Comparison between tungsten and steel polypectomy snares: evaluation of depth of colonic thermal wall injury in a pig model.

BACKGROUND AND STUDY AIMS: Thermal injury of the colonic wall during polypectomy may induce complications such as bleeding and perforation. To date, the role of the snare material in these injuries has not been examined. The aim of this study was to evaluate the depth of colonic post-polypectomy thermal wall injury induced by tungsten and steel endoscopic snares, in an effort to reduce electrosurgery-related complications. MATERIALS AND METHODS: This was a single tertiary center experimental study in a porcine model. A total of 90 polypectomies where performed in three live pigs under general anesthesia, using both steel and tungsten snares by cut, coagulation, and blend current modes. The pigs were then euthanized and their colons examined histologically. RESULTS: Steel snares induced significantly deeper tissue injury than tungsten snares in the pure cut mode (Pearson χ2 = 6.136, P = 0.013). The ordinal logistic regression analysis showed that the current mode and snare material were significantly associated with the ordinal score for the depth of injury. Thus, cut mode was positively associated with a lower score and coagulation mode with a higher score. In addition, tungsten was significantly associated with a lower depth of tissue injury. CONCLUSIONS: Due to its inherent electrical properties, tungsten is very well suited for manufacture into electrosurgical endoscopic devices. Thus, tungsten snares may be advantageous for routine use in endoscopic polypectomy, although further studies are needed to confirm these promising findings in human patients.

Laparotomic vs laparoscopic lap-band: 4-year results with early and intermediate complications.

BACKGROUND: Adjustable banding is safe, low invasive, and effective for losing weight. METHODS: 69 patients underwent this procedure by laparotomy or laparoscopy. RESULTS: Patients operated by laparotomy lost more weight than those operated by laparoscopy, but in 4 patients we were forced to re-operate in order to remove the band (3 pouch dilatations and 1 stomach slippage), and in 9 patients a ventral hernia appeared (5 patients repaired). In the laparoscopic cases there were 4 intra-operative gastric perforations, but all were repaired and the band placed at the same time (3 conversions to open), causing an increased post-operative hospital stay. There was a lower limb deep venous thromboembolism, which was followed by fatal pulmonary embolism (although the patient had been given heparin and had been treated with elastocompression and mobilization 2 hours after surgery). The band eroded in one patient. Weight losses in these morbidly obese patients were satisfactory at 2 years and maintained beyond 3 years. CONCLUSION: Laparoscopic adjustable banding is an efficient, generally safe procedure.

[Benign breast diseases: the surgeon's role in its treatment]. / La patologia mammaria benigna: ruolo del chirurgo nel suo trattamento.

INTRODUCTION: Surgery plays a key role in the diagnosis and treatment of breast diseases. Diagnostic answers and therapeutic solutions are offered thanks to surgery for both benign and malignant situations. PATIENTS AND METHODS: From January 1975 to August 1995 in our centre 1933 breast biopsy for benign breast diseases have been performed. In 98% of all cases the intervention has been performed under local anesthesia throughout the infiltration of 5 to 40 cc of Lidocaine or Mepivacaine. RESULTS: Mortality in our series was 0. Morbidity affected the 0.75% of all operated cases with hematomas or wound infections. DISCUSSION: Surgery becomes the solution in the diagnosis of breast diseases whenever previous diagnostic steps (Clinical examination+mammography+FNAB) or (Clinical examination+Ultrasonography+FNAB) or (Clinical examination+FNAB) fail to reveal a preoperative diagnosis. Of course surgery represents also the logical treatment of previously diagnosed lesions. The surgical excision of benign lesions must be meticulous due to the high recurrency rate that some of these lesions have (some histotype of fibrocystic disease or phyllodes tumors). Moreover surgery due to the benign nature of the lesions and to the fact that most part of the patients is represented by young women should always be as conservative and aesthetic as possible, by following anatomic lines and calibre sutures.

Lymph node mapping and sentinel lymph node biopsy for evaluation of axillary lymph node status in early invasive breast cancer. Our experience.

