Overall prognosis in younger patients with colorectal carcinoma.

AIM: Prognosis of colorectal cancer in younger patients is a controversial issue. While survival after curative resection seems not worse than in older patients, few data are available about the overall survival of younger patient with colorectal cancer irrespective of receiving a curative treatment or not. In this study we have reviewed our experience with patients under 45 years of age affected by colorectal cancer. METHODS: A total of 358 patients with colorectal cancer were operated on between 2001 and 2005. Nineteen patients were younger than 45. Schedules were reviewed as to palliative vs curative resection, Duke's classification, tumor grading, and compared with data from patients older than 45. RESULTS: Though no significant difference in survival can be detected after curative resection, fewer patients less than 45 years are eligible to be treated curatively. Significantly worse tumor grading and rates of curative resection make for a poorer prognosis in younger patients when compared with older ones. CONCLUSIONS: Prognosis for colorectal cancer in the overall group of patients less than 45 years is worse than in older patients. Younger patients more frequently present with distant metastases or peritoneal carcinosis which preclude the possibility of a curative treatment.

Chronic autoimmune thyroid disease.

A total of 67 patients with chronic autoimmune thyroid disease were followed, mainly as outpatients, for a period of a few months to over 15 years. The diagnosis was euthyroidism (n = 16, 23.8%), subclinical hypothyroidism (n = 20, 29.8%), primary hypothyroidism (n = 28, 41.7%) or hashitoxicosis (n = 3, 4.47%). Patients with goiters fit Hashimoto's original description of "struma lymphomatosa". The diagnosis was made on clinical grounds and the usual laboratory hormonal tests. Histological examination was carried out at surgery or by fine needle aspiration in 35 patients (52.2%), and a clinical diagnosis was made in 32 (47.7%). Three patients had juvenile Hashimoto's thyroiditis. Most patients were in the fourth, fifth or sixth decade (64.8%), and of these 12 (18%) had subclinical hypothyroidism, which should be suspected when thyrotropin (TSH) is twice the upper normal limit. In these cases thyrotropin releasing hormone (TRH) testing and evaluation of anti-thyroglobulin antibodies (TgAb) and anti-microsomal antigen antibodies (MsAb) are mandatory. Hypothyroidism with few symptoms develops insidiously in young or elderly patients; the most sensitive test is TSH assay in conjunction with tests for TgAb and MsAb. L-thyroxine administration may be harmful in older patients with late diagnosed primary hypothyroidism. Thyroid supplementation is suggested for patients with subclinical hypothyroidism if TSH values are above 10 mU/L; otherwise they should be followed up annually, as should patients with positive thyroid autoantibodies who are still euthyroid.

Ritodrine sulphation in the human liver and duodenal mucosa: interindividual variability.

The beta2-adrenoceptor agonist ritodrine has a bioavailability of 30% due to its presystemic metabolism and sulphation is an important metabolic route. The interindividual variability in the rate of ritodrine sulphation in 100 specimens of human liver and duodenum is reported. The final concentrations of ritodrine were 2 mM (duodenum) and 20 mM (liver). The mean estimates of ritodrine sulphation rate were 490 pmol x min(-1) x mg(-1) (duodenum) and 140 pmol x min(-1) x mg(-1) (liver). There was a 4-5-fold variation within +/- 2 SD units in the hepatic and duodenal rates of ritodrine sulphation. Statistical analysis revealed the presence of at least two subgroups of ritodrine sulphation. In the liver, 30% and 70% of the population fell into two subgroups with the mean estimates of ritodrine sulphation rate of 114 and 149 pmol x min(-1) x mg(-1), respectively (P < 0.05). In the duodenum, 25% and 75% of the population fell into two subgroups and the mean estimates of ritodrine sulphation rate were 332 and 538 pmol x min(-1) x mg(-1), respectively (P < 0.05). The rates of ritodrine and 4-nitrophenol sulphation correlated highly in the liver (r = 0.865; P < 0.001) and the rates of ritodrine and dopamine sulphation correlated highly (r = 0.914; P < 0.001) in the duodenum. In both tissues, the rates of ritodrine and (-)-salbutamol sulphation underwent a similar extent of variation and correlated highly. The intrinsic clearance of ritodrine sulphation was over one order of magnitude higher in the duodenum than in the liver suggesting that the duodenum is an important site of ritodrine sulphation.

