[Functional outcomes and quality of life in patients with anterior resection for rectal cancer. Does preoperative manometry predict the feasibility of a J-pouch?]

INTRODUCTION

The goal in the treatment of rectal cancer is the recovery of the disease with the best fecal continence and quality of life. The Authors compared quality of life and manometric results in patients treated with neo-adjuvant chemotherapy and rectal low anterior resection (LRA).

METHODS

From January 1998 to March 2002 50 patients with advanced (T3-T4) rectal cancer underwent neo-adjuvant chemotherapy. Subsequently 41 of them underwent LRA with colon pouch (19) or without the pouch (22). After few months the quality of life was evaluated through a questionnaire. Later they underwent manometric evaluation measuring resting, squeeze and rectal compliance.

RESULTS

The manometric results and the questionnaire scores agreed in 75% of patients. In detail, patients with hypotonic sphincter had a better (one could say good) quality of life if a LAR with pouch had been performed respect to the patients without pouch.

CONCLUSION

Performing LAR with colon pouch after neoadjuvant chemotherapy in patients with hypotonic sphincter improves quality of life. Preoperative anorectal manometry could select patient who would benefit from pouch construction.

Thyroid carcinosarcoma, a rare and aggressive histotype: a case report

Thyroid carcinosarcoma is a rare and aggressive thyroid tumor. Histological examination of a tumor showed the characteristic of epithelial carcinoma and mesenchymal differentiation. We retrospectively analyzed the course of the patient and reviewed the literature in which only 19 other cases are described. Carcinosarcoma of the thyroid is a very aggressive tumor with a clinical course similar to anaplastic thyroid carcinoma. Survival is very short despite aggressive multimodal treatment.

[Spectral analysis of EEG signals in Alzheimer's disease]

Alzheimer's disease (AD) represents the most frequent cause of senile dementia in Western countries. The disease has a slow onset and gradual progress. Over the past few years considerable importance has been attributed to the diagnostic techniques of brain imaging able to highlight morphological and functional images. EEG mapping is one of the most widely used methods.

METHODS

The authors evaluated the characteristics of EEG mapping in relation to frequency and amplitude in a group of elderly patients with AD and in a group of healthy elderly control subjects. The former group consisted of 10 patients with AD aged between 65 and 83 years old. The control group included 10 healthy subjects who were matched for age and sex.

RESULTS

The spectral analysis of EEG signals relating to frequency and amplitude showed a slowing down of underlying activity in AD patients, with a frequency between 1 and 4 c/sec, amplitudes below 5 microW and no arrest reaction. In healthy subjects spectral analysis showed a signal percentage colocated at a frequency of between 8 and 13 c/sec in relation to frequency.

CONCLUSIONS

In view of these results, the authors recommend the use of EEG mapping to complete the diagnosis of Alzheimer's disease in the aged.

[Study of mapped slow auditory evoked potentials in Alzheimer's disease]

BACKGROUND

Alzheimer's disease affects around 500,000 persons in Italy and its diagnosis remains essentially clinical. Our aim was to contribute to the diagnosis of Alzheimer's disease by mapping auditory evoked potentials (AEP). Evoked potentials represent the electric response of the CNS to an external stimulus and can be represented as a sequence of waves. Brain mapping allows a chromotopogram to be compiled showing chromatic maps.

METHODS

A group of 12 patients were studied aged between 68 and 84 years old who were referred to our attention at the Department of Geriatrics and Gerontology at Catania University and the A.O. Cannizzaro, Geriatrics Unit. All patients completed an assessment form (MM-SE, ADAS) and underwent brain NMR and AEP.

RESULTS

These tests enabled us to identify two types of patients (Group A and Group B) based on the responses shown. The overall evaluation of results revealed that patients with Alzheimer-type dementia present an anomalous cortical neurogenic response to mapped AEP, and that patients in Group A showed anomalous wave morphology, latency and localisation and asymmetric impregnation. The data gathered in this study did not confirm any specific characteristics of AEP given that similar anomalies are found in metabolic dysfunction syndromes and demyelination pathologies.

CONCLUSIONS

However, while it does not constitute a specific technique for screening against Alzheimer's disease, the mapping of AEP may contribute to the diagnosis of this disease.

Mapped auditory evoked potentials before and after interferon treatment

Neurotoxicity induced by interferon (IFN) is revealed by neurobehavioral changes, such as irritability, somnolence, lack of motivation, and delayed ideation. As these side effects persist throughout IFN-alpha treatment, we studied cerebral mapped auditory evoked potentials (MAEP) in 20 hepatitis C virus antibody (HCV Ab)-positive chronic active hepatitis patients before and after administration of leukocyte IFN-alpha (i.m. 3,000,000 IU). Some of the main components of MAEP, such as morphology, latency, and power spectra, were altered before IFN injection. These parameters changed 7 h after administration as revealed by increased quality and quantity of acoustic signal reaching the brain cortex and appearance of physiologic waves in patients with mild/intermediate liver disease. These effects revealed 48 h after IFN administration.

