Diet and pancreatic cancer: many questions with few certainties.

UNLABELLED: BACKGROUND, OBJECTIVES: Pancreatic cancer ranks fourth for cancer mortality for men and women in the United States. This is a particularly devastating cancer since the case-fatality proportion approaches 90% within 12 months following diagnosis. Therefore, understanding the etiology and identifying the risk factors are essential for the primary prevention of this deadly disease. Of the few potentially modifiable risk factors that have been identified, cigarette smoking, history of diabetes mellitus, and obesity seem to be among the most consistent, but the effect of dietary factors is still unclear. The aim of our study is to review of the literature examining the potential role of carbohydrates, fatty acids, meat, fruit and vegetables, alcohol. DISCUSSION: Although large prospective cohort studies with questionnaire based analyses will continue to have much to offer in defining predisposing factors for difficult diseases, such as pancreatic cancer, unfortunately dietary questionnaires do not reflect the bioavailability of the nutrients from various foods, the level of absorption from the digestive tract, or individual differences in metabolism. CONCLUSIONS: Greater use of participant-derived biological samples, banked plasma, germline DNA, and tumour tissue samples may help to the understanding of pancreatic cancer pathogenesis.

Comparison of verapamil versus felodipine on heart rate variability after acute myocardial infarction.

A depressed heart rate variability (HRV) is a powerful predictor of poor outcome in myocardial infarction patients. The beneficial effect of specific interventions on its recovery has been reported, but data concerning calcium antagonists are scarce. We evaluated the effect of a phenylalkylamine derivative, verapamil, and a dihydropyridine derivative, felodipine, on time- and frequency-domain measurements of HRV by 24-hour Holter monitoring in 60 patients with acute myocardial infarction (AMI). After a first Holter recording (65 +/- 8 hours from the onset of symptoms), patients were randomly assigned to continue standard treatment or to also receive verapamil retard (120 mg 3 times daily) or felodipine extended-release (10 mg/day). Holter recording was repeated after 7 days. After verapamil, mean RR interval increased from 823 +/- 92 to 907 +/- 95 ms and the SD of all normal RR (NN) intervals (SDNN) from 99 +/- 24 to 120 +/- 30 ms (p < 0.01); the root mean square successive difference (r-MSSD) and the percent of differences between adjacent NN intervals > 50 ms (pNN50) also increased (p < 0.01). After felodipine, only SDNN increased (p < 0.01). Regarding frequency-domain measurements, after receiving verapamil, very low frequency, low- and high-frequency powers increased (p < 0.01), whereas the low- to high-frequency ratio decreased (p < 0.01). After receiving felodipine, very low-frequency power increased (p < 0.01), whereas low- and high-frequency powers and the low- to high-frequency ratio remained unchanged. This study demonstrates that verapamil, but not felodipine, improves HRV in the early phase after AMI.

Intensive training and cardiac autonomic control in high level athletes.

PURPOSE: We aimed to evaluate in a longitudinal study the effect of intensive training on cardiac autonomic control in athletes using 24-h heart rate variability analysis. METHODS: Time and frequency domain measures of heart rate variability were calculated from 24-h Holter monitoring in 15 high level bicyclists (mean age 21 +/- 4 yr) after 1 month of detraining and after 5 months of vigorous training. At the same times echocardiographic left ventricular mass and dimensions and maximal oxygen consumption (VO2max) were assessed. RESULTS: In detrained athletes, VO2max values, left ventricular mass and dimensions, and time and frequency domain measures of vagal modulation of heart rate were higher than in a group of untrained subjects of similar age while heart rate and the low-to-high frequency ratio were lower, indicating an enhanced vagal modulation of heart rate in athletes as compared with that in control subjects. After 5 months of vigorous training, left ventricular mass and dimensions and VO2max increased in athletes, while heart rate decreased further. In contrast, no changes were detectable in time and frequency domain measures of heart rate variability over the entire 24-h and in both waking and sleeping hours. CONCLUSIONS: This study demonstrates that an increased cardiac vagal control is detectable in detrained athletes; however, after intensive training, despite a significant decrease in heart rate, time and frequency domain measures of heart rate variability reflecting cardiac vagal control remain unchanged. Thus, other mechanisms than changes in cardiac autonomic control could be involved in determining the profound bradycardia of athletes.

Effect of a broad-spectrum cephalosporin on the oral and intestinal microflora in patients undergoing colorectal surgery.

