when the use of other graft material is not feasible.

Assessment of proliferating cell nuclear antigen (PCNA) immunoreactivity in exocrine pancreatic carcinomas.

Ten patient with exocrine pancreatic carcinomas were studied immunohistochemically, using a monoclonal antibody against PCNA. The percentage of tumor cells with positive staining was defined as PCNA Labelling Index (L.I.), and ranged from 13.8% to 92.8%. PCNA L.I. was found to correlate significantly with grading and more specifically with mitotic activity and degree of nuclear anaplasia. No correlation was found with granular differentiation or with vessel invasion, lymphatic vessel invasion, lymph node metastasis, perineural invasion or size of tumor. Our results indicate that mitotic activity and degree of nuclear anaplasia might be the most important parameters to take into consideration, when studying the role of PCNA in exocrine pancreatic carcinomas.

[Prokinetic activity and antral inflammation. Usefulness of cisapride combined with H2 antagonists in gastritis]. / Attività procinetica e flogosi antrale. Utilità della cisapride associata ad H2 antagonista nella gastrite.

In order to evaluate the symptomatic efficacy of cisapride on motility disorders often associated with mild inflammatory changes of the upper gastrointestinal tract, the authors carried out a comparison between two groups of patients (15 patients in each group, 10 males and 5 females) with histologic antral gastritis, treated respectively with famotidine 40 mg/day per os plus cisapride 10 mg ter/die per os, and famotidine alone. While the endoscopic evaluation performed four weeks later did not show a significant difference between the two groups, both macroscopically and microscopically, cisapride was able to ameliorate all those symptoms presumably provoked by delayed gastric emptying.

[Peptic ulcer and Helicobacter pylori. Comments on the authors' cases]. / Ulcera peptica ed Helicobacter pylori. Considerazioni su casistica personale.

The presence of Helicobacter was tested on a group with antral or duodenal ulcer with or without gastritis, versus a group without gastric or duodenal pathology. Furthermore an open trial was performed between omeprazole and colloidal bismuth subcitrate (CBS) on patients similarly affected by peptic disease. Although CBS did eliminate Helicobacter in more than a half of patients, what was not obtained by omeprazole, this result did not mean a better control of peptic disease: in fact the omeprazole was remarkably more active in our series on clinical and endoscopic ground, whether the Helicobacter was present or not, and further studies are required to assess the real significance of Helicobacter pylori in the above conditions.

[The efficacy of the omeprazole-levosulpiride combination in the therapy of distal reflux esophagitis]. / Efficacia della associazione omeprazolo-levosulpiride nella terapia dell'esofagopatia distale da reflusso.

The therapeutic effectiveness of levosulpiride associated with omeprazole versus omeprazole alone in the reflux esophagitis has been evaluated. Two groups, each of 9 patients, were investigated before and after therapy on a clinical ground and endoscopically. While no difference was shown in terms of macro and microscopic resolution, a better subjective relief was obtained in the group treated with the association levosulpiride-omeprazole.

[Churg-Strauss vasculitis in a 53-year-old man]. / Vasculite di Churg-Strauss in un uomo di 53 anni.

The Authors describe a 53 year old patient, who, after suffering from asthma over the past 10 years, presented with abdominal pain, diarrhoea, dyspnea, petechias on lower limbs, and subsequently developed fever, polyneuritis, pericardial effusion and renal failure. Laboratory showed elevated IgE, presence of antinuclear antibodies to DNA, serum rheumatoid factor and peripheral eosinophilia. The clinical course was suggestive for systemic vasculitis; lung, skin biopsies and renal angiography confirmed this diagnosis: the association with asthma and eosinophilia fulfill the diagnosis of allergic angiitis and granulomatosis (Churg-Strauss syndrome).

[Drugs affecting upper respiratory tract motility: cisapride]. / Farmaci attivi sulla motilità delle prime vie digestive: cisapride.

The article is a short review of older and more recent drugs aimed to modify the gastrointestinal motility. Cisapride the newer one is considered with particular attention.

[Constipation. A critical review]. / La stipsi. Revisione critica.

The paper reviews the current knowledge about constipation, a widespread although often overlooked medical problem. Correct management entails a thorough clinical, diagnostic and therapeutic assessment.

[Influence of smoking on healing in patients with NSAID-induced peptic ulcer]. / Influenza del fumo sulla guarigione di pazienti con malattia peptica da FANS.

The influence of smoking on the cure of patients with peptic disease under non-steroidal antiphlogistic drugs. Observation over a 2-month period of 35 patients with peptic ulcer or erosive duodenitis related to the use of non-steroidal antiphlogistic drugs shows a significant delay in endoscopic cure in smokers, whether or not they have stopped smoking.

Unilateral seizures following vincristine intravenous injection.

A case of acute central nervous system toxicity following the intravenous injection of vincristine was observed in a patient treated with a chemotherapy regimen including cyclophosphamide, doxorubicin and prednisone for non-Hodgkin lymphoma. The neurological symptoms consisted of right-sided epileptiform jacksonian seizures limited to the face, that lasted about 10 min, followed by spontaneous recovery. A cerebrospinal fluid study and computed tomographic scan of the brain failed to reveal any central nervous system lymphomatous involvement.

Erythrocytosis associated with thyroid tumor.

A patient with erythrocytosis is described. No other evidence exists for polycythaemia vera or a known cause of secondary erythrocytosis in this patient, and management with phlebotomy resulted in temporary normalization of hematologic parameters. Subsequently a cold thyroid nodule was found which was then surgically removed and turned out to be a papillary carcinoma (phi 2 cm) at histologic evaluation. Following thyroidectomy hematologic remission was observed which is still maintained 15 months after surgery. It seems to be the first reported case of erythrocytosis associated with thyroid tumor. X