Polyamines and estrogen-receptor concentrations in human colorectal carcinomas.

We assayed the estrogen receptors and polyamine levels (putrescine, spermidine and spermine) in the neoplastic and "normal" surrounding tissue of patients with colorectal cancer. Polyamine levels and the spermidine/spermine ratio were significantly higher in the neoplastic tissue than in the "normal" surrounding colonic mucosa of the same patients. Estrogen receptors were fewer in neoplastic mucosa than in the surrounding tissue, and polyamine levels were higher in estrogen-receptor negative tumours than in estrogen-receptor positive ones, although this was statistically significant only in the case of spermidine. Polyamine levels and estrogen receptor concentrations did not correlate with the tumour site, histological differentiation, or the age and sex of patients.

[Reconstruction of the digestive tract after total gastrectomy. A comparison of Roux anastomosis with Nakayama's beta-anastomosis]. / Ricostruzione del tratto digestivo dopo gastrectomia totale. Confronto tra anastomosi secondo Roux e beta-anastomosi secondo Nakayama.

Digestive tract reconstruction following total gastrectomy can be classified into two types according to whether the duodenal tract is excluded or preserved. Two groups of patients who underwent digestive tract reconstruction excluding the duodenal tract following total gastrectomy due to cancer were compared retrospectively: Nakayama's anastomosis was used in 20 patients (57%), and a Roux-en-Y anastomosis was performed in 15 (43%). The main technical difference between the two groups consists in the distance between esophagojejunostomy and jejunojejuno anastomosis: 20 cm in the case of Nakayama's technique and 50 cm in the case of the Roux-en-Y reconstruction. Results showed that 40% of patients with Roux-en-Y anastomoses were asymptomatic compared to 60% of patients with Nakayama's beta-anastomosis (chi-square test, p = 0.36). The most frequent symptom in patients with Roux-en-Y reconstructions was a feeling of postprandial fullness (33%), whereas pyrosis (25%) was the most common compliant in patients with Nakayama's reconstruction. Endoscopy revealed the presence of esophagitis in 35% of patients with Nakayam's beta-anastomosis compared to 6.5% in patients with Roux-en-Y anastomosis (chi-square test, p = 0.012). Results confirm that a minimum distance of at least 50 cm between the esophagojejunal and jejunojejunal anastomoses is decisive in reducing the frequency of reflux esophagitis after total gastrectomy.

[Colorectal carcinoma. A review of our cases]. / Carcinoma del colon-retto. Nostra revisione casistica.

A retrospective study was carried out on patients who underwent surgery for colorectal carcinoma between January 1980 and December 1987 in order identify additional prognostic factors. A total of 203 patients were studied. The probability of survival in relation to time and other variables (sex, age, stage of disease) was assessed using Cox's proportional method with the aid of an EPILOG III statistics pack. The overall 60-month survival rate was 55% and no difference was found between colon and rectum. The following factors were taken into account as prognostic markers: the site of the carcinoma (colon or rectum), sex, age, the tract of the colon involved (right, transverse, left and sigma colon) and the stage of disease. None of these parameters, with the exception of the stage of disease, were statistically significant. On the contrary, the division into stages of disease showed a statistically significant difference in the 60-month survival curve which fell from approximately 80% for stages A, B1, B2 and B3 to 50% for stage C and to 0% for stage D.

[Primary carcinoma of the gallbladder]. / Il carcinoma primitivo della colecisti.

Primary carcinoma of the gallbladder is still a controversial issue. The paper reports a series of 25 patients affected by carcinoma of the gallbladder, observed from May 1975 to October 1989. Patients presented symptoms which in most cases were similar to those of cholelithiasis. Instrumental tests enabled a preoperative diagnosis to be made in only 8 cases (32%). In the remaining 17 cases (68%), diagnosis was only possible during the operation following the histological examination of the affected part. Mean survival was 7.3 months. These findings are in line with those reported in the literature, from which it is clear that carcinoma of the gallbladder, even when identified using instrumental tests, cannot be treated by radical surgery except in a very small percentage of cases.

