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The correct staging is of crucial importance in the choice of surgical treatment in patients affected by stomach carcinoma. In an attempt to achieve a greater accuracy in the diagnosis of depth of tumor invasion, we propose to perform ultrasonography of the gastric wall during surgery (in vitro ultrasonography). Immediately after removal by the surgeon, the portion of the stomach containing the tumor is submitted to ultrasonography with a linear 7.5-MHz probe. To obtain good ultrasonographic images it was necessary to interpose an echo-free standoff pad between the probe and the gastric wall and between the latter and support surface. On completion of ultrasonography, the surgical specimen was sent to the pathologist, who was unaware of the diagnosis formulated on the basis of in vitro ultrasonography (VUS). The VUS diagnosis of T corresponded to the pathological diagnosis in 87/93 cases (93.5% accuracy). In the early cancers the diagnosis was correct in 24/28 cases (85.7%); in the advanced cancers the diagnosis was correct in 63/65 cases (96.9%). In comparison with the results of the other preoperative and intraoperative techniques the accuracy of in vitro ultrasonography in diagnosing the depth of tumor invasion was clearly superior. We feel that VUS may become a basic instrument in T staging and an aid to the surgeon in deciding the extent of the resection and of lymphadenectomy in patients with gastric cancer. [ABSTRACT FROM AUTHOR]

Ehlers-Danlos syndromes are a heterogeneous group of Heritable Connective Tissue Disorders characterized by joint hypermobility, skin hyperextensibility, and tissue fragility. Among the different types, the hypermobile Ehlers-Danlos syndrome is the most frequent and includes generalized joint hypermobility as the major diagnostic criterion. Joint hypermobility in hypermobile Ehlers-Danlos syndrome is often associated with pain that does not always allow the use of effective pain-reducing treatments. Patients with hEDS constantly describe their pain in detail. Eighty-nine patients with hEDS diagnoses were recruited and evaluated. They were asked to describe their pain in writing. The texts were examined through Linguistic Inquiry and Word Count. Correlational analyses were conducted between pain perception and language. A comparison of high/low pain perception and the quality of metaphors was carried out. The results showed that language quality varies depending on how much pain is perceived. The greater the pain is perceived, the lesser the positive effects and the greater the negative effects and dehumanizing metaphors are being used. Moreover, a greater pain seems to be related to a verbal experience of greater isolation and less self-care. In conclusion, the use of metaphors is a useful tool for examining illness experience and may help clinicians in the rehabilitation program.