Immunohistochemical assessment of growth fractions in colorectal adenocarcinomas with monoclonal antibody Ki-67. Relation to clinical and pathological variables.

Immunostaining with monoclonal antibody Ki-67 (MAb Ki-67) has been employed to determine the growth fractions in a series of 139 primary adenocarcinomas of the large bowel. A wide range (18.9-71.4%; mean 39.4%; median 37.2%) in the percentage of Ki-67 reacting cells (Ki-67 index) was observed. The Ki-67 index was found to be unrelated to tumour stage, lymph node involvement, and presence of synchronous distant metastases. Mucinous carcinomas showed higher levels of Ki-67 reactivity than non-mucinous adenocarcinomas (P = 0.0003). Among non-mucinous adenocarcinomas a significant inverse correlation was demonstrated between the percentage of Ki-67 stained cells and the degree of differentiation (P = 0.002), and preservation of nuclear polarity (P less than 0.001). Moreover, tumours of patients younger than 45 years were generally characterized by high numbers of proliferating cells. There was no correlation between Ki-67 index and the other clinical and pathological variables examined. In most cases small differences in Ki-67 reactivity were observed in different samples from the same tumour. These results demonstrate that immunohistochemical assay with MAb Ki-67 represents a simple and reliable method for the assessment of proliferative activity in colorectal adenocarcinomas and suggest that Ki-67 labeling may provide information of clinical relevance in the management of patients with large bowel cancer.

Isolated true atherosclerotic aneurysms of the superficial femoral artery. Case report and literature review.

Isolated true atherosclerotic aneurysms of the superficial femoral artery are rare. We report an original case of superficial femoral artery aneurysm (SFAA) not associated with dilatation of the common femoral or popliteal artery. The review of the literature emphasizes the great latency of the disease and the high incidence of complication at presentation, as well as, echosonographic diagnostical advantages over angiography. After surgical treatment the prognosis is favourable. Early recognition and surgical repair are recommended for patients with aneurysms of the superficial femoral artery greater at least twice the normal vessel size. Elective surgical treatment is associated with little risk to the patients and avoids the need for operation in the setting of limb-threatening ischemia.

[Internal drainage of the thoracic duct in the surgical treatment of cirrhotic ascites. 3-year follow-up]. / Il drenaggio interno del dotto toracico nella terapia chirurgica dell'ascite cirrotica. Follow-up a 3 anni

The results of reimplantation of the thoracic duct carried out in 22 patients suffering from cirrhotic ascites refractory to medical therapy are presented and analysed. 3-year survival was 54,5% with disappearance of the ascites in 83% of cases. Other conditions being equal, these results are superior to those obtained with porto-systemic shunt.

[Iatrogenic lesions of cranial nerves during endarterectomy of the carotid artery]. / Le lesioni iatrogene dei nervi cranici in corso di endoarteriectomia della carotide.

Cranial nerve injuries may result from carotid endarterectomy. In a retrospective study of 222 surgical procedures, from July 1982 through June 1990 only three cranial nerve injuries were documented (1.35%). In a prospective study of 79 carotid endarterectomies performed from July 1990 through June 1992, there were 11 nerve injuries (13.9%), fortunately most of them were temporary. We conclude that carotid endarterectomy is associated with a much higher incidence of local nerve injury than retrospective surveys would indicate.

[Hernia surgery with short hospitalization]. / La chirurgia dell'ernia in regime di ricovero breve.

The hospital stay of 55 patients, 47 males and 8 females, admitted to hospital for surgical repair of inguinal (53 procedures) and crural (4 procedures) hernias was analyzed. The mean age was 60.7 years (range from 25 to 82 years), local anesthesia was the method of choice (55 procedures), it has suppressed post-anesthetic respiratory and urinary troubles. The mean hospital stay was 1.18 days. One superficial skin hematoma and 1 wound infection were found, local anesthetic intolerance occurred in 1 case, and low fever in three cases. Over 90 percent of patients were favourable to short stay surgery for hernia repair at 30 days follow-up. The authors conclude on the feasibility, acceptability, social benefits and usefulness of short stay and day care surgery for hernia repair.

[The role of supraduodenal choledocho-duodenostomy in non-neoplastic obstructive pathology of the principal bile duct]. / Il ruolo della coledocoduodenostomia sopraduodenale nella patologia ostruttiva non neoplastica della via biliare principale.

