Biological effects of preoperative radiotherapy on metastatic lymph nodes from rectal cancer.

The quantitative description of the proliferative activity of cancer cells correlates with the aggressiveness of malignant tumors. The aim of this retrospective study was to determine the biological effect of adjuvant therapy on metastatic lymph nodes from rectal cancer and to compare the results between patients treated with surgery alone and patients treated with preoperative radiotherapy. Expression of the proliferating cell nuclear antigen (PCNA) was examined in metastatic lymph node samples of 12 rectal cancer patients receiving and 14 patients not receiving preoperative radiotherapy. PCNA immunostaining was performed by an avidin-biotin complex immunoperoxidase technique. The results of the mean proliferation index (PI) between the two groups were compared. A semiquantitative PCNA grading system was also estimated. In patients receiving preoperative radiotherapy, the PI was 22.8 per cent, and only one patient had high proliferative grade. On the contrary, the PI in nonirradiated patients was 67.6 per cent, and nine patients showed high proliferative grade. Although not sufficient to reach significance in terms of prognosis, the present study confirms the clinical value of radiation therapy, and it supports the suggestion to treat Dukes' C patients with preoperative radiotherapy to decrease the risk of local recurrence.

Juvenile polyposis: case report and assessment of the neoplastic risk in 271 patients reported in the literature.

A case of juvenile polyposis is reported and 271 cases are collected from the literature. The risk for neoplasia is analyzed and the endoscopic or surgical therapy is discussed. The authors conclude that juvenile polyposis should be considered as a challenge to the surgeon with regard to familial adenomatous syndromes, and strongly recommend a close follow-up of patients with juvenile polyposis.

[Prospective research on fetal cholelithiasis: incidence, predisposing conditions, echographic diagnosis, and clinical features]. / Una ricerca prospettica sulla colelitiasi fetale: incidenza, condizioni predisponenti, diagnosi ecografica e quadro clinico.

The Authors report a prospective study on fetal cholelithiasis, analyzing its differences with the more widely known cholelithiasis of paediatric age. The study shows that the number of cases diagnosed by ultrasonography is higher than expected (0.39%, 3 cases on 764 pregnancies). The Authors could find no correlation between fetal cholelithiasis and any maternal, obstetrical and fetal factor. They have focused attention on sonographic imaging showing clinical-instrumental correlation between echogenic material, clinical features and their evolution. The study confirms that the most common evolution results in spontaneous resolution of fetal endocholecystic pathological images. Finally, wide review of the international literature is reported on the rare, but possible clinical manifestations and their complications.

[Juvenile polyposis coli associated with hereditary spherocytosis]. / Associazione morbosa tra poliposi giovanile del colon e sferocitosi ereditaria.

The first case of colorectal juvenile polyposis associated with hereditary spherocytosis is reported. Symptoms, diagnosis and therapy of juvenile polyposis are described along with the associated syndromes reported in the literature. The scientific and clinical consequences of this association are discussed.

[Pylorus-preserving pancreatoduodenectomy allows a better maintenance of glucose homeostasis]. / La duodenocefalopancreatectomia con conservazione del piloro assicura il mantenimento di una fisiologica omeostasi glicidica.

BACKGROUND: Pancreatic diseases and pancreatic surgery usually cause a derangement of glucose metabolism ranging from a change in glucose tolerance test to insulin-dependent diabetes. The authors assess the changes in glycemia both in basal condition and after a challenge test in a group of patients who underwent Pylorus Preserving Pancreatoduodenectomy (PPPD) according to an original technique of reconstruction with two separate bowel loops. MATERIALS AND METHODS: Ten patients who underwent PPPD either for chronic pancreatitis or ampullar carcinoma were enrolled in this study. Pre- and postoperative assessment of pancreatic endocrine function was carried out in all the patients. The evaluation included: 1) oral glucose tolerance test (OGTT), 2) intravenous glucose tolerance test (IVGTT) and 3) glucagon challenge test. RESULTS: Plasma glucose level in basal condition, after oral glucose tolerance test, intravenous glucose tolerance test and glucagone challenge test, shows that insulin secretion and/or its effectiveness is not impaired after PPPD. Two patients with preoperative insulin-dependent diabetes needed a lower dose of insulin in the postoperative period. One patient responded abnormally to OGTT both in the preoperative and postoperative periods. Seven patients maintained normal glucose homeostasis in the postoperative period. DISCUSSION: PPPD allows a normal control of glucose metabolism. Better digestive and endocrine function noted in our patients in the postoperative period is due to the integrity of the stomach and the reconstruction technique with two bowel loops used to drain biliary and pancreatic secretion separately.

