Trend of Bacterial Uropathogens and Their Susceptibility Pattern: Study of Single Academic High-Volume Center in Italy (2015-2019).

Urinary tract infections (UTIs) are a very widespread infection that can occur in disparate age range, in both sexes and in pregnancy/menopause state. Treatment of UTIs is difficult due to the emergence of antibiotic-resistant bacterial strains. The present study shows five years of data collected on patients admitted at the University Hospital "San Giovann di Dio e Ruggi d'Aragona" in Salerno, Italy. The investigation exhibits the incidence of the infection, of the gender, and of the age group affected, identifying the most representative bacteria involved, drawing their profile of antimicrobial resistance. Bacterial identification and antibiotic susceptibility testing were performed using the VITEK 2 system. Among the 46382 studied patients, 9896 (21.34%) and 36486 (78.66%) were positive and negative for microorganism growth, respectively. Of 9896 positive patients, 6158 (62.23%) females and 3738 (37.77%) males were identified. The highest incidence of positive subjects (56.66%) was recorded in the elderly (>61 years). 8431 (85.20%) uropathogens were Gram-negative, 1367 (13.81%) were Gram-positive, and 98 (0.99%) were Candida species (Candida spp.). Escherichia coli (E. coli) and Enterococcus faecalis (E. faecalis) were the most representative Gram-negative and Gram-positive strains, respectively. The Gram-negative bacteria most representative were highly resistant to ampicillin, whereas among the Gram-positive bacteria, E. faecalis was highly resistant to gentamicin and streptomycin high level synergy, and Enterococcus faecium (E. faecium) to ampicillin, ampicillin/sulbactam, and imipenem. This retrospective work investigates the local epidemiological trend in our university hospital in order to induce an increasingly targeted empirical therapeutic approach for the treatment of UTIs.

Knowledge, experiences, and attitudes toward Mantoux test among medical and health professional students in Italy: a cross-sectional study.

BACKGROUND: The World Health Organization's Action Framework for tuberculosis elimination in low-tuberculosis incidence countries includes the screening for active and latent tuberculosis in selected high-risk groups, including health care workers. In this context, medical and health profession students, exposed to nosocomial tuberculosis transmission during training and clinical rotations, are target populations for tuberculosis screening. No updated data are available on tuberculosis screening practice and knowledge of medical and health profession students in Italy. METHODS: Within the activities Italian Study Group on Hospital Hygiene of the Italian Society of Hygiene, Preventive Medicine and Public Health, we carried out a multicentre cross-sectional study to assess knowledge, attitude and practices on tuberculosis prevention and control among Medical, Dentistry, Nursing and other health professions' students. Students were enrolled in the study on a voluntary basis and were administered a previously piloted structured questionnaire. Logistic regression models were applied to explore knowledge on tuberculosis prevention by selected socio-demographic variables and University-based tuberculosis prevention practice. RESULTS: Students of seventeen Universities across Italy participated in the study, and 58.2% of them received compulsory tuberculin skin test either at enrollment or while attending clinical practice. A total of 5,209 students filled the questionnaire. 37.7% were medicine and dentistry students (Group 1), 44.9% were nursing students (Group 2) and 17.4% were other health professions' students (Group 3). Age and gender had different distributions by groups, as well as knowledge and practice on tuberculin skin test. 84.4% of the study population (95% CI = 83.3-85.3) was aware of the existence of the tuberculin skin test, 74.4% (95% CI = 73.2-75.6) knew what is the first-level screening test for latent tuberculosis and only 22.5% (95% CI = 21.4-23.6) knew how to proceed after a positive tuberculin skin test result. Overall, knowledge on tuberculosis prevention was higher in Group 2 and lower Group 3, as compared to Group 1. CONCLUSION: In Italy, the knowledge on tuberculosis screening among University students is generally good. To reduce some of the criticalities found among the different study courses, it would be appropriate to harmonize both the regulations on tuberculosis screening practices for admission to University courses, and the educational activities on the topic of tuberculosis, to be extended to all workers involved in health care setting.

Subtotal gastrectomy for gastric cancer: long term outcomes of Billroth I reconstruction at a single European institute.