The influence of ceftriaxone on oral and intestinal flora was investigated in 10 patients undergoing colorectal surgery. Ceftriaxone was given intravenously in one 2g dose before anesthesia. Saliva and feces samples were collected and analyzed on day 0, 3, 5, 14 and 28 after drug administration. All specimens were cultured quantitatively for aerobic and anaerobic microorganisms; representative colonies of each morphologic type of organism cultured were identified. The oral aerobic flora was somewhat affected by the administration of ceftriaxone. In all patients the number of Streptococci, Staphylococci and Neisseria decreased during the 5 days after ceftriaxone administration. No significant changes in the number of anaerobic commensal occurred. The oral microflora of all patients after 14 days had returned to normal. The aerobic fecal flora was considerably affected: in all patients enterobacteria were eliminated or strongly suppressed. Only minor changes in the number of aerobic gram-positive bacteria were observed, and the anaerobic intestinal flora showed only minor alterations. On day 28 the intestinal flora were normalized in all respects. No new colonizing microorganisms were isolated during the investigation period and no colonization with ceftriaxone-resistant bacteria was observed. No postoperative infection occurred and no adverse effects were registered.

The effect of cefepime on some immune parameters in vitro: lack of interference with mitogen-induced lymphoproliferation, immunoglobulin synthesis, IFN-gamma and IL-2 secretion and IL-2 receptor expression.

The possible interference of the novel antibiotic cefepime (CPE) with some functions of the immune system was investigated in vitro. Peripheral blood mononuclear cells (PBMC) cultured in the presence of drug concentrations ranging from 25 to 100 micrograms/ml normally maintained their responsiveness to polyclonal (PHA, Con A, PWM) mitogenic stimulation in regard to proliferative response, IgM and IgG synthesis and IFN-gamma and IL-2 secretory capacity. Moreover, PHA-induced expression of IL-2 receptors was comparable in PBMCs cultured in the presence or absence of CPE. Taken together, these data suggest that CPE does not interfere, at this specific level, with T- and B-cell mediated functions in vitro.

[Preliminary results of a bacteriologic and immunologic study in patients subjected to colorectal surgery]. / Risultati preliminari di uno studio batteriologico e immunologico in pazienti sottoposti a chirurgia retto-colica.

This study examines patients undergoing colorectal surgery for carcinoma, bacteriological data in faecal and systemic immunological data; these patients before surgery received short-term chemoprophylaxis with ceftriaxone (2 g e.v.) and thymopentina (1 phial/day for 15 days) and after surgery thymopentina (1 phial for three time a week). With these data the authors try to create immunomodulation and antibiotic chemoprophylaxis protocol for the reduction of the septic complications due to intestinal bacterial flora and immunological defence reduction.

[The thyroidectomized follow-up]. / Il follow-up dei tiroidectomizzati.

Thyroid neoplasties are largely benign, and only 1% of all over malignant neoplasties with clinical diagnosis regard the thyroid. The histologic characteristics of the thyroid neoplasties assume fundamental importance both in diagnosis and in therapy. The authors underline the importance of the surgical treatment of malignant neoplasties of the thyroid with the problems connected to the choice of the entity of the demolition of the organ and the post-operative thyrohyoid residue and the importance of the correct follow-up for few patients, consenting to optmize the available resources.

[Early gastric cancer. The therapeutic options]. / Early gastric cancer. Opzioni terapeutiche.

The best therapeutic treatments for early gastric cancer are evaluated. Due to the difficulty of preoperative and intraoperative staging, it's reasonable to consider early gastric cancer as a composite disease; while some mucous localizations can benefit of minor therapeutic treatments, the submucous cancer must be treated as the parietal gastric cancer.

[Pseudomyxoma peritonei with appendiceal and ovarian mucinous cystadenoma. A case report. Correlations with synchronous or metachronous colorectal carcinomas]. / Pseudomixoma peritonei con cistoadenoma mucinoso appendicolare ed ovarico. Contributo clinico. Rapporti con i carcinomi colo-rettali sincroni o metacroni.

