Primary gastric lymphoma: a clinical and therapeutic evaluation of 82 patients.

Eighty-two patients with primary gastric (IE, II1E, and II2E) non-Hodgkin's lymphoma according to the Musshoff's staging system were treated with combined modality including surgery with/without radiotherapy between January 1985 and December 1991. According to the Updated Kiel classification 54 had high-grade histologic subtypes and 28 low-grade. The strategy throughout the study was to resect primary tumor: all patients underwent gastrectomy, 40 subtotal and 42 total gastrectomy. The resection permitted complete surgical staging utilizing three pathologic features: disease confined within or beyond the serosa, negative/positive regional lymph nodes, and negative/positive surgical margins. If there was no evidence of these pathologic factors, the patients who underwent surgery alone received no further radiotherapy. On the other hand, all patients who presented at least one of three pathologic factors were treated with adjuvant radiotherapy after the resection. All except 14 patients presented at least one of the pathologic features and 50 (61%) patients had involvement of the whole gastric wall. Radiotherapy included the gastric bed and para-aortic lymph nodes and, for the patients, who had positive regional lymph nodes in combination with the complete involvement of the gastric wall, the irradiation included the whole abdominal approach. The complete response rate was 97% and the 9-year disease-free survival was 93%. All but one of the 5 relapses occurred within 18 months stressing the need for more specific staging. Gastric resection with/without radiotherapy may still represent the primary therapeutic procedure in early stage gastric non-Hodgkin's lymphoma.

[Combined treatment of stage I and II gastric lymphoma]. / Trattamento combinato dei linfomi gastrici negli stadi I e II.

From 1981 to 1991, fifty-three patients with primary gastric lymphoma were referred to our Institute and submitted to a complete pathologic staging followed by gastric resection, i.e., total or partial gastrectomy. According to the Working Formulation criteria, 14 patients (26.4%) were affected with high grade lymphomas, 22 (41.5%) with intermediate lymphomas and 17 (32.1%) with low grade lymphomas. MALT (mucosa associated lymphoid tissue) lymphomas were observed in > 50% of cases. At the pathologic examination of the surgical specimens, infiltration depth was assessed, according to TNM criteria, in the patients whose disease was limited to the muscular gastric wall (T1-T2) and in those whose disease spread to the serosa or beyond it (T3-T4). Twenty-five patients were classified as stage I and 28 as stage II (9 of them in stage II E1 and 19 in stage II E2 according to Musshoff's classification). The treatment protocol of these patients was as follows: stage I patients (T1-T2) with normal surgical resection margins underwent no adjuvant treatment (10 patients); stage I patients (T1-T2) with resection margins infiltrated by the disease were submitted to local irradiation; stage I (T3-T4) and stage II E1 patients underwent large-field postoperative irradiation (14 patients); stage II E2 patients (n = 19) received conventional chemotherapy (CHOP, F-CVP, N-CVP): the ones who failed to reach complete remission or presented with bulky disease at diagnosis completed the treatment with large-field irradiation (10 patients). The disease-free survival (86.5%) and the overall survival (96%) rates of stage I patients exhibited no significant difference relative to stage II patients (DFS: 87% and OS: 90%). The analysis of relapses relative to disease extent demonstrated that this parameter is more significant to prognosis than nodal involvement (T1-T2: 2/39 relapses, 5.1%; T3-T4: 4/14 relapses, 28.6%).

[Dupuytren's disease. Current etiopathogenetic perspectives]. / Malattia di Dupuytren. Prospettive etiopatogenetiche attuali.

The Authors after discussing some of the aetiopathogenetic factors of Dupuytren's disease, have studied the behavior of sera glycemic shape after oral load in 368 patients with Dupuytren's disease, finding a impairment tollerance of glucose in the 93.20% of these patients. This suggest that the impairment of the glycemic metabolism still outside of alcoholic pathology is one important factor in the Dupuytren's disease and perhaps in the development of cirrhosis and hepatica fibrosis.