Gastric cancer surveillance in a high-risk population in tuscany (Central Italy): preliminary results.

BACKGROUND/AIMS: The surveillance of subjects at high risk for developing gastric cancer (GC) may represent an effective strategy for reducing specific morbidity and mortality. The aim of this study was to identify GC at its initial phase and to identify precancerous lesions in a group of GC high-risk subjects. METHODS: We enrolled first-degree relatives of patients affected by GC who resided in a GC high-risk area (Tuscany, Central Italy). The study's protocol included the collection of several individual measurements, including a blood sample for the determination of specific biomarkers, an upper digestive tract endoscopy with detailed gastric biopsies and Helicobacter pylori (Hp) treatment followed by a specific check. RESULTS: We enrolled 167 subjects who were members of 128 different familial groups with GC history. We identified 1 case of initial-phase GC, 1 gastric dysplasia type II, 32 intestinal metaplasia, 10 gastric atrophy, and 21 atrophic chronic gastritis. 81 subjects were Hp-positive and underwent eradication therapy. CONCLUSION: This study of a GC high-risk Italian population reveals positive results in terms of population compliance, the identification of specific gastric lesions requiring close follow-up and successful therapy for Hp infection. To define future surveillance strategies, a longer follow-up of these patients is necessary.

Coronary artery bypass grafting in the awake patient: combined thoracic epidural and lumbar subarachnoid block.

High thoracic epidural anaesthesia has recently been proposed to perform surgical revascularisation with arterial grafts in awake patients. However, in high-risk patients with associated co-morbidity it is not always possible to perform complete arterial revascularisation. A technique which combines thoracic epidural and selective lumbar subarachnoid block is described, allowing harvesting of saphenous vein and complete surgical revascularisation in awake patients.

Evaluation of myocardial metabolism and function during beating heart coronary surgery.

Coronary artery bypass surgery on the beating heart either via a left anterior small thoracotomy (LAST) or a median sternotomy is becoming increasing popular world-wide. Concern still remains about the potential for a temporary regional myocardial ischaemia associated with the stabilisation and occlusion of the coronary during construction of the anastomosis. This review summarises the results of a series of studies intended to evaluate the effect of beating heart coronary revascularization on myocardial function, myocardial tissue injury and clinical outcome.

Short periods of regional ischaemia and reperfusion provoke release of troponin I from the human hearts.

Whether cardiac troponin I (cTnI) is better at detecting minor myocardial damage than other biochemical markers, is still controversial. In this report we monitored the response of the human heart to short periods of regional ischaemia and reperfusion (3 min each) by measuring cTnI release in the coronary sinus and the radial artery of patients undergoing coronary revascularisation surgery on beating heart without cardiopulmonary bypass. Our data show for the first time that the human heart releases significant amounts of cTnI in response to minor cardiac insults. However because of dilution, this release cannot be easily detected outside the coronary circulation. Therefore, an improved sensitivity of the assays used to measure cTnI may provide an ideal tool for assessing minor myocardial damage.

Intracoronary shunt prevents left ventricular function impairment during beating heart coronary revascularization.

OBJECTIVE: Beating heart coronary revascularization is becoming increasingly popular world-wide. Temporary occlusion of the coronary artery is often required in order to perform the anastomosis. An alternative method to maintain perfusion is to use an intracoronary shunt. In this study, we monitored global left ventricular function and regional wall motion in the presence or absence of a shunt using transesophageal echocardiography (TEE). METHOD: Left ventricular wall motion score index (WMSI), wall motion score (WMS) in the left anterior descending (LAD) coronary artery territory, and ejection fraction (EF%) were measured by multiplane TEE during construction of the left internal mammary artery (LIMA)-LAD coronary artery anastomosis in 40 patients undergoing revascularization with or without the use of a shunt. WMSI was assessed preoperatively, 1, 3 and 6 min during the construction of the anastomosis and after 5 min of reperfusion. WMS was assessed at 6 min during anastomosis and after 5 min of reperfusion. EF% was calculated preoperatively, 5 min into the construction of the anastomosis, and 5 min after reperfusion. RESULTS: During construction of the anastomosis, when the shunt was used, there were no changes in WMSI, WMS in the LAD territory or EF%. A significant decline in these parameters was seen in the group in which the shunt was not used, although on reperfusion all the values returned to baseline control. CONCLUSION: (i) occlusion of the LAD to perform the anastomosis results in temporary impairment in left ventricular function with complete recovery on reperfusion; (ii) the use of an intracoronary shunt presumably by maintaining myocardial perfusion prevents deterioration in ventricular function; (iii) from this data it seems therefore advisable to use an intracoronary shunt in patients with unstable angina, poor left ventricular function, or in cases in which a longer time to perform the anastomosis is anticipated.

An inexpensive method of heart stabilization during coronary artery operations without cardiopulmonary bypass.

A method of stabilization of the heart during construction of the distal anastomosis in coronary artery procedures without cardiopulmonary bypass is described. The technique exposes and immobilizes the coronary artery, allowing a precise anastomosis on the beating heart. In addition, it is simple, safe, and inexpensive.

Metabolic differences between hearts of patients with aortic valve disease and hearts of patients with ischaemic disease.

The hypertrophic hearts of patients with aortic valve disease are likely to have metabolic demands different from hearts with ischaemic disease. In this study we measured the myocardial concentration of ATP, ADP, lactate and 16 different amino acids in left ventricular biopsies collected from patients with aortic valve disease and from patients with ischaemic heart disease. Compared to hearts with ischaemic disease, hypertrophic hearts had significantly higher concentrations of ATP, but lower concentrations of lactate, branched-chain amino acids and alanine. These differences have important implications for energy metabolism and protein turnover in the two pathologies.

[Use of a 1:1 association of ampicillin and flucloxacillin in surgical patients (author's transl)]. / L'associazione ampicillina-flucloxacillina 1:1 nel paziente chirurgico.

This clinical trial was designed to assess the validity of an association of equal parts of ampicillin and flucloxacillin in surgical patients; the product was administered by injection in daily doses of 2-3 grams. In a group of 20 patients the same product was used prophylactically against infection, with positive results in 85% of the cases; the mean duration of treatment was 5 days. In 13 patients affected by urinary and biliary infections the product was effective. After a 7 days-therapy, 11 cases showed a marked improvement of the clinical symptomatology. Allergic cutaneous reactions (rashes, itching) appeared in five cases. No other side-effects had been noticed.