Role of radioimmunoguided surgery using iodine-125-labeled B72.3 monoclonal antibody in gastric cancer surgery.

Uniform and accurate staging of gastric cancer is essential to predict prognosis and assess the effectiveness of treatment strategies. An appropriate amount of surgical resection of the primary tumor and lymph node dissection appears to be fundamental for such staging. In seven out of 10 patients who were candidates for curative surgery, we assessed the usefulness of radioimmunoguided surgery (RIGS) using B72.2 monoclonal antibody (MoAb) labeled to Iodine-125 (I125) for the intraoperative staging of the tumor and the first (N1) and second echelon (N2) lymph nodes. We obtained a correct RIGS identification of primary lesions in four out of seven patients (57.1%), while lymph node staging assessment showed positive results in two out of four patients with lymph node metastases. RIGS correctly identified 26/ 40 (65%) metastatic nodes of these last two patients. RIGS intraoperative staging of gastric cancer--which may be essential for the assessment of the extension of the primary resection and to modulate lymph node dissection--was unsatisfactory. We believe that other technical approaches and more specific MoAbs should be evaluated for RIGS purposes in gastric cancer surgery.

The simultaneous presence of primary lymphoma and adenocarcinoma in the stomach.

The authors describe a rare case, recently observed by them, of coexisting primary lymphoma and adenocarcinoma of the stomach. After illustrating the more salient aspects of the clinical and anatomopathological pattern, the Authors discuss the general issue of the simultaneous presence of the two pathologies, analysing in particular their classification and etiopathogenic aspects. They then discuss the peculiar aspects of the case considered, including the preoperative diagnosis of non-Hodgkin gastric lymphoma, and highlight the fact that, unlike what is more frequently reported in the literature, the carcinomatous component had been completely ignored. As a final consideration, they stress the importance of studying this rare combination of tumoral components in order to gain a better understanding of oncogenic mechanisms so far unknown.

Apendicite aguda como inicio clínico de carcinoma de cólon direito ou de apêndice: relato de oito casos / Acute appendicitis as clinical exordium of a right-sided colonic appendiceal carcinoma: report of 8 cases

Os autores revêem sua casuística operatória dos últimos dez anos, relativa aos pacientes operados em caráter de urgência por abdômen agudo devido a uma presumida flogose apendicular, reunindo oito casos, nos quais, na realidade, o mesmo tinha sido desencadeado ou completamente simulado por uma lesäo neoplásica maligna do cólon direito ou do apêndice. A finalidade dos autores é evidenciar os problemas diagnósticos e terapêuticos que tal modalidade de apresentaçäo clínica de uma lesäo carcinomatosa coloca em relaçäo à patologia apendicular puramente benigna, principalmente nas faixas etárias que incluem adultos e idosos, nos quais o abdômen agudo neoplásico pseudo-apendicular ocorre com freqüência discreta. Foram realizadas cinco intervençöes radicais, duas paliativas, associadas em um caso à apendicetomia, e uma apendicectomia em uma paciente de 24 anos, que voltou à observaçäo após 40 dias, apresentando estado oclusivo; na reintervençäo foi verificada a presença de uma neoformaçäo infiltrante da flexura cólica direita, que, ao exame histológico, mostrou ser um carcinoma mucíparo com células em anel com castäo, de localizaçäo cólica raríssima. Os AA. chegam à conclusäo que o diagnóstico pré-operatório no abdômen agudo de origem neoplásica com localizaçäo no quadrante inferior direito é sempre difícil, senäo impossível: de fato, em sua experiência, em sete casos, somente a intervençäo cirúrgica permitiu estabelecer o diagnóstico certo, diretamente quatro vezes e, somente após o exame histológico da peça extirpada, em três pacientes. Em um caso, muito raro e particularmente insidiosos, a doença neoplásica revelou sua presença durante o pós-operatório

[Esophagotracheal fistula without esophageal atresia: discussion of 2 cases (author's transl)]. / La fistola esofago-tracheale senza atresia esofagea: considerazioni su due casi.

The authors report two cases of esophagotracheal fistula without esophageal atresia, of their own observation, on the grounds that the anomaly is less rare than common belief would have it; in fact, available literature indicates that a good many cases go undetected. So, in the presence of clinical evidence suggesting an esophagotracheal fistula, one must do everything possible to diagnose it correctly and to take timely corrective action in view of forestalling severe respiratory complications. The predominant oblique cranial orientation of the fistular passage creates considerable difficulty in radiological detection, although this difficulty is lessened by modern roentgenocinematography. Surgical correction, at any rate, solves all extant clinical problems at the same time as it eliminates possible complications.

[Tc99m pertechnetate in the study of gastric function]. / Il Tc99m pertecnetato nello studio della funzionalità gastrica.

The authors explored the gastric function of 20 volunteers by classical methods and by the assessment of gastric 99Tc pertechnetate clearance. From a comparison of results obtained with the various methods they come to the conclusion that the pertechnetate clearance method is dependable, easy to perform, and noninvasive; accordingly, they recommend its use as the method of choice for monitoring the treatment of duodenal ulcers and evaluating its results.