BACKGROUND/AIMS: The role of Billroth I (BI) subtotal gastrectomy (SG) for gastric cancer (GC) remains controversial in Western countries. The aim of the study is to critically analyze the long term outcomes of this procedure in a large single-institution experience. METHODOLOGY: Between 1990 and 2004, 158 patients underwent BI SG for GC at the Regina Elena Cancer Institute of Rome. Evaluation focused on cancer recurrence of the gastric stump, functional outcome and endoscopic findings. RESULTS: Actuarial survival rate 10 years after resection in stage I-II was 70.7 per cent. After curative resection, primary cancer of the gastric stump occurred in one patient seven years after resection (0.7 per cent), whereas two patients had early recurrence (1.4 per cent) one and three years postoperatively. There were no oesophageal cancers. In survivors, Visick grades I and II achieved 95 per cent, and postoperative endoscopy showed no evidence of mucosal changes in 85 per cent of the patients. Twelve per cent of the patients took acid blocker regularly, however, the incidence of functional failure was 5 per cent. CONCLUSIONS: In selected patients, Billroth I subtotal gastrectomy is a safe and effective procedure that provides long-term survival and very good functional outcome.

Laparoscopic versus open appendectomy for the treatment of complicated appendicitis.

AIM: Laparoscopic Appendectomy (LA) is widely performed for the treatment of acute appendicitis. However the use of laparoscopic approach for complicated appendicitis is controversial, in particular because it has been reported an increased risk of postoperative IntraAbdominal Abscess (IAA). The aim of this study was to compare the outcomes of LA versus Open Appendectomy (OA) in the treatment of complicated appendicitis, especially with regard to the incidence of postoperative IAA. PATIENTS AND METHODS: A retrospective study of all patients treated at our institution for complicated appendicitis, from May 2004 to June 2009, was performed. Data collection included demographic characteristics, postoperative complications, conversion rate, and length of hospital stay. RESULTS: Thirty-eight patients with complicated appendicitis were analysed. Among these, 18 (47,3%) had LA and 20 (52,7%) had OA. There were no statistical differences in characteristics between the two groups. The incidence of postoperative IAA was higher (16,6%), although not statistically significant, in the LA compared with OA group (5%). On the other hand the rate of wound infection was lower (5%) in the LA versus OA (20%). CONCLUSION: Our study indicated that LA should be utilised with caution in case of perforated appendicitis, because it is associated with an increased risk of postoperative IAA compared with OA.

Bronchodilator activity of (3R)-3-[[[(3-fluorophenyl)[(3,4,5-trifluorophenyl)methyl]amino] carbonyl]oxy]-1-[2-oxo-2-(2-thienyl)ethyl]-1-azoniabicyclo[2.2.2]octane bromide (CHF5407), a potent, long-acting, and selective muscarinic M3 receptor antagonist.

The novel quaternary ammonium salt (3R)-3-[[[(3-fluorophenyl)[(3,4,5-trifluorophenyl)methyl]amino]carbonyl]oxy]-1-[2-oxo-2-(2-thienyl)ethyl]-1-azoniabicyclo[2.2.2]octane bromide (CHF5407) showed subnanomolar affinities for human muscarinic M1 (hM1), M2 (hM2), and M3 (hM3) receptors and dissociated very slowly from hM3 receptors (t(½) = 166 min) with a large part of the receptorial complex (54%) remaining undissociated at 32 h from radioligand washout. In contrast, [(3)H]CHF5407 dissociated quickly from hM2 receptors (t(½) = 31 min), whereas [(3)H]tiotropium dissociated slowly from both hM3 (t(½) = 163 min) and hM2 receptor (t(½) = 297 min). In the guinea pig isolated trachea and human isolated bronchus, CHF5407 produced a potent (pIC(50) = 9.0-9.6) and long-lasting (up to 24 h) inhibition of M3 receptor-mediated contractile responses to carbachol. In the guinea pig electrically driven left atrium, the M2 receptor-mediated inhibitory response to carbachol was recovered more quickly in CHF5407-pretreated than in tiotropium-pretreated preparations. CHF5407, administered intratracheally to anesthetized guinea pigs, potently inhibited acetylcholine (Ach)-induced bronchoconstriction with an ED(50) value of 0.15 nmol/kg. The effect was sustained over a period of 24 h, with a residual 57% inhibition 48 h after antagonist administration at 1 nmol/kg. In conscious guinea pigs, inhaled CHF5407 inhibited Ach-induced bronchoconstriction for at least 24 h as did tiotropium at similar dosages. Cardiovascular parameters in anesthetized guinea pigs were not significantly changed by CHF5407, up to 100 nmol/kg i.v. and up to 1000 nmol/kg i.t. In conclusion, CHF5407 shows a prolonged antibronchospastic activity both in vitro and in vivo, caused by a very slow dissociation from M3 receptors. In contrast, CHF5407 is markedly short-acting at M2 receptors, a behavior not shared by tiotropium.

