Interleukin-1 gene polymorphisms and gastric cancer risk in a high-risk Italian population.

OBJECTIVES: Host genetic factors, including the IL1 gene cluster, play a key role in determining the long-term outcome of Helicobacter pylori infection. The aim of the study was to investigate the relationship between selected IL1 loci polymorphisms and gastric cancer risk in an Italian population. METHODS: In a case-control study we compared the IL1B-31 and IL1B+3954 biallelic and IL1RN pentaallelic variable number of tandem repeats (VNTR) polymorphisms in 185 gastric cancer patients and 546 controls randomly sampled from the general population of an area at high gastric cancer risk (Tuscany, Central Italy). RESULTS: Genotype frequencies of the IL1B-31 T/C, IL1B+3954 C/T, and IL1RN polymorphisms among our population controls were in Hardy-Weinberg equilibrium. In multivariate analyses, no increase in gastric cancer risk was observed for the IL1B-31*C- and IL1B+3954*T- carriers; a significant 50% increase emerged for IL1RN*2 allele carriers (OR = 1.49; 95% CI: 1.01-2.21). Analyses based on combined genotypes showed also that the association with IL1RN*2 allele was limited to two-variant allele carriers who were also homozygous for the IL1B-31*T allele (OR = 2.23; 95% CI: 1.18-4.23) with a statistically significant interaction between these two genotypes (p= 0.043). Haplotype analysis showed an increased risk for the haplotype IL1RN*2/IL1B-31*T. CONCLUSIONS: Our results suggest that host genetic factors (such as the IL1RN and the IL1B-31 polymorphisms) interact in the complex process of gastric carcinogenesis in this high-risk Italian population. Overall, this effect appears more modest than previously reported in other populations, supporting the hypothesis that other still-to-be-defined factors are important in gastric carcinogenesis. These findings might be due to a haplotype effect.

[Liver resection with the water dissector; preliminary experience of 8 cases]. / Resezioni epatiche con dissettore ad acqua: esperienza preliminare di otto casi.

New methods for the resection of liver parenchyma was developed in order to simplify liver surgery. The object of our study was to test a method using the water dissector, a rather new equipment. Eight patients, four men end four women, have been operated, from March to September 1997, using the water dissector. Age of the patients ranged from 42 to 83 years (mean age 67 years). Indication for surgery was liver metastasis from colon cancer (6 patients), and gallbladder cancer (2 patients). 1 right lobectomy, 1 left side segmentectomy, 2 V and IV segments resection, 1 unitectomy of the VII segment and 2 III and IV segment resections was performed. In the first four patients we used the Pringle manoeuvre (clamping of the liver stalk), while we did not do it in the last four so we could compare both the operation time and the loss of blood with or without this manoeuvre. One patient died of ARDS in the seventh post-operative day, another patient, who underwent a right lobectomy, developed a biliary fistula which healed in the 10 degrees postoperative day. All the seven surviving patients was in good health, with normal liver ultrasonography when checked on the 31/12/1997. Our results show that the water dissector offers the possibility to isolate vascular stalks very easily, both with a posterior ilar approach and with an intraparenchymal approach, making possible a very accurate haemostasis, in such minimizing blood and biliary losses. This method allows the performing of oncologically correct dissections and in the meanwhile the saving of as much healthy parenchyma as possible.

[Leiomyoma of the small intestine. Case report]. / II leiomioma del tenue. Contributo clinico.

The paper reports the case of a 53-year-old man admitted to hospital with melena. The initial diagnosis was bleeding duodenal ulcer; after 8 weeks of therapy the duodenal ulcer was completely healed, but renewed intestinal bleeding occurred three months later. Angiography of the upper mesenteric artery revealed a clear tumour form. A tumour of the small intestine the size of a fist was found during surgery. An ileal resection was performed. Histopathological tests confirmed the diagnosis of leiomyoma of the small intestine.

[Carcinoma of the gallbladder. Our experience]. / II carcinoma della colecisti. La nostra esperienza.

A series of 11 patients (3 males and 8 females, mean age 63.4 yrs.) suffering from gallbladder cancer has been reviewed. Authors' purpose in reviewing their experience was to identify factors either in patient characteristics or treatment, that may influence statistic data. Symptoms, signs, laboratory and imaging studies were uniformly unhelpful in determining the diagnosis. Early diagnosis at a stage amenable to surgical excision remains the only therapeutical possibility.

[Intensive therapy in general surgery]. / La terapia intensiva in chirurgia generale.

A good diagnostic protocol as well as a proper preparation to surgery and a careful intensive observation (associated if necessary with an intensive therapy) can lead to a better prognosis in major surgical procedures or routine surgery in poor risk patients. Candidates to ICU are divided in three classes: type A is a stable patient requiring constant monitoring for high probability of complications, type B is still a stable patient who needs an intensive nursing; finally type C is an instable patient who requires a true intensive care. In the surgical department of USL 20/B Figline Valdarno (FI) a postoperative Intensive Care Unit (ICU) has been established in the last three years: a three-bed section with its own staff is located in the surgical department itself. In 37 months 467 operated patients requiring intensive observation or intensive therapy have been admitted.

[Subscapular elastofibroma (elastofibroma dorsi)]. / Elastofibroma sottoscapolare (elastofibroma dorsi).

The Authors describe a case of elastofibroma in its typical location; the most interesting aspect of this lesion is the microscopic appearance. The benignity of this lesion is absolute, from the clinical and microscopic points of view.

[A personal case of spontaneous pneumoperitoneum and review of the literature]. / Considerazioni su un caso di pneumoperitoneo spontaneo da noi osservato e revisione della letteratura.

A personal case of spontaneous pneumoperitoneum is reported and the nosographic importance of this form is reviewed. It is showed that primary forms, as opposed to those secondary to visceral perforation, always display a benign outcome. In some clearly-defined situations, therefore, a wait-and-see policy may be adopted, provided continuous surveillance of the position is assured.