[Gastro-intestinal stromal tumours (GISTs): prognostic and therapeutic features]. / Tumori stromali gastro-intestinali (GISTs): aspetti prognostici e terapeutici.

The prognostic factors may be different evaluated. The biological behaviour is only hypothetical, according to the duration of symptomatology, the site and size of the tumour, the presence of hemorrhagic or necrotic areas, the cytological modifications and, above all, the number of mytosis: 5 mytosis x 50 HPF are considered significant for malignancy. In last thirty years we have reported 40 GISTs, mostly gastric. All of them have been operated on with simple enucleation or organ resection. In the benign GISTs (26 pts) we have reported early mortality only in 5 cases; in the borderline forms (6 pts), in 4 rapidly evolving cases, the tumour had > 5 cm in size and the mytosis were > 5 x 50 HPF. Also in the malignant GISTs we have noted a good correlation between survival and clinical and histopathological findings. As well in this experience the biological behaviour of GISTs is difficult in interpretation. Anyway the dimensions, the genetic modifications and the number of mytosis are considered good indicators for malignancy. We have always indicated a surgical treatment, enlarged according to the invasion of adjacent organs.

Factors affecting prognosis in patients with short bowel syndrome.

Aim of the study is to analyse physiopathological implications of massive intestinal resection and factors affecting prognosis in patients with short bowel syndrome. Twenty massive intestinal resections were performed. The causes of bowel resection were: intestinal infarction (11 cases), Crohn's disease (5 cases), small bowel volvulus (4 cases). All intestinal resections were more than 50-60% of the intestinal length. In eighteen patients intestinal anastomosis was performed immediately. In all the patients postoperative therapy with parenteral nutrition (PN) was performed. The operative morbidity and thirty-day mortality were respectively 30% (6 cases) and 35% (7 cases). The diarrhea was the dominant symptom. The average weight was 20% lower compared to the initial weight. The length of residual small bowel and type of anastomosis strongly affect survival of patients underwent massive intestinal resections. Parenteral nutrition (PN) has great importance in postoperative treatment. A useful treatment, in severe short bowel syndrome, can be small bowel transplantation.

Sentinel lymph node biopsy for sparing axillary dissection in selected patients with breast cancer.

Axillary lymph nodal status in breast cancer remains one of the more important prognostic factors. In early breast cancer axillary lymph node metastasis are found only in 10-18%. It can be deduced that in all these patients a complete axillary dissection is an overtreatment. The concept of sentinel lymph node (SN) was applied to breast cancer. Of course if SN examination gives negative findings, the patient will avoid axillary lymphadenectomy. 134 patients with localized breast cancer were evaluated for enrollment into the study. In 40 (29.8%) patients lymphoscintigraphy was performed together with an injection of vital dye to identify the SN, in 94 (70.1%) only vital dye was utilized. The mapping procedure was successful in 129 cases (96.2%). In our study there was concordance between SNs and axillary nodes in 120 out off 124 cases (96.7%). The false-negative rate was 4.8% (4/83). The overall sensitivity of the SN biopsy was 91.1% (41/45), with a negative predictive value of 95.1% (79/83). Five patients had SN negative and they decided do not undergo axillary lymphadenectomy. This study demonstrates that accurate SN identification was obtained combining lymphoscintigraphy and blue dye. Moreover, each method requires a suitable learning curve. After an accurate training, complete axillary lymphadenectomy can be avoided in selected patients.

[Acute colonic pseudoobstruction: physiopathology and treatment]. / La pseudo-occlusione acuta del colon: fisiopatologia e trattamento.

The acute colonic pseudo-obstruction is a rare condition. Pathophysiological knowledges, nowadays, are still discussed. Several associated pathological conditions (cardiological, neurological, metabolic) would mainly cause, with different mechanisms, a sympathetic-parasympathetic imbalance. In Authors' experience with 19 patients the sudden onset and the rapid evolution to a serious condition set the difference with a mechanical obstruction. The radiological control was essential to the therapeutic options. The endoscopic decompression was successful in 2 cases; the tube cecostomy was effective in 13; the right emycolectomy was necessary in 1 case with multiple diastasic cecal perforations. Mortality rate: 3 patients (15.70%).