The Authors show their preliminary experience with the sentinel lymph node biopsy (SLNB) in clinical early invasive breast cancer (T1N0). During a period of 15 months, forty-two patients were submitted to SLNB upon Tc99-colloid albumin injection and SLN identification by lymphoscintigraphy. The middle number of lymph nodes found in the SLNB was 1 (1-3), whereas the middle number of lymph nodes identified in level I/II ALND specimens was 15. The SLN was identified with success in all cases (100%). The axilla was positive for metastasis in 4/42 cases. The SLN was positive in all four cases in which nodal metastasis was identified. The negative predictive value of SLN was 100%. The SLN was the only site of metastasis in 3/4 cases. The SLN pathological status accurately reflected the lymphatic basin status, but further investigation is needed to define the optimal timing of colloid injection and method of examination of the SLN.

Genista sessilifolia DC. extracts induce apoptosis across a range of cancer cell lines.

OBJECTIVES: Restorative properties of medicinal plants such as Genista sessilifolia DC. have often been suggested to occur, in epidemiological studies. However, full characterization of effective principles responsible for this action has never previously been performed. Here, we have characterized G. sessilifolia's anti-cancer effects and identified the chemical components involved in this anti-tumour action. MATERIALS AND METHODS: Cell cycle, apoptosis, necrosis, differentiation analyses, high-performance liquid chromatography, western blotting, RNA extraction, real-time PCR and primers have all been observed/used in the study. RESULTS: We report that G. sessilifolia methanol extract has anti-cancer activity on solid and haematological cancer cells. G. sessilifolia extract's anti-proliferative action is closely bound to induction of apoptosis, whereas differentiation is only weakly modulated. Analysis of G. sessilifolia extract, by high-performance liquid chromatography, identifies fraction 18-22 as the pertinent component for induction of apoptosis, whereas fractions 11-13 and 27-30 both seem to contribute to differentiation. G. sessilifolia extract induces apoptosis mediated by caspase activation and p21, Rb, p53, Bcl2-associated agonist of cell death (BAD), tumour necrosis factor receptor super-family, member 10 (TRAIL) overexpression and death receptor 5 (DR5). Accordingly, fraction 18-22 inducing apoptosis was able to induce TRAIL. CONCLUSIONS: Our results indicate that G. sessilifolia extract and its fraction 18-22 containing genistin and isoprunetin, were able to induce anti-cancer effects supporting the hypothesis of a pro-apoptotic intrinsic content of this natural medicinal plant.

Short bowel syndrome: clinical manifestations following extensive intestinal by-pass.

A personal experience with 43 cases of end-to-side jejunoileal bypass is reported. Two major clinical entities appear to emerge from the present study and in accordance with data from the literature: liver failure and the so-called enteric disease from bypass. Such observations were confirmed by the results obtained from an experimental investigation on 96 Wistar rats. The fact that the intestinal bacterial contamination seems to be the common cause of both effects and complications of intestinal bypass should limit by itself possible further developments of the procedure.

A modified Payne technique with a personal antireflux valvular system in the surgical treatment of morbid obesity.

Reflux into the blind loop in end-to-side jejuno-ileal bypass is commonly considered the cause of weight loss failure, but the lower morbidity and mortality suggest that this procedure should be preferred to end-to-end bypass in the surgical treatment of morbid obesity, with the proper technical modifications to prevent the reflux. An antireflux single or double valvular system created 3-6 cm proximally to the anastomosis, with few introverting seroserous stitches, parallel and perpendicular to the ileal axis, is reported. This technique, as compared to others, is not time consuming, is easily feasible and does not interfere with the blind loop down-flow. Comparative clinical data and x-ray controls demonstrated the value of this procedure which is able to give excellent results in cases where other procedures (gastric operations, bilio-intestinal, bilio-pancreatic bypass etc.), are contraindicated.

Carcinoma following gastric surgery: a national survey.

Definitive results of a national survey on the incidence of carcinoma following gastric surgery are reported. Data concern 8427 cases of surgically treated gastric cancer. 558 were affected by carcinoma following gastric surgery and 471 of them were operated on, representing 5.59% of all gastric cancers (8427) submitted to surgery. The statistical analysis of results has pointed out the need for a close follow-up program in patients over 50 years, operated on for benign gastroduodenal disease, especially 10 years postoperatively and in case of pre-cancerous lesions.