Dietary supplementation with green tea extract improves the antioxidant status and oocyte developmental competence in Italian Mediterranean buffaloes.

The aim of this work was to assess the antioxidant status and the developmental competence of oocytes recovered by ovum pick-up (OPU) in Italian Mediterranean buffaloes supplemented with green tea extracts (GTE) for 90 days. Buffalo cows (n = 16) were randomly assigned to a control group receiving no supplement and a treatment group, receiving GTE starting 90 days before OPU, carried out for five consecutive sessions. Blood samples were collected before the start of supplementation with GTE (T0) and at day 45 (T1) and day 90 (T2) of supplementation, to measure ferric reducing activity (FRAP), total antioxidant capacity (TAC), superoxide dismutase (SOD) and catalase (CAT). The antioxidant status of follicles was measured as TAC on the follicular fluid collected from the dominant follicle just prior OPU, coinciding with T2, and at the end of five repeated OPU sessions (T3). Another objective was to assess in vitro the protective effects of green tea extracts on hepatic cells exposed to methanol insult. Different concentrations of GTE (0.5 µM and 1 µM) were tested on cultured hepatic cells and viability, morphology and SOD activity were assessed at 24, 48 and 72 h. Supplementation with GTE increased (P < 0.05) the number of total follicles (8.7 ± 0.5 vs 6.9 ± 0.5), the number and the percentage of Grade A + B cumulus-oocyte complexes (COCs) compared with the control (3.7 ± 0.4 vs 2.3 ± 0.3 and 57.5 ± 4.2 vs 40.4 ± 4.9 %, respectively). Oocyte developmental competence was improved in the GTE group as indicated by the higher (P < 0.05) percentages of Grade 1,2 blastocysts (44.8 vs 29.1 %). In the GTE group, plasma TAC was higher both at T1 and T2, while FRAP increased only at T2, with no differences in SOD and CAT. The TAC of follicular fluid was higher (P < 0.05) in the GTE compared to the control both at T2 and at T3 The in vitro experiment showed that co-treatment with methanol and 1 µM GTE increased (p < 0.01) cell viability at 24 h (P < 0.01), 48 h (P < 0.05) and 72 h (P < 0.01) compared with the methanol treatment co-treatment with 1 µM GTE prevented the decrease in SOD activity observed with methanol at 24 and 48 h of culture. In conclusion, the results of in vivo and in vitro experiments suggest that supplementation with GTE increases buffalo oocyte developmental competence, by improving oxidative status and liver function.

Elastofibroma dorsi: three cases of personal experience.

Elastofibroma dorsi is a rare, slow growing, soft tissue lesion, which occurs mainly in elderly women, typical located in the infrascapular region. This lesion is characterized by a poorly defined solid mass of fibro-elastic and fatty tissue, enlarging into intermuscular spaces. Elastofibroma may simulate an aggressive behaviour, and differential diagnosis with malignant tumors is sometimes difficult. Surgical resection is generally recommended in symptomatic lesions or in the suspicion of malignancy. We report our experience of three cases of elastofibroma, two of which typically located in the infrascapular region and one located in the supra-clavicle fossa, atypical site never reported so far.

Giant Sigmoid Diverticulum: A Rare Presentation of a Common Pathology.

Although colonic diverticulum is a common disease, affecting about 35% of patients above the age of 60, giant sigmoid diverticulum is an uncommon variant of which only relatively few cases have been described in the literature. We report on our experience with a patient affected by giant sigmoid diverticulum who was treated with diverticulectomy. Resection of the diverticulum is a safe surgical procedure, provided that the colon section close to the lesion presents no sign of flogosis or diverticula; in addition, recurrences are not reported after 6-year follow-up.

Radiotherapy for maxillo-facial hemangiomas in children. Dental and periodontal long term effects.

Vascular maxillo-facial malformations, common pathologies in children, represent 7% of all benign tumors. They are divided into vascular malformations and hemangiomas. In the 70s-80s radiotherapy was the most applied technique, but because of its misuse or overdose, it could lead to relevant and hard consequences for the impact on the salivar glands, periodontium and growing maxillo-facial nuclei. The authors describe the case of a 38-year-old man, who, during infancy, was submitted to radiotherapy for a hemangioma to his chin and cheek. He was under observation for an agressive periodontitis, followed by a serious facial asimmetry, located in his irradiated side. They describe the therapy and the results obtained, underlying the particular difficulties detected in operating on tissues hardly and often irreversibly injured by radiotherapy. On the basis of this clinical case and of the most up-dated knowledge, therapeutical alternatives such as embolization, cryotherapy, cortisonic systemic and intralesional therapy, the use of interferon gamma 2 and the use of the most recent laser, are analyzed, and advantages and disadvantages and the most appropriate indications are underlined.

