Strong impact of sarcopenia as a risk factor of survival in resected gastric cancer patients: first Italian report of a Bicentric study.

Gastric cancer (GC) accounts for 4% of all cancers in Europe. Sarcopenia is a complex syndrome characterized by a loss of muscle mass and function associated with age, often present in neoplastic patients. Recently, several studies have shown a significant association between sarcopenia and poor prognosis in various pathological conditions. The current observational retrospective study investigates the association between sarcopenia and overall survival (OS) and recurrence-free survival (RFS) in patients with GC undergoing up-front surgery with curative intent. Resected GC patients' clinical records and CT images were retrospectively assessed. The preoperative CT calculation of the skeletal muscle index (SMI) at L3 level allowed us to categorize patients as sarcopenic or not. Kaplan-Meyer and univariate and multivariate Cox regression analyses were performed to determine the difference in survival and presence of independent prognostic factors. Fifty-five patients, 28 male and 27 female, out of 298 studied for gastric cancer were enrolled in the current study from two cancer referral centers in Italy. The preoperative CT calculation of the SMI at L3 level allowed us to identify 39 patients with and 16 without sarcopenia. A statistically significant difference between the sarcopenic and non-sarcopenic groups was observed in both OS and RFS (p < 0.023; p < 0.006). Moreover, sarcopenia was strongly correlated to a higher risk of recurrence in univariate and multivariate analysis (p < 0.02). Sarcopenia can be considered a critical risk factor for survival in patients with resectable GC treated with up-front surgery. Identifying sarcopenic patients at the time of diagnosis would direct selection of patients who could benefit from early nutritional and/or physical treatments able to increase their muscle mass and possibly improve the prognosis. More extensive multicenter studies are needed to address this issue.

Tuberculosis, Brucellosis and Leucosis in Cattle: A Cost Description of Eradication Programmes in the Region of Lazio, Italy.

The eradication of tuberculosis, brucellosis and leucosis in cattle has not yet been achieved in the entire Italian territory. The region of Lazio, Central Italy, represents an interesting case study to evaluate the evolution of costs for these eradication programmes, as in some provinces the eradication has been officially achieved, in some others the prevalence has been close to zero for years, and in still others disease outbreaks have been continuously reported. The objectives of this study were i) to describe the costs for the eradication programmes for tuberculosis, brucellosis and leucosis in cattle carried out in Lazio between 2007 and 2011, ii) to calculate the ratio between the financial contribution of the European Union (EU) for the eradication programmes and the estimated total costs and iii) to estimate the potential savings that can be made when a province gains the certification of freedom from disease. For the i) and ii) objectives, data were collected from official sources and a costing procedure was applied from the perspective of the Regional Health Service. For the iii) objective, a Bayesian AR(1) regression was used to evaluate the average percentage reduction in costs for a province that gained the certification. The total cost for the eradication programmes adjusted for inflation to 1 January 2016 was estimated at 18 919 797 euro (5th and 95th percentiles of the distribution: 18 325 050-19 552 080 euro). When a province gained the certification of freedom from disease, costs decreased on average by (median of the posterior distribution) 47.5%, 54.5% and 54.9% for the eradication programmes of tuberculosis, brucellosis and leucosis, respectively. Information on possible savings from the reduction of control costs can help policy makers operating under budget constraints to justify the use of additional resources for the final phase of eradication.

Dynamic contrast-enhanced MR evaluation of prostate cancer before and after endorectal high-intensity focused ultrasound.

PURPOSE: The authors sought to determine the diagnostic performance of dynamic contrast-enhanced magnetic resonance (DCE-MR) imaging in the evaluation of prostate cancer before and after transrectal high-intensity focused ultrasound (HIFU) treatment. MATERIALS AND METHODS: We analysed 25 patients with prostate cancer. The prostate-specific antigen (PSA) value was evaluated 1, 4 and 6 months after treatment. DCE-MR imaging was performed the day prior to and 1, 4 and 6 months after HIFU treatment. Transrectal prostate biopsies were obtained at the time of diagnosis and 6 months after treatment. RESULTS: Before treatment, intraglandular lesions were considered to be potential sites of neoplasm and subsequently confirmed as sites of prostate adenocarcinoma in all 25 patients based on prostatespecific antigen (PSA) values and histological examinations (rho=1; p<0.001). Using histology as the gold standard, DCE-MR imaging displayed 100% sensitivity, 100% specificity, 100% positive predictive value and 100% negative predictive value before treatment. After HIFU treatment, DCE-MR imaging showed 100% sensitivity and 96% specificity. CONCLUSIONS: DCE-MR imaging can be used to visualise prostate adenocarcinoma. Several morphological and postgadolinium modifications in the follow-up DCE-MR images after HIFU treatment were also observed.

