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.

[SCS (spinal cord stimulation) in severe ischemia of the legs]. / SCS (spinal cord stimulation) nelle gravi ischemie degli arti inferiori.

Spinal cord stimulation (SCS) of the low thoracic spinal epidural space was carried out in 11 patients with pain from peripheral arterial disease of the lower limbs. Conservative treatment or vasoactive drugs also failed. Results are reported relating to pain, exercise endurance on the bicycle ergometer, trophic lesion changes and TCpO2. After a mean postimulation follow-up period of 15 months, substantial pain relief was preoperative non healing skin ulcerations, but gangrenous conditions were not benefited. Exercise tolerance as measured on a bicycle ergometer increased by 40%. It is concluded that SCS is vary promising in severe limb ischemia where reconstruction surgery is not possible or has been unsuccessful.

[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.

[Spinal anesthesia in the surgery of inguinocrural hernias]. / L'anestesia spinale nella chirurgia delle ernie inguino-crurali.

The experience in the surgical treatment of inguinal and crural hernias with epidural and subarachnoidal anaesthesia over a period of fifteen years (1976-1989) is reported. Results obtained in 1,283 cases confirm the validity of the technique and the clinical course suggests that it could well be applied to cardiopathic, hypertensive, obese, bronchopneumopathic patients as well as to dysmetabolic diseases. Furthermore, advantages of spinal anaesthesia compared to general and local anaesthesia are emphasized. The use of ultrathin needles (24 gauge) in performing subarachnoidal anaesthesia is recommended to prevent headache.

Prediction of all causes of death as a function of some factors commonly measured in cardiovascular population surveys.

A 20-year follow-up study for all causes of death has been conducted on two groups of men aged 40-59 at entry in two rural communities of northern and central Italy on a total of 1,712 subjects representing 98.9% of defined demographic samples. Personal characteristics or risk factors usually studied for coronary heart disease (CHD), as measured at entry, have been related to the risk of dying in 20 years (600 cases). By means of multivariate analysis, 11 out of 33 considered characteristics were shown to be significant predictors of any cause of death. These were mean blood pressure, age, arm circumference (protective), early death of parents, cigarette smoking, forced expiratory volume (protective), CHD, arcus senilis, vital capacity (protective), xanthelasma, and serum cholesterol. Discrimination between cases and noncases was satisfactory with about 40% of deaths in the upper quintile of the estimated distribution of risk and less than 7% in the lowest quintile (relative risk = 6.20).

Vitamin B12 absorption in total gastrectomy. Study with (57Co) B12 and radioimmunoassay.

Vitamin B12 absorption and real amount of circulating cyanocobalamin were determined by Thurangh Schilling's test and radioimmunoassay respectively, in 28 patients undergone total gastrectomy. The methods are described and the results discussed, in relation to the parameters under consideration, that is: age, sex, pathology of lesion, time elapsed from surgery, and type of reconstruction of intestinal continuity.

[Two-dimensional contrast echocardiography of hepatic veins in the diagnosis of tricuspid regurgitation (author's transl)]. / Ecocontrastografia bidimensionale delle vene sovraepatiche nella identificazione e valutazione dell'insufficienza tricuspidale.

The diagnosis of tricuspid regurgitation (TR) is often controversial. We used peripheral venous contrast echocardiography for the detection and the quantitative assessment of valvular regurgitation. We studied 10 normal subjects, 7 patients with atrial fibrillation, but without tricuspid lesions, 36 patients with TR confirmed by right heart catheterization, divided in three subgroups, according to ventriculography and jugular pulse recording: 10 cases with mild TR, 17 cases with moderate TR, 9 with severe regurgitation. After the injection of contrast medium (CM) (saline solution), the regurgitant flow was visualized in the hepatic veins (HV) and in the inferior vena cava (IVC), by two-dimensional subxiphoid projections; the time of disappearance of the CM was studied by time-motion echograms. The appearance of CM in the HV and in IVC wasn't demonstrated in any normal case. Subjects with atrial fibrillation alone, showed, in 71,5% of cases of persistence of CM in IVC for less than 10 cardiac beats. The diagnosis of severe TR was correctly made in 100% of cases; in all the patients the CM was showed in the HV for more than 40 beats. In patients with mild TR, the diagnosis was correct in 60% of cases with a short persistence of the CM in the HV. In the other cases of mild TR, the presence of CM in HV was misinterpreted as due to atrial fibrillation. Moderate TR was correctly recognized in 70.5% of patients, while in the remainder it was under or overestimated. The method shows a good sensitivity; some cases with atrial fibrillation, in the absence of TR, may cause "false-positive" diagnosis.

