Impact of laparoscopy and ultrasonography in gastrointestinal malignancies.

BACKGROUND/AIMS: An adequate preoperative disease staging is highly required before surgical treatment, even in gastrointestinal malignancies. Our study wants to give a contribution in order to define echolaparoscopy weight in gastrointestinal tumors and its impact in surgical therapy. METHODOLOGY: 33 patients were affected by pancreas, 22 by stomach, 16 by extrahepatic biliary tract and 18 by liver cancers; every patient was considered worthy of radical or palliative surgery according to preoperative staging (thorax-abdominal CT and percutaneous ultrasonography). Paired sample t-tests were used to analyze the results of each methodical and probability values of less than 0.05 were considered significant. RESULTS: Preoperative instrumental examinations gave correct evaluations only in 44 of 89 cases (49%) while echolaparoscopic gave correct evaluations in 82 on 89 cases (92%) (P<0.05). So after echolaparoscopic in only 7 cases we performed an explorative laparotomy. CONCLUSIONS: Laparoscopy and ultrasound impact on therapy is worthy of attention. It seems to be able to give advantages in staging gastrointestinal malignancies, except for pancreas cancers, in which some limits and negative aspects have been demonstrated, regarding the possibility of giving correct diagnosis of portal axis infiltration.

Single pulmonary nodules: localization with intrathoracoscopic ultrasound -- a prospective study.

This prospective study, based on 13 patients with single pulmonary nodules of width between 10 and 30 mm, was performed to verify the utility of intrathoracoscopic ultrasound to localize the single pulmonary nodule. In all 13 cases the ultrasound examination was able to localize the position of nodules, but the homogeneous hypoechoic pattern of nodules observed in ten of 13 cases did not prove whether the lesion was benign or malign. In conclusion, we can confirm that intrathoracoscopic ultrasound examination is a safe, risk-free and less expensive method of localizing the single pulmonary nodules.

Malignant lymphoma complicating ulcerative colitis.

Carcinoma of the colon as a complication of chronic ulcerative colitis is relatively common, whereas malignant lymphoma is apparently rare. We report two cases of patients with malignant lymphoma complicating ulcerative colitis, a CD 30 + T-cell lymphoma of the intestine and a low grade B-cell non-Hodgkin's lymphoma of MALT type. It is important to be aware of the possibility of malignant lymphoma in ulcerative colitis in order to evaluate correctly any lymphoid infiltrate seen in a biopsy, especially when anti-inflammatory treatment seems to be ineffective or when symptoms change.

[The preoperative staging of rectal cancer. A comparative assessment between endorectal echography and pelvic CT]. / Stadiazione pre-operatoria del cancro del retto. Valutazione comparativa tra ecografia endorettale e TC pelvica.

The authors report a comparative study between endorectal ultrasonography (EU) and computed tomography (CT) in the preoperative assessment of 94 patients with rectal cancer. In evaluating the depth of wall penetration of rectal tumors EUS and CT offered good results: EUS confirmed a clear superiority with overall accuracy of 88.4% versus 80% of CT. On the contrary, in detecting lymph node metastases both techniques had poor results obtaining a correct diagnosis in 75.6% of the cases with EUS and in 69.4% of the cases with CT. In conclusion, the authors believe that EUS and CT may by very useful in the study of tumor penetration of the rectal wall; while in the study of lymph node involvement new techniques for a more accurate diagnosis are needed.

[Infectious chemoprophylaxis in colorectal surgery. A multicenter study of imipenem-cilastatin vs. cefuroxime and metronidazole or cefotetan]. / Chemioprofilassi infettiva in chirurgia colo-rettale. Studio policentrico su imipenem-cilastatina vs. cefuroxime e metronidazolo o cefotetan.

The authors report the results of a multicentric clinical study on prevention of surgical infections in colorectal surgery by chemo-antibiotic prophylaxis. This trial was carried on to evaluate the effect of imipenem-cilastatin (1 g i.v. just before operation and 1 g i.v. 3 hours from surgical procedure) vs. cefuroxime + metronidazole (1.5 g + 0.25 g i.v.) or cefotetan (1 g i.v.) given with the same modalities. In 48 patients undergoing colorectal resection (47 with malignant neoplastic disease) 24 were treated with imipenem, 18 with cefuroxime and 6 with cefotetan. In group A (imipenem-cilastatin) the infection rate was 4.2% (1/24 cases), in group B (cefuroxime + metronidazole or cefotetan) postoperative infections were registered in 4 out of 24 cases (16.6%). This study documented the good results of systemic chemoprophylaxis and the great efficacy of imipenem-cilastatin in colorectal surgery.

[Postoperative biliary calculosis: our experience with therapeutic strategy]. / La calcolosi biliare post-chirurgica: nostra esperienza in tema di strategia terapeutica.

The Authors report their experience in the treatment of 92 cases of post-surgical biliary tract stones: 17 early cases (18.5%) were treated by percutaneous nonsurgical extraction (10 cases) or by operative procedures (7 cases); 75 late cases (81.5%) were surgically treated. The Authors summarize the results of the treatment, discussing advantages and disadvantages of the various techniques.

[Use of imipenem-cilastatin in antibiotic therapy and prevention in general surgery. One year of clinical experience]. / L'uso dell'imipenem-cilastatina nell'antibioticoterapia e nella profilassi in chirurgia generale. Un anno di sperimentazione clinica.

The authors report one year of clinical experience with imipenem-cilastatin, first antibiotic of thienamycin class, in the therapy and prophylaxis of postoperative infectious diseases. One hundred thirty four patients were treated with antibiotic therapy and 10 days after in 98.5% of cases a clinical remission of the disease was obtained; only in 2 patients the effect wasn't evaluable because they died for not drug-related causes. The prophylactic use of this antibiotic was limited to 34 patients with high risk of infectious diseases; only 3 cases (8.8%) showed bacterial contamination and one of them had clinical signs of disease which indicated the absolute need for antibiotic therapy. The Authors also emphasize the excellent results, the tolerability of the drug and the absence of side-effects.