The insulin gene variable number of tandemrepeats (INS VNTR) genotype and sleep disordered breathing in childhood obesity.

Aim of our study is to verify the association between the genetic predisposition to hyperinsulinism due to the presence of the insulin gene (INS) I/I genotype and the development of sleep-related breathing disorders (SRBD) in obese children and adolescents. Two hundred and fifty-six obese children and adolescents (125 girls) have been investigated. As initial screening all subjects' mothers filled out the Sleep Disturbances Scale for Children (SDSC). The Sleep-Disordered Breathing (SDB) scale has been taken into account. Successively, a subgroup of 34 patients belonging to the first (14 children) and the last (20 children) SDB score quintiles underwent an overnight polysomnography and the apnea-hypopnea index (AHI) was evaluated. All subjects were genotyped for the INS VNTR and fasting insulin levels were evaluated. The population was divided into two groups according to the genotype: the first group was comprehensive of patients homozygotes for class I allele and the second group was composed by class III allele heterozygotes and homozygotes patients. Subjects I/I showed statistically signifIcant higher insulin levels (p<0.001) and SDB scores (p<0.001). Moreover, in the subgroup of patients investigated with polysomnography, class I homozygous subjects showed higher AHI compared to those patients carrying class III allele (p<0.001). Our data support the hypothesis that INS VNTR is associated with the development of SDB among obese children and adolescents.

New approach for evaluating the public health risk of living near a polluted river.

Chemical, physical and microbial analyses were conducted in the Sarno River basin to obtain a comprehensive description of the overall quality of the water bodies. The collection period lasted 12 months, between 2005 and 2006, with high frequency of sampling and analysis. More than 6,000 analytical determinations were performed on samples collected at six sampling points along the Sarno River and two points each on tributaries Solofrana and Cavaiola. The results indicated the presence of inorganic contaminants, which, in most cases, were below the Italian State water quality thresholds. The organic contamination showed an increasing trend, with respect to previous determinations, thus demonstrating the major contribution of untreated urban wastewater to the overall pollution of the river. Moreover, this study was designed to explore the correlation between the presence of microbial indicators of fecal contamination in Sarno River and their presumable presence in the aerosol surrounding the river, thus pointing to the possible environmental hazard associated with the presence of pathogens in the air.

First-line liver resection and salvage liver transplantation are increasing therapeutic strategies for patients with hepatocellular carcinoma and child a cirrhosis.

AIM: The present study focused on nine patients with hepatocellular carcinoma (HCC) associated with Child A liver cirrhosis undergoing first-line liver resection and salvage liver transplantation (SLT) for liver tumor recurrence. PATIENTS AND METHODS: Forty-six patients with HCC underwent liver transplantation (OLT); 37 (80.5%) were primary liver transplantations (PLTs) and 9 (19.5%) were SLTs. All patients who underwent SLT received minor transabdominal liver resections. RESULTS: The posttransplant 1-, 3-, and 5-year overall survival rates for SLT (88.9%, 88.9%, and 88.9%) were similar to those for PLT (78%, 62.7%, and 62.7%). Four (10.8%) patients in the PLT group had HCC recurrence, while there was zero recurrence in the SLT group. The 1-, 3-, 5-year disease-free survival rates for PLT (89%, 74%, and 74%) were similar to those for SLT (100%, 100%, and 100%). The 1-, 3-, 5-year disease-free survival rates after PLT were 89%, 74%, and 74%, and after SLT were 100%, 100%, and 100%, respectively. The operative mortality, intraperioperative bleeding, operative time, intensive care unit stay, in-hospital stay, and overall incidence of postoperative complications were similar in the two groups. CONCLUSIONS: In our experience, SLT for HCC is a feasible procedure with similar results in terms of overall survival, disease-free survival, and postoperative complications to those reported for patients who underwent PLT at our institute. An important role exists for SLT as shown by the fact that such a strategy has been used in the 20% of the patients undergoing OLT for HCC.

Modified liver hanging maneuver during orthotopic liver transplantation with inferior vena cava preservation: results after 120 consecutive applications.

