[Duodenal gangliocytic paraganglioma: intraoperative ultrasound evaluation]. / Paraganglioma gangliocitico del duodeno: studio ecografico intraoperatorio.

Case report. A case of obstructive jaundice due to a preoperative unrecognized rare periampullary tumor, histologically demonstrated to be a gangliocytic paraganglioma of duodenum associated with Von Recklinghausen's disease, is herein reported. Intraoperative ultrasonography guided identification and evaluation of the obstructing lesion, suggesting in Whipple's procedure the most suitable treatment. The clinical case and ultrasonographic and Color Doppler findings are in detail described.

[One-stage curative treatment of neoplastic colonic obstruction: long-term results, comparison with elective surgery and therapeutic implications]. / Il trattamento curativo in un tempo dell'occlusione colica neoplastica: risultati a lungo termine, confronto con l'elezione e implicazioni terapeutiche.

Over a period of ten years (1980-1989) 528 patients with colon cancer were treated at one institution. One hundred seventy nine (33.9%) were obstructed (O) and underwent emergency surgery, while 349 received elective (E) treatment; of these 363 had one-stage curative treatment. Operative mortality was 10.3% (O) and 3.5% (E) respectively (p < .0.5). Three hundred forty three patients survived surgery and entered follow-up: 96 were O (M:F, 54:42) and 247 E (M:F, 119:128, p = N.S.). Their mean age was 69.5 and 64.4 (p < .001), respectively. Dukes' stage and histological grading were evenly distributed within the two groups, but sites of the primary were not (p < .001). During the follow-up local recurrence occurred in 40 patients (13 O, 27 E, p = N.S.) and metastatic disease in 78 (28 O, 50 E, p < .05, Life Table Analysis) including liver recurrence in 17 O and 30 E (p = .063). Five year crude survival (51%) was significantly worse in obstructed patients. Multivariate analysis showed that Dukes' stage and obstruction were the only prognostic factors of recurrent disease, while survival was affected by the same variables and age over 70. When recurrent disease was introduced in the model survival depended on Dukes' stage, site of the primary and age over 70 and the variable obstruction disappeared as prognostic factor. Right sided tumours showed a better and those at the splenic flexure a worse prognosis. Despite one-stage curative treatment obstruction carries a significantly higher risk of developing metastatic disease, suggesting that obstruction enhances cancer cell dissemination. These patients might benefit from per-operative intra-portal and post-operative systemic adjuvant chemotherapy.

Changes of the human liver GM3 ganglioside molecular species during aging.

Sialosyl-lactosylceramide, GM3, is the major ganglioside of human liver, where it constitutes more than 90% of the total lipid-bound sialic acid. When analyzed by thin-layer chromatography, human liver GM3 migrates as two main spots. They are representative of ganglioside molecular species which differ in the acyl moiety. The faster running spot is mainly composed of molecular species with non-hydroxylated C22-C24 acyl chains; the other contains mainly molecular species bearing non-hydroxylated C16-C18 and alpha-hydroxylated C16-C24 acyl chains. In this study the content of the two GM3 molecular species groups was investigated in 31 subjects ranging from 19 to 85 years of age. By thin-layer chromatography we observed that the group of molecular species containing non-hydroxylated C22-C24 acyl chains, decreased linearly with subject age, while that of non-hydroxylated C16-C18 acyl chains and hydroxylated C16-C24 acyl chains increased linearly. Fast-atom-bombardment mass spectrometry performed on seven samples from subjects ranging from 21 to 78 years of age demonstrated that the age-dependent increase of the lower spot is caused by an increase in the hydroxylated fatty acid form of GM3, the content of non-hydroxylated C16-C18 fatty acid species remaining constant with age.