[Internal carotid artery aneurisms: two cases]. / Anévrismes de l'artère carotide interne extra-crânienne: à propos de 2 cas.

INTRODUCTION: Aneurysms of the extracranial portion of the internal carotid artery (ICA) are rare (accounting for only 0.1-2% of all surgical procedures affecting the ICA, 0.4-1% of all arterial aneurysms, and 4% of all aneurysms involving peripheral arteries), but they are nonetheless clinically significant because of the high related risk of cerebral thromboembolism. Given the rarity of these lesions, it seems worthwhile to report on two extracranial ICA aneurysms, one of atherosclerotic, the other of fibrodysplastic etiology that came under our observation. PATIENTS AND METHODS: Our experience concerns just two cases, treated at the Department of Surgical and Gastroenterological Sciences of the Policlinico G.B. Rossi in Verona, presenting with very different clinical and instrumental findings, and requiring a different surgical treatment. The former underwent resection of the aneurysm and end-to-end reconstruction; in the latter, we performed a carotid transposition with internalization of the external carotid artery. RESULTS: Neither patient suffered from any major or minor neurological complications during or after surgery, and the follow-up confirmed a normal extracranial carotid patency. CONCLUSIONS: Based on our, albeit limited experience and an analysis of the literature, we make a few points concerning the diagnostic approach (which differs from the case of stenosing carotid lesions), the indications and type of treatment for extracranial ICA aneurysms.

Gastrointestinal carcinoids. Prognosis and survival.

BACKGROUND: Gastrointestinal carcinoid tumors are rare and little is known about factors related to prognosis in patients with carcinoid disease. Aim of this study is to determine the impact of clinical presentation variables on the management and survival. METHODS: We have evaluated 31 consecutive patients with gastrointestinal carcinoid tu-mours who underwent surgical intervention at the I Department of Surgery of Milano-Bicocca University over 15 years (1985-1999). Tumor distribution, hormone production, prognostic factors and survival were analysed. RESULTS: Carcinoid syndrome was the only clinical pattern diagnostic of carcinoid tumour. Most common symptoms were abdominal pain (64%), nausea and vomiting (48%). High levels of urinary 5-hydroxyindolacetic acid were significantly associated with carcinoid syndrome and metastatic disease. Tumor size, depth and gender were significant predictors of metastases. Age, gender, tumor size, metastatic spread and location were statistically significant predictors of death. CONCLUSIONS: Clinical presentation was non specific except for those patients affected by carcinoid syndrome. Ten years overall survival was 43%, with 52% metastatic spread incidence. The extent of surgical resection should be modulated on patient related risk factors. Poor prognostic factors affecting survival were: age, gender, metastatic disease, depth of invasion and tumour size.

Alteration of hypothalamus-pituitary-adrenal gland axis in colorectal cancer patients. Preliminary report.

AIM: In advanced cancer patients a cell-mediated immunological impairment, both at baseline and during postoperative period, is often found and is associated with poor prognosis. Cortisol is strictly involved in the response to major surgical stress, is an immunosuppressor and causes a redistribution of immunological population cells in different tissues. The aim of the study was to verify serum levels and circadian rhythm of cortisol in patients with colorectal cancer at baseline before surgery and in the postoperative period, and relate it to the immune status. METHODS: In 21 patients with colorectal cancer undergoing surgery we evaluated the assessment of total lymphocytes, CD4+, cortisolemia, circadian rhythm of cortisol (11 p.m. and 8 a.m.) at baseline and in 3(rd) and 7(th) postoperative days. RESULTS: Increase of cortisolemia, as decrease of total and CD4+ lymphocytes in the postoperative period versus baseline was statistically significant. Patients with an altered circadian rhythm were 47% and 36% at 3rd and 7th postoperative days, respectively. At baseline 19% of patients had an altered cortisol circadian rhythm and it was more frequent in patients with nodal involvement (p<0.05) and with metastasis (p<0.01). No relations between lymphocytopenia and alteration of cortisolemia and cortisol circadian rhythm were found, either at baseline or postoperatively (p<0.05). CONCLUSION: Lymphocytopenia in cancer patients seems not to be associated with cortisol level and circadian rhythm alteration, either at baseline or after surgical stress. An impairment of circadian rhythm of cortisol was found at baseline in 19% of patients. It was significantly associated with the presence of metastatic disease.