Sex steroid receptors, secondary bile acids and colorectal cancer. A possible mechanism of interaction.

AIM: The aim of the work was to study in colon-rectum cancer mucosae the binding charateristics, as sex steroid receptors. METHODS: Specific androgen (AR), estrogen (ER) and progesterone (PgR) receptors were measured in the tissue samples of 35 patients (15 males, 20 females) undergoing colectomy or coloproctectomy for adenocarcinoma. The characteristics of androgen receptor (AR, DHT-R: dihydrotestosterone receptor) were also investigated using competitive activity of cyproterone acetate, cortisol, aldosterone and steroid-like substances such as deoxycholic and lithocholic acid, present in the milieu of the considered organ. Binding assays and competition tests were conducted using a charcoal dextran method. RESULTS: When present (50%), ER and PgR receptors showed very low levels and no difference was noted between cancerous and the surrounding healthy mucosa. AR were found in all samples from both neoplastic and non neoplastic surrounding mucosa, with no significant difference. Androgen receptor however exhibited an altered binding activity in cancer specimens. Cyproterone acetate did not displace DHT from AR while significant displacing activity was elicited by DHT, testosterone, as well as by lithocholic acid, but not by deoxycholic acid. CONCLUSION: In cancerous large bowel mucosa, androgen receptors show altered binding characteristics. The selective binding of lithocholic acid to AR supports the hypothesis that diet-related endoluminal substances may play a role in cancer development model where molecular alterations such as DNA damage or mutation is the 1st event.

[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.

[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.

[Perineal sarcoma. Report of a clinical case]. / Sarcoma perineale. Presentazione di un caso clinico.

The authors report a case of perineal leiomyosarcoma treated using a combined surgical and radiotherapy protocol. Exeresis was performed through an incision in the left anterior perineum, beside the vagina. The patient then underwent TCT with excellent results.

[Surgical treatment of alkaline and mixed reflux after surgical interventions on the stomach]. / Trattamento chirurgico del reflusso alcalino e misto dopo interventi chirurgici sullo stomaco.

The Authors report their experience in the surgical management of 13 cases of alkaline and/or mixed type gastroesophageal reflux (GER) secondary to gastric surgery. In 5 cases the gastroesophageal "diversion" "technique" proposed by the Authors, was used. Results obtained with this procedure (clinically and instrumentally evaluated) are presented.

Our experience with strictureplasty in the surgical treatment of Crohn's disease.

Strictureplasty is a recent surgical procedure that permits surgical cure of chronic intestinal strictures due to Crohn's disease without the need for bowel resection. The authors report the results of 19 stricture-plasties in eight patients, all of whom were affected by Crohn's disease in the chronic phase and showed subocclusive symptoms due to ileal strictures and fistulas. After surgery all patients improved, and none showed occlusive or subocclusive symptoms or signs of relapse after a mean follow-up of 16.5 months. Radiographic examination of the small bowel, when performed, showed normal transit in all patients. The authors stress the importance of performing strictureplasty only during quiescent periods of the disease and in patients in a good nutritional state, in order to avoid complications and recrudescences. If these requirements are met, stricureplasty can be very useful for saving bowel length in the surgical treatment of Crohn's disease.

Lateral high abdominal ovariopexy: an original surgical technique for protection of the ovaries during curative radiotherapy for Hodgkin's disease.

An original surgical method for gonadal protection in young women given pelvic radiation for Hodgkin's disease is presented. Lateral high ovarian transposition (LHAO) consists of the transposition of the ovaries into the paracolic gutter during staging laparotomy, after disconnecting the gonads from the fallopian tubes by dividing the tubo-ovarian vessels. The technique's effectiveness was assessed by a study using clinical investigation, radioimmunoassay (RIA) determination of sex hormones, and dosimetry; of 18 patients treated, 10 participated in the study. All but one have normal menses and hormone values, and one pregnancy occurred. We also calculated the doses absorbed by the ovaries and proved that, during inverted Y irradiation following LHAO, the ovaries are exposed to nearly one-half the dose they receive after traditional medial transposition. During subtotal nodal irradiation after LHAO, the irradiation dose is higher than after medialisation, but absolute values are minimal and castration is not induced.

A study of esophageal reflux following total gastrectomy with hepatobiliary sequential scintigraphy using TC-99m DISIDA.

A new technique to study esophageal reflux by means of hepatobiliary photoscintigraphy using TC-99m DISIDA was examined. The study was undertaken on 19 patients undergoing total gastrectomy without esophageal recurrence or hepatic or pulmonary metastases. The results of hepatobiliary photoscintigraphy were compared with the clinical, endoscopic and radiologic data. From this comparison it was demonstrated that photoscintigraphy is a non-invasive procedure which permits the study of the intestinal loops excluded from the transit of food but not of bile. Hepatobiliary scintigraphy was shown to be a reliable examination and the only one which demonstrates the reflux under physiological conditions, since the 24h. pH test in the absence of the stomach does not clearly prove the presence of alkaline reflux (bile) in an alkaline environment (esophagus). The disadvantages of photoscintigraphy are that the reflux is demonstrated only during the period of examination and in the patients undergoing total gastrectomy it is difficult to identify with accuracy the esophageal anastomosis. In these cases however, the radioactive bolus was used to localize the anastomosis and therefore to assess the esophageal reflux.