[Surgical treatment and prognostic factors in colorectal cancer]. / Trattamento chirurgico e fattori prognostici nel cancro colo-rettale.

AIM: The aim of this study was to make a contribution to improve the care of patients with colorectal cancer by optimizing times and methods of the follow-up; particular attention is given to factors which may be important for the prognosis and for the quality of life in the immediate postoperative period. METHODS: The study includes all the patients with colorectal cancer who underwent laparotomic surgical treatment from 1996 to 2003. The total number of patients was 226 with an average age of 65 years; male to female ratio was 1.57:1. According to the stage of tumor, an adjuvant radiotherapeutic and/or chemiotherapeutic treatment was associated to surgery. RESULTS: On the basis of the preoperative staging and tumor localization, our patients underwent: 3 total colectomies, 57 right hemicolectomies, 137 left hemicolectomies, 6 Hartmann resections, 19 Miles resections, 4 transverse resections. CONCLUSION: The results obtained show that the 5-year overall survival is particularly influenced by the stage and the factors which directly or indirectly affect the primary tumor; thus the prognostic factors which should be considered for the survival and in the follow-up of these patients are: stage, grading and nodal involvement of the tumor.

[Relations between health and natural and artificial environment]. / Correlazioni tra la salute dell'uomo e l'ambiente naturale e costruito.

On June 2007 WHO issued their first report on impacts of environmental conditions on human health, "Country profiles of the environmental burden of disease". Data relevant to Italy indicate that health diseases caused by environment are 14%. Further papers demonstrated that, in highly technologically developed countries the air available in non industrial buildings (schools, offices, houses, etc.) is more polluted then the air outside and, adding to this that these are the places where population lives up to 90% of the time, this data highlight the importance and extension of the issue. This study recognize, thanks to the cross check of data from various international studies, a strong connection existing between health and psycho physic well-being of human being and a salubrious environment, outdoor and indoor; but, also, the existence of a vicious circle where the outdoor environment degradation lead to buildings indoor pollution and non eco-sustainable buildings new erections worsen the outdoor environment. The challenge for the future is to guard natural environment and to achieve buildings suitable for human being needs and demands and in harmony with natural environment.

[Subjective perception and comfort/discomfort ergonomic evaluation in school environment]. / Percezione soggettiva e valutazione ergonomica del comfort/discomfort in ambienti scolastici.

In order to carry out the present study a school place representative of the entire Italian school have been identified, an Institute within Rome province have been selected. The first step has been the measurement of the dimensional and structural features of the classrooms considered, their furniture and work-posts, also considering the activities carried on in the classrooms and their environmental conditions. Pictures and videos have been shot so as to have a deep analysis of the ergonomic level of the work-posts and, at the same time, an inquiry to understand the needs of the students with respect to the environment "classroom", the work-posts and didactical tools utilized, by means of a multiple answers questionnaire, drawing, and the implementation of the shared design method. Applying with the young users the creative sharing design method it have been produced the "diagnosis paper", where the problems and the criticalities relevant to the well-being and healthiness of the users of the school environment have been listed, and which allow to identify patterns, useful basis for future re-designs. The data obtained have been then the subject of an exact and deep analytical and statistical examination carried on by the multi-discipline.

Impact on the quality of remaining life of treatment with self-expandable metal prostheses in patients with inoperable esophago-cardial cancer. Results of a study of 107 consecutive patients treated with Ultraflex-type prostheses.

BACKGROUND: Self-expanding metal stents are a new alternative for palliation of esophagocardial malignancies. We evaluated the impact of these stents on the quality of remaining life in patients affected by inoperable esophago-cardial cancer. METHODS: Between September 1992 and September 1997, 102 patients underwent implantation of self expanding metal stents for palliation of dysphagia due to esophagene or cardial cancer (76 patients), or for locally recurrent carcinoma after surgery (14 patients), lasertherapy (13 patients) or radiotherapy (5 patients). Stents were implanted under radiological and endoscopic control in patients under mild sedation. RESULTS: Successful stent implantation was achieved in 102/107 patients (95.3%). Early complications were observed in 4.9% and per-operative mortality was 1.96%. After stent implantation the dysphagia score improved from 3.0, on average, to 0.5, on average. Late complications were evidenced in 25.5%. Weight gain was evidenced in 24.5% and the performance status improved in 14.3%. The mean survival time was 6.9 months. CONCLUSIONS: Self expanding metal stents are an effective alternative for palliation of malignant dysphagia due to esophageal and cardial cancers.

[Acute pseudoabdomen. A proposed nosographic picture]. / Pseudoaddome acuto. Proposta di inquadramento nosografico.

The authors put forward a new and original classification of the clinical pictures of acute pseudo-abdomen. They separate the cases due to extra-abdominal causes which are not marked by the essential features of acuity and severity from those which do not require surgery.

[Circumscribed peritonitis of colonic origin]. / Peritoniti circoscritte di origine colica.

The Authors present their personal experience of circumscribed peritonitis of colic origin. They review some physiopathological aspects of these peritonitis and then emphasize the new therapeutic possibilities offered by percutaneous prick echo or TC guided.

[Hepatic hemangioma: diagnosis and treatment]. / Emangioma epatico. Diagnosi e trattamento.

Cavernous hemangioma is the most common benign tumor of the liver. Most patients are asymptomatic and the tumor is discovered incidentally during diagnostics procedures, at laparotomy or at autopsy. Only 10% of hepatic hemangiomas reach dimensions that need surgical treatment. The role of surgical excision in their treatment has not been well defined. We report a careful examination of our casuistry and at the same time a study of the literature.

Hemangiomas of the large bowel. Report of a case.

This report concerns a 19-year-old man who complained of rectal bleeding of about one year's duration. Colonoscopy revealed a 10-cm segment of sigmoid colon characterized by the presence of multiple lesions identified as probable hemangiomas; one sessile dark tumor, 0.5 cm large, was snared endoscopically; histologic examination revealed a cavernous hemangioma. Three weeks later anterior resection was performed and histologic examination of the surgical specimen confirmed the diagnosis of hemangiomas.

Increased risk of surgery in undiagnosed celiac disease.

The diagnosis of celiac disease patients may be delayed by misdiagnosis. Our aim was to evaluate in celiac patients the prevalence of surgery before diagnosis. Two hundred forty-four adult celiac patients and 232 controls were retrospectively investigated for surgery before diagnosis of celiac disease. The prevalence of surgery was increased in celiac patients versus controls (P = 0.001). Frequency of appendectomy (P = 0.0001), tonsillectomy (P = 0.009), and hernia repair (P = 0.05) were increased in celiac patients versus controls. Appendectomy was related to anemia (P = 0.006) and abdominal pain (P = 0.005); tonsillectomy was related to diarrhea (P = 0.02) and weight loss (P = 0,04). Appendectomy was elective in 73% of celiac patients and in 46% of controls. Cosmetic surgery was increased in celiac patients versus controls (P = 0.058). In conclusions, surgery before celiac disease diagnosis is increased in celiac patients compared to controls, as a result of doctors' misdiagnosis and/or poor health status, which increases the demand for medical intervention. The frequency of cosmetic surgery in celiac patients may berelated to impaired psychological profile of patients.