Quality of life among five-year survivors after treatment for very low rectal cancer with or without a permanent abdominal stoma.

BACKGROUND: Low rectal cancers situated less than 5 cm from the anal margin are still usually treated with abdomino-perineal excision (APE). Our aim is to compare the quality of life (QOL) of five-year survivors treated for low or very low rectal cancer with an advanced/complex coloanal procedure with the QOL of patients submitted to a standard APE with a definitive abdominal stoma. METHODS: Sixty-two patients, operated on radically for low or very low rectal cancer, who came for their fifth year follow-up visit and were free from cancer, were studied. Thirty patients (group 1) had an APE with permanent abdominal stoma. Thirty-two patients (group 2) had undergone a radical advanced and complex procedure to avoid the abdominal stoma. The patients received the European Organisation for the Research and Treatment of Cancer (EORTC) QOL-30 generic and the CR38 colorectal cancer QOL questionnaires with the recommendation to return the questionnaire to the hospital. The Mann-Whitney U-test and chi (2) Fisher test were employed for statistical analysis. RESULTS: All questionnaires were returned. Patients without a terminal abdominal stoma had a better score in six categories of the QOL 30 and in two categories of the CR38. No differences were observed in the other variables examined. CONCLUSIONS: After five years, cancer-free patients operated on for low or very low rectal cancer have a better QOL if a definitive terminal abdominal stoma was avoided.

Treatment of locally advanced hepatocellular carcinoma by hepatic intra-artery chemotherapy: a pilot study.

BACKGROUND: Hepatocarcinoma is one of the most common malignant tumours world-wide with poor prognosis. Treatment of locally advanced hepatocarcinoma is still controversial. Transcatheter arterial (chemo-)embolisation of hepatocarcinoma are widely used methods but some aspects regarding their use and usefulness have not yet been clarified. Systemic remedies have not yet been proven to affect patient survival. AIMS: To determine if intra-arterial chemotherapy with 5-flurouracil and folinic acid in locally advanced hepatocarcinoma is a viable alternative to existing therapies. PATIENTS: Twenty-four inoperable consecutive patients with locally advanced hepatocarcinoma were enrolled. They all underwent intra-arterial chemotherapy via a surgically implanted port-a-cath, and folinic acid (100 mg/m2) and 5-flurouracil (up to 550 mg/m2) were administered with a 1-week or a 2-week schedule. RESULTS: Nineteen patients completed the study: 2 showed a complete positive response, 11 a partial response, 6 stable disease, while 4 showed a disease progression. Median survival time was 19 (range 4-85) months. Child A patients showed a significant longer survival. CONCLUSIONS: Intra-arterial chemotherapy using folinic acid and 5-flurouracil may be useful in the treatment of locally advanced hepatocarcinoma in cirrhotic patients even in the presence of thrombosis. This treatment could be also useful in comparing transarterial chemoembolisation to a curative treatment.

[Umbilical endometriosis: report of a case and review of the literature]. / Endometriosi ombelicale: presentazione di un caso e revisione della letteratura.

The authors present a clinical of umbilical endometriosis in a young woman. This patient never underwent any operation or diagnostic abdominal procedures. The case is very interesting because of problems concerning differential diagnosis with other umbilical and periumbilical diseases and pathogenetic theories. In this study the authors suggest a hypothesis to explain the localization of ectopic endometrium in this site. We review the literature, with some comments on therapeutic options; finally we compare the medical and the surgical approach and we suggest an advisable therapy.

[Biofragmentable anastomosis ring (BAR) in surgery of the digestive system]. / Le anastomosi con l'anello bioframmentabile (BAR) in chirurgia dell'apparato digerente.

Twenty-six patients submitted to surgery using BAR in intestinal anastomosis have been studied. The results were compared with data of the literature concerning this device of anastomosis and about mechanical staplers and manual suture. The following data were taken into consideration: type of operation, type of anastomosis, average time of execution, complications, days of postoperative canalization and feeding, costs of three anastomosis types. Postoperative complications rate were 23% with a postoperative death rate of 7.6%. There was only one intraoperative complication during a colorectal anastomosis. The average time, to package an intestinal anastomosis using BAR, was 69.9 minutes. The average type of postoperative canalization was 3.7 days and average period in hospital was 10.3 days. The costs of manual suture, of mechanical staplers and of BAR are respectively L. 50,000, 1,340,000 and 583,000. BAR complications are similar to the other techniques; this study shows a reduction of operative time, postoperative canalization and period in hospital, with a consequent decreasing of global costs. The execution of intestinal anastomosis using BAR is easier then the other techniques, the learning time is least and the procedure is uniform. The introduction of this technique in the common operative practice together with manual suture and stapler is stressed.

