Breast cancer cellular proliferation indexes and 99mTc-sesta Mibi capture: what correlation?

Aim of this study was to verify existing correlations between breast cancer 99mTc-sestaMIBI cells uptake and their cytological characteristics. Forty-five patients with clinically and/or mammographically suspect breast cancer were enrolled. In all patients 99mTc-sestaMIBI scintimammography was performed and malignant lesions were detected in 44 cases and benign in one case. In positive uptake (PU) lesions with diameter <1.5cm, 85.7% showed a high tumor grade (II-III degrees) while in negative uptake (NU) lesions with diameter <1.5cm, 100% showed a low tumor grade (I degrees). In PU lesions, 70% had expressed a high value of Ki 67, while 100% of the NU lesions showed normal values. In this series, tumor diameter does not play a basic role, while the correlations between uptake and the histological grade (G) and/or cellular kinetics (Ki67) seem to be more important. Further studies are needed to confirm our present results.

[Gasless laparoscopic cholecystectomy. Our experience with 130 cases compared with 450 cases treated with the CO2 technique]. / Colecistectomia laparoscopica gasless. La nostra esperienza su 130 casi confrontati con 450 casi trattati con la tecnica con CO2.

Alongside the technique based on the creation of an abdominal cavity for surgery following the introduction of gas (usually CO2) into the peritoneal cavity, a new method has been developed. This involves the use of an atraumatic mechanical lifting device connected to the same abdominal wall (gasless laparoscopy). The authors report a technique that uses an inflatable cushion inserted into the abdomen through a periumbilical incision. The cushion is connected to an external motorized hydraulic jack fixed to the operating table, fitted with an electric motor and friction gear. Between May 1991 and June 1998, 580 patients underwent laparoscopic cholecystectomy. Since December 1995 a total of 130 patients have undergone surgery using gasless laparoscopy. Shoulder pain and pain in the upper abdominal quadrant were no longer reported; pain was present in 70% of the patients operated using the CO2 technique. There was also a marked reduction in the anesthesiological risks, above all in elderly patients with cardiopulmonary insufficiency. Surgical manoeuvres are made easier owing to the possibility of using traditional surgical instruments. Washing and continuous aspiration allow a good control of intraoperative hemostasis, and reduce the phenomenon of lens misting without the risk of losing pneumoperitoneum. Less visibility of the surgical field was reported, particularly in obese patients, above all because of the reduced diaphragmatic distension and the lack of displacement of the intestinal loops. In the authors' opinion the gasless technique is suitable above all in patients affected by cardiopulmonary disorders in whom hypercapnia might represent a significant operating risk.

Severe steroid-unresponsive ulcerative colitis: outcomes of restorative proctocolectomy in patients undergoing cyclosporin treatment.

PURPOSE: The recent introduction of the immune suppressor cyclosporin for treatment of steroid-refractory ulcerative colitis has required surgeons to perform a colectomy in those patients who eventually fail this rescue treatment, thus raising questions as to the safety of surgery as performed in patients with a heavily manipulated immune system. To assess the rates of mortality and morbidity in this setting, we studied a cohort of consecutive patients who had surgery after failing cyclosporin for refractory ulcerative colitis at our center. METHODS: Between January 1991 and December 1996, 25 patients with ulcerative colitis underwent restorative proctocolectomy performed in three steps (21 patients) and in two steps (4 patients). Seventeen of the 25 patients (68 percent) were initial nonresponders to a dose of 2 mg/kg/day of intravenous cyclosporin and underwent surgery immediately, the remaining 8 (32 percent) relapsed as outpatients on oral cyclosporin and were readmitted for surgery. RESULTS: There was no operative mortality. Nine patients of the 25 developed postoperative (early) complications (36 percent). The three-step operation subset had a 28 percent complication rate, the two-step 75 percent. Three patients needed reoperation. A total of 11 patients (44 percent) reported with late complications: two patients required surgical treatment, one for obstruction and one for pouch-perianal fistula. Three cases of pouchitis were recorded. No patient required pouch removal. CONCLUSION: Given the absence of postoperative mortality and a low overall complication rate, restorative proctocolectomy can safely be performed in patients who fail rescue treatment with a dose of 2 mg/kg of cyclosporin for steroid-refractory ulcerative colitis. Corollary evidence in this article hints but does not prove that the three-step procedure is safer than the two-step operation.

[Cicatricial stenosis of colorectal anastomosis. Transanal treatment with circular stapler]. / Stenosi cicatriziale dell'anastomosi colorettale. Trattamento transanale con stapler circolare.

Anastomotic strictures complicating colorectal anastomoses can be difficult to treat. This condition must not be considered as an uncommon complication. In 20% of patients it may be a serious state that may require a therapy. Two patients treated successfully without complication with the transanal use of an CEEA stapler are presented. The staple cutter is safe and easy to use, and except for a conventional anoscope, no special equipment, including fluoroscope, is needed. On the basis of the successful results obtained, the procedure using staple cutter is recommended for the treatment of anastomotic stricture of the rectum.

[Breast carcinoma and the axillary lymph node status: the use of 99mTc-sestamibi scintimammography for the diagnosis and preoperative staging. Preliminary results]. / Il carcinoma mammario e lo status linfonodale ascellare: uso della 99mTc sestaMIBI scintimammografia a scopo diagnostico e stadiativo prechirurgico. Risultati preliminari.

