Search

not found

BACKGROUND: The aim of this study was to investigate the effect of neoadjuvant chemoradiotherapy on the lymph node yield of rectal cancer surgery. METHODS: Data for patients who underwent neoadjuvant chemoradiotherapy followed by surgery for resectable rectal cancer from June 1992 to June 2009 were reviewed. The primary outcomes measured were the number of lymph nodes retrieved, their status, and patient survival. RESULTS: In total, 345 patients underwent neoadjuvant chemoradiotherapy followed by surgery, and 95 patients had surgery alone. Neoadjuvant chemoradiotherapy decreased both the median (range) number of lymph nodes retrieved (7 (1-33) versus 12.5 (0-44) respectively; P < 0.001) and the number of positive lymph nodes (0 (0-11) versus 0 (0-16); P = 0.001). After neoadjuvant chemoradiotherapy, the number of retrieved lymph nodes was inversely correlated with tumour regression, and with the interval between treatment and surgery. The 5-year overall and disease-free survival rates were 86.5 and 79.1 per cent respectively. After neoadjuvant therapy, lymph node status was found to be an independent predictor of survival, whereas the number of retrieved lymph nodes did not represent a prognostic factor for either overall or disease-free survival. CONCLUSION: Low lymph node count after neoadjuvant chemoradiotherapy for rectal cancer does not signify an inadequate resection or understaging, but represents an increased sensitivity to the treatment.

Introduction: We evaluated the gene expression levels of atrogin-1, MuRF1, myostatin, follistatin, activin A, and inhibin alpha in skeletal muscle samples of patients with gastric cancer and controls. Methods: We studied 38 cancer patients and 12 controls who underwent surgery for gastric adenocarcinoma and benign abdominal diseases, respectively. A biopsy specimen was obtained from the rectus abdominis muscle from all participants. The relative gene expression of atrogin-1, MuRF1, myostatin, follistatin, activin A, and inhibin alpha was determined by quantitative real-time polymerase chain reaction analysis. Results: Atrogin-1 and MuRF1 mRNA expression was similar between cancer patients and controls and was unaffected by the disease stage or the severity of body weight loss. Transcript levels of myostatin and follistatin did not differ between cases and controls and were similar across disease stages and categories of weight loss. Finally, no differences were detected in activin A and inhibin alpha gene expression between cancer patients and controls. Conclusions: In skeletal muscle, the gene expression of atrogin-1, MuRF1, myostatin, follistatin, activin A, and inhibin alpha is not affected by the presence of cancer. The expression of atrophy-related genes is unaffected by the disease stage and the degree of weight loss. Muscle Nerve, 2014.

The management of post-endoscopic retrograde cholangiopancreatography (ERCP) perforation is often unknown by many physicians, and there is a paucity of literature regarding the best surgical management approach.

Gastrointestinal stromal tumors (GISTs) are the most frequent mesenchymal tumors of the digestive tract. They have recently been recognized as a separate nosological entity and the literature on these stromal tumors has rapidly expanded.

Preoperative determination of Ki-67 expression, an important prognostic factor for grading nonfunctioning pancreatic endocrine tumors (NF-PETs), remains an important clinical challenge.

This study was to assess the influence of perioperative blood transfusions on the prognosis of patients undergoing a potentially curative resection for gastric cancer and to investigate the interaction between transfusions and splenectomy.

Gastrointestinal stromal tumor (GIST) account for 1% of all gastrointestinal neoplasms and are the most common mesenchymal tumor of gastrointestinal tract. There are considered to originate fom the intestinal cell of Cajal, an intestinal pacemaker cell, characterized usually express the KIT protein on immunohistochemistry. The stomach (40-60%) and small intestine (30-40%) are the most common locations. Diagnosis of these tumors is difficult to establish, because symptoms are vague and traditional diagnostic tests are not specific. GISTs shows a wide variety of clinical behaviours ranging fom benign to frankly malignant, making the outcome totally unpredictable. Surgery is the standard treatment of local GIST while Imatinib (tyrosine kinasi inhibitor) is considered as the standard treatment of metastatic disease. Resistence to Imatinib is also becoming a major clinical problem but new tirosyne kinase inibitor are being studied to improve the treatment and survival. The present paper is a review of the salient features of epidemiology, pathophysiology, diagnosis, therapy and prognostic factors of GIST

The ilioinguinal nerve, iliohypogastric nerve, and inguinal segment of the genital branch of the genitofemoral nerve all cross the inguinal channel and consequently are vulnerable to injury. © 2010 Springer-Verlag Berlin Heidelberg.