[Colorectal carcinoma in the elderly. Assessment of prognostic factors]. / Carcinoma colorettale nell'anziano. Valutazione dei fattori prognostici.

Between 1976 and December 1992 a total of 80 patients aged 80 or over underwent surgery for colorectal cancer at the Surgical Clinic of Pisa University. Twelve patients died, 18 presented non-lethal complications and 48 had a normal postoperative recovery. The type of surgery did not appear to be correlated with mortality. Urgency, associated with the advanced stage of cancer (according to Duke's classification modified by Aster-Coller), was the factor which most severely influenced mortality. A marked prognostic improvement can be obtained by an early diagnosis and careful evaluation of the patient's overall conditions.

[Roux-en-y hepatojejunostomy in benign pathology of the common duct]. / L'epaticodigiunostomia su ansa alla Roux nella patologia benigna della via biliare principale.

Personal experience is reported of 59 hepaticojejunostomies performed on an excluded Roux loop in the treatment of benign pathologies of the main bile duct. The advantages and disadvantages of this approach are discussed. Several particular cases are described as is the surgical technique adopted. Complications arising in 5 patients included 3 duodenal ulcers, one of them bleeding and 2 cases of anastomotic stenosis. In all other cases the operation was satisfactory. Follow-up involved echographic and cholescintigraphic examinations. It is concluded that Roux en Y hepaticojejunostomy is the treatment of choice in benign pathologies of the main bile duct when transduodenal papillostomy is contraindicated.

[Importance of endoscopic follow-up in the diagnosis of metachronous colorectal cancer]. / Importanza del follow-up endoscopico nella diagnosi di cancro metacrono del colon-retto.

Between 1976 and December 1992 a total of 748 patients with colorectal cancer were observed at the Surgical Clinic of Pisa University; in 9 of these a second colorectal tumour appeared between 30 months and 18 years after the original tumor. Coloscopy is the treatment of choice for evaluating the colon operated due to cancer since it allows an early diagnosis of any metachronous tumours, reveals synchronous tumours which have been overlooked prior to the operation and performs a therapeutic and prophylactic function in terms of the endoscopic removal of adenomatous polyps which have appeared in the meantime.

[Primary carcinoma of the gallbladder]. / Il carcinoma primitivo della colecisti.

A series of 4 patients with gallbladder cancer encountered in 1977-86 is presented. Carcinoma accounted for 2.5% of all biliary surgery with a higher incidence among female (F = 22, M = 12). Most of the tumours had reached an advanced by the time they reached the operating theatre. Given the difficulty in diagnosing tumours at an early stage, prophylactic cholecystectomy is highly recommended in patients with gallstones whether they are symptomatic or not.

[Perforations in free peritoneum in Crohn disease]. / Perforazione in peritoneo libero nel morbo di Crohn.

Among Crohn's disease complications, perforation in free peritoneum is extremely rare, this being due to the disease's anatomopathological characteristics. Three cases of free perforation are described: one of the colon and two of the intestine. On the basis of the results of surgical treatment, straightforward suture of the perforation is contraindicated. The most rational treatment, when possible, is resection with immediate or deferred reconstruction.

[Neoplasm on cholecysto-jejunal anastomosis: an endoscopic diagnosis]. / Neoplasia su anastomosi colecisto-digiunale: una diagnosi endoscopica.

Bilio-digestive anastomoses represent a tried and tested surgical procedure in lithiasic or neoplastic type obstructions of the main biliary way. Among long-term postoperative complications the case of neoplasia in the stomy is rare. A clinical case of neoplasia on cholecystojejunal anastomosis diagnosed endoscopically is reported. The physiopathological aspects are discussed.