A novel biweekly multidrug regimen of gemcitabine, oxaliplatin, 5-fluorouracil (5-FU), and folinic acid (FA) in pretreated patients with advanced colorectal carcinoma.

Previous results suggest that GEM affects 5-fluorouracil (5-FU) metabolism and pharmacokinetics in cancer patients, while combined with oxaliplatin, levo-folinic acid, and 5-FU (GOLF regimen), at doses achievable in cancer patients, determines high cytotoxic and proapoptotic antitumour activity in colon cancer cells in vitro. On these bases we designed a phase I-II clinical trial testing the GOLF regimen in patients with metastatic colorectal carcinoma, who had received at least a prior line of chemotherapy. In total, 29 patients (20 males and nine females) enrolled in the study received every 2 weeks, gemcitabine (patients #1-3 received 600 mg m(-2); patients # 4-6 received 850 mg m(-2); while patients # 7-29 received 1000 mg m(-2)) on the day 1, levo-folinic acid (100 mg m(-2)) on the days 1 and 2; 5-fluorouracil (400 mg m(-2)) in bolus injection, followed by a 22-h continuous infusion (800 mg m(-2)) on the days 1 and 2, and oxaliplatin (85 mg m(-2)), 6 h after the 5-FU bolus on day 2. The most frequent side effect was grade I-II haematological toxicity. In total, 28 patients were evaluable for response: three achieved a complete response, nine a partial response, 10 had a stable disease, and six progressed. The average time to progression and overall survival of the patients was, respectively, 7.26 and 22 months. Our GOLF combination is well tolerated and seems promising for the treatment of advanced colorectal cancer.

Initial experience with laparoscopic adjustable gastric banding and pouch dilatation: two cases.

BACKGROUND: Late proximal pouch dilatation (LPPD) has occurred occasionally following gastric banding for morbid obesity. At present, laparoscopic conservative resetting and oversuturing of the band is considered the standard procedure for pouch dilatation without any important posterior component. METHODS: Two cases of LPPD are presented, which occurred in our initial experience with the Lap-Band, corrected via a laparoscopic approach. RESULTS: The reintervention was necessary in both patients, with conservative laparoscopic repositioning and oversuturing of the band in the first case and laparoscopic substitution of the gastric band in the second. We have not observed further complications, and weight loss has been maintained in a midterm outcome in both cases (30 and 18 months follow-up). CONCLUSIONS: LPPD can be corrected with a conservative laparoscopic surgical approach, without complications and negative functional effects on mid-term outcome.

Bariatric surgery: early results with a multidisciplinary team.

BACKGROUND: Bariatric surgery depends on complete preoperative study of morbid obesity, in order to obtain the treatment of choice. A multidisciplinary group was founded in 1998 at the University of Siena. METHODS: During 1998, 16 patients, with median weight 121.8 +/- 31 kg and median body mass index (BMI) 43 +/- 6, underwent bariatric surgery. A multidisciplinary assessment was used in order to evaluate psychological status, food intake problems and patient compliance, and hemodynamic, respiratory, metabolic and arthritic functions. 13 patients were submitted to laparoscopic surgery: in 11 adjustable gastric banding was performed and 2 were submitted to a vertical gastroplasty plus adjustable gastric banding. Three patients were operated via traditional laparotomy, due to previous abdominal surgery in 2 cases (submitted to an adjustable gastric banding) and one woman was submitted to a bilio-intestinal bypass according to the Hallberg technique, for her psychiatric troubles and coexisting systolic hypertension and uncontrolled diabetes. Monthly follow-up for each patient continues after 6 months. RESULTS: No morbidity or mortality has occurred. The median weight loss at three months, was 19.5 kg. Two cases required injection of 1 ml more of fluid into the port, respectively at 4 and 9 months. Fifteen days after surgery, seven patients (46%) had vomiting episodes, due to rapid food intake. All patients have shown an improvement of their comorbidities after surgery. CONCLUSION: Early results via the multidisciplinary team and laparoscopic banding have been satisfactory thus far.

Surgical treatment of gastrointestinal carcinomas in octogenarians: risk factors for complications and long-term outcome.

