The diagnostic accuracy of the immunocytochemical markers in the pre-operative evaluation of follicular thyroid lesions.

UNLABELLED: Aim of the study was to consider the diagnostic accuracy of galectine-3 (GAL3) in the pre-operative cytological evaluation of follicular lesions. MATERIALS AND METHODS: We retrospectively evaluated 100 patients suffering from thyroid nodular disease submitted to thyroidectomy from 2006 to 2007 in our Institution. Before surgery all patients underwent fine needle aspiration biopsy. The immunocytochemical analysis was performed on fine needle aspiration specimens using species-specific monoclonal antibodies and a biotin-free detection system. Based on preoperative cytological reports, 40 patients had pre-operative malignant results, and 60 patients (46 females and 14 males) showed follicular lesions. The sensitivity, specificity, positive and negative predictive values, and diagnostic accuracy of GAL3 was evaluated. STATISTICAL ANALYSIS: Chi-square test was used to compare frequencies of GAL3 expression between the different hystopathological groups. RESULTS: GAL3 proved to have 55% sensitivity, 100% specificity, 70% negative predictive value, and 78% diagnostic accuracy. The GAL3 expression in neoplastic and benign lesions was significantly different (GAL3+ in 16 out of 29 neoplastic lesions, GAL3+ 0 out of 31 benign lesions, p<0.01). Even comparing the GAL3 positivity between the follicular adenomas (0 GAL3+ out of 20) and the group of follicular carcinomas (5 GAL3+ out of 6), we found a statistically significant difference (p<0.01). CONCLUSIONS: Based on the data from our experience, the patients with a cytological diagnosis of GAL3 positive follicular neoformation should be referred for surgery without any further immunocytological testing.

[Reoperations in hyperparathyroidism]. / I reinterventi nell'iperparatiroidismo.

Reoperative parathyroidectomy (PTx) is challenging for the surgeon. Before reintervention it is essential to evaluate the operative notes and pathology reports from the previous operation, the localization exams (sestaMIBI scintigraphy and ultrasound) and IOPTH assay are also essential. The surgeon is supposed to perfectly know the anatomy and embryology of parathyroid glands and experience with parathyroid surgery is still the most important predictor of success in reoperative PTx. Reinterventions in HPT have good results with a resolution of hyperparathyroidism in 85-90% for primary HPT and in 70% for secondary and tertiary HPT. Authors present their experience of 76 reinterventions after HPT I and 85 reinterventions after HPT II and III over a total of 2072 parathyroidectomies, carried out between January 1975 and October 2009.

Marginal adaptation of full-coverage CAD/CAM restorations: in vitro study using a non-destructive method.

AIM: Marginal fit of full-coverage crowns is a major requirement for long term success of this kind of restorations. The purpose of the study was to verify the marginal adaptation of computer assisted design (CAD)/computer assisted manufacturing (CAM) crowns on prepared teeth and on plaster dies. METHODS: Four couples of materials: zirconia-ceramic veneering (DC-Zircon, DCS Dental, Allschwill, CH/Cercon S, Degussa, DeguDent GmbH, Hanau, Germany), fiber-reinforced composite-composite veneering (DC-Tell, DCS Dental/Gradia, GC Europe, LEuven, Belgium), titanium-ceramic veneering (DC Titan, DCS Dental/Tikrom, Orotig, Verona, Italy) and titanium-composite veneering (DC Titan, DCS Dental/Gradia, GC Europe) were evaluated following the guidelines provided by ADA specific #8. Five crowns were fabricated for each material. Marginal gap values were measured at four points (0 degrees, 90 degrees, 180 degrees and 270 degrees starting from the centre of the vestibular surface) around the finishing line, on prepared teeth and on plaster dies at each step of the fabrication process. Digital photographs were taken at each reference point and a computer software was used to measure the amount of marginal discrepancy in microm. Statistical analysis was performed using t test at 95 percent confidence interval. RESULTS: All the tested materials, except for fiber-reinforced composite, show a marginal adaptation within the limits of ADA specification (25-40 microm). The application of veneering material causes decay in marginal adaptation, except for fiber-reinforced composite. CONCLUSION: Within the limitations of this study, it was concluded that marginal fit of CAD/CAM restoration is within the limits considered clinically acceptable by ADA specification #8. From the results of this in vitro study, it can be stated that CAD/CAM crowns produced with DCS system show a marginal adaptation within the limits of ADA specific #8, therefore milled CAD/CAM crowns can be considered a good alternative to more traditional waxing-investing-casting technique.

Aberrant activation of c-kit protects colon carcinoma cells against apoptosis and enhances their invasive potential.

