Mid-transverse colon cancer and extended versus transverse colectomy: Results of the Italian society of surgical oncology colorectal cancer network (SICO CCN) multicenter collaborative study.

INTRODUCTION: Transverse colon cancer (TCC) is poorly studied, and TCC cases are often excluded from large prospective randomized trials because of their complexity and their potentially high complication rate. The best surgical approach for TCC has yet to be established. The aim of this large retrospective multicenter Italian series is to investigate the advantages and disadvantages of both hemicolectomy and transverse colectomy in order to identify the best surgical approach. MATERIALS AND METHODS: This was a retrospective cohort study of patients with mid-transverse colon cancer treated with a segmental colon resection or an extended hemicolectomy (right or left) between 2006 and 2016 in 28 high-volume (more than 70 procedures/year) Italian referral centers for colorectal surgery. RESULTS: The study included 1529 patients, 388 of whom underwent a segmental resection while 1141 underwent an extended resection. A higher number of complications has been reported in the segmental group than in the extended group (30.1% versus 23.6%; p 0.010). In 42 cases the main complication was the anastomotic leak (4.4% versus 2.2%; p 0.020). Recovery outcomes also showed statistical differences: time to first flatus (p 0.014), time to first mobilization (p 0.040), and overall hospital stay (p < 0.001) were significantly shorter in the extended group. Even if overall survival were similar between the groups (95.1% versus 97%; p 0.384), 3-year disease-free survival worsened after segmental resection (78.1% versus 86.2%; p 0.001). CONCLUSIONS: According to our results, an extended right colon resection for TCC seems to be surgically safer and more oncologically valid.

Parathyroidectomy in chronic renal failure: short- and long-term results on parathyroid function, blood pressure and anemia.

To evaluate the long-term results of parathyroidectomy (PTX) on parathyroid function, blood pressure and anemia, data of 45 patients with secondary Hyperparathyroidism in dialysis who had undergone PTX were collected retrospectively from 8 different dialysis units. The patients, 25 M and 20 F, mean age 56 +/- 11 years, who were followed up for an average period of 3.3 +/- 2.3 years, were divided into four groups according to the surgical procedure: 19 patients had had a subtotal PTX; 10 patients had undergone total PTX with autotransplantation (AT); 10 patients had had total PTX without AT, and 6 patients had undergone partial PTX. Taking a reduction in intact PTH > 50% as sign of successful PTX, only 5 patients did not attain this result. Considering values of PTH between 20 and 200 pg/ml at the mid-term observation (1-2 years) as the optimal result, values under 20 pg/ml as an expression of permanent hypoparathyroidism, and those above 200 pg/ml as indicating persistent/recurrent hyperparathyroidism, 65.5% of patients operated with subtotal PTX and total PTX + AT had a therapeutic success, versus 31.2% of patients in the other two groups, due to excess permanent hypoparathyroidism and persistent/recurrent hyperparathyroidism; 20 of 45 patients with preoperative hypertension experienced a statistically and clinically significant decrease in blood pressure levels. An increase in serum hemoglobin was also observed, despite a reduction of administered erythropoietin. In conclusion, the results of PTX obtained from this multicenter study are comparable to those reported by single leading centers. Recommended surgical procedures are subtotal PTX and total PTX with AT. The fall in blood pressure in hypertensive patients is clinically significant, and improvement in anemia is also observed with a reduction in erythropoietin dosage.

Effect of high-flux dialysis on the anaemia of haemodialysis patients.