BACKGROUND: The aims of this retrospective study were to determine the factors predictive of morbidity and mortality, and to evaluate the probability of long-term survival in octogenarians with carcinomas of the gastrointestinal tract. PATIENTS AND METHODS: Out of a total of 194 patients, aged 80 years or over, with histologically diagnosed carcinoma of the stomach or colon-rectum, observed between 1987 and 1995, 167 underwent surgery and were included in this study. The relationship between a series of clinico-pathological variables and morbidity/mortality rates was investigated by univariate and multivariate analysis. Complete follow-up data were available in 161 patients. RESULTS: Fifty-nine patients (35.3%) experienced complications and 14 (8.4%) died during hospitalization. Statistical analysis identified hypoalbuminaemia (P<0.01, relative risk (RR)=2.92) and hypercreatininaemia (P<0.05, RR=3.59) as independent predictors of post-operative complications. Hypercreatininaemia (P<0.05, RR=5.22) and non-curative surgery (P<0. 05, RR=3.99) significantly affected operative mortality. Crude 5-year survival rate, including operative mortality after curative surgery, was 41% in gastric cancer and 39% in colorectal cancer patients. CONCLUSION: These results indicate that surgery for gastrointestinal carcinomas yields an acceptable operative risk in octogenarians, and provides good long-term results if oncological radicality can be obtained. Pre-operative evaluation of tumour stage and patient's general condition is useful to identify subgroups of patients at high risk of surgical complications and mortality.

[Diverticulosis and neoplasms of the colon]. / Diverticolosi e neoplasie del colon.

About half of the carcinomas and polyps of the large intestine is placed in the descendent colon and in the sigma, where most frequently the diverticula are found. Literature refers to them as varying percentage of association diverticulosis-carcinoma between 2 to 8 percent. The increase of the frequency of neoplasms and diverticula in the same population classes may indicate common factors in their development. The study includes 1149 cases of colo-rectal neoplasms examined in the Department of Scienze Chirurgiche--University of Siena, from january 1981 to december 1993. The association of carcinomas and diverticula has been found in 8.96% of the cases (103 pts) and the tumours with stenosis in 59,2% of the cases. The colonoscopy is very important for a more precise differential diagnosis especially in occlusive forms, in which a multiple biopsy is indispensable. Referring to the data of literature, the authors consider that patients with symptomatic diverticular disease have a major general risk for cancer of the large intestine; the existence of certain common symptoms in either disease (especially the bleeding) may not exclude the presence of a tumor in patients with diverticular disease.

[Surgical treatment of neoplasms in geriatric patients]. / Il trattamento chirurgico delle neoplasie nei pazienti in età geriatrica.

The Authors report their experience in the surgical management of cancer in the aged (over 65 year old patients), during the period 1988-1992 at the Istituto Policattedra di Scienze Chirurgiche, University of Siena. They consider colon and rectum, breast, stomach, pancreas and biliary tract neoplasms in relation to site, staging, emergency or delayed surgical treatment, and early postoperative results. Finally, they outline the frequently encountered problems in treating old patients and the most appropriate surgical approach.

[Postoperative morbidity and mortality after surgical intervention for gastric carcinoma in advanced stage]. / Morbilità e mortalità postoperatoria dopo interventi chirurgici per carcinomi gastrici in fase avanzata.

The paper reports the authors' experience in a group of 546 patients who underwent surgical treatment for gastric cancer from 1981 to 1988. Of 437 patients (80%) with advanced gastric cancer, 121 (28%) received palliative treatment and 316 (72%) were treated for curative purposes. Postoperative care was normal in 331 patients with a mean hospital stay of 11 days; various complications occurred in 106 patients with a mean hospital stay of 26 days. Overall operative mortality was 6% (27 patients). This study aimed to assess the main factor responsible for postoperative morbidity and mortality. Findings were compared to previously reported data and were shown to be similar.

[Antropyloric preservation in pancreatic excisions]. / La conservazione antro-pilorica nelle exeresi pancreatiche.

The authors report 11 consecutive partial or total pancreatectomies with preservation of the pylorus. They believe this technique is to be preferred because it allows a better digestion and reduces complication rate.

[The surgery of rectosigmoid cancer: 10 years of experience]. / La chirurgia del cancro del sigma-retto: dieci anni di esperienza.

The results of a ten-year experience are reported. According to the literature data, abdominoperineal resection for rectal cancers located 6-10 cm above the anal verge as well as anterior resection for upper locations confirmed to be the best therapeutical choice.

[Use of mechanical staplers in colostomy]. / Impiego della cucitrice meccanica nelle colostomie.

The authors used the technique of Chung, slightly modified, to perform the end colostomy in five patients who underwent abdomino-perineal resection according to Miles for rectal carcinoma. The technique proved to be easy and quick. The results have been satisfactory, without complications such as infections, necrosis, stenosis, retraction or paracolostomy hernias.

[Validity and limitations of the CEA test in the treatment of colorectal carcinoma]. / Validità e limiti del CEA test nel trattamento del carcinoma retto-colico.

CEA appears to be a good marker in the follow up of patients operated for colorectal cancer. The Authors analyse, on the base of literature data, the results of CEA test in their experience of colorectal cancers operated from 1978 to 1987. They confirm the importance of CEA as recurrence marker, however the test, by itself, is not sufficient to always identify a new onset of the disease.