Multiple genetic aberrations contribute to the development of biologically aggressive, clinically malignant colorectal carcinomas (CRCs). Some of these have been linked to inappropriate signaling through the tyrosine kinase moieties of growth factor receptors. We have described previously (G. Bellone et al., J. Cell. Physiol., 172: 1-11, 1997) that human CRCs overexpress both the receptor tyrosine kinase c-kit and its ligand, stem cell factor (SCF), relative to normal mucosa cells, thus establishing an autocrine c-kit-mediated loop. In addition, we noted that exogenous SCF contributes to anchorage-independent growth of HT-29 colon carcinoma cells in semisolid medium. Here, we investigated possible roles of the c-kit/SCF autocrine/paracrine system in survival and invasive capacity of DLD-1 colon carcinoma cells. We report that SCF was required for migration and invasion of DLD-1 cells through reconstituted basement membranes (Matrigel) and up-regulated gelatinase (matrix metalloproteinase-9) activity in DLD-1 cells. Furthermore, we describe that SCF supported survival of DLD-1 cells in growth factor-deprived conditions. These results suggest multiple roles of c-kit activation in support of the malignant phenotype of DLD-1 cells related to growth, survival, migration, and invasive potential.

[The choice of surgical therapy in adenocarcinoma of the cardia]. / La scelta della terapia chirurgica nell'adenocarcinoma del cardias.

AIM: From 1996 the adenocarcinoma of the esophago-gastric junction (AEG) is divided into 3 types according to Siewert's classification. For AEG type I and III the surgical treatment is codified, while for type II is still controversial. The aim of our study is to understand what is the better surgical treatment for AEG type II. METHODS: From 1990 to 2002 we have performed 111 resections for adenocarcinoma of the cardia: 25 for AEG type I (all esophago-gastric resection), 39 for type II (22 esophago-gastric resection, 17 extended total gastrectomy with esophageal resection) and 47 for type III (8 esophago-gastric resection, 39 extended total gastrectomy with esophageal resection). RESULTS: The morbidity and mortality rates are 17 and 5.4%, without significant difference between the different surgical treatment (p>0.01). The 5 year survival rate is 35%. Significant prognostic factors are the staging TNM (p=0.002) and principally the presence of metastatic lymph nodes (p=0.001). For AEG type II any significant difference in survival is associated with surgical strategy, also in early stage (p>0.01). CONCLUSIONS: According to the results of our study and those of the other authors, who have showed that a 10 cm distance of the neoplasm by the gastric side and the esophageal one could assure oncologic radicality and also that metastatic lymph nodes below pylorus and near greater curvature are uncommon, we can consider esophago-gastric resection for AEG II a speedy, safe and oncologically correct surgical treatment.

Differential expression of transforming growth factors-beta1, -beta2 and -beta3 in human colon carcinoma.

Transforming growth factor (TGF)-beta is a protein family which affects multiple cellular functions including survival, proliferation, differentiation and adhesion. Among the three known isoforms, TGF-beta1 is commonly overexpressed in solid malignancies. Recent studies in knock-out mice demonstrated non-redundant roles of different TGF-beta isoforms in development. The present study was performed to assess tumour-associated expression of the three TGF-beta isoforms in colon carcinoma. We report that colon carcinoma progression is associated with gradual and significant increases in expression of TGF-beta1 and TGF-beta2 mRNA and proteins. By contrast, TGF-beta3 expression was detected in normal colonic mucosa and, at slightly higher levels, in tumour tissues. In addition, plasma levels of both TGF-beta1 and TGF-beta2 were significantly higher in cancer patients when compared with unaffected individuals. Taken together, our results indicate distinct expression patterns of the three TGF-beta isoforms in colon carcinoma cells and possible systemic effects of TGF-beta1 and TGF-beta2 in tumour patients.

Sliding hiatal hernia in the elderly: a clinical entity.

Sliding hiatal hernia occurs in the elderly with a symptom complex which differs from that seen in younger persons. A comparison of the symptoms of this disease in 66 older patients with the symptoms in 154 younger patients revealed four categories in the elderly: digestive, anemic, anginal, and pseudoneoplastic. Of these, the digestive-tract abnormality, even though the most common, was the least characteristic and was caused by the associated pathologic lesions rather than by the hiatal hernia itself.

Cancer of the esophagus: ten years' experience.

The paper reports the authors' ten-year experience of the surgical treatment of cancer of the esophagus. A total of 625 patients with esophageal carcinoma were observed during the period 1980-89 of whom 490 were admitted to hospital and, of the latter, 172 (35.1%) were operated with a sectile rate of 86% (148 patients). Data from this period were analysed both retrospectively and prospectively using a computerised system. There were 105 radical operations (70.9%) and 43 palliative operations (29.1%). The 3-year actuarial survival rate was 21.7% and the difference between radical and palliative resections was at the limit of significance (p less than 0.1).

Biliary reflux after cholecystectomy: a prospective study.