BACKGROUND: Anaemia is one of the major clinical characteristics of patients with chronic renal failure, and has a considerable effect on morbidity and mortality. Adequate dialysis is of paramount importance in correcting anaemia by removing small and medium-sized molecules, which may inhibit erythropoiesis. However, high-molecular-weight inhibitors cleared only by means of highly porous membranes have also been found in uraemic serum and it has been claimed from uncontrolled studies that high-flux dialysis could improve anaemia in haemodialysis patients. METHODS: We therefore planned this multicentre randomized controlled trial with the aim of testing whether the use of a large-pore biocompatible membrane for a fixed 12-week follow-up improves anaemia in haemodialysis patients in comparison with the use of a conventional cellulose membrane. Eighty-four (5.3%) of a total of 1576 adult haemodialysed patients attending 13 Dialysis Units fulfilled the entry criteria and were randomly assigned to the experimental treatment (42 patients) or conventional treatment (42 patients). RESULTS: Haemoglobin levels increased non-significantly from 9.5+/-0.8 to 9.8+/-1.3 g/dl (dP=0. 069) in the population as a whole, with no significant difference between the two groups (P:=0.485). Erythropoietin therapy was given to 32/39 patients (82%) in the conventional group, and 26/35 (74%) in the experimental group (P:=0.783) with subcutaneous administration to 26/32 patients in conventional and to 23/26 patients in experimental group, P:=0.495. Dialysis dose (Kt/V) remained constant in both groups (from 1.30+/-0.17 to 1.33+/-0.20 in the conventional group and from 1.28+/-0.26 to 1.26+/-0.21 in the experimental group, P:=0.242). Median pre- and post-dialysis beta(2)-microglobulin levels remained constant in the conventional group (31.9 and 34.1 mg/dl at baseline) and decreased in the experimental group (pre-dialysis values from 31.1 to 24.7 mg/dl, P:=0.004 and post-dialysis values from 24.8 to 20.8 mg/dl, P:=0.002). Median erythropoietin doses were not different at baseline (70 IU/kg/week in conventional treatment and 90 IU/kg/week in experimental treatment, P:=0.628) and remained constant during follow-up (from 70 to 69 IU/kg/week in the conventional group and from 90 to 91 IU/kg/week in the experimental group, P:=0.410). Median erythropoietin plasma levels were in the normal range and remained constant (from 12.1 to 12.9 mU/ml in the conventional group and from 13.2 to 14.0 mU/ml in the experimental group, P:=0.550). CONCLUSIONS: This study showed no difference in haemoglobin level increase between patients treated for 3 months with a high-flux biocompatible membrane in comparison with those treated with a standard membrane. When patients are highly selected, adequately dialysed, and have no iron or vitamin depletion, the effect of a high-flux membrane is much less than might be expected from the results of uncontrolled studies.

[Risk factors for cystic kidney disease in hemodialysis patients]. / Fattori di rischio nella malattia cistica renale dell'emodializzato.

Acquired bilateral cystic transformation of kidneys in patients on chronic dialysis has been increasingly noted by morphological and clinical studies. Our study aims to identify a group of high-risk patients for incidence and extent of such disease. We studied with ultrasonography 87 patients on maintenance hemodialysis (60 men and 27 women), median age 58 years (range 18 to 81), mean duration of hemodialysis 75 months (range 2-256). The presence of cysts was divided into five grades from 0 no cysts to 4 more than 15 cysts detected for each kidney. 74 patients 85% of our dialytic population had acquired cystic disease; cysts varied in size from 0.5 to 4.5 cm in diameter. The cysts were found in 97% of patients dialyzed for more than 8 years and in 73% of patients on hemodialysis for less than 3 years. The incidence of cystic disease was highly and significantly correlated with the duration of dialysis, the grade correlated with duration of chronic renal failure and hemodialysis. The extent of disease appears to be increased in males. Because of high incidence of disease in long term dialysis patients ultrasonography monitoring is recommended for patients on dialysis for more than 3 years with more attention for males.

[Effects of nifedipine, in primary hypertension, on calcium metabolism and on the excretion of the main urinary electrolytes]. / Effetti della nifedipina, nell'ipertensione primitiva, sul metabolismo calcico e sull'escrezione dei principali elettroliti urinari.

The short term or acute intravenous administration of nifedipine has been reported to increase urine flow rate and sodium clearance but does not significantly alter the patient's serum or urine electrolytes as other vasodilators. Still comparatively little is known, however, about the effects of antihypertensive drugs on calcium metabolism. Our data, on 15 hypertensive patients with normal renal function, don't show significative changes in plasma or urine levels of calcium in short term treatment; moreover there isn't water and salt retention. Thus nifedipine is confirmed as a prime choice drug in hypertensive patients with normal renal function.

[Light-chain deposition disease. Presentation of a case]. / Malattia da depositi di catene leggere (lcdd). Presentazione di un caso.

A case of 66-years-old woman with mild renal failure due to deposition of K light chains on glomerular nodules, is reported. Monoclonal K light chains were found by immunofixation in serum and concentrated urine. Bone marrow examination showed a moderate increase of plasma cells, all stained for K light chains. Amyloid was not identified. No chemotherapy was started. Despite this, in the 15-months follow-up, renal function was preserved; no signs of myeloma, nor of extrarenal involvement were found. Careful follow-up is emphasized. The reason why light chains form amyloidoses or nodular deposits, like diabetic glomerulosclerosis of Kimmelstiel-Wilson, is briefly discussed, together with the differential diagnosis from other nephropathies.