Extended lymphadenectomy in elderly and/or highly co-morbid gastric cancer patients: A retrospective multicenter study.

BACKGROUND: Gastrectomy with extended lymphadenectomy is considered the gold standard treatment for advanced gastric cancer, with no age- or comorbidity-related limitations. We evaluated the safety and efficacy of curative gastrectomy with extended nodal dissection, verifying survival in elderly and highly co-morbid patients. METHODS: In a retrospective multicenter study, we examined 1322 non-metastatic gastric-cancer patients that underwent curative gastrectomy with D2 versus D1 lymphadenectomy from January 2000 to December 2009. Postoperative complications, overall survival (OS), and disease-specific survival (DSS) according to age and the Charlson Comorbidity Score were analyzed in relation to the extent of lymphadenectomy. RESULTS: Postoperative morbidity was 30.4%. Complications were more frequent in highly co-morbid elderly patients, and, although general morbidity rates after D2 and D1 lymphadenectomy were similar (29.9% and 33.2%, respectively), they increased following D2 in highly co-morbid elderly patients (39.6%). D2-lymphadenectomy significantly improved 5-year OS and DSS (48.0% vs. 37.6% in D1, p < 0.001 and 72.6% vs. 58.1% in D1, p < 0.001, respectively) in all patients. In elderly patients, this benefit was present only in 5-year DSS. D2 nodal dissection induced better 5-year OS and DSS rates in elderly patients with positive nodes (29.7% vs. 21.2% in D1, p = 0.008 and 47.5% vs. 30.6% in D1, p = 0.001, respectively), although it was present only in DSS when highly co-morbid elderly patients were considered. CONCLUSION: Extended lymphadenectomy confirmed better survival rates in gastric cancer patients. Due to high postoperative complication rate and no significant improvement of the OS, D1 lymphadenectomy should be considered in elderly and/or highly co-morbid gastric cancer patients.

Colored grounds of gilt stucco surfaces as analyzed by a combined microscopic, spectroscopic and elemental analytical approach.

A survey of gilts applied to stucco surfaces that specifically focuses on the compositions of their colored grounds is reported. Gilt samples of a common geographical (Lombardy in Italy) and temporal provenance (17th-18th century) were studied in the form of polished cross-sections by optical and electron microscopy (SEM-EDS), micro-Raman (microRaman) spectroscopy and Fourier-transform infrared microspectroscopy (microFTIR). Comparing samples with superimposed grounds and gilts enabled light to be shed on the choice of specific materials, their stratigraphic functions, decorative effects, and technological performances. Iron oxide pigments were found in the older grounds, sometimes in the presence of lead white (2PbCO(3).Pb(OH)(2)) or minium (Pb(3)O(4)). In more recent grounds, chrome yellow (PbCrO(4)), chrome orange (PbCrO(4).PbO), cinnabar (alpha-HgS) and barium white (BaSO(4)), invariably mixed with lead white, were encountered. Evidence for the use of organic mordants (colophony and wax, or siccative oil) was obtained by microFTIR. This combined microFTIR and microRaman spectroscopic and elemental (SEM-EDS) analytical approach enhances knowledge of the composition of gold grounds, their variability and their chronological evolution.

Role of basal ganglia and ectostriatum in the context-dependent properties of the optocollic reflex (OCR) in the pigeon (Columba livia): a lesion study.

