Prognostic factors associated with survival in a large cohort of gastric cancer patients resected over a decade at a single Italian center: the Cremona experience.

BACKGROUND: Incidence of gastric cancer (GC) shows different distribution in Italy, with higher incidence in the north and center. We retrospectively analyzed the clinical data of patients resected at the Hospital of Cremona between January 2007 and December 2016. Available clinical variables were linked with survival to identify possible prognostic factors. MATERIALS AND METHODS: Variables analyzed were age, sex, type of surgery, site, histology, invasion, nodal status, resection margins, grade, HER2 status, Helicobacter pylori infection (neo)adjuvant chemotherapy, adjuvant chemoradiotherapy, neutrophil-to-lymphocyte ratio, number of nodes removed and type of lymphadenectomy. Overall survival (OS) was estimated by the Kaplan-Meier method and differences between groups by the log-rank test. Data on OS were analyzed by Cox regression and the final model was obtained using the step-wise method. RESULTS: 379 patients were considered, out of which 195 were operated from 2007 to 2011 and 184 from 2012 to 2016. Median follow-up was 25.5 months, median OS 31.3 months and time to recurrence 23.2 months. D2 resection rate increased from 36% (period 2007-2011) to 74% in 2012-2016 (p = 0.01) with a higher mean number of nodes collected (20.98 for 2007-2011 and 23.53 for 2012-2016, p = 0.040). Only 37% of patients received a postoperative treatment. At multivariate analysis, variables associated with OS were age (p = 0.002), stage (p < 0.001), resection margins status (p < 0.001), adjuvant chemotherapy (p < 0.010) and tumor location (cardia vs non-cardia) (p = 0.029). CONCLUSIONS: Our analysis shows that completeness of resection and lower stage are strong predictors of long-term survival in GC, providing the rationale for adjuvant and neoadjuvant approaches (chemotherapy, radiotherapy or combined). Cardial GC has worse prognosis compared to distal cancers. TRIAL REGISTRATION NUMBER: Service evaluation number 256, protocol 16821/17, date 05 June 2017.

[A case of neurogenic bladder caused by spinal cord traction in childhood. Diagnostic and therapeutic aspects]. / Un caso di neurovescica da trazione midollare in età pediatrica. Aspetti diagnostici e terapeutici.

The diagnostic and therapeutic aspects of a pediatric case of tethered cord syndrome are described. The urological symptoms were of primary importance; bladder dysfunction was confirmed urodynamically; voiding cystourethrography showed trabeculation and elongation of bladder with distal sphincter obstruction and left vesicoureteral reflux. The bladder dysfunction was managed satisfactorily with pharmacological therapy and clean intermittent self-catheterization. Nuclear magnetic resonance demonstrated a tethered spinal cord with lipoma of cauda equina. The importance of neuroradiology is emphasized in order to establish an early and precise diagnosis. Early neurosurgery is justified by the need to avoid any progressive and severe lower extremity deficit and by the high frequency of urological improvement in cases treated with spinal operation. However, in this case, clinical and pathological findings suggested to defer any surgical intervention.

[Effects of the treatment using synthetic LH-RH nasal spray in cryptorchism]. / Effetti del trattamento con LH-RH sintetico spray nasale nel criptorchidismo.

The effects of hormonal treatment with synthetic LH-RH (Kryptocur) applied as nasal spray at a dose of 1.2 mg daily over a period of 28 days were investigated on 62 undescended testes in 40 boys divided in two groups: below and above 6 years. Only retained testes were treated. Complete descent was achieved primarily in 46.7%, but follow up examination 6 months after therapy showed relapse in 9%, so that percent was reduced to 39.7%. Therapy was more effective in patients with unilateral undescended testes aged below 6 years; however they showed relapse in 33%. Bilateral undescended testes were more sensitive to the treatment (25%) in children aged over 6 years. In these patients we didn't observe relapse. No hormonal changes in FSH, LH and testosterone were observed before and after treatment, whether in basal or in pick after 25 micrograms i.v. of LHRH. 3 boys treated unsuccessfully showed low values of FSH after LHRH test at end of treatment. Treatment of cryptorchidism with intranasal synthetic LH-RH seems to be effective without side effects and painless. For this reason it may be used as attempt before surgery, particularly in boys aged below 6 years.

[A case of congenital defect of the scalp and skull]. / Un caso di difetto congenito del cuoio capelluto e del cranio.

The authors report a case of congenital defect of the skull and scalp. They consider the etiopathogenetic, diagnostic and therapeutic aspects of the syndrome.

[Embryo-pathogenic considerations and clinico-radiologic aspects of an enterogenous caudal cyst]. / Considerazioni embriopatogenetiche ed aspetti clinico-radiologici della cisti enterogena caudale.

This is a description of a rare intestinal malformation. The authors consider the theories for development of gastrointestinal duplications and emphasize for the underscribed abnormality seen in a female infant the embryology of the tailgut and neuroenteric canal.

[Neonatal gastric obstruction]. / L'ostruzione gastrica neonatale.

Gastric outlet obstruction in newborn may be due to segmental atresia or mucosal diaphragm. The authors report two cases of pyloric obstruction and they consider the etiopathogenetic and diagnostic aspects.

[A case of focal necrotizing granulomatous hepatitis in childhood]. / Su un caso di epatite granulomatosa necrotizzante a focolai, in età pediatrica.

Granulomatous hepatitis make up a group of conditions of various aetiologies. The diagnosis of granulomatous hepatitis is histologic, since the aspect of the granulomatous lesion is not always indicative of a specific disease. It is important to take into consideration for the aetiologic diagnosis a good response to a specific therapy or the execution of complementary examinations. The 25% of granulomatous hepatitis remain undiagnosed.