Gastric cancer in the elderly.

Nowadays an increased number of elderly patients undergo surgery for gastric cancer. The old age by itself does not seem to represent a prohibitive risk factor anymore. Two groups of patients operated on of gastric cancer at our surgical unit (Group A = 378 patients younger or as old as 65 years and Group B = 330 patients older than 65 year) were compared. There were not statistically significant differences between the two groups in terms of number of performed radical exereses (57.7% vs. 42.3% respectively), kind of resective operation (total gastrectomy or subtotal gastrectomy) and extent of lymphadenectomy (D2-D3 type: 64.7% vs 63.8% respectively). The location of tumor, the distribution by stage and the long term survival of radically resected cases were not statistically different in the two groups of patients. Five-year survival after radical resection was 56.8% and 54.0% respectively. We conclude that elderly patients in good clinical conditions affected by gastric cancer should undergo radical resection with lymphadenectomy such extensive as D2-D3 type.

The nightly spontaneous alkalinization of the stomach.

Authors evaluated eighty-four 24-hour intragastric pH recordings of 73 subjects in different pathophysiologic conditions. Among them there were 12 healthy subjects, 27 duodenal ulcer patients, 10 of whom were examined both before and after treatment with H2 receptor antagonists, 18 gastro-esophageal refluxers and 16 other patients who complained of dyspepsia of various origins. Authors observed a spontaneous nocturnal alkalinization phenomenon of the stomach (SNA) which began in the latter part of the night; its onset was strongly related with sleeping and interrupted by waking up. This phenomenon was absent in duodenal ulcer patients but could be restored by treatment with anti-H2 drugs. The authors, moreover, gave evidences of a relation between SNA and the vagal integrity and modulation of the gastric secretions.

Rome pouch: pre-peritoneal continent ileal reservoir with hydraulic valve.

We present our experience with a modified technique for constructing a continent ileal reservoir, using the terminal ileum in a pre-peritoneal position. The ureters were implanted using the Le Duc-Camey technique; the Benchekroun valve was used as a continence mechanism. This technique was used in 18 patients and its advantages and complications are discussed.

Twenty-four-hour intragastric pH-metry: H2-receptor antagonist restoration of nightly gastric spontaneous alkalinization in duodenal ulcer healing.

Continuous 24-hour intragastric pH monitoring allows the evaluation of spontaneous late night gastric alkalinization phenomenon (SNA). This nocturnal increase of intragastric pH is strongly evident in healthy volunteers but is insignificant in patients with active duodenal ulcer. Gastric acidity was monitored by 24-hour continuous pH-metry in nine patients with active duodenal ulcer disease before and after two weeks of therapy with ranitidine. A twice daily dose of the drug (150 mg at 08.00 h and 150 mg at 20.00 h) was orally administered to each subject. Before treatment the ulcer patients did not show the SNA phenomenon, but the therapy led it to reappear. Ranitidine significantly reduced the time during which the gastric acidity was lower than 4 pH units; moreover the drug was effective on the ulcer healing during a period as brief as two weeks of therapy. At least a complete healing of the duodenal ulcer could be seen in patients whose overall gastric acidity time was reduced almost to the 40% of the pre-treatment value, meal times excluded from the pH-metric calculation.

Twenty-four-hour intragastric pH-metry: evidence of nightly gastric alkalinization in subjects with and without active duodenal ulcer.

Continuous 24-hour gastric pH monitoring was performed in 68 subjects to evaluate the spontaneous nightly alkalinization phenomenon (SNA). Two groups of patients were compared: the first (group A) was composed of 27 subjects with active duodenal ulcer disease; group B included 12 healthy volunteers and 29 patients with gastroesophageal reflux. Patients with duodenal disease had an alkalinization of 196.2 +/- 97.9 seconds in duration, while healthy subjects and even gastroesophageal refluxers exhibit a SNA lasting 5269 +/- 748.3 seconds (t = 6.72; p < 0.001). The absence of SNA was used as a predictive test of duodenal ulcer disease and its discriminating ability was evaluated. The evidence of this phenomenon was able to exclude the disease in 90% of group B subjects (negative predictive value) while its absence suggested correctly the presence of duodenal disease in 82% of patients (positive predictive value). The lack of SNA in duodenal ulcer patients is so frequent that its absence might be a diagnostic sign of the peptic disease.