The possible participation of basal ganglia and associated structures [dorsal striato-pallidum, nucleus spiriformis lateralis (SpL), ectostriatum] in the elaboration of the optocollic reflex (OCR) was investigated by making bilateral chemical lesions (ibotenic acid). Previous data have shown that both the slow and fast phases of the OCR are dependent on the behavioural context. The slow phase velocity (SPV) and the peak velocity of fast phases obtained in non-flying pigeons ('resting condition') were enhanced in pigeons in which a flying posture was experimentally provoked ('flying condition'). Therefore, the effect of lesions was analysed in pigeons standing in the 'resting' or 'flying' condition. In the 'resting' as in the 'flying' condition, all the lesions provoked a decrease in SPV, which augmented with the stimulation velocity. Velocity step stimuli revealed greater OCR deficits than velocity ramp stimuli. Extensive lesions (including the striato-pallidum, ectostriatum and a part of the neostriatum), as well as SpL lesions, provoked a greater SPV decrease over a longer time than lesions restricted to the striato-pallidum or the ectostriatum. The peak velocity of fast phases was only reduced by the 'extensive lesion' in the 'flying condition'. The present data show that the basal ganglia system is involved in the elaboration of optokinetic responses and suggest that, to work in an optimal range, the optokinetic centres need to receive integrated information from basal ganglia in addition to direct visual input.

Characteristics of slow and fast phases of the optocollic reflex (OCR) in head free pigeons (Columba livia): influence of flight behaviour.

The effect of behavioural context on the properties of slow and fast phases of the horizontal optocollic reflex (OCR) were investigated in head free pigeons for two situations, i.e.: (i) animals were hung in a harness ('resting condition'); (ii) animals were additionally submitted to a frontal airflow that provoked a flight posture ('flying condition') [Bilo and Bilo (1983) J. Comp. Physiol., 153, 111]. A 'transient flight' was also provoked in the 'resting condition' by tapping the breastbone region. Stimuli consisted either of velocity steps (30-300 degrees/s) or of an increasing velocity stimulus (0-300 degrees/s). The amplitude of nystagmic beats and the OCR gain increased in the 'flying condition' and during 'transient flight' as compared to the 'resting condition'. The OCR working range was considerably extended toward high velocities by the flying behaviour. In the 'resting condition', spontaneous head oscillations generally triggered a high-gain OCR, close to that obtained in the 'flying condition'. One-third of the animals showed a higher gain in response to an increasing velocity stimulus than with step stimuli, in the high velocity range. The linear relation between amplitude and peak velocity of OCR fast phases was independent of the stimulation velocity in the 'resting condition', whereas the amplitude and peak velocity increased with the stimulation velocity in the 'flying condition'. In this condition, the fast phase velocity was correlated with the slow phase velocity, but not with the retinal slip velocity. Thus, both the slow and fast phases of the OCR are dependent on the behavioural context.

Oculocardiac reflex and postoperative vomiting in paediatric strabismus surgery. A randomised controlled trial comparing four anaesthetic techniques.

BACKGROUND: Oculocardiac reflex (OCR) and postoperative vomiting are major complications of paediatric strabismus surgery. METHODS: Children (3-16 yr) undergoing elective strabismus surgery as inpatients were randomly allocated to four anaesthetic techniques: (A) thiopentone induction and isoflurane maintenance; (B) as (A) plus ondansetron 5 mg x m(-2) i.v.; (C) propofol induction and maintenance; (D) as (C) plus lignocaine 2 mg x kg(-1) i.v. All children received prophylactic atropine 0.02 mg x kg(-1) and alfentanil. Nitrous oxide was omitted. RESULTS: Data on 157 children were analysed. The cumulative incidence of vomiting within 6 and 24 h after surgery with thiopentone-isoflurane was 26% and 46%, respectively. Adding ondansetron decreased the incidence to 8% and 33%, respectively. This improvement was significant within 6 h only; the number-needed-to-treat was 5.5 (95% CI 2.9-46). Propofol was not different from thiopentone-isoflurane. The addition of lignocaine to propofol was of no benefit. The risk of an OCR was significantly increased with propofol (incidence 40%) compared with isoflurane (14%); the number-needed-to-harm was 3.9 (95% CI 2.6-8). CONCLUSIONS: Thiopental-isoflurane-air/O2-alfentanil resulted in a moderate risk of vomiting. Adding ondansetron significantly decreased this risk, but 6 children have to be treated for one to benefit in the early postoperative period. Propofol and propofol-lignocaine showed no benefit on vomiting but significantly increased the risk of an OCR despite high-dose prophylactic atropine.