BACKGROUND: The purpose of this study is the sensitivity and specificity evaluation of the 99mTc-sestaMIBI scintimammography (SMM) in the diagnosis and pre-surgical staging of patients with clinical and/or radiological suspicion of breast cancer. MATERIALS AND METHODS: Forty-five patients with clinical and/or mammographic breast cancer suspicion were enrolled. Prone lateral views of both mammalian glands and anterior of chest, to evaluate the axillary lymph node infiltration, were acquired 60 min after i.v. injection of 20-25 mCi of 99mTc-sestaMIBI. RESULTS: Breast cancer was diagnosed by histological findings in 44 patients; benign disease in 1 case. The tumors diameter ranged from 0.3 to 4 cm. The SMM sensitivity in the detection of breast cancer was 90% and the VPP was 100%. The smallest diameter in these detected lesions was 0.5 cm. The pathologic examination showed metastatic axillary involvement in 15 patients. The SMM sensitivity in the detection of axillary lymph node metastases was 75%, specificity was 90%. For each lesion grading, mitosis number, 67Ki expression, diameter, were considered and correlated to 99mTC-sestaMIBI uptake. The 5 breast cancer non-uptake cases had low cytoproliferative indexes. According to our data it is possible to observe that there is a correlation between uptake and cellular proliferation. CONCLUSIONS: The 99mTc-sestaMIBI SMM is a highly accuracy test in the breast cancer detection. The sensitivity in the axillary lymph node metastatic detection is just little below average according to the literature; it is possible that the results can improve with higher accrual of patients, operator experience and equipment improvement and the using of SPECT.

Nutritional patterns in elderly patients with dementia of Alzheimer type.

Body weight and some nutritional serum parameters (albumin, urea nitrogen, creatinine, glycemia, hemoglobin, total cholesterol, triglycerides, potassium) were analyzed in 44 subjects aged over 60 in order to evaluate weight loss and its possible link with the progression of dementia. Patients were consecutively admitted to our Day Hospital with the complaint of psychogeriatric symptoms. They all were living at home, no one presented risk factors for malnutrition and their cognitive impairment did not exceed the 4th degree of GDS (Global Deterioration Scale). Subjects were divided into two groups on the basis of diagnosis at discharge: (i) Possible or probable dementia of Alzheimer type (30 subjects, mean age 72.1 +/- 5.9 years), (ii) Age-associated memory impairment (14 subjects, mean age 73.6 +/- 6.2 years). One year later, a second control of body weight and nutritional parameters was performed. Differences between these latter measures versus the initial values were not significant when analyzed in the total group of demented patients or in the subgroups with different degree of cognitive impairment and physical activity. A possible hypothesis to explain the absence of differences among groups is that the caregivers were very carefully looking after all the patients examined.

[Superior mesenteric artery syndrome after surgical correction of severe dorso-lumbar deformities. Authors' experience]. / La sindrome da compasso aorto-mesenterico dopo correzione chirurgica delle gravi deformità del rachide dorso-lombare. Nostra esperienza.

The authors report two cases of superior mesenteric artery syndrome observed in 22 operations for severe spinal deformities. Medical, dietary and postural treatment enabled the situation to be resolved in one case; whereas an intestinal derotation according to Strong-Valdoni was successfully performed in the other. The various surgical alternatives are discussed.

[Osteodystrophy in thalassemia major]. / Osteodistrofia nella talassemia major.

Subjects with thalassemia major frequently have bone disorders of debatable pathogenesis. We attempt here to analyze the relationships between siderosis and thalassemic osteodystrophy by assessing calcium-phosphorus balance, hormone-vitamin homeostasis, osteoblastic-osteoclastic activity parameters, and bone mineral density (BMD) in 30 patients with thalassemia major (16 males, 14 females, age range 17-30 years). We found a significant increase in ferritin (p < 0.001) and significant decreases in serum i-PTH, 25OHD3, 1.25(OH)2D3, osteocalcin, estradiol, testosterone and FT4 (p < 0.001) in both sexes. In all patients a net decrease of bone mineral density was documented (p < 0.001). These results were then submitted to linear regression analysis: positive correlations between BMD and FT3, testosterone, estradiol (p < 0.01), were documented, and an inverse correlation between osteocalcin and ferritin was confirmed. Our findings suggest that thalassemic osteodystrophy is the result of several inhibitory influences on osteoblastic activity and bone apposition (related to hormone deficits and siderosis) which are aggravated further by anemia, chronic hypoxia and red marrow expansion.

[Biliary cystadenoma. Discussion of a clinical case]. / Il cistoadenoma biliare. Discussione su un caso clinico.

A case of biliary cystadenoma is reported. The neoplasm was located at the left lobe of the liver and its diameter was 18 cm. It presented with abdominal swelling and palpable mass in epigastric region. A left hepatectomy was performed, to achieve a complete resection of the tumor.

[Multiple diverticulosis of the small intestine]. / La diverticolosi multipla del piccolo intestino.

A case of jejunum-ileum multiple diverticulosis observed during a cholecystectomy due to cholelithiasis, is reported. Stress is laid on this unusual localization of diverticulosis in the small intestine. The clinical picture can be silent or present an acute or chronic symptomatology and radical surgical treatment can performed or not. When the disease involves all the intestine, without presenting serious inflammatory phenomena and without clinical symptoms (as in the case observed), medical and not surgical treatment can be envisaged.