The authors carried out a prospective study to ascertain whether cholecystectomy itself might be the cause of duodenogastric reflux. Patients with cholelithiasis were examined and underwent the following tests: hemanalysis, gastroscopy with biopsy, 24 hour pH-metry and acetaminophen test. Twelve patients were selected. Six months after the operation the tests were repeated. All patients were asymptomatic. Hemanalysis was normal in all 12 patients and no difference was seen in the tests of 5 of the patients; however in the other 7 differences were observed in all the tests. The authors conclude that cholecystectomy helps to provoke duodenogastric reflux in predisposed patients, and that this reflux may be asymptomatic.

Leukocyte adherence inhibition test: cell-mediated reactivity to tumor antigens in colorectal and lung tumor long survivors.

Cell-mediated immunity versus tumor antigens (cytosols) of the same histotype and site was evaluated by means of the leukocyte adherence inhibition (LAI) test in 44 colorectal adenocarcinoma and 17 lung squamous-cell carcinoma patients 3-10 years after surgical resection. LAI-positivity was observed in 17/44 (38.6%) and 13/17 (76.5%) patients, respectively, together with serum blocking factors in 7/17 (41.2%) compared to 0/13. These results indicate that a high percentage of long survivors retain an immunologic memory of the tumor antigen to which they have been exposed. The prognostic significance of serum blocking factors is less clear.

[Adenocarcinoma of the cardia: surgical strategies compared]. / Adenocarcinoma del cardias: strategie chirurgiche a confronto.

BACKGROUND: The incidence of adenocarcinoma of the cardia is increasing. The choice of surgical strategy for AEG type II of Siewert classification is the subjects of controversial discussion. The aim of our retrospective study is to analyse the surgical results in 12 years. MATERIAL AND METHODS: Since 1990 to 2002, 111 patients underwent resection for adenocarcinoma of the cardia at III Division of General Surgery, University of Turin. Twenty-five patients had AEG type I, 39 had type II and 47 type III. Transthoracic or transhiatal oesophagectomy with resection of the proximal stomach were performed in 55 cases and extended total gastrectomy with transthoracic or transhiatal oesophagectomy in 56. RESULTS: The morbidity and mortality rates are 17% and 5.4%. The 5 years survival rate is poor (35%) for all Siewert type. Survival is significantly associated with stage and the presence of lymph node metastasis, but not correlated with Siewert classification and surgical approach. Also in the AEG II the survival is not modified by the surgical approach. CONCLUSION: In patient with AEG I the therapy of choice is a radical transthoracic or transhiatal oesophagectomy with resection of the proximal stomach. For type III extended total gastrectomy with transthoracic or transhiatal oesophagectomy is the procedure of choice. The superiority of the thoracoabdominal approach is therefore evident in terms of oncologic radicality. Survival is similar in AEG type II patients for both operations. A oesophagectomy with proximal gastric resection should be adopted for these tumors as the standard procedure in the majority of cases.

[Vascular endothelial growth factor. From basic research to clinical application]. / Il vascular endothelial growth factor. Dalla ricerca di base all'applicazione clinica.

There is increasing evidence to support the concept that growth and metastasis of solid tumors, including those of gastrointestinal tract, is facilitated by neoangiogenesis. Vascular Endothelial Growth Factor (VEGF) is one of the most powerful known inducer of endothelial cell growth. Therefore, VEGF is likely to contribute to tumor growth by promoting angiogenesis and stroma formation both directly, through its neovascularization inducing activity, and indirectly, by increasing vascular permeability. In addition, VEGF facilitates tumor diffusion favouring metastatic spread of cancer cells. In view of these implications, it is important to understand the physiopathological role played by this factor. In this review the authors present the accumulating body of data on the biological and functional properties of VEGF, paying special reference to new evidence on its contribution in tumor immune escape, through a marked inhibition of differentiation and activity of the professional antigen presenting cells (APC), namely dendritic cells (DC). As the molecular and cellular events that underlie the functional role of VEGF in tumor angiogenesis and immune suppression become better defined, rational pharmacological and/or gene therapies can be derived in order to treat those neoplasms, such as pancreatic adenocarcinoma, not well amenable to chemo- and radiotherapy or immunotherapy.

[High serum levels of Transforming Growth Factor-beta1, Interleukin-10 and Vascular Endothelial Growth Factor in pancreatic adenocarcinoma patients]. / Elevati livelli di Transforming Growth Factor-beta1 di Interleuchina-10 e di Vascular Endothelial Growth Factor nei sieri di pazienti affetti da adenocarcinoma pancreatico.