Electrophysiological alterations in hepatic encephalopathy detected by brain mapping

Analogical electroencephalogram has been used to study electric alterations in the brain during liver encephalopathy. We adopted digital technique brain mapping to study the electric background activity in the brain and to evaluate the diagnostic and prognosis usefulness of this technique compared with the methods routinely used in this disease. We studied 18 patients with liver cirrhosis and varying degrees of liver encephalopathy and 7 healthy control subjects to assess correlation between the severity of encephalopathy and abnormal electric activity in the brain, and to detect the main differences between the brain mapping findings obtained in the two groups. The findings revealed an overall reduction in the rhythm, increased amplitude and anomalous distribution of the waveforms in the cirrhotic patients. Although similar results have already been reported, brain mapping furnished prompt and more easily visualised findings. Moreover, brain mapping facilitated detailed analysis of wave amplitude, frequency and topographic location indicating that this technique is a valid tool in diagnosing brain disorders.

Chordoma-natural history, treatment and prognosis. The Florence Radiotherapy Department experience (1956-1990) and a critical review of the literature

Fifteen cases of chordoma, seen between 1956 and 1990 at the Florence Radiotherapy Department are reported. Twelve of them were treated with radiotherapy and surgery, while one was left untreated. We analyzed the course of the disease in the treated cases, with particular emphasis on the problem of symptom control. The natural history of the disease seemed to be only marginally affected by the treatment and new therapeutic options are strongly needed. While actuarial survival rates at 5 and 10 years were 58% and 35% respectively (owing to the slow growth rate of this neoplasm), 10 years' symptomatic progression-free, symptom-free, and disease-free survival rates were only 25%, 17% and 8% respectively.

Phase II double-blind randomized study of lonidamine and radiotherapy in epidermoid carcinoma of the lung

Patients with non metastatic squamous cell lung cancer were treated with radiotherapy (RT) plus lonidamine (LND) or placebo (PLAC), according to a randomized double-blind study design. Treatment with lonidamine 150 mg t.i.d. (27 patients) or placebo (23 patients) started 3 days before RT, lasted up to 7 months. Partial responses were observed in 14 and 6 patients respectively in the LND + RT and PLAC + RT groups. Statistical analysis of the survival curves showed no significant difference between the LND + RT (median 311 days) and PLAC + RT (median 193 days) groups. Stage III patients survived significantly longer (p less than 0.05) when treated with LND + RT (median 318 days) than with PLAC + RT (median 163 days). No synergistic toxic effects between radiation and LND were noted. To confirm these data a new and larger multicentric study is now in progress.

Copper (II) complexes of aminoacids: gastric acid antisecretory activity in rats

The effect of simple and mixed copper(II) complexes of L-tryptophan (trp) and L-phenylalanine (phe) on the gastric acid secretion was investigated in Shay rats. Graded doses (from 15 to 75 mg/kg) of [Cu(trp)2(H2O)], [Cu(phe)2(H2O)] and [Cu(trp)(phe)(H2O)], administered i.g., caused a progressive inhibition of gastric acid secretion. The antisecretory activity of the mixed complex, [Cu(trp)(phe)(H2O)], was significantly greater (ID50 = 33 +/- 3 mg/kg) than that of the simple complexes [Cu(trp)2(H2O)] (ID50 = 48 +/- 3 mg/kg) and [Cu(phe)2(H2O)] (ID50 = 43 +/- 3 mg/kg). At the experimental conditions of intragastric pH, the different biological activities were directly related to the percentage of neutral species present in solution as determined by means of potentiometric measurements (at 37 degrees, I = 0.15 mol dm-3 in NaClO4). A possible mechanism of action of the investigated compounds is discussed.

[Effects of graded doses of copper complexes with L-aminoacids on gastric acid secretion in the rat]

Gastric acid responses to intragastric administration of graded doses (14-30-45 mg/Kg) of copper (II) complexes with aminoacids (two simple complexes, Cu-Trp2 and Cu-Phe2, and on mixed complex, Cu-Trp-Phe) were investigated in Shay rats. The results (% inhibition of H+ mEq/4h) shown that graded doses of copper complexes caused a progressive inhibition on gastric acid secretion, and that percentage inhibition values were, for all complexes, in linear correlation with employed doses. A possible mechanism by which copper complexes affect gastric acid secretion is discussed.