[Prognostic factors in gastric cancer. Our experience and review of the literature].

Background: This review of the latest literature and retrospective analysis of the authors' series aimed to identify the most relevant prognostic factors for gastric cancer.

Methods: A total of 81 patients were operated in our series from 1980 onwards. Eighteen patients underwent minor surgery and 5 were not treated.

Reversal of type 1 hepatorenal syndrome with the administration of midodrine and octreotide.

The aim of the study was to verify the effects of the administration of an inhibitor of the release of endogenous vasodilators together with a vasoconstrictor agent in patients with hepatorenal syndrome (HRS). This new medical perspective was compared with a traditional medical approach for HRS, such as the infusion of nonpressor doses of dopamine to produce renal vasodilation. Thirteen patients with type 1 HRS were enrolled in the study.

Splenic Doppler impedance indices: influence of different portal hemodynamic conditions.

The spleen plays a pivotal role in the pathogenesis and maintenance of portal hypertension. Few data exist about splenic hemodynamics evaluated by duplex sonography in this condition. Twenty-six normal subjects, 207 patients with portal hypertension of various causes, and in different splenoportal hemodynamic conditions, and 31 patients with liver transplantation were evaluated.

Pancreatic cancer and retroperitoneal neural tissue invasion. Its implication for survival following radical surgery.

To analyze the implication of retroperitoneal perineural lymphatic infiltration (rpli) for the survival of patients affected by exocrine pancreatic cancer, we considered 17 cases which underwent radical resection at our Institute from 1980 to 1993. Histology of specimens showed an rpli in 15 cases, without any correlation between this anatomopathologic aspect and the neoplasm size or the presence of lymph node metastases. The 2 patients without rpli are both alive and have been free from disease during a follow-up period of more than 5 years.

Implication of laparoscopy and peritoneal cytology in the staging of early pancreatic cancer.

Staging of pancreatic cancer still represents a challenge for surgeons involved in this field. Diagnostic methods of radiological imaging used routinely (CT, NMR, angiography) may understage this neoplasm. In fact, the presence of peritoneal or subglissonian hepatic micrometastases (< 2 cm) is a frequent surprise at laparotomy and forces the surgeon to use a palliative procedure.

Routine determination of biliary lipid composition with the entero-test.

A simple method for the assay of biliary lipids was used for routine determination of biliary cholesterol saturation index (CSI) in 17 healthy subjects, 40 untreated patients with radiolucent gallstones and 21 gallstone patients treated with ursodiol. The method is based on collection of bile with the Entero-Test, a device for easy sampling of gastrointestinal contents. The procedure was easy to perform and well accepted by the patients.

[The role of laparoscopy and peritoneal cytology in the preoperative staging of pancreatic carcinoma].

The staging of pancreatic cancer still represents a challenge for surgeons involved in this field; radiological diagnostic methods used routinely (CT, NMR, angiography) may under-estimate this neoplasm; in fact, the presence of peritoneal or subglissonian hepatic micrometastasis (< 2 cm) is a frequent surprise at laparotomy and force the surgeon to undertake a palliative procedure. This policy need not be followed because it is possible to perform non-surgical palliation of jaundice or pain respectively by percutaneous radiological stent insertion and coeliac alcoholisation. Pre-operative staging thus acquires an important role in the correct treatment, surgical or medical.

[Reoperation in differentiated carcinoma of the thyroid gland].

A series of 112 patients reoperated on for differentiated thyroid cancer is analyzed; 60 patients (38 with papillary and 22 with follicular cancer) underwent ex-principio to completion of a non total thyroidectomy and 52 (37 with papillary and 15 with follicular cancer) to repeat surgery for local relapse. At a mean follow-up of 8.7 years, all the 38 patients with papillary cancer reoperated on for completion are alive and disease-free, while of those with follicular cancer 4 are dead, 2 are alive with carcinoma and 16 (72.

[The palliative treatment of hepatocarcinoma: chemoembolization vs. the combination of tamoxifen plus beta-interferon].