Experimental studies have suggested that defective skeletal muscle regeneration could contribute to muscle wasting in cancer patients. However, data in humans are still lacking. In this study we aimed to assess the expression of the genes involved in muscle regeneration in gastric cancer patients. The RNA expression of the genes involved in muscle regeneration was assessed in the rectus abdominis muscle of patients with gastric cancer (n=30) and in age-matched control subjects (n=8). The Pax7 expression was significantly increased in the muscle of gastric cancer patients, either in the first stages of the disease or in stages IIIA and B. The increased expression was present both in stages IA and B and in stages II and III. The MyoD espression was also higher in the cancer patients than in the controls. However, the increased MyoD expression was present only in stages IA and B and not in the more advanced stages of the disease. The Myf5 expression, as well as that of the neonatal isoform of Myosin Heavy Chain (nMHC) did not differ significantly between the cancer patients and the controls. The necdin expression was negligible in healthy adult muscles and was significantly up-regulated in the muscle of gastric cancer patients. Its expression was highly increased in stages IA and B while it was similar to the control in stages II and III. The results of the present study show that in the skeletal muscle of gastric cancer patients, the expression of the genes involved in muscle regeneration is increased with respect to the controls.

Pelvic recurrent rectal cancer is still a challenging clinical problem, and patients generally have a dismal prognosis and a poor quality of life. Surgical resection represents the only potentially curative treatment; neoadjuvant treatments are presently being taken into consideration to increase the resectability rate and to improve long-term survival.

Although total gastrectomy (TG) has been generally accepted as the treatment of choice for upper and middle gastric cancers, some issues are still debated. The objective of this retrospective study was to analyze short- and long-term results of TG (radical and palliative) in a series of 400 patients consecutively admitted to our surgical unit.

The present study evaluated the effects of preoperative parenteral nutrition (PN) on tumor cell proliferation in malnourished gastric cancer patients.

The ascites hepatoma Yoshida AH-130 induces loss of body weight and tissue waste. Tumour necrosis factor alpha (TNF-alpha) plays a pivotal role in the pathogenesis of muscle wasting in this model system, but other cytokines, such as interleukin-6, may be involved. In order to verify whether a combined anticytokine treatment may synergistically counteract muscle protein degradation, tumour bearing rats were treated with pentoxyfilline (PTX, an inhibitor of TNF-alpha synthesis), or with suramin (SUR, an antiprotozoal drug blocking the peripheral action of several cytokines including IL-6 and TNF-alpha), or both the drugs, and the effects on muscle proteolytic systems were assessed. Muscle protein loss in the AH-130-bearing rats was associated with increased activity of both the ATP-ubiquitin- and the calpain- dependent proteolytic pathways (246% and 230% of controls, respectively). Both PTX and SUR, either alone or in combination, prevented the depletion of muscle mass and significantly reduced the activity of muscle proteolytic systems. In particular, treatment with SUR, either alone or with PTX, induced a decrease in enzymatic activities to values similar to those of controls. The results obtained in the present paper demonstrate that: (i) muscle depletion in this model is indeed associated with increased proteasome- and calpain-dependent proteolysis, as previously suggested by increased mRNA expression of molecules pertaining to both pathways; (ii) anticytokine treatments effectively reduce muscle protein loss by down-regulating the activity of at least two major proteolitic systems; (iii) SUR is more effective than PTX in reducing the activity of proteolytic systems, possibly because of its multiple anticytokine action.

The intramuscular ATP-dependent ubiquitin (Ub)-proteasome proteolytic system is hyperactivated in experimental cancer cachexia. The present study aimed at verifying whether the expression of the muscle Ub mRNA is altered in patients with cancer. Total muscle RNA was extracted using the guanidinium isothiocyanate/phenol/chloroform method from rectus abdominis biopsies obtained intraoperatively from 20 gastric cancer (GC) patients and 10 subjects with benign abdominal diseases (CON) undergoing surgery. Ub mRNA levels were measured by northern blot analysis. Serum soluble tumor necrosis factor receptor (sTNFR) was measured by ELISA. Ub mRNA levels (arbitrary units, means +/- SD) were 2,345 +/- 195 in GC and 1,162 +/- 132 in CON (P = 0.0005). Ub mRNA levels directly correlated with disease stage (r = 0.608, P = 0.005), being 1,945 +/- 786 in stages I and II, 2,480 +/- 650 in stage III, and 3,799 +/- 66 in stage IV. Ub mRNA and sTNFR did not correlate with age and nutritional parameters. This study confirms experimental data indicating an overexpression of muscle Ub mRNA in cancer cachexia. Lack of correlation with nutritional status suggests that Ub activation in human cancer is an early feature that precedes any clinical sign of cachexia.