Low incidence of the oculocardiac reflex and postoperative nausea and vomiting in adults undergoing strabismus surgery.

PURPOSE: To investigate the incidence of the oculocardiac reflex (OCR), and of postoperative nausea and vomiting (PONV) in adults undergoing strabismus surgery. METHODS: Adults (18-86 yr) undergoing inpatient strabismus surgery received 10 micrograms.kg-1 atropine and 10 micrograms.kg-1 altentanil iv and were randomly allocated to: (A) 5 mg.kg-1 thiopentone iv, isoflurane/N2O maintenance; (B) 3 mg.kg-1 propofol iv, propofol/N2O maintenance (10-14 mg.kg-1.hr-1); 3 mg.kg-1 propofol iv, propofol/air/O2 maintenance (10-14 mg.kg-1.hr-1). Analyses were with the number-needed-to-treat/harm. RESULTS: In 97 adults the absolute risk of OCR (13-20%) and PONV (21-31% after 24 hr) was low, with no differences between groups. Number-needed-to-treat to prevent PONV with propofol with or without N2O compared with thiopentone-isoflurane was 7 to 11. Number-needed-to-harm for one OCR with propofol compared with thiopentone-isoflurane was 17. CONCLUSION: Adults undergoing strabismus surgery with prophylactic atropine had a low risk of OCR and PONV, independent of the anaesthetic technique used.

Cytomegalovirus retinitis: decreased risk of bilaterality with increased use of systemic treatment. Swiss HIV Cohort Study Group.

Cytomegalovirus (CMV) retinitis may be treated systemically or intravitreally. We reviewed retrospectively patients with CMV retinitis, in order to determine whether systemic treatment was associated with less spread of CMV retinitis from one eye to the other. Of 222 cases, 92 patients had bilateral disease at onset of CMV retinitis, leaving 130 for analysis. Bilaterality occurred in 10 patients during 12,687 days of systemic treatment and in 34 during 14,791 days without systemic treatment (odds ratio [OR] = 2.92; confidence interval [CI], 1.44-5.90). Patients who had received systemic treatment for <50% of the follow-up period had a greater risk of bilaterality (OR = 3.7; CI, 2.79-4.54) than did the more intensively treated patients. CD4 cell levels also contributed to increased risk, but multivariate analysis showed that CD4 cell counts and treatment intensity were independent risk factors. CMV retinitis was more likely to become bilateral in patients who received less intravenous therapy. Local treatment can complete but does not replace systemically administered therapy.

Characteristics of cervico-ocular responses in the chameleon.

The cervico-ocular reflex (COR) was investigated in the chameleon. Two kinds of responses were observed by oscillating the body (sine-wave stimuli) in the fixed-head animal: a "smooth response" of very low gain (around 0.08) and a saccadic response composed of 1-12 saccades per cycle of stimulation (depending on the stimulation frequency). Both responses were elicited in the compensatory direction (same direction as the stimulation) and exhibited a frequency dependence with low-pass properties. The saccadic response was especially developed and displayed a higher gain (up to 0.4) than the smooth response. In darkness, the saccades were triggered near the zero point (head-body alignment), whereas in the presence of a fixed visual surround they were elicited more regularly throughout the stimulation cycle. The amplitude of saccades was increased in the light. Consequently, the gain and the phase lag of the saccadic response were enhanced by the visual input. No visuo-cervical interaction was observed for the smooth response. Oscillating the body at a constant velocity (seesaw or ramp stimuli) revealed a frequency effect on the number of saccades (during a cycle of stimulation), but not on the gain of the response. Increasing the amplitude of oscillations augmented only very slightly the amplitude of saccades and consequently decreased the gain. Hence, the best working range of the saccadic response corresponds to body or head movements of low amplitude (up to +/- 20 deg) and low frequency (up to 0.25 Hz), and is improved by a visual input. These properties are discussed on a comparative point of view. It is proposed that, in chameleons, the saccadic response could contribute to gaze stabilization and add to the vestibulo-ocular and the optokinetic responses.