Composite carcinoid-adenocarcinoma of the stomach associated with multiple gastric carcinoids and nonantral gastric atrophy.

A case of multiple gastric carcinoids and nonantral atrophic gastritis in which the larger tumor was a composite carcinoid-adenocarcinoma is presented. The two components of the composite tumor immunohistochemically showed clear-cut diverging functional differentiations although the available evidence supported a common histogenesis from the metaplastic intestinal epithelium of the gastric mucosa. The carcinoid tissue of the composite tumor, which showed "atypical" features, also differed from the other, pure carcinoids, in which the histologic appearance was "typical." Total gastrectomy performed 1 month after the original gastric resection with antrectomy disclosed regressive changes in the endocrine cell proliferations of the gastric stump consistent with the withdrawal of a stimulating effect of the antral gastrin.

[CEA (carcinoembryonic antigen): its value as an early indicator of recurrence of neoplastic disease in carcinoma of the colon and rectum]. / C.E.A. (antigene carcino-embrionario): valore come indice precoce di ripresa della malattia neoplastica nel carcinoma colo-rettale.

A personal series is examined in order to assess the reliability of CEA in the diagnosis of returning colorectal cancer and to compare the data accumulated with reports in the literature with a view to establishing reliable criteria for the use and assessment of this test.

[Intestinal occlusion caused by ileo-colic invagination in a patient with intestinal metastasis of melanoma]. / Occlusione intestinale da invaginazione ileo-colica in un paziente con metastasi intestinale da melanoma.

An unusual case of intestinal obstruction due to ileal metastatic melanoma is reported. An ileocolic intussusception led to intestinal obstruction. The patient underwent palliative surgery to re-establish intestinal continuity.

[Diagnostic value of CEA in neoplasms fo the colon and rectum. Review of cases]. / Valore diagnostico del C.E.A. nelle neoplasie del colon-retto. Revisione casistica.

A personal series of colo-rectal tumours from 1979 to 1987 has been examined so as to check the validity of CEA as a marker in the diagnosis of these tumours. The data confirmed what has already been reported, namely its poor diagnostic sensitivity even though its utility for prognosis and in the follow-up of these patients remains confirmed, as is shown by the literature.

Gallstones and uterine fibroids.

In a series published in 1961, an unusual frequency of hysterectomies for uterine leiomyomas (fibroids) was reported in women with gallstones. The purpose of this study was to confirm the association between gallstones and uterine leiomyomas with a patient control study and to investigate its physiopathologic basis comparing the cholesterol saturation of bile in women with gallstones, in women with leiomyomas but no gallstones and in those in the control group with no gallstones or leiomyomas. Patients admitted to the surgical department have, routinely, echography of the gallbladder before and manual exploration of the pelvic floor during surgical intervention. For the first part of the study, we collected information concerning the diagnosis of leiomyomas from the operating room registers and about the diagnosis of gallstones from the clinical records. In 1982, 42 of 139 women operated upon consecutively for gallstones and five of 69 operated upon for other diseases of the gastrointestinal tract had leiomyomas, a statistically significant difference (chi-square test, p less than 0.001). This difference persisted stratifying women with gallstones and those in the control group for age. In the second part of the study, we examined the bile collected at duodenal drainage after gallbladder stimulation with cholecystokinin, in 11 young women with radiolucent gallstones (echography and cholecystography), in ten women with leiomyomas (gynecologic examination and pelvic echography) but no gallstones (echography) and in 11 women with no leiomyomas (gynecologic examination or pelvic echography) or gallstones (echography). Cholesterol, phospholipids and total bile acids in the biliary tract were analyzed with standardized enzymatic methods. The cholesterol saturation index of the biliary tract was higher in patients with leiomyomas than in those in the control group (Wilcoxon rank sum test, p less than 0.01) and similar to that of women with radiolucent gallstones. These data suggest that gallstones and leiomyomas are associated diseases, probably sharing a common cause.