Extended lymphadenectomy in elderly and/or highly co-morbid gastric cancer patients: A retrospective multicenter study.

BACKGROUND: Gastrectomy with extended lymphadenectomy is considered the gold standard treatment for advanced gastric cancer, with no age- or comorbidity-related limitations. We evaluated the safety and efficacy of curative gastrectomy with extended nodal dissection, verifying survival in elderly and highly co-morbid patients. METHODS: In a retrospective multicenter study, we examined 1322 non-metastatic gastric-cancer patients that underwent curative gastrectomy with D2 versus D1 lymphadenectomy from January 2000 to December 2009. Postoperative complications, overall survival (OS), and disease-specific survival (DSS) according to age and the Charlson Comorbidity Score were analyzed in relation to the extent of lymphadenectomy. RESULTS: Postoperative morbidity was 30.4%. Complications were more frequent in highly co-morbid elderly patients, and, although general morbidity rates after D2 and D1 lymphadenectomy were similar (29.9% and 33.2%, respectively), they increased following D2 in highly co-morbid elderly patients (39.6%). D2-lymphadenectomy significantly improved 5-year OS and DSS (48.0% vs. 37.6% in D1, p < 0.001 and 72.6% vs. 58.1% in D1, p < 0.001, respectively) in all patients. In elderly patients, this benefit was present only in 5-year DSS. D2 nodal dissection induced better 5-year OS and DSS rates in elderly patients with positive nodes (29.7% vs. 21.2% in D1, p = 0.008 and 47.5% vs. 30.6% in D1, p = 0.001, respectively), although it was present only in DSS when highly co-morbid elderly patients were considered. CONCLUSION: Extended lymphadenectomy confirmed better survival rates in gastric cancer patients. Due to high postoperative complication rate and no significant improvement of the OS, D1 lymphadenectomy should be considered in elderly and/or highly co-morbid gastric cancer patients.

Oculocardiac reflex and postoperative vomiting in paediatric strabismus surgery. A randomised controlled trial comparing four anaesthetic techniques.

BACKGROUND: Oculocardiac reflex (OCR) and postoperative vomiting are major complications of paediatric strabismus surgery. METHODS: Children (3-16 yr) undergoing elective strabismus surgery as inpatients were randomly allocated to four anaesthetic techniques: (A) thiopentone induction and isoflurane maintenance; (B) as (A) plus ondansetron 5 mg x m(-2) i.v.; (C) propofol induction and maintenance; (D) as (C) plus lignocaine 2 mg x kg(-1) i.v. All children received prophylactic atropine 0.02 mg x kg(-1) and alfentanil. Nitrous oxide was omitted. RESULTS: Data on 157 children were analysed. The cumulative incidence of vomiting within 6 and 24 h after surgery with thiopentone-isoflurane was 26% and 46%, respectively. Adding ondansetron decreased the incidence to 8% and 33%, respectively. This improvement was significant within 6 h only; the number-needed-to-treat was 5.5 (95% CI 2.9-46). Propofol was not different from thiopentone-isoflurane. The addition of lignocaine to propofol was of no benefit. The risk of an OCR was significantly increased with propofol (incidence 40%) compared with isoflurane (14%); the number-needed-to-harm was 3.9 (95% CI 2.6-8). CONCLUSIONS: Thiopental-isoflurane-air/O2-alfentanil resulted in a moderate risk of vomiting. Adding ondansetron significantly decreased this risk, but 6 children have to be treated for one to benefit in the early postoperative period. Propofol and propofol-lignocaine showed no benefit on vomiting but significantly increased the risk of an OCR despite high-dose prophylactic atropine.

Low incidence of the oculocardiac reflex and postoperative nausea and vomiting in adults undergoing strabismus surgery.