Developmental, nutritional, and hormonal regulation of the pancreatitis-associated protein I and III gene expression in the rat small intestine.

BACKGROUND: The pancreatitis-associated protein (PAP) I and III, but not PAP II, mRNAs are constitutively expressed in the small intestine of rats. METHODS: We studied expression of both PAP I and PAP III mRNAs during development and on nutritional and hormonal manipulations. RESULTS: Between day 20 of gestation and day 21 of age, PAP mRNAs could barely be detected. Their concentrations increased dramatically from day 21 to day 45 of age and remained constant thereafter. Rats adapted to a diet with low carbohydrate content showed a significant decrease in PAP mRNA concentrations. Finally, whereas thyroidectomy and ovariectomy induced a decrease in both mRNA concentrations, and adrenalectomy a limited decrease in PAP III mRNA only, diabetes and castration did not alter the expression of either gene. CONCLUSION: Gene expression of PAP I and III mRNAs is regulated in a coordinate manner in the rat small intestine during development and on nutritional and hormonal manipulations.

[Diagnostic aspects and frequency of retrocorneal precipitates in diagnosis of cytomegalovirus retinitis in the HIV+ patient]. / Aspect et fréquence des précipités rétrocornéens lors du diagnostic de la rétinite à CMV chez le patient VIH+.

Cytomegalovirus retinitis (CMV) is the most common ocular opportunistic infection seen in patients with acquired immune deficiency syndrome. The anterior segment is usually quiet or with minimal aqueous humour flare and cell reaction. Nevertheless, in this prospective study of 30 eyes with CMV retinitis, 22 (73%) had white, small and filamentous keratic precipitates (KPS) which seem to corroborate this inflammation. The positivity of the KPS depends upon the extent of CMV retinitis.

[Prosthetic repair of hernias and laparocele. Our experience with Goretex prosthesis]. / La riparazione protesica delle ernie e dei laparoceli. Nostra esperienza con protesi di Goretex.

For about ten years repair of inguinal or abdominal hernias using prosthetic materials has been in routine use in general surgery. Various experimental and clinical observations of surgical physiopathology have been proved that the most important cause of recidivation is abnormal tension between diastasis tissues. From the beginning of 1991, in the Surgical Department of "Clinica S. Anna" in Pomezia (Rome), we have been using tension free technique. Goretex was preferred versus other prosthetic devices because of our experience in vascular surgery. Hundred-fifteen operations have been carried out; 23 for ventral hernias, 92 for inguinal and femoral hernias. The age of patients varied from 18 to 69 years. Localization of inguinal hernias was indirect in 48 cases, direct in 16 an associated in 13; 9 were recidive and 3 bilateral, 3 femoral hernias. Abdominal wall hernias consisted of 12 epigastric localizations, 8 hypogastric and 3 pararectal. All cases of abdominal and bilateral hernias were operated under general anesthesia with orotracheal intubation. Inguinal hernias were treated with local (pubivacaine 0.5%, 1:2 with physiologic solution) or spinal anesthesia, except for 2 cases operated in total anesthesia. As regards surgical technique, the objective pursued was that of filling up the parietal defect with a patch of the same form fixed with a non absorbable suture in Goretex 2/0. The peritoneum was not opened in abdominal hernias, if not necessary, because prosthetic devices must not touch directly the small and large bowel; patches have been positioned between the peritoneum and transversalis aponeurosis. For inguinal hernias Rives' technique was used. Goretex patches were cut with "no-touch" technique.(ABSTRACT TRUNCATED AT 250 WORDS)

[Update on laparoscopic surgery: on the treatment of hydatid cyst of the liver and peritonitis caused by a perforated duodenal ulcer]. / Attualità in tema di chirurgia celioscopica: a proposito del trattamento di una cisti idatidea del fegato e di una peritonite da ulcera duodenale perforata.