Colonic cell proliferation in normal mucosa of patients with colon cancer.

Cell kinetics parameters have been analysed in colonic mucosa at different distances from a tumour in patients with colon carcinoma. Total cell number (TCN), 3H thymidine labelling index (TLI), mitotic index (MI), Goblet cell index (GCI) and the distribution of labelled cells along the crypt column (cell position frequency plot) were determined in well-aligned crypts. Total cell number, GCI and the labelled cell position frequency plots were similar in different samples from the same individual. A negative linear correlation between TCN and TLI was observed. The analysis of the cell position plots showed two patterns 1) with a high concentration in the bottom fifth of the crypt and 2) with frequent labelled cells at high positions. Whereas a negative correlation between overall TLI and the percent contribution to the TLI of the lowermost fifth was seen, the correlation was positive for the next 3 fifths and labelling was absent in the last part of the crypt.

[Etiopathogenic, diagnostic and therapeutic problems apropos of 2 observations of acute acalculous cholecystitis]. / Problematiche eziopatogenetiche, diagnostiche e terapeutiche a proposito di due osservazioni di colecistite acuta alitiasica.

The acute acalculous cholecystitis (A.A.C.) is a disease with high rates of morbidity and mortality and risk and promoting factors are very important. Pathogenesis has not completely explained, diagnosis is difficult, and there is no agreement on the more effective therapy. The authors present two cases of A.A.C. and one case of not true A.A.C., discuss them and conclude: 1. Parietal ischemia of gallbladder is the most important factor in the pathogenesis. 2. No many diagnostic procedures are necessary if one stress patient's history and clinical findings. 3. The emergency cholecystectomy is the best effective therapeutic procedure and only in selected cases the not invasive procedures are usefull.

Polyamine levels in healthy and tumor tissues of patients with colon adenocarcinoma.

Tissue polyamine levels were determined in patients with colon adenocarcinoma to try to identify biochemical indicators able to characterize the growth and the metabolism of human solid tumors. Polyamine content was determined in the tumor and in the "healthy" mucosa sampled at different distances within the resection edges. For each patient the polyamine content in the tumor was compared with that in the mucosa. The results demonstrated that the spermidine concentration was higher in the tumor than in the healthy mucosa; the differences were statistically significant. However, spermine in the tumor increased to a lesser degree. No statistically significant differences were observed among these mucosae at different localizations, but the spermine concentration in the mucosa after the tumor showed values very close to those of the neoplasia.

[Lipoma of the colon: apropos of 2 cases]. / I lipomi del colon: a proposito di due casi.

The lipoma of the colon is a rare benign tumour. The Authors describe two cases of colonic lipoma and stress diagnostic and therapeutic problems related to this condition. They also emphasize the importance of double contrast enema and colonoscopy associated to bioptic examination. The indication to lipomas removal is based on clinical remarks and differential diagnosis with adenomatous polyps. The modality of removal, where feasible for local conditions, should be preferably endoscopic.

Increase of the mitotic index of colonic mucosa after cholecystectomy.

This study was undertaken to assess possible modifications of the proliferative activity of colonic mucosa, which could be related to a suggested cancer-promoting role of cholecystectomy. The mitotic index (number of mitoses per 1000 gland cells) was evaluated in the colonic mucosa of 14 healthy subjects, 11 patients with cholelithiasis, before and 6 months after surgery, and 10 patients who had undergone cholecystectomy 2 or more years previously. The mitotic index of cholecystectomized patients was significantly higher than controls. It rose significantly within 6 months of cholecystectomy. The mitotic index of patients with cholelithiasis before surgery was similar to controls. These data suggest that cholecystectomy is followed by an enhancement in the proliferative activity of the colonic mucosa, which could play a cancer-promoting role.

[Cholelithiasis and carcinoma of the colon]. / Colelitiasi e carcinoma del colon.

It results cholelithiasis is very frequently associated to colorectal cancer. Clinical and autoptic studies thereabout result to be doubtful. In the present research, the Authors evaluated the proliferative activity of colonic mucous membrane, through the mitotic index, and the secretion of mucins, with histochemical methods, in control subjects and cholelithiasic patients. The results show no significant differences in both groups; the data obtained are discussed in the light of the importance of the biologic parameter considered in the evaluation of risk groups for colorectal neoplasms and, moreover, as morphologic support to the clinical question.

[Is cholecystectomy a risk factor in the development of gastric neoplasms?]. / La colecistectomia è fattore di rischio per lo sviluppo di una neoplasia gastrica?

