[Screening of obesity, overweight and thinness in a children population in Rome, Italy]. / Screening per obesità, sovrappeso e sottopeso in una popolazione in età scolare a Roma, Italia.

AIM: Objective of the study was to estimate the prevalence of obesity, overweight and thinness in a children population in Rome, Italy. METHODS: The study sample was created, after informed consent, in a school in Rome, available to the study project. A total of 595 children (289 males, 306 females), aged between 6 to 19 years, underwent following measurements: height and weight, evaluation of body mass index. RESULTS: A normal BMI was recorded in 73.6% of cases. Morbid obesity, obesity, overweight, and thinness grade 1 and 2 prevalence was 1.2%, 4%, 15.3%, 9.2% and 3.8%, respectively, without statistical differences in both genders, except the prevalence of overweight that resulted statistically significant (11.4% females vs. 19.3% males, P<0.05). Differences in the age groups have been found. About 17.2% and 18.7% of children between 7 to 11 years were overweight and obese and about 33.3% and 26.6% between 6 to 8 years thin grade 1 and 2, respectively. CONCLUSION: The study suggests a prevalence of overweight and obesity in our sample lower than that reported in a recent epidemiological survey carried out on Italy. Attention must be taken to underweight, particularly with regard to the most severe form, as a public health problem for all possible risks correlated. In addition, our study shows the involvement of specific age groups. This finding, if confirmed in a larger population, should be associated with a major attention on specific age groups at risk, in order to plan an appropriate treatment program.

Shock induction by arterial hypoperfusion of the gut involves synergistic interactions between the peripheral enkephalin and nitric oxide systems.

To determine whether critical splanchnic artery hypoperfusion can provoke systemic shock and to identify the roles of the peripheral opioid and nitric oxide (NO) systems in this process, various degrees of superior mesenteric artery hypoperfusion (SMA-H) were produced in anesthetized adult rabbits (n=40), and hemodynamic and metabolic indices were measured. Metabolic acidosis and irreversible hypodynamic shock occurred with SMA-H at levels representing 25-20% of mean baseline SMA blood flow. In 112 other rabbits subjected to SMA-H at 20% (SMA-H20%), we studied plasma NO and enkephalin (ENK) levels, cardiovascular reactivity to selected physiological agonists, effects of ENKs on plasma NO levels, and effects of peripheral opioid receptor blockade and inducible NO synthase (iNOS) inhibition. SMA-H20% progressively increased systemic blood levels of NO and ENKs. Exogenous ENK administration accentuated SMA-H20%-induced increases in plasma NO levels, and their cardiovascular depressing effects were significantly greater when they were administered during SMA-H20% (vs. administration under baseline conditions). Selective blockade of cardiovascular delta-opioid receptors improved hemodynamics, prevented shock irreversibility and reduced plasma NO levels; similar effects were obtained by selective iNOS inhibition. These findings demonstrate that critical arterial hypoperfusion of the gut can induce hypodynamic systemic shock through ENK-induced hyperactivation of cardiovascular delta-opioid receptors, which leads to increased plasma levels of NO related in part to increased iNOS activity. Since pronounced splanchnic artery hypoperfusion occurs in all advanced systemic shock states, selective delta-opioid receptor antagonists and/or iNOS inhibitors may prove to be useful in improving shock hemodynamics and metabolic derangements and/or preventing progression toward irreversibility.

Galectin-3, a marker of well-differentiated thyroid carcinoma, is expressed in thyroid nodules with cytological atypia.