Tumour necrosis factor-alpha (TNF) has been regarded as a potential mediator of cancer cachexia. Assessment of TNF circulating levels in cancer patients and their correlation with weight loss has led to controversial results.

Immunosuppression associated with homologous blood transfusion was first observed in renal allograft transplantation. Clinical effects of transfusion-induced immunosuppression in surgical patients have been debated in the literature for more than a decade with contradictory results.

not found

Risk of local recurrence of rectal cancer remains high despite extensive therapeutic strategies, many of which have been tried to achieve better local control (i.e., external beam radiation therapy (EBRT)). Recently, intraoperative radiation therapy (IORT) has been introduced in clinical protocols to boost the areas at risk of local recurrence.

To compare the results of closed treatment (CT) with the results of open treatment (OT) that uses laparostomy and marsupialization of the lesser sac in patients affected by secondary pancreatic infections.

To compare extensive with limited lymph node dissection in the surgical treatment of gastric cancer, 320 patients undergoing gastric resection during 1981-1990 were divided into two groups. Although patients undergoing extended lymphadenectomy (n = 157) had a longer operating time (P = 0.0001) and a greater intraoperative blood transfusion requirement (P = 0.009) than those receiving limited dissection (n = 163), the incidence of postoperative complications (22.3 versus 28.2 per cent, P = 0.13) and the hospital mortality rate (3.8 versus 7.4 per cent, P = 0.12) were similar in the two groups. The 5-year survival rate after curative resection (117 and 121 patients after extensive and limited lymph node dissection respectively) was 65.4 versus 50.1 per cent (P = 0.01): 85.9 versus 82.2 per cent for stage I disease (P = 0.60), 66.1 versus 57.8 per cent for stage II (P = 0.82) and 48.7 versus 29.8 per cent for stage III (P = 0.02). Multivariate analysis using the Cox model showed that the extent of lymphadenectomy was an independent prognostic factor for survival (P = 0.01). The results support the value of extensive lymph node dissection in the surgical treatment of gastric carcinoma.

Intraoperative radiation therapy (IORT) was delivered to remnant rat liver after partial hepatectomy to determine the chronic effects of treatment on survival, blood chemistry, liver weight, and histology. Survival at one year was 100%. Remnant liver weight was markedly increased in all animals. Liver function appeared to be unaltered in all groups and at all observation times. Inflammatory cell infiltration occurred immediately after treatment in all animals, showing a slight progression until day 45; by day 180 the values had returned to baseline. Vascular changes were seen early in all groups, then progressively decreased; the vascular score was back to baseline at days 180 and 365. Nuclear alterations were observed in both irradiated and nonirradiated hepatic cells; in all cases these were limited to isolated or focal areas of hepatocytes. There was little fibrosis formation and by day 180 all scores were back to baseline. We conclude that the chronic effects of whole liver IORT after one-third hepatectomy are minimal in the rat and are similar to those observed after surgery alone.

Lymph node involvement in colorectal cancer, one of the most important prognostic factors, can be sometimes underestimated. In this study the authors report the results of two different techniques of specimen preparation and examination. In 240 patients (Group I), histologic examination was performed using a conventional procedure. In Group II (60 cases) the resected bowel and its mesentery were separately stretched, pinned on to a cork board, and fixed. The mesentery was divided according to node location (intermediate and principal) and evaluated by sight and palpation to identify lymph nodes. The bowel segment was divided from 5 cm proximally to 5 cm distally to the tumor every 10 mm in serial 3 mm slices. Three and 10 mm slices were then carefully examined by sight and palpation. Isolated lymph nodes embedded in groups (10-12 per paraffin block) were stained and investigated for neoplastic involvement. The specimen examination procedure used in Group II resulted in identification of a higher number of lymph nodes (mean = 41.1) and nodal metastases (mean = 10) compared to the standard technique used in Group I (mean = 11.3 and 2.4, respectively--P < .05). The percentage of N+ cases also was increased in Group II (48.3%) when compared to that in Group I (30.4%; P < .05). The new technique is simple, inexpensive, and efficacious for the detection of lymphatic metastases in colorectal cancer.

