[Malignant fibrous histiocytoma. Case report]. / Istiocitoma fibroso maligno. Caso clinico.

Malignant fibroous histiocytoma (MFH) is an aggressive soft tissue sarcoma, that most frequently occurs in the muscles of the extremities and in abdominal or in retroperitoneal space of young adults. It is seldom confined to the skin and subcutaneous tissue. It is rarely diagnosed before excision and pathological exam, and has an unfavorable prognostic in some cases. This work reports the case of a 94 years old patient with originally cutaneous MFH stressing the importance of the early diagnosis.

[Colo-anal anastomosis. Our experience]. / Anastomosi coloanale. Casistica clinica.

The aim of study is to report the results of our experience about ultra-low rectum carcinomas treated with anterior resection and colo-anal anastomosis. The surgery still represents the treatment of choice for the cancer of the rectum. The problems concern the conservation of the sphincter functions (anal and urethral), and sexual function and the reduction of the locoregional recurrences. From 2005 to 2007, 33 patients underwent surgery for low and ultralow rectal carcinoma (30 treated with neoadjuvant radio-chemotherapy, and 3 only with surgery). In 16 of these we have performed a colo-anal anastomosis, in 11 an ultralow colorectal anastomosis and in 7 a Miles resection. We report our updated results.

[GIST: our experience]. / GIST: nostra esperienza.

Gastrointestinal stromal tumors (GIST) are generally found in the stomach or small intestine and less commonly in the colon and rectum. Complete surgical remove remains the best current therapy. In the treatment of advanced/metastatic GIST is available imatinib, a selective tyrosine kinase inhibitor. In our experience, 12 patients observed between 2000 and 2007 and affected by GIST underwent surgery, in one case associated to treatment with imatinib.

[Downstaging after neoadjuvant therapy for rectal cancer modifies the planned original surgery]. / Il downstaging dopo terapia neoadiuvante del cancro del retto modifica l'intervento originariamente programmato.

Cancer of the rectum has been for more years burdened with a heavy rate of local relapse about 30%. The introduction of total meso-rectum excision has reduced the rate of up to 5-8%. Later more studies proved how the preoperative radiotherapy was able to reduce the rate of local relapse. The Authors introduce studies about downstaging after neoadjuvant chemoradiotherapy for rectal cancer and discuss about their own series from 2005 to 2007.

Primary adenocarcinoma of the duodenum: treatment and survival in 89 patients.

BACKGROUND/AIMS: Primary adenocarcinoma of the duodenum is a rare disease and diagnosis is always late in being confirmed because of the non-specific symptoms, consequently leading to poor prognosis. METHODOLOGY: A retrospective review of 89 patients with non-ampullary duodenal adenocarcinoma treated in 36 different surgical departments in Italy between 1980 and 1994 was performed. The signs and symptoms, diagnostic studies conducted, tumor locations, surgical treatment, and survival were analyzed. RESULTS: Duodenography and endoscopy were the most effective diagnostic tests, showing an accuracy of 81.9% and 88%, respectively. The most common tumor site was periampullary, observed in 62.9% of the cases. A curative resection was performed in 65 of the 89 patients (73%), a partial pancreatoduodenectomy in 37, a segmentary duodenal resection in 15 and a wide local excision in 11. The postoperative mortality rate was 10.1% (9 patients), and the overall 5-year survival was 25%, which was significantly better after resection. The most important prognostic factors were stage and tumor location. CONCLUSION: Early diagnosis of primary duodenal adenocarcinoma is the only way to improve the results, by providing a higher resectability rate.

Continent perineal colostomy by transposition of gracilis muscles. Technical remarks and results in 14 cases.