AIMS: The distribution of galectin-3, a widely recognized marker of well-differentiated thyroid carcinoma, was investigated in 95 thyroid lesions including nodules with foci of cytoarchitectural atypia. METHODS AND RESULTS: Twenty-eight papillary carcinomas, five follicular carcinomas, one Hurthle cell carcinoma, three poorly differentiated carcinomas, one anaplastic carcinoma, 25 nodular hyperplasias and 27 follicular adenomas, including nodules with atypical features, three neoplasms of undetermined malignant potential and two thyroiditis cases were examined. By immunohistochemistry, galectin-3 was consistently found in carcinomas; otherwise benign nodules exhibited galectin-3-positive clusters of cells with poorly developed features of differentiated carcinoma (mainly of papillary type) such as nuclear chromatin clearing, nuclear clefting, pseudoinclusions, which, in each case, were not histologically sufficient to warrant a definitive diagnosis of malignancy. In other nodules galectin-3 staining was negative. The latter were either clearly benign or showed constantly a minor degree of chromatin clearing and of other atypical features when compared with galectin-3-positive cases. CONCLUSIONS: Galectin-3, a reliable marker of differentiated thyroid carcinoma as confirmed in our series of malignant neoplasms, appears expressed in nodules with an overall benign appearance but with focal areas suspicious for malignancy. The significance of such findings needs to be further investigated.

Colorectal cancer: obstruction is an independent negative prognostic factor after radical resection.

The rate of colorectal tumors causing large bowel obstruction is still high (about 16%). In our experience, 93 out of 985 patients (9.4%) affected by colorectal cancer required surgery because of large bowel obstruction. The comparative analysis between 64 (68.8%) obstructed and 738 (82.7%) non-obstructed radically resected patients showed that sex and age of patients, tumor site, tumor diameter, parietal infiltration, grading, lymphnode involvement, distant metastases, and staging were not significantly different. Post-operative mortality rates (1.6% vs. 0.5%) and morbidity rates (15.6% vs. 15.6%) were not significantly different as well. On the contrary, survival rate was different. Patients submitted to radical resections had a far poorer prognosis as compared with non-obstructed radically resected ones: the five-year survival was 41.2% and 78.9% respectively. Radically resected obstructed patients showed an higher and earlier ráte of local and distant recurrence with a disease-related death rate of 47.6% vs. 16.3% as compared with non-obstructed ones. The occlusive phenomenon by itself resulted to represent an independent unfavorable factor negatively affecting long term prognosis after radical resections.

Gastric cancer in the elderly.

Nowadays an increased number of elderly patients undergo surgery for gastric cancer. The old age by itself does not seem to represent a prohibitive risk factor anymore. Two groups of patients operated on of gastric cancer at our surgical unit (Group A = 378 patients younger or as old as 65 years and Group B = 330 patients older than 65 year) were compared. There were not statistically significant differences between the two groups in terms of number of performed radical exereses (57.7% vs. 42.3% respectively), kind of resective operation (total gastrectomy or subtotal gastrectomy) and extent of lymphadenectomy (D2-D3 type: 64.7% vs 63.8% respectively). The location of tumor, the distribution by stage and the long term survival of radically resected cases were not statistically different in the two groups of patients. Five-year survival after radical resection was 56.8% and 54.0% respectively. We conclude that elderly patients in good clinical conditions affected by gastric cancer should undergo radical resection with lymphadenectomy such extensive as D2-D3 type.

Papillary carcinoma in amyloid goitre.

Amyloid goitre is a rare lesion characterized by a diffuse and bilateral enlargement of the thyroid gland due to amyloid deposition. It is uncommon that a massive and widespread amount of adipose tissue deposition is found within these lesions and only in exceptional cases a differentiated carcinoma can develop. We describe the third example of thyroid carcinoma, arising in a 74-year old female who had also massive adipose thyroidal metaplasia, within amyloid goitre. The Congo red stain confirmed the diagnosis of amyloid goitre. Immunohistochemistry showed reactivity with MoAb against amyloid fibril protein A. The patient suffered from renal failure of undetermined aetiology for three years, but neither systemic amyloidosis nor risk factors for its development were found. It is important to correctly diagnose amyloid goitre both to rule out the presence of a differentiated thyroidal carcinoma and to search for amyloid infiltration in other organs in view of an early appropriate therapy.

[Neurinoma of the vagus nerve. Description of 2 cases and review of the literature]. / Neurinomi del nervo vago. Descrizione di due casi e revisione della letteratura.