Clinical and experimental data show that beta-IFN enhances the effect of tamoxifen on advanced breast cancer. There is a similarity between breast and liver as far as the proliferating effect on normal and neoplastic tissue of estrogen and progestin receptors is concerned. The authors tested this pharmacological association in unresectable liver neoplasms.

[Isolated rupture of the right hemidiaphragm with complete herniation of the liver into the thorax. Considerations of diagnosis and therapy].

The Authors report a case of right diaphragmatic hernia due to road-traffic accident. They discuss the problems of early diagnosis because it is delayed for multiple associated lesions or a low index of suspicion. The ratio of laceration of the left side to that of the right is twenty to one.

Dermatan sulphate: a safe approach to prevention of postoperative deep vein thrombosis.

To assess the efficacy and safety of dermatan sulphate (MF 701) in preventing postoperative deep vein thrombosis (DVT), 324 patients aged 40 years or over undergoing elective major general surgical operations were included in a randomized trial comparing MF 701 (100 mg intramuscularly once a day) with unfractionated calcium heparin (UFH, 5000 units subcutaneously three times daily). Both treatments were initiated before operation and continued until discharge. In all, 316 patients were included in the analysis (MF 701, 157; UFH, 159).

Selective variceal decompression and its role relative to other therapies.

Seventy patients, selected from 265 patients with proved variceal bleeding, underwent a distal splenorenal shunt (DSRS) procedure with or without splenopancreatic disconnection (SPD). Alcoholic cirrhosis was the cause of portal hypertension in 57% of the patients. The operative mortality was 13% (Child's classes A and B 2%, class C 66%).

The role of the leukocyte adherence inhibition (LAI), CA 19-9, and tissue polypeptide antigen (TPA) tests in the diagnosis of pancreatic cancer.

The leukocyte adherence inhibition (LAI) assay measures host cell-mediated tumor immunity. The original test used by Halliday and Miller was modified by substituting tissue extracts with purified tumor antigens (gastrointestinal cancer antigen [GICA]) with the aim of reducing false-positive results in the diagnosis of patients with early pancreatic cancer. By our modified technique, the LAI assay identified four of five pancreatic cancers at an early stage and gave only one false-positive result in 16, showing a sensitivity of 80% and a specificity of 94%.

[The L.A.I. test and tumor markers (Ca 19-9 and TPA) in the diagnosis of pancreatic carcinoma].

A particular cell-mediated immune response is tested in this work: the leukocyte adherence inhibition (L.A.I.

[Benign Castleman's lymphoma. Remarks on 2 cases].

Two personally observed cases of Castleman's benign lymphoma of the hyaline vascular type located in the mediastinum are described. The stages in the development of our knowledge of this tumour are traced and the various aetiopathogenic theories discussed. The difficulty of preoperative diagnosis is emphasised while the potential predictive value of calcifications combined with hypervascularization in an asymptomatic mass usually in the mediastinum and revealed by CT is pointed out.

Thrombocytopenia in liver cirrhosis complicated by variceal haemorrhage: lack of increase in platelet count after spleno renal distal shunt.

10 patients with liver cirrhosis (LC) and previous variceal bleeding have been studied. Platelet count was markedly depressed. Giant platelet percentage (MTI) was significantly increased, reflecting bone marrow compensatory hyperactivity.

[Changes in portal hemodynamics during pharmacologic stimulation: somatostatin vs glypressin].

Sixteen patients with cirrhosis of the liver and a history of haemorrhaging oesophageal varices all given Warren-type splenorenal bypasses were subjected to intraoperative measurement of portal flow and pressure after the administration of Somatostatin and Glypressin. Glypressin was distinctly more effective in producing a significant and long term reduction in portal flow and pressure. Somatostatin made no significant difference to these parameters.

Medullary thyroid carcinoma in multiple endocrine neoplasm type II syndromes.

A case of multiple endocrine neoplasm (MEN) type IIa and 2 cases of MEN type IIb are reported. The biological behavior of medullary thyroid carcinoma was more aggressive in the MEN type IIb. C-cell hyperplasia was present in the thyroid gland of the patient with a positive family history.