[Pre-peritoneal trans-ileal uretero-cutaneostomy. Apropos of 41 cases]. / Uretero-cutaneostomia trans ileale pre-peritoneale. A proposito di 41 casi.

In the last 15 years we have used a modified version of the classic Bricker for external urine derivation in 41 cases (32 cases of neurobladder and 9 cancer of the bladder). This modification essentially involves placing the ileal loop in front of the peritoneum, in a superficial position which facilitates urethroileal anastomosis especially when trying to prevent reflux. The positioning of the loop greatly reduces urine stasis and ureteral stenosis, which in the classic Bricker is due to the ureter crossing the meso. We hope this technique will be used more widely in view of the excellent results obtained (low morbidity with hardly any complications).

Effects of various prostaglandin synthesis inhibitors on the tone of the lower oesophageal sphincter in man.

The role of endogenous prostaglandins in the modulation of lower oesophageal sphincter (LES) function has been assessed by giving three structurally unrelated cyclooxygenase inhibitors and monitoring their acute effects on LES tonus and platelet thromboxane (TX) B2 production in 20 healthy volunteers. In a double-blind, placebo-controlled, cross-over study, IV injection of soluble salts of acetylsalicylic acid and indomethacin elicited a transient increase in LES tonus of approximately 50% over baseline. A similar pattern was observed after the rectal administration of indomethacin. In contrast, indoprofen had no measurable effect on LES tones, despite comparable inhibition of platelet cyclooxygenase activity. This may have been due to the markedly different tissue distribution of the drug. The results suggest that endogenous prostaglandins physiologically exert an inhibitory influence on LES function.

Autonomously functioning thyroid adenoma in a seven year old boy.

Hyperfunctioning thyroid adenoma is an extremely rare disorder in childhood. A case of a seven year old boy is reported. Clinical and laboratory findings were similar to those seen in adults. Recovery of thyroid function was prompt after ablative surgery and no substitutive therapy was required.

Transvenous sclerotherapy of the gonadal veins for treatment of varicocele: long-term results.

Percutaneous occlusion of the spermatic vein has been performed on 136 consecutive patients with varicocele scroti during the last six years. The authors report their long-term results on the first 119 cases to have a follow-up of at least six months. Occlusion of the insufficient gonadal vein is induced by the selective transcatheter injection of sclerosing agent with local anesthesia. Their patients are always evaluated before and after the procedure by Doppler examination. A spermiogram is done before the procedure and after six months. In this series they registered only 4 recurrences with no major complications.

Emergency abdominal surgery in patients with acute leukemia and lymphoma.

Seventeen cases of acute leukemia or lymphoma which required emergency surgery for acute abdominal pain, are reported. It is concluded that surgery in these patients should be performed whenever indicated because the mortality rate of medical treatment is around 100%.

Appearance of esophageal peristalsis in treated idiopathic achalasia.

The authors studied 22 patients with severe dysphagia, and follow-up studies showed the appearance of some esophageal peristalsis for the first time in three of these patients after Heller myotomy. Comparison of pre- and postoperative clinical, radiological, and manometric data of these three subjects and the data of the other 19 patients showed no statistically significant differences between the two groups of patients either before or after cardiomyotomy except for the unusual appearance of esophageal peristalsis after surgery. According to these results it is not possible to predict which patients will develop peristalsis after cardiomyotomy. The different motor pattern observed after surgery might suggest the existence of a different pathogenesis underlying the esophageal motor disorders in these two groups of patients.

Pulmonary vascular resistance changes in experimental hemorrhagic shock.

Hemorrhagic shock was experimentally induced in 40 mongrel dogs, and the resulting pulmonary vascular resistances studied. A mechanical test with closure of the left branch of the pulmonary artery and two pharmacological tests with isoproterenol (isuprel) and cyclic adenosine-monophosphate (cAMP) were performed. The results suggest that there is a block in the beta-control during prolonged shock, and that beta-control is restored by cAMP.