[Post-traumatic arterio-venous popliteal aneurysm]. / Aneurisma popliteo artero-venoso post-traumatico.

A case of artero-venous pseudo-aneurysm caused by traumatic aetiology is reported. After a description of the case and a review of the literature, the pathogenesis, clinical aspects and therapy of acquired artero-venous fistulas are discussed.

[Hepato-cholescintigraphy using technetium Tc 99m diethyl IDA in the follow-up of biliodigestive anastomoses]. / L'epato-colescintigrafia con 99m Tc-dietil-IDA nel follow-up delle anastomosi bilio-digestive.

The results of a study conducted on 24 patients given biliodigestive shunts are reported. Follow-up involved cholescintigraphy using 99m-IDA technetium. This examination provided valuable information about the morphodynamics of biliary flow and when the biliary peak and intestinal appearance times were lengthened, it was also able to identify significant obstructions. The technique is considered highly significant.

[Usefulness of ranitidine in the treatment of esophagitis caused by gastro-esophageal acid reflux]. / Utilità della ranitidina nella terapia dell'esofagite da reflusso acido gastro-esofageo.

The results of a randomised prospective study conducted on 40 patients with erosive oesophagitis caused by gastro-oesophageal acid reflux are reported. The patients were divided into two groups and given either ranitidine or a placebo. The clinical and endoscopic evolution confirmed by the histological findings and pH figures demonstrated a significantly better performance in the patients treated with ranitidine. No clinically significant side effects were noted.

Thyroid carcinoma in intrathoracic goiter.

INTRODUCTION: Most cases of intrathoracic goiter can be managed by cervical incision alone. A thoracic approach may be needed when adhesions or an anomalous blood supply are present or carcinoma is suspected. PATIENTS AND METHODS: Only 44 patients out of 5263 operated on for goiter needed a thoracic incision. A sternotomy was performed in 29 cases and a thoracotomy in 15; a malignancy was present in 9 cases. Symptoms, surgical approach, histology, survival and pTN staging of these 9 patients were reviewed and discussed; no perioperative mortality was observed. DISCUSSION: A thoracic approach is more frequently needed for treatment of intrathoracic thyroid carcinoma as it offers a greater chance of radical excision and better control of intraoperative bleeding. Histologically, thyroid carcinoma in intrathoracic goiter is often anaplastic or rare and has a poor long-term survival rate when compared to cervical forms.

(-)-salbutamol sulphation in the human liver and duodenal mucosa: interindividual variability.

1. Salbutamol as a beta 2-adrenergic agonist used in the treatment of lung obstructive disease and premature labour. It has a bioavailability of 50% and sulphation is the main route of its metabolism. (-)-Salbutamol retains most of the beta 2-adrenergic activity and, thereby, we describe the interindividual variability in the sulphation rate of (-)-salbutamol in 100 specimens of human liver and duodenal mucosa. 2. The mean rate (pmol/min/mg of salbutamol sulphation was 498 in the duodenum and 141 in the liver with 4-fold variation within +/-2 SD units in both tissues. 3. A modelling approach based on the comparison of the best fittings obtained using a gaussian and the sum of two gaussian curves revealed the presence of two subgroups in the hepatic rate of salbutamol sulphation and their means were 69.5 and 105 pmol/min/mg (p < 0.05). In the duodenum, the rate of salbutamol sulphation approached normality. 4. The rates of salbutamol and 4-nitrophenol sulphation correlated highly (r = 0.853; p < 0.001) in the liver whereas in duodenum the rates of salbutamol and dopamine correlated highly (r = 0.914; p < 0.001), 4-Nitrophenol and dopamine are the diagnostic substrates of phenol- and catechol-sulphotransferases respectively. These findings are consistent with the view that the rate of salbutamol sulphation is higher in the gut than in liver and it varies considerably in both tissues.