Mucocele is a rare pathology which is difficult to diagnose prior to surgery. The clinical symptoms are aspecific. Diagnosis is generally made at the time of surgery. Explorative laparoscopy is not advised owing to the possibility of encouraging metastatic diffusion. Surgery associated with ex tempore freezer tests must be carried out with the greatest caution to avoid rupture of organs and the spread of mucin. Appendectomy and removal of the adnexa is recommended in benign forms, with or without omentectomy. Omentectomy is necessary together with hystero-adnexectomy and right hemicolectomy in malignant forms, as well as lymph node cleaning and removal of all mucin in pseudomyxoma peritonei.

[The laparoscopic approach to the polycystic liver and adnexal cysts]. / Approccio laparoscopico alla policistosi epatica e alle cisti annessiali.

Having re-examined the nosographic data acquired on the subject of hepatic polycystosis and uterine adnexal cysts, the authors report the results of their experience. On the basis of the evaluation of these results (no laparotomic conversion, no postoperative complications, reduced hospital stay), which are comparable to those reported in the literature, the authors conclude that the modern technology may be used to advantage in all cases where laparoscopic surgery is not difficult, does not require numerous tests and does not entail a high risk of complications.

[Heredity and colorectal cancer]. / Familiarità e cancro colorettale.

The authors underline the role of inheritance in colorectal cancer and reporting the genealogical study of two families with high incidence of colorectal cancers personally observed. They thought that the genetic endowment (oncogenes, suppressor genes, microsatellite instability, protein-kinase C) was implicated directly in the genesis of disease.

[The utility of isolating the recurrent nerve and parathyroids in the prevention of complications in thyroid surgery. The role of the superior laryngeal nerve and C cells]. / Utilità dell'isolamento del nervo ricorrente e delle paratiroidi nella prevenzione delle complicanze in chirurgia tiroidea. Il ruolo del laringeo superiore e delle cellule C.

The authors emphasize systematic isolation of the recurrent nerve and of the parathyroids, to prevent complications in surgery of the thyroid. Moreover they try to underline the significance of the superior laryngeal nerve and the role of parafollicular cells (today unknown) for a rational and modern therapy of the non-neoplastic diseases of the thyroid.

[Biliary tract carcinoma. Case report]. / Il carcinoma della via biliare principale. Contributo clinico.

Carcinoma of the main biliary way is a condition that often leads to a fatal outcome owing to the rapid growth and late onset of the symptoms. The importance of a correct, timely diagnosis is stressed, with reference to a clinical case in which even CT scanning did not confirm either the presence of the neoformation or the dilation of the intra and extrahepatic bile ways. The usefulness of humoral markers for the diagnosis of the disease in its preclinical phase in the interests of surgical treatment that is as radical as possible is underlined.

[Staplers in surgery: state of the art]. / Le suturatrici meccaniche in chirurgia: stato dell'arte.

After a review of the technical development and application of staplers from their introduction to the present day, the indications to the use of this instrument in all gastroenterological areas from the oesophagus to the rectum as well as in chest, gynaecological and urological surgery specified. The advantages offered by staplers in the creation of intestinal anastomoses are undeniable, but these instruments must be considered alternatives to traditional surgery, the techniques of which should be well known to all surgeons. In certain areas (gastric, ileal and colonic resections etc.), the now widespread return to single thread manual stitches sheds a new light on staplers and reflects the fact that an anastomosis can be performed just as quickly by hand but will be softer and less rigid than a stapled one. It is only in oesophageal and lower rectal surgery that staplers offer a significant advantage, solving problems where hand suturing cannot.

[Primary lymphoma of the small intestine. A clinical case report and review of the literature]. / Il linfoma primitivo dell'intestino tenue. Descrizione di un caso clinico e revisione della letteratura.

The authors present a case of small bowel primitive lymphoma found in a 66-years-old female. After having briefly reviewed the literature they direct their attention to the clinical-instrumental diagnostic difficulties of this neoplasm which is often discovered only when it has already invaded various organs. Therefore surgical therapy is not always radical. This fact in addition to the fatally rapid postoperative course led the authors to discuss the problems involved in a correct treatment of this pathology.

[Low ileorectal anastomosis in the surgery of ulcerative rectocolitis]. / L'ileorettoanastomosi bassa nella chirurgia della rettocolite ulcerosa.