The outflow venovenous anastomosis represent a crucial aspect during orthotopic liver transplantation (OLT) with inferior vena cava (IVC) preservation. The modified Belghiti liver hanging maneuver applied to the last phase of hepatectomy, lifting the liver, provides a better exposure of the suprahepatic region and allows easier orthogonal clamping of the three suprahepatic veins with a minimal portion of IVC occlusion. The outflow anastomosis constructed with a common cloacae of the three native suprahepatic veins is associated with a lower incidence of graft related venous outflow complications. The procedure planned in 120 consecutive OLT was achieved in 118 (99%). The outflow anastomosis was constructed on the common cloaca of the three hepatic veins in 111/120 cases (92.5%). No major complications were observed (bleeding during tunnel creation, graft outflow dysfunction, etc) except in one patient with acute Budd-Chiari, who successfully underwent retransplantation.

Liver transplantation in HIV-positive patients.

AIMS: The aim of this study was to evaluate the feasibility of liver transplantation (OLT) in human immunodeficiency virus (HIV), hepatitis C virus (HCV) coinfected patients in Italy. METHODS: Between September 2002 and April 2006, 12 HIV(+) coinfected patients (11 men, mean age 42 years) underwent OLT at our Institute. Eleven (91%) patients were HCV-positive and one was hepatitis B virus-positive. Pre-OLT plasma HIV 1-RNA level was undetectable and CD4(+) T-cell count >200 cells/microL for 3 months in all patients. Six patients had to stop highly active antiretroviral therapy (HAART) before OLT because of liver disease severity (n = 2) and for hepato cellular carcinoma (n = 4). RESULTS: The actuarial 1-, 2-, and 3-year survival rates were 83.3%, 58.3%, and 58.3%, respectively, which were significantly lower than those observed among HIV-negative patients transplanted in our center. Six patients are alive with a mean follow-up of 26 months (range: 5 to 46 months). We recorded a low rate of opportunistic infections and rejection. All alive patients have low levels of HIV RNA, and the CD4(+) T-cell counts increased after OLT. Nine patients developed early recurrence of hepatitis C requiring combination therapy with peg-interferon plus ribavirin. Significant improvement in the quality of life was observed in 7/11 patients. CONCLUSIONS: OLT in HIV-positive patients was feasible with good results in the short and medium term. Early severe HCV recurrence may be observed. Key challenges for the management of HIV(+) patients after transplantation included treatment of severe HCV recurrence and attention to the pharmacological interactions of HAART with immunosuppressive drugs.

Clinicopathological features and prognosis of gastric cancer in young European adults.

BACKGROUND: The aims of this study were to define the clinicopathological features and prognosis of gastric cancer in young European adults. METHODS: Between 1990 and 2004, 603 patients with gastric cancer were enrolled in a prospective database. The findings for 51 (8.5 per cent) patients aged 45 years or less were compared with those of 457 aged between 46 and 75 years. RESULTS: In the younger group there were significantly more women (57 versus 36.3 per cent; P = 0.004), Laurén diffuse-type carcinomas (73 versus 42.7 per cent; P < 0.001), N2-3 lymph node metastases (59 versus 38.9 per cent; P = 0.005), stage IV disease (49 versus 35.7 per cent; P = 0.085) and resections that were non-curative (36 versus 18.5 per cent; P = 0.007) than in the older patients. Actuarial survival rates in younger patients at 5 and 10 years after resection were 40 and 32 per cent respectively, similar to those in older patients (P = 0.540). Unfavourable prognostic factors associated with poor 5-year survival were the degree of gastric wall invasion (T3-4 versus T1-2; P < 0.001), lymph node invasion (positive versus negative; P < 0.001), disease stage (III-IV versus I-II; P < 0.001) and curability of resection (non-curative versus curative; P < 0.001). CONCLUSION: Gastric cancer in young adults tends to be more advanced; however, when matched for stage, the prognosis does not differ from that of older patients.

Surveillance of nosocomial infections: a preliminary study on hand hygiene compliance of healthcare workers.