A retrospective study of 103 thymectomies examines the effects of the integration of surgical and medical therapy in patients affected by myasthenia gravis accompanied by thymoma. An extended thymectomy via a median longitudinal sternotomy was used in 102 patients. The operative mortality was 4.85% (5/103 patients), the 10-year survival rate was 78% with a recurrence rate of 3.06% (3/98). Neoplastic infiltration and postoperative radiotherapy did not influence the survival rate. There was no correlation between a preoperative Osserman's class better than III and postoperative outcome. The improvement of medical treatment, and anaesthesiological and intensive care techniques resulted in a decrease of the operative mortality and long-term death rate during the last 10 years of our 20-year series. Extended thymectomy via sternotomy is the best intervention in patients with myasthenia gravis associated with thymoma judged by the low operative mortality and the favorable 10-year survival rates.

Results of cultured islet transplantation in the management of insulin-dependent diabetes are still unsatisfactory. The main problem preventing success is the swift and resolute host immune rejection. To obviate this we designed and experimented a model of bioartificial pancreas, made of polymeric hollow fibers, put into the blood circulation as an artero-venous bypass to immunoisolate endocrine tissue from leucocytes and immunoglobulins. We tested four different membrane bioreactors (BR1-4). BR1 and 2 had seven hollow fibers, the others more than 6,000 smaller fibers. In BR4 a connecting tube with a high-permeability membrane was inserted between the islet compartment and the bioreactor outlet to improve the ultrafiltration flow. In vitro, the islets inside the bioreactor perfused with glucose solutions (300 mg%) showed a rapid, high insulin secretory response, related to the glucose stimulation. The use of the outside connection allowed a twofold increase of insulin production.

The use of pancreatic islet transplantation in membrane bioreactors put in vascular circuits aims at resetting the glucose homeostasis in diabetic or pancreatectomized patients, avoiding immune host rejection. Our experience was carried out at following stages: porcine pancreas explantation and enzymatic separation of endocrine tissue from exocrine fraction by collagenase; evaluation of islet functionality (culture tests); in vitro tests of the islets-bioreactor system, to assess the metabolic response to the glucose; in vivo evaluation to assay the haemodynamic behaviour. The trials showed a good metabolic bioreactor functionality and a decreasing incidence of coagulative problems.

na

To clarify the risk factors contributing to postoperative complications in elderly patients undergoing total gastrectomy, 84 patients with primary gastric cancer were evaluated. Twenty-seven patients were older than 65 years of age; they had much more preoperative cardiac (P = 0.00003), respiratory (P = 0.0008), and multiorgan impairment (P = 0.009) than did the control group (age less than 65 yrs). Although overall morbidities (44.4% vs. 19.2%; P = 0.01) and overall septic complication rates (33.3% vs. 12.2%; P = 0.02) were higher in aged patients, no significant differences between the two groups were found in the incidence of major surgical complications (18.5% in aged patients vs. 10.5% in control groups; P = NS), serious septic (sepsis score greater than 10) complications (18.5% vs. 7.0%; P = NS) and hospital mortalities (11.1% vs. 3.5%; P = NS). In older patients the occurrence of multiorgan impairment and malnutrition was significantly related to postoperative complication rates. These results suggest that the degree of organ impairment rather than age is predictive of postoperative difficulty and should be used in assessing preoperative risk.

The clinical, laboratory, and pathologic data of 361 patients who had curative resections for colorectal cancers were collected and analyzed in a multiple stepwise regression model. In univariate analysis, among clinical factors, bowel obstruction and emergency surgery showed the most significant prognostic value (P = 0.002, P = 0.004, respectively). Vegetating growth, Astler-Coller stage of tumor, intramural spread, lymph node involvement, and synchronous liver metastases resulted in the pathologic variable significantly affecting the prognosis (P = 0.006, P less than 0.001, P = 0.036, P less than 0.001, P less than 0.001, respectively). In the multivariate analysis, stage was the predictive factor with the highest hazard ratio in conjunction with bowel obstruction (P less than 0.0001 in both cases). Processing data excluding stage ("multiparametric factor" itself), hepatic metastases, lymph node involvement, bowel obstruction, and intramural spread appeared as independent predictors of survival (P less than 0.0001, P less than 0.0001, P = 0.0004, P = 0.0316, respectively). Other variables, as biologic and molecular factors, should be more widely tested in order to assess their impact on prognosis.