Some studies suggest cholecystectomy and the cholelithiasic disease are frequently associated to some neoplasms of the digestive tract. Cholecystectomy, through the physiopathologic alterations it causes, seems to assume the role of factor of risk for the development of a gastric neoplasm. The authors reviewed their casuistry by analysing the percentages of subjects in whom the gastric neoplasm was associated to a previous cholecystectomy or a concomitant cholelithiasis. The data obtained do not support the hypothesis that cholecystectomy or the "lithogenicity of the biliary ducts" may be a factor of risk for gastric cancer.

[Cystic lymphangioma: etiopathogenetic and diagnostic considerations apropos of 2 cases]. / Il linfangioma cistico: considerazioni etiopatogenetiche e diagnostiche a proposito di 2 casi.

The authors show two cases of cystic lymphangioma, one located at the neck, the other in the inguinal region, both arising in aged patients. From the study of such cases, the Authors start for studying the etiopathogenetic and histologic aspects, dwell upon the clinics and diagnosis of such neoplasms, and indicate as the sole radical treatment the surgical extirpation.

Are postoperative fever and/or septic complications prognostic factors in colorectal cancer resected for cure?

The authors have examined the survival rate of 111 patients with colorectal cancer (Dukes' A, B, and C stages) treated by potentially curative surgery. In particular, the survival has been evaluated with regard to the appearance of postoperative fever and/or septic complications. The preliminary results demonstrate that these factors do not significantly influence the long-term prognosis.

Increase of the mitotic activity of colonic mucosa in patients with multiple non-familial adenomatous polyps.

A histological study of colonic mucosa, including the measurement of the mitotic index, was performed in routinely processed specimens from control subjects and patients with multiple non-familial adenomatous polyps, to ascertain whether the onset of adenomatous polyps was accompanied by an increase in mucosal mitotic activity as compared with controls. The mitotic index of both the polyps and the mucosa 20 cm from the anal orifice of the same patients was significantly (P less than 0.01) higher than that of control 20 cm from the anal orifice and a shift of the mitotic activity from the lower two-thirds to the upper third of glands was observed in the polyps. These data suggest that an increase of mitotic activity in the superficial third of the glands as compared with controls plays a pathogenetic role in the onset of adenomatous polyps and that this phenomenon is accompanied by a diffuse increase of mitotic activity in the deeper two-thirds of the glands.

Increase of mitotic activity in the colonic mucosa of patients with colorectal cancer.

A histologic and histochemical study of the colonic mucosa, including a study of the mitotic index, was performed in routinely processed specimens from control and tumor-bearing patients. A significant increase in the mitotic index (number of mitosis X 1000 gland cells), without concomitant modifications in the distribution of mitotic figures along the crypt depth, in mucosal thickness, or in mucin secretion, was demonstrated in the colonic mucosa of patients with colonic or rectal cancer compared with controls. The results point to an accelerated cell renewal in the colonic mucosa of tumor-bearing patients compared with the controls, without concomitant dysplasia. Results are discussed in the light of the possibility that an increased cell proliferation may have preceded the onset of tumor and played a role in the second step of carcinogenesis, i.e., tumor promotion, independently of dysplasia.

[Early observations of pancreatic ultrastructure during hemorrhagic necrosis in the rat with closed duodenal pouch]. / Prime osservazioni ultrastrutturali sulla necrosi emorragica del pancreas nel ratto con tasca duodenale chiusa.

Many problems are still unanswered in the pathogenesis of acute clinical and experimental pancreatic necrosis. A new technique which can be performed in the rat seems a suitable model for reflux pancreatic necrosis without artificial pressure changes in the ductal system. A closed duodenal loop is obtained with ligation proximal and distal to Vater's ampulla and a gastroenteroanastomosis is associated to avoid intestinal obstruction. All the rats die with hemorrhagic pancreatic necrosis in 36 hours. After 12 hours from the operation ductal and acinar lumina are enlarged. In the centroacinar and intercalated duct cells some lysosomes and mitochondria with clear matrix and reduced cristae are detected. Intercellular junctions in ducts and acini have normal morphology. In the basal cytoplasm of acinar cells some prominent autophagic vacuoles are detectable. After 24 hours in the acinar cells autophagic vacuoles are greatly increased and basal cytoplasmic degeneration often occurs, with plasmalemma and basal lamina interruptions. Intercellular junctions are apparently unaffected until cell necrosis sets in. In blood capillaries endothelial cells are swollen, fibrin thrombosis, hemorrhage and leucocyte infiltration are often detectable. As lysosomal activity occurs also in different kinds of experimental pancreatic necrosis, it could be a common pathogenetic factor, responsible for hydrolytic enzyme activation and for vascular damage in the early stages of hemorrhagic pancreatic necrosis.