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Aim: Many studies have indicated that lymph node metastases and the depth of invasion of the primary tumor are the most reliable prognostic factors for patients with radically resected gastric cancer. Recently the ratio between metastatic and examined lymph nodes (n ratio) has been proposed as a new prognostic indicator. The aim of this study was to evaluate the prognostic value of n ratio in patients with gastric cancer., Methods: We retrospectively reviewed the data of 399 patients who had undergone radical resection for gastric carcinoma., Results: N ratio was significantly greater in patients with large and undifferentiated tumors. Moreover, it was significantly related to both the number and location of lymph node metastases. Survival curves showed that n ratio was strictly related to patients' survival. Multivariate analysis confirmed that it was an important independent prognostic indicator., Conclusion: N ratio is useful to better evaluate the status of lymph node metastases in patients with gastric cancer submitted to radical surgery. Moreover it is a very important independent prognostic factor for gastric cancer.

Myelolipoma is a rare benign pathology whose pathogenesis is still unclear. It is most frequently localised in the adrenal gland, followed by the presacral region, mediastinum, and perirenal and hepatic region. It varies in size from a few millimetres to several centimetres. The lesion is usually capsulated, detachable from the surrounding tissues and hypovascularised. In histological terms, it is composed of lipomatous and hematopoietic tissues. A 65-year-old female patient was referred to our unit after the finding of a nonbiopsied, pelvic mass during earlier surgery. The patient was in considerable pain owing to the extrinsic compression of the mass on abdominal and pelvic organs. Preoperative tests confirmed the presence of a voluminous presacral neoformation that appeared to have a possible medullary origin (chordoma or schwannoma). During surgery, the lesion was found to be capsulated and mainly adherent to the rectum. Histological analysis confirmed the myelolipomatous nature of the lesion. A review of 21 cases reported in the literature is presented.

Solitary fibrous tumors of the pleura represent a rare clinicopathological entity: 456 cases only have been reported since 1991. A interesting case of solitary fibrous tumor of the pleura is described here, because it turned up in a female patient followed up for a bilateral breast cancer and so with the exact determination of the period of beginning. The complex morphological picture is illustrated in relation to other cases reported in the literature. Immunohistochemical results are stressed, particularly as regards the coexpression of vimentin and desmin without necrosis and the low number of mitosis. As there are no criteria to determine the possible aggressive or malignant behaviour of the tumor, surgical resection of the lesion is indispensable both to resolve the diagnosis and to carry out the only proposable therapy.

Posterior partial fundoplication can be as effective as total fundoplication in the long-term control of gastroesophageal reflux if the gastric fundus valve is encircled around the distal esophagus for no less than 270 degrees to obtain effective pressures in the newly built sphincter. In order to minimize the adverse effects, to reach constant results and to guarantee the reproducibility of the technique we have modified the 270 degrees posterior fundoplicatio (formerly described by Lind) according to the following principles: 1) the length of the gastric valve must be limited to 3 cm for each side of the esophagus; 2) the gastric valve must be fixed to the right and left side of the hiatal orifice by a single stitch; 3) the gastric valve must be calibrated with an intraoperative manometry, this allowing the standardization of the valve pressure to an average value of 35 mmHg by varying its wrapping angle; 4) the hiatal orifice must not be closed unless it is large enough for thoracic migration of the gastroplasty. Since 1984 to 1991 43 patients with proven gastroesophageal reflux not controlled by medical treatment were submitted to surgery. Twelve Nissen procedures (NP) and 31 posterior calibrated fundoplications (PCF) were performed; PCF seemed to be superior to NP in terms of postoperative mobility. After two years 20 patients treated with PCF were evaluated clinically, manometrically and by 24-hour pH monitoring. No dysphagia was reported; in two patients a pH-metric, asymptomatic relapse was observed, while one patient complained mild and occasional heartburn.(ABSTRACT TRUNCATED AT 250 WORDS)

On the basis of six surgically operated patients, current thinking with regard to the treatment of Zollinger-Ellison syndrome is outlined. Total gastrectomy which for many years was the most common surgical intervention, is now confined to just a very specially indicated few cases because the introduction of anti-H2 gives good control of gastric secretion. The operation should therefore be targeted at removing the gastrinoma, helped in this by modern methodologies for pinpointing the neoplasia. Long-term however include a certain number of failures.

As complete as possible a picture of the current state of cytostatic chemotherapy in the treatment of metastatic breast carcinoma is offered. Attention is therefore mainly concentrated on application modalities of this form of therapy in relation to the clinical stage of the disease and to the use of other treatment possibilities. Methods and results of cytostatic therapy are then considered. The present situation is reviewed and the pharmacological and toxic aspects of prolonged antiblastic treatment are assessed. After outlining a number of special problems relating to the treatment of CNS and pleural metastases, the personal series is presented and results, which do not differ from other reported series, reported. In conclusion, stress is laid on the importance and effectiveness of cytostatic therapy in the treatment of metastatic breast carcinoma, but extended, controlled studies are also recommended.