The authors report their experience of 23 patients with ulcerative colitis treated with surgery from 1991 to 1994. At admission 8 patients had a high-grade illness, 10 patients had a middle-grade illness, 5 patients had a toxic megacolon. All the patients were treated with systemic medical management (mesalazine + methylprednisolone) and topical medical management with rectal steroid (methylprednisolone) and rectal mesalazine by enema, and with nutritional support (Total Parenteral Nutrition). The 5 patients with toxic megacolon, after 48 hours of unsuccessful medical management, underwent surgery with deferred urgency; the other 18 patients underwent surgery after one-four months. The authors prefer the ileorectal anastomosis (IRA), since the rectal lesions are more susceptible to topical therapy. A single-stage IRA was performed in 17 patients. A sigmoid resection has been employed in the first stage in the 18th patient with a local development of the disease in the sigma; a following relapse of the lesions required a total colectomy with a low ileorectal anastomosis. A first-stage subtotal colectomy with ileostomy and Hartmann closure of the rectum with low ileorectal anastomosis at a later date was performed in the 5 patients with toxic megacolon. One of these, 18 years old, died after a heart failure. After surgery, as soon as the patients start moving their bowels all of these had again a systemic therapy with mesalazine for a short period and after they had a topical therapy with mesalazine + methylprednisolone by enema, for a long period. The average postoperative period of admission was 16.3 days. The functional results have been encouraging with an average of 1.6 bowel movements daily and an average of 0.4 nocturnal bowel movements. All the patients had a normal anal sphincter function with an acceptable stool frequency. In male patients there no urinary or sexual defects. In one case of these, there was a low grade of dysplasia, revealed by endoscopic biopsy. The authors conclude that today surgical treatment of ulcerative colitis is not well established.

[Intestinal subocclusion caused by lymphoma of the small intestine]. / Subocclusione intestinale da linfoma del tenue.

Primitive gastrointestinal lymphomas constitute a rare pathological event, may involve any part of the gastrointestinal tube, and normally belong to the non-hodgkin variety. They do not present characteristic symptoms as compared with what can be found in other gastrointestinal lesions whether neoplastic or inflammatory. Radiologically and endoscopically they do not evidence any particular aspects, so that they can be confused with other diseases (gastroduodenal ulcer, benign tumours, epithelial malignant tumours). For such primitive forms, radical surgical treatment constitutes the first treatment and undoubtedly the fundamental form, with which radiotherapy and chemotherapy may be associated. In addition to a review of the literature, the Authors examine a case of intestinal lymphoma complicated by a picture of subocclusion.

[Diagnostic value of pan-cavography in obstructed central venous return of intrinsic causes]. / Contributo diagnostico della pan-cavografia nell'ostacolo al ritorno venoso centrale da cause intrinseche.

The authors, after having analyzed the clinical patterns and the causes producing cava syndrome, propose a sequential diagnostic approach to it, whose course makes use of radiological procedures more or less invasive, and of endoscopic and histobioptic techniques. Among radiological investigations pan-cavography has allowed the authors to formulate the diagnosis of limited venous return because of intrinsic causes, conferring so an aetiological connotation and a physiopathological correlation indispensable for a correct and rapid therapy of the uncommon "intrinsic cava syndrome" of two patients, suffering respectively from "idiopathic thrombosis of superior vena cava, concerning also the beginning of inferior vena cava" and from "Fiedler cardiomyopathy".

[Surgical chemoprophylaxis with ceftriaxone]. / Chemioprofilassi chirurgica con ceftriaxone.

UNLABELLED: Ceftriaxone is a cephalosporin of third generation. It is characterized by a broad spectrum, a long half-life and a good capacity of diffusion in tissue. We have studied 67 patients. Age ratio was 44 years. 25 patients did not receive short term prophylaxis; 42 patients did (2 gr iv of ceftriaxone one hour before the operation). In clean surgery, only patients immunodepressed or malnourished received chemoprophylaxis. Patients who received 2 gr iv of ceftriaxone one hour before incision, received antibiotic therapy only on the appearance of septic complications. RESULTS: two patients submitted to chemoprophylaxis (4.8%) showed complications (cystitis and bronchial pneumonia). In the control group antibiotic therapy was undertaken only if septic complication appeared. 19 patients (76%) did not showed any complications. 6 patients (24%) showed surgical wound infection, acute pharyngo-tracheitis, cystitis. Finally, wound infections were limited exclusively to the control group. The ratio of respiratory infections was not statistically significant in the two groups; cystitis resulted more frequent in the control group than in the prophylaxis group. Prophylaxis with 2 gr single dose of ceftriaxone intravenously is effective in reducing the influence of infective complications in clean/contaminated surgery and clean risk surgery.