The observance of hand hygiene compliance is important to reduce cross-infection by micro-organisms. The aim of this preliminary study was to evaluate the level of hand hygiene in healthcare workers from different departments, with particular emphasis on transient flora. The study was conducted in three departments (Surgery, Intensive Care Unit, Obstetrics and Gynecology) of a hospital in Campania, southern Italy. Over a six-month period, 50 healthcare workers were randomly tested. Imprints of palms and fingertips were taken monthly during the morning shift. The number of colonies per plate was counted and transient pathogens were identified. Risk factors for hand contamination were determined. Total flora was found in the following CFU means per palm and per five fingertips (95% CI): Obstetrics and Gynecology [palms 130 CFUs (95% CI 85-180); fingertips 125 CFUs (95% CI 92-160)]; ICU [palms 80 CFUs (95% CI 58-99); fingertips 62 CFUs (95% CI 45-82)]; Surgery [palms 75 CFUs (95% CI 41-120); fingertips 70 CFUs (95% CI 52-90)] Transient flora was found on 39% of healthcare workers' hands. The only factor associated with hand contamination by transient flora was the absence of gloving during healthcare procedure (P = 0.02).

Two-years surveillance of fungal contamination in three hospital departments in Campania region.

A two-years (2003-2005) fungal environmental surveillance was carried out in three departments of a hospital in Campania region (Surgery, Intensive Care Unit, Obstetrics and Gynaecology). Four operating theatres rooms and their relative areas of service and support, 4 patient rooms of intensive care unit, 1 delivery room, 1 labour room and 1 nursery of Obstetrics and Gynaecology were checked. A total of 12,120 surfaces and 2,904 air samples were collected in 24 monthly determinations. A seasonal variation in the fungal development was observed, in particular the lowest level of air and surface fungi contamination was found in winter and autumn whereas it was higher in spring and summer. In this study 30 fungal species were identified and, among these, the most frequent specie isolated was the Aspergillus spp. The results show an air contamination, expressed in percentage of positive determinations for Aspergillus spp, and the other fungi in the following percentages: Obstetrics and Gynaecology (25% and 33,3%); Intensive Care Unit (17% and 25%); Surgery (12.5% and 21%). For surfaces contamination it was found: Obstetrics and Gynaecology (67% and 75%); Intensive Care Unit (63% and 71%); Surgery (58.3% and 67%). This study shows that in the departments observed environmental fungi contamination is always present and therefore it would be necessary to apply environmental surveillance procedure and monitor the effectiveness.

Cystic pancreatic neoplasms: 12-year surgical experience.

Cystic pancreatic neoplasms have been increasingly diagnosed in the last years. Resection is recommended in most cases, but their management has not been standardized since an accurate nonoperative differentiation is often difficult. A retrospective review of 30 patients undergoing surgical resection for cystic pancreatic neoplasms between 1993 and 2005 was performed. Median age of the patients was 63 years and 63.5% were female. Twelve patients (40%) were asymptomatic. Twenty-nine had curative resections. Pathologic analysis revealed 13 serous cystadenomas, 9 mucinous cystadenomas, 3 mucinous cystadenocarcinomas, 4 intraductal papillary mucinous neoplasms and 1 solid pseudopapillary neoplasm. Overall mortality was 6.5% (2 patients). Postoperative complications occurred in 12 patients (41%). Pancreatic fistula occurred in 7 cases (24%). Reoperation was required in 2 patients (6.5%). Two patients operated for mucinous cystadenocarcinoma and invasive intraductal papillary mucinous neoplasms died of recurrence at 24 and 7 months postoperatively. Excluding another patient died from other cause, all others are currently alive with no evidence of disease. Diagnostic accuracy for cystic pancreatic neoplasms is still limited. Considering the good prognosis and acceptable morbidity and minimal mortality after surgical treatment in specialized centers, resection seems still justified in most cases.

[Isolated resection of the caudate lobe in metastasis of colorectal cancer]. / Resezione isolata del lobo caudato per metastasi da cancro colorettale.

The presence of metastatic lesions confined to the caudate lobe (CL or segment I) is quite a rare event. Even more rare is the decision to perform an isolate CL resection. Segmental resection in the liver is justified by the evidence that primary and secondary lesions, in early stage, are confined to the originating segment, and therefore a segmentectomy can be considered for the CL as well. Anatomy of the CL was deeply studied through the years since the surgical approach to this liver segment requires a detailed knowledge of its surgical anatomy and only after 1985 the surgical technique for CL isolate resection was established. We report our experience with 1 case of isolate colo-rectal metastasis confined to the caudate lobe and describe the surgical technique employed.

Pancreaticoduodenectomy for pancreatic metastatic melanoma.

