Bioprofiling over grid for eHealthcare.

A trend in modern medicine is towards individualization of healthcare and, potentially, grid computing can play an important role in this by allowing sharing of resources and expertise to improve the quality of care. In this paper, we present a new test bed, the BIOPATTERN Grid, which aims to fulfil this role in the long term. The main objectives in this paper are 1) to report the development of the BIOPATTERN Grid, for biopattern analysis and bioprofiling in support of individualization of healthcare. The BIOPATTERN Grid is designed to facilitate secure and seamless sharing of geographically distributed bioprofile databases and to support the analysis of bioprofiles to combat major diseases such as brain diseases and cancer within a major EU project, BIOPATTERN (www.biopattern.org); 2) to illustrate how the BIOPATTERN Grid could be used for biopattern analysis and bioprofiling for early detection of dementia and for brain injury assessment on an individual basis. We highlight important issues that would arise from the mobility of citizens in the EU, such as those associated with access to medical data, ethical and security; and 3) to describe two grid services which aim to integrate BIOPATTERN Grid with existing grid projects on crawling service and remote data acquisition which is necessary to underpin the use of the test bed for biopattern analysis and bioprofiling.

Influence of the surgical treatment on local recurrence of rectal cancer: a prospective study (1980-1992).

BACKGROUND AND OBJECTIVES: The incidence of locoregional recurrences (LR) following radical surgery of rectal cancer varies from 5% to 30% according to the literature. The purpose of this prospective study was to compare the outcome of the Abdomino-Perineal Excision (APE) vs. the Anterior Resection (AR) in a consecutive series of 188 patients who underwent surgery for cure from 1980 to the end of 1992 (81 APE and 107 AR), followed for 5 years, evaluating their influence on the incidence of the recurrences. METHODS: The patients were enrolled at random in the two surgical groups, provided that a radical excision of the tumour, with only two limits: the level of the lesion from the anal verge and the presence of a severe incontinence instrumentally proven. TNM, Dukes staging, grading, and tumour location were statistically evaluated. Further primary suture vs. packing of the perineal wound in APE and handsewn vs. stapled anastomosis in AR were compared in relation with the incidence of LR. RESULTS: The overall local recurrence rate was 19.2% (32/167), in details 19.7% for APE and 18.5% for AR. Similar recurrence rates were observed following both procedures, matching the patients according to the Dukes stage and different details of techniques. A slight statistically significant difference was found as far as the tumour location is concerned in the group treated with anterior resection (p = <0.05) because of the higher recurrence observed in AR performed for tumours of the lower third of the rectum in comparison with the more proximal level. CONCLUSIONS: The AA conclude that the choice of the right surgical procedure in the rectal carcinoma depends on the characteristics of the tumour and the conditions of the patients, provided that the oncologic indications were respected, because recurrence and survival rate are independent from the surgical approaches.

Surgical laparoscopy with intraoperative manometry in the treatment of esophageal achalasia.

The aim of this study was to describe and evaluate the laparoscopic treatment of esophageal achalasia in nine patients over a 35-month period. Five trocars were used to perform a Heller's myotomy to completely eliminate the cardial high-pressure zone, under manometric control. Intraoperative manometry also was used to calibrate a pick degrees 360 Rossetti's antireflux wrap. A complete regression of symptoms was observed postoperatively in seven of nine patients (77.8%); in two patients (22.2%) a moderate dysphagia persisted, but it disappeared 3 and 6 months, respectively. Only one intraoperative complication (esophageal perforation, recognized and laparoscopically repaired) occurred. At the present follow-up of 18 +/- 5.34 months (range 6-35), no dysphagia or symptoms related to reflux have been observed. Laparoscopic treatment of esophageal achalasia is considered a safe and effective procedure, and the results of this procedure are comparable with those of the open technique. Advantages common to other laparoscopic techniques are emphasized.

[Anorectal sphincter function after mechanical anterior resection in cancer of the rectum]. / La funzione sfinteriale ano-rettale dopo resezione anteriore meccanica per cancro del retto.

Out of a total of 365 operations for colo-rectal disease performed during the period 1980-1989 at the III and V Division of General Surgery of the 2nd Faculty of Medicine and Surgery of Naples, 181 (49.6%) patients had rectosigmoidal cancer: 95 (52.5%) underwent anterior resection and 86 (47.5%) Miles' operation. In 46 patients who underwent mechanical anterior resection during the period 1986-1989, pre and postoperative sphincter function was studied through a complete anamnesis, physical examination, sigmoidoscopy or colonoscopy and balloon manometry. All data were analyzed considering both the distance of the anastomosis from the anal verge and the patient age in order to stress possible relations with incontinence. The low incidence of incontinence registered after 12 months (6.5%), confirms the importance of manometry and rehabilitation, both necessary to improve the quality of life in old patients who undergo low anterior resection.

Hürthle cell neoplasm.

Hürthle cell neoplasms (HNC) of the thyroid gland are uncommon, but potentially malignant lesions. Opinion is divided as to their most suitable surgical treatment. In the ten-year period between 1976 and 1986, 46 patients with Hürthle cell tumor underwent surgery in our Department. Preoperative diagnosis was made by fine needle biopsy. In all cases but six, total lobectomy plus isthmusectomy was performed. In our experience HCC can be differentiated from benign forms by careful evaluation of invasive malignancy criteria performed by an experienced thyroid pathologist and by electron microscopy. In agreement with Bondeson et al. we found that lesions larger than 2 cm should not be considered potentially malignant, and do not warrant aggressive surgical treatment. Therefore, on the basis of our experience, we initially treat Hürthle cell tumors with hemithyroidectomy and isthmusectomy, and only if biopsy tissue shows histologic and electron microscopic signs of malignancy, do we resort to total thyroidectomy.