DNA sequences and proteic antigens of H. pylori in cholecystic bile and tissue of patients with gallstones.

BACKGROUND: Although Helicobacter pylori DNA sequences have been detected in cholecystic bile and tissue of patients with gallstones, controversial results are reported from different geographic areas. AIM: To detect H. pylori in cholecystic bile and tissue of patients with gallstones from a previously uninvestigated geographic area, southern Italy. Detection included both the bacterial DNA and the specific antigen (H. pylori stool antigen) identified in the stools of infected patients for diagnostic purposes. PATIENTS AND METHODS: The study enclosed 33 consecutive patients undergoing laparoscopic cholecystectomy for gallstones. DNA sequences of H. pylori were detected by polymerase chain reaction in both cholecystic bile and tissue homogenate. Moreover, we assayed H.pylori stool antigen on gall-bladder cytosolic and biliary proteins after their extraction. Bacterial presence in the stomach was assessed by urea breath test in all patients and Deltadelta13CPDB value assumed as marker of intragastric load. Fisher's exact probability and Student's t-tests were used for statistical analysis. RESULTS: DNA sequences of H. pylori in bile were found in 51.5% and significantly correlated with its presence in cholecystic tissue homogenate (P<0.005), H. pylori stool antigen in gall-bladder (P=0.0013) and bile (P=0.04) proteins, gastric infection (P<0.01) and intragastric bacterial load (P<0.001). No correlation was found, however, with sex and age of the patients. CONCLUSIONS: Our prevalence value of bacterial DNA in bile and gall-bladder of patients with gallstones agreed with that of the only other Italian study. The simultaneous presence of both bacterial DNA and proteic antigen suggests that the same prototype of bacterium could be located at both intestinal and cholecystic level and, therefore, the intestine represents the source of biliary contagion.

Right colectomy for cancer: validity of laparoscopic approach.

AIM: Laaroscopic assisted right colectomy for carcinoma is a procedure with demonstrated feasibility. We want to evaluate the advantages. MATERIAL: In the period 1999/2002 we have executed 7 laparoscopic right colectomy for carcinoma. We have compared the results with one group of 10 patients traditionally operated in the period 1998/2002. In both groups the oncologic staging was almost the same. RESULTS: Immediate results: operative time was 240' for laparoscopy vs. 150' for open operation; no anastomotic dehiscence for laparoscopy vs. 1/10 for open; no bronchopulmonary-thrombotic complications for laparoscopy vs. 2/10 for open, but there was 1/7 wound infection for laparoscopy vs. 1/10 for open; the return to the mobilization and normal diet was 3 days for laparoscopy vs. 7 days for open; the postoperative stay was 7 days for laparoscopy vs. 12 days for open. DISCUSSION: The two procedures did not condition differences neither in the extension of the resection and of the lymphectomy nor a different incidence of the anastomosis dehiscences. Differences were noted, in the operative time, in a more precocious mobilization with a minor use of analgesics, in a more rapid renewal of peristalsis and of feeding with a lower postoperative stay. These advantages are remarkable in our study, by reducing the postoperative morbidity. The very brief follow-up of almost 6 months, did not show a relapse of the disease in patients of both series. CONCLUSION: In our experience, laparoscopic-assisted right colectomy confirmed evident advantages in the immediate postoperative period for the treatment of the colonic cancer.

[Papillary carcinoma of the thyroglossal duct cyst: a case report]. / Il carcinoma papillifero della cisti del dotto tireoglosso: caso clinico.

The thyroglossal duct cyst is the most common anomaly in thyroid development. To date, approximately 250 cases have been reported, the majority being papillary thyroid carcinomas. In most cases the diagnosis is established only after excision of a clinically benign thyroglossal duct cyst. Controversies exist in relation to a rational and effective therapeutic approach. A further case of thyroglossal duct papillary carcinoma affecting a 52 years-old man is presented to highlight the clinicopathological features of this condition. FNAC resulted false negative. Surgery consisted in a Sistrunk procedure, followed by total thyroidectomy and central lymphectomy after definitive histological diagnosis. In view of the prolonged course of papillary carcinoma, long-term follow-up is mandatory.

[Para-aortic lymph node involvement in gastric adenocarcinoma]. / Envahissement des ganglions para-aortiques dans les adénocarcinomes de l'estomac.