Laparoscopic surgery represents a real innovation with respect to the traditional laparotomic way of access, owing to its undeniable advantages, both intraoperative and postoperative. This new technique reduces the complications connected with the surgical wound and with forced allerement. Therefore it allows the patient's fast recovery. Laparoscopic surgery application ground get's wider and wider every day: in fact, the authors report two medical cases, one of elective surgery (treatment of a hidatid cyst of the liver) and the other in emergency surgery (peritonitis due to perforated duodenal ulcer), both obtaining a positive result about the clinical and the postoperative timing of recovery.

Visual and vestibular reflexes that stabilize gaze in the chameleon.

Spontaneous eye movements as well as visual, vestibular, and proprioceptive cervical reflexes which contribute to gaze stabilization were investigated in the chameleon using the magnetic search-coil technique. The oculomotor range of each eye was very large (180 deg horizontally x 80 deg vertically). Spontaneous ocular saccades were independent in the two eyes and could have very large amplitudes. The fast phases of nystagmus during the stabilization reflexes were also independent in the eyes. In the head-restrained condition, optokinetic nystagmus (OKN) had a low gain in both horizontal and vertical planes (0.35 at 5 deg/s) and showed little binocular interaction. The vestibulo-ocular reflex (VOR) exhibited a low gain (0.2-0.3 from 0.05-1 Hz) and a high-phase lead at low frequency (140 deg at 0.05 Hz). Rotation of the animal in the presence of a visible surround increased the overall gain of gaze stabilization to 0.4-0.5 (P < 0.01) and considerably reduced the phase lead (38 deg at 0.05 Hz). In the head-free condition, head and eye reflexes were active simultaneously during both optokinetic and vestibular stimulation, but nystagmic head movements appeared only occasionally with a rather loose eye-head coordination. During optokinetic stimulation, eye movements contributed more than head movements to gaze stabilization, whereas, during vestibular or visuo-vestibular stimulation, the relative contribution of eye and head responses varied with stimulus frequency. When the head was freed, overall gain for gaze stabilization increased from 0.35 to 0.45 (P < 0.05) for optokinetic stimulation at 5 deg/s and from 0.2-0.3 to 0.4-0.75 (P < 0.001) for vestibular stimulation at 0.05-1 Hz.(ABSTRACT TRUNCATED AT 250 WORDS)

A gene homologous to the reg gene is expressed in the human pancreas.

We have determined the nucleotide sequence of regl a human genomic DNA fragment homologous to the reg gene which is expressed in the exocrine pancreas and regenerating islets. Sequence comparisons of reg and regl suggested similar exon-intron organisation. Based on this assumption, specific oligonucleotides for regl exons were used to demonstrate expression of the regl gene in pancreas and liver. The proteins encoded by reg and regl comprise 166 amino acids and differ by 22 amino acids only.

Topical timolol maleate might adversely affect serum lipoproteins.

Conflicting observations have been reported about the effects of topically administered timolol maleate on serum lipoproteins. We therefore considered this issue in a series of eight glaucoma patients receiving timolol maleate. Cholesterol and triglycerides were measured in plasma and in low-density lipoproteins (LDL), and high-density lipoproteins (HDL), both before and following three months of treatment. Following the treatment, the mean atherogenic index was increased from 2.72 to 3.38 (p = 0.012). This suggests that the atherogenic index should be determined before and during timolol maleate treatment in high-risk cardiovascular patients.

Human regeneration protein/lithostathine genes map to chromosome 2p12.

The pancreatic stone protein (lithostathine) secreted by the exocrine pancreas is an inhibitor of CaCO3 crystal growth. This protein, which is also present in endocrine pancreas, has also been called the regeneration protein (reg). Here we report the mapping of the REG gene to chromosome 2 using the polymerase chain reaction for the specific amplification of human reg sequences in rodent/human somatic cell hybrid DNA. A regional assignment has been made by in situ hybridization to metaphase chromosomes using two different fluorescently labelled genomic probes corresponding to the REG gene and a related gene REGL. Both probes hybridized to chromosome 2p12 suggesting the tandem organization of these genes.