[Reliability of M-mode and B-mode echocardiography in detection of left intra-atrial masses (author's transl)]. / Affidabilita' della ecocardiografia M-mode/B-mode nella identificazione delle masse intra-atriali sinistre.

Although the role of echocardiography in the detection of left atrial masses is well established, reliability of the method is yet unknown. In 312 patients who underwent cardiac surgery, echocardiographic and anatomic findings were confronted. Pre-operative diagnosis was confirmed in the 8 cases with prolapsing tumors: in the remaining patients we had 5 false positive and 9 false negative diagnosis. So in our experience, sensibility has 73.5 and specificity 98.20.

Coronary risk factors predicting coronary and other causes of death in fifteen years.

A multivariate analysis employing the multiple logistic function model has been performed for the prediction of coronary heart disease (CHD) deaths and of other causes of death as function of 14 coronary risk factors measured at entry examination in the pool of two Italian rural population samples, made of 1712 men aged 40-59 at entry and followed for 15 years. A limited number of factors--namely age, serum cholesterol, blood pressure, smoking habits, forced expiratory volume, diabetes--yielded significant coefficients variously associated each other in the different solutions. They were able to provide a satisfactory discrimination between cases and non cases, not only for CHD but also for other end-points including strokes, cancer and lung cancer in particular, chronic bronchitis, and all causes of death. A suggestive prediction of violent causes of death was possible thank to a significant coefficient attributable to blood pressure. Serum cholesterol was significantly contributory only in the prediction of CHD. The multipotentiality of some factors is stressed in view of the planning of community prevention programs directed towards several chronic conditions at the same time.

[Incidence and prediction of coronary heart disease in the Italian cohorts of the Seven Countries Study. 10 year experience (author's transl)]. / Incidenza e predizione della cordiopati coronarica nelle aree italiane del Seven Countries Study. Esperienza di 10 anni.

Three cohorts of man aged 40-59 at entry have been enrolled in Italy within the Seven Countries Study and followed-up for 10 years. They included demographic samples in the rural areas of Crevalcore, north Italy (n. 993) and of Montegiorgio, central Italy (n. 719) and a sample of Railroad men living in Rome and surroundings (n. 768) with an entry participating of about 92% and a 5 and 10 year follow-up participating of about the same level. Incidence of coronary heart disease in 10 years in men coronary-free at entry has been, for the pool of the three cohorts, of about 0.4% per year for hard criteria coronary heart disease (coronary deaths and hard infarcts) and of about 1% per year for all kinds of coronary heart disease including softer diagnoses. Differences between cohorts were small and altogether not significant except for coronary deaths which were higher in the Railroad group than in Montegiorgio. The prediction of coronary heart disease as function of the entry levels of some risk factors, estimated by the multiple logistic equation, suggested that also for these Italian samples, age, blood pressure, serum cholesterol, smoking habits and physical activity (the latter with a protective role) are the main risk factors although cholesterol seems to play a lesser role in the Railroad group than in the Rural cohorts. Proportions of 34 to 68% of the observed cases were located in the upper 20% of the distribution of the estimated risk and the ratio between cases in the upper and bottom quintile of risk ranged 4 to 14 folds. The degree of discrimination suggested by these and other indicators resulted to be directly related to the severity of the coronary heart disease manifestations considered as end-points (deaths, hard cases, all cases). Such varying discriminating role was mainly due to the varying predicting power of serum cholesterol.

[Characteristics of drinking water and coronary heart disease. An epidemiological experience (author's transl)]. / Caratteristiche dell'acqua potabile e cardiopatia coronarica.

Mortality for coronary heart disease (CHD) in two samples of men aged 40-59 at entry was rather different after the first 5 year follow-up, but became more and more similar - and substancially identical - after 15 year follow-up. In the community which showed the greatest relative increase of CHD mortality beyond the fifth year, a drastic change in the characteristics of drinking water had occurred, with a large reduction of hardness, and of calcium and magnesium concentration.