The authors review the indications of their 146 cases of supraduodenal choledochoduodenostomy (SDC) from 1970 to 1977. The conditions for which the procedure was carried out were dilatation of the choledochus (100%), multiple calculosis (83%), and primitive or secondary stenosing odditis (17%). After a detailed discussion of these indications, the authors report their immediate and long-term results, which were good in 96% of the patients. In the matter of surgical technic the authors give preference to laterolateral SDC, stressing that effective anastomosis requires a choledochal diameter of at least 10 or 12 mm. In good accord with data published from other sources, the authors' data suggest further restriction of direct procedures (in view of the associated risk of acute pancreatitis) in favor of SDC. The authors also review the objections to, and complications of, this surgical procedure, and conclude that these are never so important as to discourage the procedure when definitely indicated.

[So-called cystic stump syndrome]. / Considerazioni sulla cosiddetta sindrome da moncone cistico.

After outlining and discussing the etiology and pathophysiology of the postcholecystectomy syndrome, the authors describe their own series of 35 cases, therapeutic policies, and results obtained. In the discussion they suggest that the so-called cystic stump syndrome has probably been overplayed, since in the authors' own series of cases there was a high incidence of associated pathology.

[Reoperations in surgery of biliary lithiasis (author's transl)]. / I reinterventi nella chirurgia della litiasi biliare.

The Authors report on their cases of biliary surgery reoperation, necessary in 267 cases out of 3193 primary operations. After a short discussion of the aetiological, diagnostic and therapeutic problems of relapsing biliary pathology, they compare their results with those of the most important sets of cases reported in world literature.

[Technical considerations on 222 cases of esophageal anastomosis using a stapler]. / Considerazioni tecniche su 222 casi di anastomosi esofagee con stapler.

The Authors report their experience with 222 esophagoenteric anastomoses, performed in 211 cases for malignant neoplasms (middle and lower third) of the esophagus or stomach. Particularly, they have performed 4 Sujura operations, 31 esophagogastric, 4 esophagocolic, 183 esophagojejunal anastomoses utilizing SPTU, ILS and EEA circular stapler. GIA was used in the preparation of the stomach before esophagogastroplasty. Mortality rate of the manual period (1970-1980: 114 cases operated) was 14.5% versus 2.2% of the stapling period (1981-1987: 222 cases operated). From the technical point of view reasons of the superiority of stapled technique are discussed and summarized as follows: 1) space not favourable for handsewn anastomoses; 2) stapled technique allows the surgeon to save anastomoses vascularization; 3) the stapler performs the suture simultaneously so to reduce tensile strength on the anastomoses and the fragile esophageal wall especially; 4) stapled agraphes are fixed in three points vs. the two points of the handsewn stitches.

[Esophageal anastomosis using a stapler: new technical variants]. / Anastomosi esofagee con stapler: varianti tecniche originali.

Stapling techniques are considered the safer alternative for esophageal anastomosis in the Authors experience. In order to further improve results they suggest stapled esophageal anastomoses should be constructed avoiding purse-string sutures and the use of purse-string devices or Satinsky forceps.

[Mechanical staplers in colorectal surgery: cost-benefit ratio]. / Le suturatrici meccaniche in chirurgia colo-rettale: rapporto costi/benefìci.

The cost/benefit ratio of stapled anastomoses in colorectal surgery has been retrospectively evaluated on the basis of a 8 year experience taking into account the overall costs in surgery as well as short term and long term benefits. With this aim, our experience was divided in two periods: 1st period: November 1970-January 1981: 598 hand sutures; 2nd period: February 1981-December 1988: 787 stapled sutures. Mechanical suturing was found to be superior based on the following: a) the average postoperative hospital stay decreased from 20.2 days to 14.7 days; b) temporary stomas decreased from 62.2 to 25.1%; c) abdominoperineal resection for rectal cancer decreased from 60.7 to 41.6%.

[Evaluation of prognostic parameters in colorectal carcinoma. I. Histopathological variability]. / Valutazione di parametri prognostici nel carcinoma del colon-retto. I. Variabili istopatologiche.

A careful histopathological analysis was performed on a series of 244 unselected surgically removed primary colonic and rectal cancers. Tumours were staged according to the TNM system. Tumour type (adenocarcinoma or mucinous carcinoma), grade of differentiation, character of invasive margin, degree of peritumoural lymphocytic infiltration, venous and neural invasion were found to be correlated with the clinico-pathological stage and in some ways interrelated. As a whole our results seem to suggest that histological evaluation of the variables examined may provide information of clinical relevance in the management of patients with large bowel cancer.