BACKGROUND: Pancreatic adenocarcinomas are among the most aggressive types of cancer with an extremely poor diagnosis. Since this type of cancer is not well amenable to chemo- and radiotherapy or immunotherapy, surgical resection remains the only feasible treatment to date. Transforming Growth Factor (TGF)-beta and Interleukin (IL)-10 are potent immunomodulators that have been shown to suppress several aspects of the immune response. Vascular Endothelial Growth Factor (VEGF) is a powerful angiogenic factor, recently thought to be involved in neoangiogenesis and metastasis spreading. Therefore the three cytokines may contribute, by different pathways, to immune escape and growth of tumor. This study was conducted to determine the possible significance of TGF-beta1, IL-10 and VEGF as markers for monitoring the clinical course of pancreatic adenocarcinoma patients. METHODS: Cytokine serum levels were measured in 30 pancreatic cancer patients and in 30 age and sex-matched healthy subjects. RESULTS: In comparison to serum concentrations in controls, TGF-beta1, IL-10 and VEGF levels were significantly elevated in all patients. Where the patients were divided by groups on the basis of the clinical stage of the disease, no differences were observed in TGF-beta1 levels among the groups. On the contrary, IL-10 and VEGF were more represented in stage IV patients than in stage II and III patients. In addition, the 14 patients who underwent surgical resection had postoperative cytokine serum levels markedly lower than those observed at diagnosis. CONCLUSIONS: Overall, the results suggest the importance of these markers in predicting the biological activity of the disease and suggest new targets for future rational therapies.

[Cholecystectomy by minilaparotomy]. / Minilaparotomia per colecistectomia.

The authors relate their experience of 62 cases of minicholecystectomy. This procedure is compared to "open" conventional and laparoscopic cholecystectomy. Report results and the analysis of the literature shows that the technique of cholecystectomy by minilaparotomy is a valid option to laparoscopic cholecystectomy and represents a clear improvement compared to conventional cholecystectomy.

[Cervical mechanical anastomosis by transhiatal approach with a new circular stapler, Ehicon ECS 21]. / Anastomosi meccanica cervicale per via transiatale con una nuova suturatrice circolare, Ethicon ECS 21.

Authors describe a new technique of mechanical cervical anastomosis using a new, particularly long, stapler, the ECS Ethicon. Mechanical anastomosis at neck level is difficult to perform with stapler now in use, so manual anastomosis is usually preferred. However the percentage of leakage is relatively high. The possibility of doing a mechanical anastomosis introducing the stapler through the pylorus is described. At the moment cases are too few to give a full evaluation of this new technique, but certainly it could be a valid alternative, safer and quicker, to manual anastomosis.

[Our experience in 6 cases of leiomyoma of the esophagus]. / La nostra esperienza su 6 casi di leiomiomi dell'esofago.

The Authors present 6 cases of oesophageal leiomyomas operated on during the past 15 years at the Institute of Surgical Pathology of the University of Turin and compare the results with those in the literature. The pre-operative diagnosis was not always possible and often difficult: it was however, helped by many clinical and instrumental examinations. The treatment of choice was surgery, usually by enucleation or occasionally by gastroesophageal resection. There was no operative mortality and no recurrences have been observed.

[Functional study of intestinal transplants after esophagectomy]. / Studio funzionale dei visceri trasposti dopo esofagectomia.

The Authors contribute their experience covering 228 cases of esophagoplasty after esophagectomy for cancer of the esophagus and of the esophagogastric junction, from 1980 to 1989. Thirty four of these patients (24 EGP, 8 EDP, 2 ECP) underwent accurate functional investigation by X-ray, manometry, pH-metry and scintigraphy. The investigation into esophagogastroplasty in particular revealed that the transposed organ is devoid of motor activity and that emptying is therefore achieved by gravity. It was also shown that the entity of the alkaline, acid and mixed-type reflux is linked to the site of the anastomosis: greater proximity of the anastomosis translates into lower involvement. An investigation into esophagojejunoplasty, instead, highlighted normal motor function: no cases presented reflux of the alkaline type. The two cases of colon plasty investigated presented efficient emptying even though manometry could not detect the presence of motor waves of the propulsive type. The authors conclude that, although the jejunum constitutes the best prosthetic element to transpose from the functional point of view, highly inconsistent and precarious vascularization limits the use of this organ to the higher anastomoses only. Therefore the Authors claim that the stomach, despite its tendency to behave as an inert tube, is still the best choice for transpositions following esophagectomy.

[Fistulae in diverticular disease of the colon]. / Le fistole nella malattia diverticolare del colon.

Fistulas in colon diverticular disease are a not uncommon complication, that arise spontaneously in the evolution of a diverticulitis, and also as a complicated dehiscence of surgical anastomosis. The intermediate step of a fistula is a deep abscess that finds through the parietal layers of abdomen or towards other adjacent organs. So the surgeon can be confronted with external and internal and complex fistulas. As for diagnostic manoeuvres, the surgical choices are outside a rigid schedule, and is on the personal sensibility of the surgeon.