AIMS: To determine the significance of superextended lymphadenectomy (D4) in patients with gastric cancer. The incidence of para-aortic lymph node metastases (N4) was analysed as well as its relationship to the site of the tumour. PATIENTS AND METHODS: The frequency of para-aortic lymph node metastases was assessed in 110 patients who underwent gastrectomy with D4 lymphadenectomy during the period from June 1988 to October 1999; five patients with plastic linitis and three with carcinoma of the gastric stump were excluded from the study. RESULTS: The postoperative mortality rate was 2.7% (n = 3) and the postoperative morbidity rate was 29.1% (n = 32). In our experience the most frequent postoperative complications were pancreatic fistulas (7.3%) and respiratory complications (6.4%). Among the 110 patients, the total number of dissected nodes was 5245 and the mean number of dissected nodes per case was 47.7. The total number of retrieved lymph nodes from the para-aortic station level was 639, with a mean number of 5.8 per patient. N4 nodal involvement was found in 20 (18.2%) out of 110 patients: 12 (33%) patients with a carcinoma located in the proximal third, two (6%) with a tumour located in the middle third and six (15%) with a carcinoma of the distal third of the stomach. CONCLUSION: The presence of para-aortic lymph node involvement in 18.2% of the patients suggests that D4 lymphadenectomy should be considered in the curative surgical treatment of advanced gastric cancer, especially if located in the proximal third of the stomach (N4 + in 33% of the patients).

[Clinical considerations on malignant carcinoids: bronchial, gastric, ileocolic involvement]. / Considerazioni cliniche sui carcinoidi maligni: a proposito di alcune osservazioni a localizzazione bronchiale, gastrica, ileocolica.

Six cases of malignant neuroendocrine tumours (3 bronchial, 1 ileocolic) are presented; diagnostic and clinical features, functional behaviour and the results of the treatment are discussed. Early functional manifestation (diarrhoea) was observed only in the first case of ileocolic tumour: in this patient the diarrhoea disappeared after the operation but further relapse occurred at the recurrence of the pathology. In the second ileocolic tumour diarrhoea with increased levels of 5 HT appeared later on, after the operation, expressing repeated disease. In one malignant bronchial carcinoid with early spinal secondary, the typical flushes appeared only after the explosion of metastatic spread. No functional disorders were observed in one patient with metastasis localised only in the bones. On the basis of actual knowledge the authors discuss the pathogenetic hypothesis of these events. Even though these experience limited, it may remark the importance of the quantity and quality of produced hormones, of the localization of metastasis in the liver and portal district and the unconstant production of clinical symptoms. The importance of A-chromogranin and of NSE as specific markers is discussed; the studies on the chromogranin have furthermore demonstrated the possible effect of the inhibitors of protonic pump on structural, hyper-dysplastic modification of gastric mucosa and this requires further investigation.

[Congenital cystic dilatation of the bile ducts: case report and review of the literature]. / Le dilatazioni cistiche congenite delle vie biliari: case report e revisione della letteratura.

Congenital cysts of the biliary tract are rare anomalies generally observed in pediatric age, exceptionally in adults. The different extension and the morphology of cystic lesions make possible a classification in subtype. This disease, of Len asymptomatic, is characterized by high incidence of complications such as pancreatitis, cholangitis, and cancer. For these reasons, congenital cystic dilatation of bile duct should be radically treated by complete resection of the dilated extraepatic biliary tract. A review of the International Literature and a rare case of congenite dilatation of the intra and extraepatic biliary ducts in a female 54 years old, treated by choledochal resection with hepatico-jejunostomy on Roux en Y segment, are presented.

[Comparison of hernioplasty using the technic of Bassini and Trabucco. Comparative analysis and results]. / Ernioplastica secondo Bassini versus Trabucco. Analisi comparativa dei risultati.

We evaluated comparatively trough a randomized perspective study the hernioplasty by Bassini technique and the Trabucco repair, respectively using general and local anaesthesia, in a group of 80 patients. We studied incidence of complications and recurrences, surgery, in-patient hospitalization time, postoperative pain, costs and work resuming. Trabucco repair had better results in each considered parameter: hospitalization time, pain and costs respectively 80%, 50% and 66% lower vs Bassini technique; moreover we found no recurrence and work resuming two weeks shorter.

[Intestinal occlusion caused by cecal carcinoid]. / Occlusione intestinale da carcinoide del cieco.

It is possible that carcinoids present themselves by a surgical emergency, without a <>. For these reasons, whenever a rational treatment is requested, an intraoperative diagnosis should be performed. In fact these neoplasms--owing to a less intense aggressiveness--present more indications to undergo surgery. In fact the authors report a case of caecum carcinoid characterized by the lack of typical symptoms of the homonymous syndrome. Urgent surgery was performed because of intestinal occlusion; the ileocaecal valve involvement caused the necessity of a large ileocolic resection with a L-L ileo-transverse anastomosis. The diagnosis of carcinoid was revealed only by the definitive histopathological examination.