The Authors report two rare cases of schwannoma of the cervical and thoracic portion of the vagus nerve. Schwannomas of the vagus nerve are particularly uncommon; patients suffering from these neurogenic tumors typically exhibit a paucity of symptoms and in the majority of cases they present with an asymptomatic mass noted on incidental chest X-ray. Chest pain and cough may occur with tumors arising next to and compressing the trachea or major bronchi. In the cases observed, schwannomas appeared like a mass whose size had increased during the last months without producing any clinical symptom. Clinical features of the mass, laboratory tests, ultrasound, CT scanning, magnetic resonance imaging were useful only to define its extension and relationships with the adjacent structures. Needle aspiration of these lesions is not indicated because of the paucity of the material obtained for the exact diagnosis. Surgery, with preservation of the vagus nerve when possible, is the treatment of choice also for a correct diagnosis of nature and to prevent further growth and compression on adjacent structures. When the individual fibers of the vagus nerve are displayed over the surface of the tumor within a discrete capsule nerve preservation is possible. On the contrary, when it is technically difficult to preserve the nerve trunk microsurgical procedures allow to reanastomose the cut ends. Injury of homolateral recurrent nerve often is the complication of a radical removal. Recurrence of benign lesions is not usual; malignant tumors carry a poor prognosis with patients rarely surviving beyond 1 year.

Leiomyoma of the esophagus. (A case report).

Leiomyoma is the most common benign tumor of the esophagus. Its occurrence is fairly infrequent and in 50% of cases is asymptomatic. The case of esophageal leiomyoma (EL) which attracted our attention is of interest. The patient, a 44 years old women clinically assessed for cardiac rhythm disturbance with no compliant of dysphagia, had two locations of EL, demonstrated by x-ray, computed tomography and esophagoscopy. The treatment was performed in two phases, surgical and endoscopic, in relation to the non identification of the upper EL through the left thoracetomy. The various technical possibilities must all be evaluated in relation to every single case.

Tension-free hernioplasty: technical remarks and personal experience.

The authors report their experience with 463 tension free hernioplasty procedures for inguinal and femoral hernias. The surgical technique included the insertion of both a polypropylene plug and a polypropylene mesh, and was carried out mostly in local anesthesia (84.2%) using bupivacaine 0.25% for ileoinguinal and ileohypogastric blockage and mepivacaine 0.5% for local infiltration. There was no major intraoperative complication; local postoperative complications were rare (10%) and easily managed; postoperative pain was frequently observed (66%), though mild and transient; resumption of working activity occurred within a month in 96.6% of cases; there were only 3 post-operative recurrences (respectively, at 1, 6 and 12 months). The authors conclude that the tension free hernioplasty is a simple, rapid, low-cost and effective technique, easily performed under local anesthesia.

[Technical aspects of neorectum: restorative proctocolectomy]. / Aspetti tecnici del neo-retto: la proctocolectomia restaurativa.

In the last decade, restorative proctocolectomy with ileal pouch-anal anastomosis (IPAA) is considered as the procedure of choice in the surgical management of most patients with familial adenomatous polyposis and chronic ulcerative colitis. Beyond the attraction of this operation, which permit to completely remove disease-bearing mucosa, spare the anal sphincter, and avoid a permanent ileostomy, it remains a difficult procedure with not negligible complication rate. Correct operative technique is required: to the purpose, main technical aspects of IPAA are analysed.

[Conservative meso-pancreatectomy for cystic papillary tumor: apropos a case report]. / Meso-pancreasectomia conservativa per tumore cistico papillare: a proposito di un caso osservato.

A case of papillary-cystic neoplasm of the pancreas is reported in a 22-year-old woman. The only symptom was a palpable pulsating mass in her upper left abdomen. A conservative surgical treatment was adopted, consisting of pancreatic body resection (meso-pancreatectomy) and pancreaticojejunostomy to distal pancreatic stump. These neoplasms are quite uncommon, and can be difficult to differentiate from other cystic lesions of the pancreas. Surgical excision is curative in these tumors and is the treatment of choice due to its low morbidity and good long-term survival.