Isolated pancreatic metastatic melanoma is a rare occurrence. Even more rare is the surgical treatment of this lesion. However, considering the lack of effective systemic treatment and the decreasing morbidity and mortality rates of pancreatic resections in specialized centers, selected patients, especially if symptomatic, may be considered for surgical resection to achieve good palliation or improve survival. We performed a pancreaticoduodenectomy in a patient with a bleeding pancreatic metastasis from cutaneous melanoma excised 10 years before and reviewed the recent literature.

[Benign hilar stenosis mimicking Klatskin tumor]. / Sténose inflammatoire de la convergence biliaire supérieure mimant une tumeur de Klatskin.

Preoperative diagnosis of hilar carcinoma (Klatskin tumor) is usually done according to the only clinical and imaging findings. However, in 5-15% of patients operated with this diagnosis, hilar stenosis is an inflammatory pseudo-tumoral benign one. We reported the case of a patient who underwent resection of common bile duct for suspicion of hilar carcinoma in whom, despite clinical and imaging findings highly suggestive of malignancy, pathologic examination revealed aspecific cholangitis. After a review of the literature, we conclude that resection of common bile duct is mandatory to exclude malignancy and allows excellent biliary drainage. Associated major hepatectomy should ideally be indicated, due to its higher risks, after pathological confirmation of cholangiocarcinoma, if necessary by frozen section.

Bile duct injuries during laparoscopic cholecystectomy: a 1994-2001 audit on 13,718 operations in the area of Rome.

BACKGROUND: Bile duct injuries (BDIs) during laparoscopic cholecystectomy (LC) still are reported with greater frequency than during open cholecystectomy (OC). METHODS: In 1999, a retrospective study evaluating the incidence of BDIs during LC in the area of Rome from 1994 to 1998 (group A) was performed. In addition, a prospective audit was started, ending in December 2001 (group B). RESULTS: In group A, 6,419 LCs were performed (222 were converted to OC; 3.4%). In group B, 7,299 LCs were performed (225 were converted to OC; 3.1%). Seventeen BDIs (0.26%) occurred in group A and 16 (0.22%) in group B. Overall, mortality and major morbidity rates were 12.1% and 30.3%, respectively, without significant differences between the two groups. CONCLUSIONS: The incidence and clinical relevance of BDIs during LC in the area of Rome appeared to be stable over the past 8 years and were not influenced by the use of a prospective audit, as compared with a retrospective survey.

Internet and information on breast cancer: an overview.

In the past few years, many Internet breast cancer resources have appeared, including medical journals and clinical trial registries. Examples of online breast cancer journals are the The Breast, The Breast Journal, and the Breast Cancer Research and Treatment. These have replicated the experience of general medical and cancer journals such as the British Medical Journal and the Journal of Clinical Oncology. One of the most important cancer registries is the Physician Data Query, which provides information on the National Cancer Institute's clinical trials, most of which are related to breast cancer. Medical guideline databases, institutional websites, medical associations, and non-profit breast cancer organizations provide users with information including news, calendars of international breast cancer events, clinical guidelines and abstracts presented at cancer and breast cancer meetings. Finding high-quality breast cancer literature and websites is relatively easy using appropriate indexes such as Cancerlit, MedlinePlus, and Cancerlinks.

Gastrointestinal stromal tumors of the stomach. A ten-year surgical experience.

Gastrointestinal stromal tumors show an increasing incidence. Immunohistochemistry is mandatory to make differential diagnosis with other mesenchimal tumors. We retrospectively reviewed 15 primary stomach GISTs operated during the last decade. Gastroscopy, Ultrasonography and CT scan were employed to obtain the diagnosis. Tumor size ranged from 1.5 to 30 cm in diameter. Treatment consisted of curative surgical resection without sistematic lymph node dissection. A wedge resection was sufficient in 8 cases. In 2 patients a distal subtotal gastrectomy was required and in 1 a total enlarged gastrectomy with pancreaticosplenectomy was performed. 4 GISTs were incidentally discovered and removed during surgical procedures for other gastrointestinal malignancies. In 4 cases a laparoscopic wedge resection was possible. In all cases postoperative course was uneventful. No adjuvant treatment was administered. Concerning the follow-up, two patients died for local and distant relapse while 13 are still alive (most of them operated during the last three years). GISTs show a very unpredictable clinical course and curative surgery is the only potential effective curative treatment.