MR imaging of rectal cancer before and after chemoradiation therapy.

PURPOSE: This study was done to determine the diagnostic accuracy of magnetic resonance (MR) imaging in patients with rectal carcinoma by comparing post-chemoradiation MR imaging with pathological specimens. MATERIALS AND METHODS: We enrolled 39 patients with locally advanced rectal cancer. All patients received chemoradiation therapy before surgery and neoadjuvant chemoradiation therapy followed by MR imaging. MR images were analysed by a team of two expert radiologists unaware of the clinical and histopathological findings. RESULTS: Following neoadjuvant chemoradiation therapy, the analysis of MR images showed 23 (59%) patients with a rectal disease staged ≤T2 and 16 (41%) with a disease staged >T2. Post-treatment histological staging (TNM) revealed 13 patients with a disease >T2 and 26 patients with a disease ≤T2. Cohen's kappa to measure concordance between post-chemoradiation MR staging and histological response showed 83.6% concordance for disease confined to the serosa (≤T3): concordance was 97.22% for disease ≤N1 and 33.33% for disease >N1. CONCLUSIONS: MR imaging is critical for discovering T3 disease; moreover, morphological MR imaging does not always provide the opportunity to discern small residual cancer cells hidden in fibrotic tissue that could cause involvement of circumferential resection margin (CRM) on histology.

Parallel imaging and dobutamine stress magnetic resonance imaging in patients with atypical chest pain or equivocal ECG not suitable for stress echocardiography.

PURPOSE: The aim of this study was to evaluate the clinical utility of cardiac magnetic resonance imaging (MRI) with dobutamine stress in patients with atypical chest pain or equivocal electrocardiography (ECG) stress test, not suitable for stress echocardiography, using steady-state free-precession and parallel imaging technique. MATERIALS AND METHODS: Thirty-three patients (22 men, 11 women; mean age 62.4 years) underwent MRI with a 1.5-Tesla imager (General Electric, HD). We used an eight-channel phase-array dedicated coil. The MRI protocol included short-axis cine steady-state sequences with four-chamber parallel imaging of the left ventricle outflow tract at rest and after stress induction. Images were acquired 3 min after the intravenous injection of 5,10, 20, 30 or 40 microg/kg/min dobutamine. MRIs were analysed both at rest and at incremental dobutamine doses. Results were considered positive for coronary artery disease (CAD) if any new or worsening wall motion abnormality developed during the stress test. Twenty-two patients underwent coronary angiography; in the remaining ten, survival free from cardiovascular events over at least 9 months was considered as absence of disease. RESULTS: One patient presented severe hypertension at rest and was excluded from our study. We analysed 960 segments and observed appearance or worsening of kinesis in 29 different segments in seven patients. Seven patients were considered positive for CAD on the basis of new or worsening wall motion abnormalities during dobutamine stress, yielding an overall sensitivity of 85% and a specificity of 100% in CAD detection. CONCLUSIONS: Dobutamine stress cardiac MRI is an accurate method for assessing myocardial ischaemia in patients with CAD, and it could be useful as a noninvasive tool for excluding the disease. The increase in signal intensity and acquisition speed obtained by using steady-state free precession with parallel imaging proved useful in increasing test specificity with respect to previous similar studies.

[Mortality and morbidity of radical cystectomy for bladder cancer in patients over the age of 75]. / Mortalité et morbidité des cystectomies totales pour cancer de la vessie chez les patients de plus de 75 ans.

OBJECTIVE: The objective of this study was to evaluate the mortality and morbidity of cystectomy and the functional results of the associated diversions in patients over the age of 75 operated for bladder cancer. MATERIAL AND METHODS: From 1988 to 2002, 37 patients (29 men and 8 women) aged between 75 to 88 years (median: 79 years) underwent radical cystectomy for bladder cancer. All patients had at least one comorbidity factor, 17 patients were classified as ASA II (45.9%) and 20 were classified as ASA III and IV (54.1%). An external urinary diversion was performed in 35 patients and orthotopic bladder replacement was performed in two patients. The mean follow-up was 21.0 months (range: 0.3-88.6). The mortality, early and late morbidity, and functional results were analyzed. RESULTS: There was no intraoperative mortality and the early mortality rate was 5.4% (2/37). The early medical morbidity rate was 24.3%, essentially cardiovascular (pulmonary embolism, myocardial infarction, pulmonary edema), and the early surgical morbidity rate was 2.7%. The late morbidity rate was 27.0%, essentially corresponding to wound complications (peristomal or midline incisional hernias). In terms of functional results, a peristomal incisional hernia with stoma appliance difficulties was observed in 11.4% of patients with an external diversion. One of the two patients treated by bladder replacement performed intermittent self-catheterization and the other was continent during the day and required pads at night. CONCLUSION: This study shows that the acceptable mortality and early and late morbidity results allow radical cystectomy to be proposed in patients over the age of 75.