Totally extracorporeal laparoscopy-assisted colon resection without pneumoperitoneum.

We describe a new totally extracorporeal laparoscopy-assisted technique without insufflation of the peritoneum in the treatment of benign and malignant ascending and sigmoid colon lesions. Colon resection is performed using specially designed instruments that allow the surgeon to avoid insufflation of the peritoneum and, in case of cancer, allow for conventional lymph-adenectomy. With this new technique, the restrictions associated with the laparoscopic technique are nullified, and the surgeon can directly examine intra-abdominal contents. Our preliminary results are encouraging and demonstrate the feasibility of this technique as well as its positive results in terms of curability in selected cases of colon cancer. Additional experience will delineate the real clinical value of this technique in the treatment of malignant disease.

[Original excluding cecostomy procedure for the prevention of colorectal anastomotic dehiscence]. / Un'originale procedura di ciecostomia escludente per la prevenzione delle deiscenze anastomotiche colo-rettali.

The authors report the results of an original technique of cecostomy performed on 30 patients as an alternative to temporary colostomy. Colorectal anastomotic leakage following surgery represents the main indication to this procedure. This original technique seems to be safer, simpler and more effective than a temporary colostomy.

The role and timing of surgery in the treatment of pseudomembranous colitis. A case complicated by toxic megacolon.

The authors describe a particularly serious case of pseudomembranous colitis due to Clostridium difficile that was complicated by toxic megacolon. It was resolved by surgical intervention, and the reasons why subtotal colectomy is preferable to simple ileostomy are discussed.

[The surgical treatment of hepatic echinococcosis and of its biliary complications]. / Il trattamento chirurgico dell'echinococcosi epatica e delle sue complicanze biliari.

The authors report the experience of 47 patients submitted to surgery for hepatic hydatidosis. Results from different therapeutic procedures are then compared. Finally, possible biliary complications of the hepatic echinococcosis and their surgical treatment are discussed.

[Perioperative pain and stress: a comparison between video laparoscopic cholecystectomy and "open" cholecystectomy]. / Dolore e stress perioperatori: confronto tra videolaparocolecistectomia e colecistectomia "open".

Pain and endocrine-metabolic response to surgical stress, during surgery and in the early postoperative period, was compared in two groups of patients affected by gallstones and randomly assigned to Laparoscopic Cholecystectomy or Open Cholecystectomy. Pain was assessed by the VAS method also taking into account the need of analgesic administration in the postoperative period. The so called "stress hormones" (Prolactin (PRL), Cortisol (CORT), Human Growth Hormone (HGH)) and glycaemia were monitored during surgery and in the first postoperative 24 hours. The minimal invasive technique of laparoscopic cholecystectomy accounted for a very limited analgesic administration. In the intraoperative period laparoscopic cholecystectomy plasma hormone levels overlapped the open cholecystectomy ones, while in the postoperative period a constant increase in PRL and CORT levels was registered in the open cholecystectomy group demonstrating a prolonged stressful condition. The end results of this study show that laparoscopic cholecystectomy has major advantages than open cholecystectomy in the treatment of gallstones as far as pain and endocrine-metabolic response are concerned.

An original reconstructive method after pylorus-preserving pancreatoduodenectomy.