PURPOSE: To investigate the incidence of the oculocardiac reflex (OCR), and of postoperative nausea and vomiting (PONV) in adults undergoing strabismus surgery. METHODS: Adults (18-86 yr) undergoing inpatient strabismus surgery received 10 micrograms.kg-1 atropine and 10 micrograms.kg-1 altentanil iv and were randomly allocated to: (A) 5 mg.kg-1 thiopentone iv, isoflurane/N2O maintenance; (B) 3 mg.kg-1 propofol iv, propofol/N2O maintenance (10-14 mg.kg-1.hr-1); 3 mg.kg-1 propofol iv, propofol/air/O2 maintenance (10-14 mg.kg-1.hr-1). Analyses were with the number-needed-to-treat/harm. RESULTS: In 97 adults the absolute risk of OCR (13-20%) and PONV (21-31% after 24 hr) was low, with no differences between groups. Number-needed-to-treat to prevent PONV with propofol with or without N2O compared with thiopentone-isoflurane was 7 to 11. Number-needed-to-harm for one OCR with propofol compared with thiopentone-isoflurane was 17. CONCLUSION: Adults undergoing strabismus surgery with prophylactic atropine had a low risk of OCR and PONV, independent of the anaesthetic technique used.

Developmental, nutritional, and hormonal regulation of the pancreatitis-associated protein I and III gene expression in the rat small intestine.

BACKGROUND: The pancreatitis-associated protein (PAP) I and III, but not PAP II, mRNAs are constitutively expressed in the small intestine of rats. METHODS: We studied expression of both PAP I and PAP III mRNAs during development and on nutritional and hormonal manipulations. RESULTS: Between day 20 of gestation and day 21 of age, PAP mRNAs could barely be detected. Their concentrations increased dramatically from day 21 to day 45 of age and remained constant thereafter. Rats adapted to a diet with low carbohydrate content showed a significant decrease in PAP mRNA concentrations. Finally, whereas thyroidectomy and ovariectomy induced a decrease in both mRNA concentrations, and adrenalectomy a limited decrease in PAP III mRNA only, diabetes and castration did not alter the expression of either gene. CONCLUSION: Gene expression of PAP I and III mRNAs is regulated in a coordinate manner in the rat small intestine during development and on nutritional and hormonal manipulations.

[Prosthetic repair of hernias and laparocele. Our experience with Goretex prosthesis]. / La riparazione protesica delle ernie e dei laparoceli. Nostra esperienza con protesi di Goretex.

For about ten years repair of inguinal or abdominal hernias using prosthetic materials has been in routine use in general surgery. Various experimental and clinical observations of surgical physiopathology have been proved that the most important cause of recidivation is abnormal tension between diastasis tissues. From the beginning of 1991, in the Surgical Department of "Clinica S. Anna" in Pomezia (Rome), we have been using tension free technique. Goretex was preferred versus other prosthetic devices because of our experience in vascular surgery. Hundred-fifteen operations have been carried out; 23 for ventral hernias, 92 for inguinal and femoral hernias. The age of patients varied from 18 to 69 years. Localization of inguinal hernias was indirect in 48 cases, direct in 16 an associated in 13; 9 were recidive and 3 bilateral, 3 femoral hernias. Abdominal wall hernias consisted of 12 epigastric localizations, 8 hypogastric and 3 pararectal. All cases of abdominal and bilateral hernias were operated under general anesthesia with orotracheal intubation. Inguinal hernias were treated with local (pubivacaine 0.5%, 1:2 with physiologic solution) or spinal anesthesia, except for 2 cases operated in total anesthesia. As regards surgical technique, the objective pursued was that of filling up the parietal defect with a patch of the same form fixed with a non absorbable suture in Goretex 2/0. The peritoneum was not opened in abdominal hernias, if not necessary, because prosthetic devices must not touch directly the small and large bowel; patches have been positioned between the peritoneum and transversalis aponeurosis. For inguinal hernias Rives' technique was used. Goretex patches were cut with "no-touch" technique.(ABSTRACT TRUNCATED AT 250 WORDS)

[Update on laparoscopic surgery: on the treatment of hydatid cyst of the liver and peritonitis caused by a perforated duodenal ulcer]. / Attualità in tema di chirurgia celioscopica: a proposito del trattamento di una cisti idatidea del fegato e di una peritonite da ulcera duodenale perforata.

Laparoscopic surgery represents a real innovation with respect to the traditional laparotomic way of access, owing to its undeniable advantages, both intraoperative and postoperative. This new technique reduces the complications connected with the surgical wound and with forced allerement. Therefore it allows the patient's fast recovery. Laparoscopic surgery application ground get's wider and wider every day: in fact, the authors report two medical cases, one of elective surgery (treatment of a hidatid cyst of the liver) and the other in emergency surgery (peritonitis due to perforated duodenal ulcer), both obtaining a positive result about the clinical and the postoperative timing of recovery.