[Prognostic value of lymph node dissections in bladder cancer treated with radical cystectomy]. / Valeur pronostique du curage ganglionnaire lors des cystectomies totales pour cancer de la vessie.

OBJECTIVE: The objective of this retrospective study was to analyse the impact of lymph node invasion on survival after radical cystectomy for bladder cancer. MATERIAL AND METHODS: From 1988 to 2002, 192 patients underwent radical cystectomy for bladder cancer. Lymph node dissection was performed in 144 patients (75%) with bilateral pelvic lymph node dissection in 130 patients and extension to iliac chains in 14 patients. RESULTS: Lymph node dissection had no impact on medical or surgical morbidity. Lymph node invasion was demonstrated in 35.4% of cases (51/144). Tumour effraction of the lymph node capsule was reported in 70.6% (36/51) of pN+ patients. Lymph node invasion was reported in 16.7% of pT0 patients, 0% of pTa, pTis, pT1 patients and 40, 47 and 48% of pT2, pT3 and pT4 patients, respectively. The mean follow-up was 40.3+/-3.5 months (median: 26.6; range 0-207 months). Overall, specific and recurrence-free survivals were significantly influenced by lymph node invasion (p<0.0001, p<0.0001, p<0.0001, respectively) and capsular effraction (p=0.0021, p=0.0027, p=0.0113, respectively). CONCLUSION: Lymph node invasion and especially capsular effraction were significant prognostic factors of overall specific and recurrence-free survival.

[Surgical complications in kidney transplantation]. / Complications chirurgicales de la transplantation rénale.

Kidney transplantation has become the treatment of choice for patients with end stage renal disease since it offers an excellent quality of life. Moreover, the economic impact is considerable, particularly beyond the first year. Indeed, the annual cost of a successful renal transplantation is ten fold lower than haemodialysis. But surgical complications remain one of our main concerns. Surgical complications are various. They may be non-specific as haematomas, incision-induced hernias and wound infections. They may also be directly related to the procedure as vascular thrombosis and urinary fistula in the early postoperative period or arterial stenosis and ureteral obstruction in the late post-operative period. The accurate diagnosis and the appropriate management of these complications are the most important tasks for the surgical team. This review is based upon our experience in kidney transplantation and upon the medical published data.

[Hürthle cell tumor of the thyroid: which surgical approach?]. / Tumori a cellule di Hürthle della tiroide: quale tattica chirurgica?

Hürthle cell tumors are a very particular thyroid disease. Controversies exist about the most adequate treatment. Radical surgery is sometimes advocated also for benign lesions, due to their malignant potential, but conservative surgery is thought to be adequate in most cases. The Authors' experience consists of 8 Hürthle cell tumors: 7 adenomas and 1 carcinoma. The latter has been treated by total thyroidectomy and the patient died after 6 months. Adenomas have been always treated by conservative procedures and there is no recurrence at a 2-6 year follow-up.

A health examination of railway high-voltage substation workers exposed to ELF electromagnetic fields.

This is a cross-sectional survey on the health conditions of railways workers active in 258 interconnection and conversion substations all over Italy. Measurements performed in both kinds of substations operating at 220 kV have shown that maximum levels of the electric field strength and of the magnetic flux density at 50 Hz are of the order of 5 kV/m and 15 microT, respectively. Three subject groups, differently exposed (1, 10, 20 h/week), and an unexposed control group, for a total number of 627 workers, constitute the population at study. All subjects underwent a general medical examination, laboratory investigations, and a series of selected examinations relative to three systems (nervous, cardiovascular, and haematopoietic) considered at higher risk. No differences have been found between the exposed and the control groups. It is concluded that workers exposed to ELF electromagnetic fields of moderate strength do not show the presence of clear effects on their state of health.