Acute pancreatitis and leakage of pancreaticojejunal anastomosis are the most important causes of operative morbidity and mortality after pancreatoduodenectomy. We have introduced a modified technique for reconstruction that provides a functional exclusion of the pancreatic-jejunostomy in respect of the transit of gastric and biliary secretions. The immediate advantages of this technique are the reduction in the risk of leakage and the possibility of undertaking conservative treatment, in the case that leakage occurs. The preservation of the antral-pyloric unit, according to Traverso and Longmire, increases the functional features of the procedure, by reducing entero-gastric refluxes, and assuring a regulated gastric emptying. We herein present our series of 11 pancreatoduodenectomies (PD) for periampullary neoplasms and chronic pancreatitis. Throughout our series we experienced no cases of operative mortality. However, there was one specific instance of morbidity, consisting of one case of external biliary fistula by micro-dehiscence of the hepaticjejunostomy and which was later resolved by conservative treatment. Our most recent results have produced almost normal findings in terms of gastric secretion, gastric emptying and an absence of dumping syndrome, ulcers and refluxes.

[A case of extrarenal angiomyolipoma with intestinal localization]. / Un caso di angiomiolipoma extrarenale a localizzazione intestinale.

The Authors present a case of extrarenal angiomyolipoma. The tumor arose from the pericolonic fat of the sigmoid colon and, increasing in size, caused intestinal obstruction by extrinsic lesion. Extrarenal angiomyolipoma is extremely rare and to our knowledge this is the first reported case arising from the colonic wall.

A rare case of splenic hematoma following chronic pancreatitis--the diagnostic and therapeutic procedures.

We describe herein a clinical case in which a subcapsular splenic hematoma complicated chronic relapsing pancreatitis. A pathogenetic mechanism is postulated that explains the subacute insorgence of the liquid collection with the diffusion of proteolytic enzymes between the splenic capsule and parenchyma. Radical therapy, consisting of exeresis of the cystic formation, splenectomy and caudal pancreatectomy, is recommended for this extremely rare complication.

[Digestive hemorrhage caused by rupture of an aneurysm of the superior pancreaticoduodenal artery]. / Emorragia digestiva causata dalla rottura di un aneurisma dell'arteria pancreatico-duodenale superiore.

Aneurysms of the pancreaticoduodenal artery are rare. Nonoperative management of an iatrogenic superior pancreaticoduodenal artery aneurysm which ruptured into the duodenal stump of a Billroth II partial gastrectomy, is described here. Based on a literature review, both aetiology and site of rupture of this observation are very uncommon. Super-selective angiography was used for diagnosis and embolisation for definitive treatment.

Subcapsular splenic hematoma complicating chronic relapsing pancreatitis. Case report.

A case of subcapsular splenic hematoma complicating chronic relapsing pancreatitis is described. A pathogenetic mechanism is postulated to explain the subacute evolution of fluid collection with diffusion of proteolytic enzymes between the splenic capsule and parenchyma. Radical treatment comprised exercsis of the cystic structure, splenectomy and caudal pancreatectomy.

[Rare digestive hemorrhage caused by diverticular pathology of the small intestine]. / Emorragie digestive rare da patologia diverticolare del tenue.

The Authors report two cases of digestive hemorrhage secondary to diverticulosis of the small intestine. The incidence of this pathology in an overall population of 215 digestive hemorrhages was 0.9%. A clinical identity-kit is drawn of patients affected by jejunal diverticulosis, and the most important and characteristic anamnestic manifestations are defined. The most statistically significant complication is hemorrhage which was observed in 33% of cases. Clinical manifestations of hemorrhage are defined as variable and "bizarre", since they may appear as hematemesis, melena or enterorrhagia. The surgical procedure for radical definitive and prophylactic therapy is segmentary resection of the jejunum affected by pseudodiverticulosis.

[Digestive physiopathology of the pancreatectomized patient. Comparison of the results of total pancreatectomy and pancreaticoduodenectomy with preservation of the pylorus]. / La fisiopatologia digestiva del paziente pancreatectomizzato. Confronto dei risultati tra pancreatectomia totale e duodenocefalopancreatectomia con conservazione del piloro.

The authors analyze their experience with pancreatectomy, pointing out the digestive pathophysiologic sequelae of the operated patients. A follow-up protocol based on upper digestive endoscopy, laboratory tests, scintigraphic and pH-metric tests compares the results achieved after total pancreatectomy with the results of pancreaticoduodenectomy. Total pancreatectomy is complicated by peptic ulcer, stump gastritis and gastroenteric dyskinesia. The preservation of the pylorus and the separation of the gastric anastomosis from the biliary one avoid the pathologic biliary reflux and minimize the functional and organic sequelae of the operation.