UNLABELLED: We herein present a study conducted on 14 patients presenting cancer of the lower rectum or of the anal canal (10 adenocarcinomas and 4 squamous-cell carcinomas) and submitted to the Miles abdominal perineal resection in which a new perineal sphincter was constructed. PURPOSE: The aim of this study was to evaluate the efficacy of this new perineal sphincter constructed by transposing the gracilis muscles around an orthotopic colostomy in the attempt to avoid a permanent abdominal colostomy. METHODS: In all cases both gracilis muscles were employed. The right one was placed along the posterior wall of the pelvis and fixed to the contralateral ischiatic tuberosity, creating a sling comparable to the levator ani muscles. The left gracilis was passed around the colon and attached to the ipsilateral or contralateral tuberosity according to its length, reconstructing a muscular ring. The entire procedure was performed in one step in nine cases and in more steps in the remaining five. RESULTS: Of the 14 operated patients, 2 died of vascular disease and 1 developed necrosis of the colonic stump which required reconversion to an abdominal colostomy. Of the remaining 11 patients available for long-term evaluations, 8 showed adequate stool control. The remaining three manifested an incomplete level of continence. During the three-year follow-up period, all patients were evaluated by clinical examination, defecography, endoluminal ultrasonography, nuclear magnetic resonance, CT scan, and endoluminal manometry. CONCLUSION: This neosphincter realizes an elastic stenosis responsible for an efficient level of continence. Best results are observed in the young and educated patients submitted to surgery in two steps. Contraindications to this surgery seem to be advanced cancer, old age, and obesity.

Early gastric cancer: total gastrectomy vs. distal resection. Results of a study of 271 cases. The Italian Stomach Cancer Group (A.C.O.I.-I.S.C.G.).

Two hundred and seventy-one (271) patients with early gastric cancer from 26 different hospitals were examined in a retrospective study conducted by the I.S.C.G. (Italian Stomach Cancer Group). The patients were divided into two series: the first, comprising 234 patients with negative lymph nodes (Stage ITNM-UICC), had 5-year survival rates of 85%. The second group comprised 37 patients with positive lymph nodes (Stage III TNM-UICC) with a 72% five-year survival rate. Both results appear to be of great significance when compared with the five-year survival rate for advanced gastric cancer, namely 29.3%. As far as the difference between the late results of total gastrectomy and subtotal distal resection are concerned, the latter was associated with a higher five-year survival rate in the case of tumors located in the lower third and in the middle third of the stomach.

[Multicenter retrospective study of 3,024 patients operated on for stomach cancer in Italy. Epidemiology, surgical treatment and survival]. / Etude rétrospective pluricentrique de 3 024 patients opérés pour cancer de l'estomac en Italie. Epidémiologie, traitement chirurgical et survie.

This study presents the results achieved in 2,000 patients who underwent gastric resection and who had been selected from amongst 3,074 cases of gastric neoplasia included in the Retrospective Study of Carcinoma of the Stomach, carried out by the "Italian Stomach Cancer Group" of the Association of Italian Hospital Surgeons (ACOI). In terms of the UICC TNM classification, these patients consisted of 234 stage I patients, 494 stage II patients 1,011 stage III patients and 261 stage IV patients. The overall operative mortality was 7.1 percent. This was lower after subtotal distal resection. The long-term survival tended to fall in proportion with the stage of the illness, whereas the degree of the exeresis did not appear to have any impact. The overall survival at 5 years in the patients who survived the operation was 45%, that following distal resection was 54% and that after total gastrectomy was 33%. The survival rate in terms of the stage ranged from 86% for Early Gastric Cancers to 28% for the patients who underwent surgery at stage III i.e. when they had metastatic lymph nodes.

[Duodenal ulcer, study of gastric secretion and rational treatment with famotidine in different doses]. / Ulcère duodénal, étude de la sécrétion gastrique et traitement rationnel par famotidine à doses différentes.

The authors report their experience with 50 patients affected by duodenal ulcer, 80% of them with a chronic relapsing ulcer. They all underwent endoscopy and study of gastric secretion (BAO and PAO) before beginning therapy with famotidine (40 mg nocturnal) and during this treatment. In 43 patients the secretory values of BAO and PAO resulted above the ulcerogenic limit during the treatment. In 2 cases the secretory values did not decrease under the ulcerogenic limit even during the therapy with 40 mg of famotidine. These 2 cases had been affected by relapsing duodenal ulcer, non responding to H2 antagonists and nocturnal doses of 60 and 80 mg famotidine till the secretory values decreased below the ulcerogenic limit. In such a way we obtained ulcer healing in 4 weeks. The therapy was prolonged for two years with the same dosage at the beginning and later with half doses without any relapse and secondary effects. We emphasize the utility of secretory studies in peptic ulcer and suggest that non-responding duodenal ulcer can depend on very high acid gastric secretion treated by too low doses of H2 antagonists.