[Carcinoid neoplasms: report of 5 personal cases]. / Neoplasie carcinoidi: a proposito di cinque osservazioni personali.

The authors report 5 cases of carcinoid tumor differently located. The typical carcinoid syndrome has been observed only in one case, presenting with high levels of urinary serotonin and 5-OH-HIAA. The remnant patients were completely asymptomatic and the correct diagnosis was obtained only by histologic examination of the surgical specimen. On the basis of their experience and of the literature, the authors evaluate the current diagnostic and therapeutic options for these neoplasms. The indication for surgical treatment, even in cases with local or distant metastases, is emphasized.

Adenocarcinoma of the small intestine.

We examined eight patients with adenocarcinoma of the small intestine: four were localized in the duodenum and four in the jejunum. We performed six curative resections: two pancreatoduodenectomy, two total pancreatectomy and two jejunal resections; in two cases, only by-pass was performed. Three patients who were resected are alive after more than five years; the other patients died between nine and forty-one months after surgery. The evaluation of the data from our experience and from literature shows that the consistently negative results are related to a delay in diagnosis and therapy.

[Regional hemodynamic evaluation of heterotopic liver transplantation by the determination of the hepatic artery resistance index]. / Valutazione emodinamica distrettuale nel trapianto eterotopico de fegato attraverso la determinazione dell'indice di resistenza dell'arteria epatica.

Hepatic artery resistance index (I.R.) was evaluated in six pigs through Doppler scan after progressive gauge reduction of the portal vein up to complete clamping. The I.R. values were (mean +/- S.D.): 0.48 +/- 0.01 in basal conditions; 0.37 +/- 0.03, and 0.33 +/- 0.01 with a reduction of 1/3 and 2/3 respectively; 0.27 +/- 0.02 after complete portal clamping. These data confirm the close relationship existing in the hepatic circulation between changes of the arterious resistence and those of the portal flow. The same animals, subsequently, underwent heterotopic liver transplantation in the right paracolic gutter. Immediately after surgery the I.R. values of the transplanted hepatic artery were recorded without clamping (basal portal flow 0.52 +/- 0.02) and after clamping of the transplanted portal vein (0.33 +/- 0.03), while maintaining clamped the recipient portal vein at the hilus. These values were comparable to those obtained in the recipient hepatic artery. These data suggest that, in spite of parenchymal damages secondary to surgical procedure and of the haemodynamically unfavorable site in which the organ is transplanted, heterotopic liver transplantation does not produce significant changes in hepatic arterious resistance.

[Mechanical sutures in surgery of cancer of the rectum (a personal contribution)]. / La sutura meccanica nella chirurgia del cancro del retto (contributo personale).

The EEA Stapler is widely employed in the rectal cancer surgery, particularly allowing a more frequent sphincteric preservation after low anterior resection. The authors rather employ the manual suture whenever possible and report their own experience on EEA Stapler employment in the surgical management of rectal cancer located 12 to 6 cm. from the anal verge. They emphasize this technique pointing out the necessity of further investigations which may confirm the possibility of obtaining a curative complete surgical removal as well as by abdomino-perineal resection.

[Technical aspects of transileal ureterocutaneostomy]. / Considerazioni su alcuni aspetti tecnici dell'ureterocutaneostomia transileale.

The performance of the ileal conduit (Bricker's operation) is a well and minutely known surgical procedure (choice of a particular ileal loop; uretero-ileal anastomosis; uretero-cutaneostomy); however we can still observe several and different details in the operative technique management. The Authors, on the basis of their own experience of 55 cases, and after a complete review of the literature, emphasize the technical controversies of ileal loop urinary diversion; moreover they analyze the technic changes previously pointed out be several Authors, to avoid surgical complications. They conclude that the ileal conduit urinary diversion shall have less complication if: 1) the ileal loop is a short one, but with a very good blood supply; 2) antireflex techniques are not used; 3) Brooke's technique is used in performing uretero-cutaneostomy.