Role of surgery in the treatment of gastric cancer. Personal experience.

BACKGROUND: Although the decreased incidence of gastric cancer, nevertheless many surgical questions are topical, especially the entity of resection and the extent of lymph node dissection. METHODS: We analyzed retrospectively 38 patients operated for gastric adenocarcinoma in our Surgical Division from January 1997 to December 2001. We excluded cancers of cardia and gastroesophageal junction. We evaluated gastric site, macroscopic and microscopic aspect, TNM staging and grading of gastric cancer (UICC 1997), surgical treatment, postoperative complications and survival, in order to identify the rationale surgical approach to gastric cancer in a suburban hospital. RESULTS: Most of patients affected by gastric cancer were older than 60 years (28/38=73.68%). The cancer was prevalently localized in the antral-pyloric region (21/38=55.27%), in the ulcerated form (27/38=71.05%) and differentiated as intestinal subtype (21/38=55.27%). Regarding the UICC staging we found an almost unvarying distribution, but most of cancers were at stage IV (12/38=31.58%). In 71.05% of cases (27/38) a radical operation was feasible. The most performed operation was a total gastrectomy (19/27=70.37%). We performed a D1 dissection in 85.18% of radical operations (23/27). In the resective surgery we reconstructed the intestinal continuity by a mechanical circular stapler Roux en Y anastomosis. CONCLUSIONS: When possible we perform a total gastrectomy. D1 is our standard lymph node dissection, awaiting a defined D2 role in gastric cancer surgery. In the resective surgery we reconstruct the intestinal continuity by a mechanical circular stapler Roux en Y anastomosis. Morbidity was 10.5% (4/38) and mortality was 7.89% (3/38). Old age and pre-existing pathologies have an important role on surgical outcome. Prognosis of advanced gastric cancer is poor, despite a resective surgical treatment. We emphasize the importance of prevention and early diagnosis as fundamental steps of the oncological gastric surgery.

Sonographic, hysteroscopic, and histologic evaluation of the endometrium in postmenopausal women with breast cancer receiving tamoxifen.

STUDY OBJECTIVE: To evaluate the estrogenic effects of tamoxifen on the endometrium in postmenopausal women with breast cancer. DESIGN: Consecutive study (Canadian Task Force classification II-2). SETTING: University-affiliated hospital. PATIENTS: Thirty-three women. Interventions. All patients underwent transvaginal sonography (TVS) and color flow Doppler of endometrial vessels, hysteroscopy, and, if necessary, endometrial biopsy or other operative hysteroscopic procedures. MEASUREMENTS AND MAIN RESULTS: In four women the endometrium was thin on TVS and atrophic at hysteroscopic assessment. In 29 women with thick endometrium on TVS, hysteroscopy and endometrial biopsy showed atrophy (11 patients), hyperplasia (5), polyps (11), and well-differentiated adenocarcinoma (2). The two endometrial cancers were present in women with uterine bleeding. In women with positive histologic findings, the endometrium was significantly thicker (p = 0.04) and duration of tamoxifen therapy longer than in those with negative findings, although this was not statistically significant (p = 0.067). CONCLUSION: We believe regular assessment of the endometrium by TVS should be performed in postmenopausal patients at the start of the tamoxifen therapy, and hysteroscopy in women with a thick endometrium or postmenopausal bleeding. We believe that patients with thin endometrium on TVS at the beginning of tamoxifen therapy, who have no abnormal uterine bleeding should be screened with these examinations for 2 years.

Successful pregnancy in a patient with Churg-Strauss syndrome.

Vasculitis syndromes rarely occur in association with pregnancy and usually have a poor prognosis. We report the case of a 32-year-old woman, affected by Churg-Strauss syndrome in complete remission at the time of conception, who completed a successful pregnancy. The patient did well except for a recurrence of allergic rhinitis and asthma which apparently responded to an increase in steroid dosage. Clinical implications of vasculitis and pregnancy are discussed.

[The structural organization of the human myocardium: the interrelation between myocardial fibers and interstitial connective tissue]. / Organizzazione strutturale del miocardio umano: interrelazione fra fibre miocardiche e connettivo interstiziale.

The complex tridimensional structure of the human ventricular myocardium has rarely been studied in the past. In the normal heart, in the lapse of time of few weeks of the embryonic life, a radical transformation from a chaotic plexiform organization to a complex tridimensional structure occurs. From then on, the ulterior growth of the myocardial fibres will only be dimensional and quantitative, because the spatial geometry is to be considered definitive. The role of the interstitial connective tissue in following the development of the myocardium, possibly inducing or influencing it, is still unclear. We have performed an histologic study on serial sections of the ventricular mass of 7 human embryos and fetuses, from 5 to 20 weeks of gestational age. The sections have been evaluated for their morphologic characteristics as evidentiated by histochemical (PAS, trichrome, Gomori silver technique) and immunohistochemical (myosin, actin, desmin, myoglobin, vimentin, fibronectin, smooth muscle cell, endothelial factor VIII) stainings. The results show that myocardial growth is mantellar, proceeding from the epicardium toward the endocardium, with progressive structural organization in strata, variably related one to the other depending upon the considered site of the ventricular mass. The interstitium grows in parallel to the myocardial growth, beginning with a thin network surrounding each fibre that progressively in time is transformed in a complexly arranged and more densely packed structure. The collagen fibres appear initially at epicardial level, particularly around the coronary vessels.(ABSTRACT TRUNCATED AT 250 WORDS)