In a consecutive series of 175 patients with gastric carcinoma, 66.8% underwent gastric resection: 74 total gastrectomies with R3 lymphadenectomy and 43 distal subtotal gastrectomies with R2 lymphadenectomy were performed. 73% (86 cases) of resective procedures proved to be "absolute curative" according to Japanese criteria (JRSGC). Nodal involvement was present in 62 out of 117 resected patients (52.9%): 29.9% N1, 9.4% N2, 13.6% N3; a significant relationship (p = 0.012) between depth of invasion of the gastric wall and lymph node metastases was revealed. The hospital mortality after R2-R3 gastrectomy was 4.2%, major surgical complications occurred in 6.8% of cases. The actuarial 5-year survival after curative resection was 59%. The results suggest that extended lymphadenectomy (R2-R3 gastrectomy) is justified in the surgical treatment of gastric cancer; this procedure can be safely performed and permits "absolute curative" resections in a remarkable percentage of cases.

The presence of epidermal growth factor, estrogen, and progesterone receptors (EGFR, ER, and PR) was investigated by a competitive binding assay in 43 colorectal adenocarcinomas and 32 normal colorectal mucosa specimens. EGFR were expressed in most of the tumor specimens analyzed at levels comparable with normal mucosa. There was no correlation between EGFR and tumor localization, tumor size, tumor stage, and grading. Among tumor specimens, 13.9% and 6.9% expressed very low but detectable ER and PR levels, respectively. No statistically significant difference was found between steroid hormone receptor levels in the tumor and normal mucosa specimens, and neither was there any correlation of ER and PR with the pathological findings. Our results suggest that the EGFR system may play a role in regulating the growth of colorectal tissues. Further studies should demonstrate whether, despite the lack of correlation with histopathological parameters, EGFR expression may have a biological significance in human colorectal cancer.

A prospective randomized study was performed with 61 patients undergoing elective surgery for colorectal cancer, to evaluate the prophylactic effect of two different parenteral antibiotic regimens. All patients were randomly allocated into two groups, comparable in age, sex, nutritional status and operative procedures. The patients in Group A (n. 31) received 1 g i.v. of imipenem-cilastatin at induction of anesthesia. Patients in Group B (n. 30) were given cefuroxime (1.5 g i.v.) plus metronidazole (0.5 g i.v.) at the time of anesthesia and two other administrations of the combined antibiotics (cefuroxime 0.75 g plus metronidazole 0.5 g i.v.) every 8 hours. The severity of sepsis was evaluated according to the scoring system proposed by Elebute and Stoner. No significant differences were found in terms of the rate of surgical infections: 9% in Group A and 16% in Group B. Infections not of surgical origin were found only in Group B (10.4%). These data suggest that a single dose of intravenous imipenem-cilastatin appears to be as effective as three doses of cefuroxime and metronidazole as prophylaxis against infection in elective colorectal surgery.

We studied the feasibility of delivering a large single dose of intraoperative radiation as an adjuvant to partial hepatic resection. Intraoperative radiation therapy (IORT) was delivered to the remaining liver of 84 rats after partial hepatectomy to determine the acute and chronic effects of treatment on blood chemistry values, histology, survival, hepatic regeneration, and cellular appearance of the normal liver. Transient elevations in SGOT, SGPT, and alkaline phosphatase were attributed both to hepatectomy and to liver parenchymal damage induced by IORT. Microscopic examination upon necropsy, performed at frequent intervals post-treatment revealed hepatic capsular thickening with some alteration of liver architecture mainly underneath the capsule, with localized inflammation and some areas of necrosis. Survival in all groups was 100% at 45 days. Liver weight increase proved to be dose-dependent and displayed a bisphasic pattern. This study demonstrated that IORT is a feasible adjunct to surgical resection of the liver in the rat model.

NOT FOUND

NOT FOUND

NOT FOUND

Pancreatic abscess is a major cause of death from acute pancreatitis; its reported frequency is between 1.7 and 25 per cent of all patients presenting with acute pancreatitis. The mortality varies between 13 and 54 per cent. Despite apparently adequate initial surgical treatment, the recurrence rate is about 30 per cent. The key to survival in pancreatic abscess is adequate drainage of cavity. Proponents of open treatment claim that it allows better drainage of the viscid content of the pancreatic abscess which often cannot easily pass down a drain. In the present case, following laparotomy for severe intra-abdominal sepsis due to pancreatic abscess, the abdominal cavity was left open to heal by granulation. The procedure permitted early resolution of the septic process. Total parenteral nutritional support resulted in definitive wound healing. We regard laparostomy as a valuable technique in the management of pancreatic abscess; the successful of this technique hinges on expert nursing care and the capability of maintaining complication-free long term parenteral nutrition.