Colorectal Cancer: Relationship of Histologic Grading to Disease Prognosis

Ninety patients underwent curative surgery for colorectal adenocarcinoma and they were followed for a period of 3 years. The aim of this retrospective study was to relate the cell differentiation (grading) and TNM classification of the UICC (1978) with the disease evaluation and patient survival. The results showed a consistent relation between grading and lymph node metastasis in patients with moderately and poorly differentiated adenocarcinoma, whereas no relationship was found between grading and local invasion of the tumor. Therefore, histocytologic grading of colorectal cancer appears to significantly influence survival grading parameters, and it may be a good method for monitoring the disease and follow-up of the patients.

[Intestinal perforation due to accidental ingestion of foreign bodies]

Usually the ingested foreign bodies (IFB) pass the gastrointestinal tract making no lesions. Sometimes IFB could lead to a gastrointestinal perforation. The most frequently perforating IFB are chicken or fish bones and toothpicks, while risks factors are mental retardation, alcohol or drug abuse, denture usage, quick eating or habitual chewing of toothpicks. The accidentally ingestion in a high risk patient with unclear symptoms, added to a low sensitive diagnostic imaging, lead to intraoperative diagnosis in one half cases of gastrointestinal perforation by IFB. Furthermore the surgical treatment range between the less minimal invasive laparoscopic IFB extraction and intraabdominal hole suture to a laparotomic bowel or colic resection. Herein we describe our experience in 3 cases of gastrointestinal perforation by IFB have been diagnosed at surgery and treated by IFB extraction and hole suture (in 2 patients; 1 laparoscopy, 1 laparotomy) or open right emicolectomy (1 patient).

Intestinal localization of anisakiasis manifested as acute abdomen

Anisakis pathology is due mainly to two mechanisms: allergic reactions (from isolated urticaria and angioedema to life-threatening anaphylactic shock associated with gastrointestinal symptoms or 'gastroallergic anisakiasis'), and direct tissue damage, due to invasion of the gut wall, development of eosinophilic granuloma, or perforation (gastric or intestinal anisakiasis). Anisakiasis is a misdiagnosed and underestimated cause of acute abdomen: most patients undergo laparotomy, and virtually no cases are diagnosed before surgery. In some cases, diagnosis is obtained accidentally during other pathologic investigations. We report a case of acute abdomen due to terminal ileum involvement. Microscopic examination of the resected segment showed the presence of helminthic sections consistent with larvae of Anisakis spp. A history of raw fish ingestion was recorded. Histopathologic features are illustrated. A short but up-to-date review of the literature on diagnostic devices (particularly imaging and serology), clinical aspects and therapy is presented.

Progesterone-induced increase of sperm cytosolic calcium is enhanced by previous fusion of spermatozoa to prostasomes

Ejaculated spermatozoa must undergo a number of modifications before becoming able to fertilize the oocyte. The interaction of sperm with other semen components may influence these phenomena; human semen contains vesicles of prostatic origin, called prostasomes that may fuse to sperm at slightly acidic to neutral pH values. Prostasomes contain calcium and it has been demonstrated that their fusion with spermatozoa produces a transient increase (wave) of [Ca(2+)](i) in these cells. The fusion process also transfers protein and lipid to spermatozoa. These phenomena may induce long-lasting changes of sperm properties. We test the hypothesis that spermatozoa, as modified by fusion, change their ability to undergo the progesterone-induced increase of [Ca(2+)](i) and we find that the increase of [Ca(2+)](i) produced by the fusion with prostasomes and by the stimulation with progesterone are independent and additive phenomena. We also find that spermatozoa present a stronger response to the progesterone-induced increase of [Ca(2+)](i) if they are previously made to fuse with prostasomes. This effect does not depend directly on the [Ca(2+)](i) increase due to fusion, since it is still present after the [Ca(2+)](i) has returned to resting values.

First-trimester screening for Down syndrome using nuchal translucency measurement with free beta-hCG and PAPP-A between 10 and 13 weeks of pregnancy--the combined test

In a population of 1467 women attending the 'G. Gaslini' Institute for antenatal care, we evaluated first-trimester risk screening for Down syndrome using the 'combined test' based on ultrasound measurement of nuchal translucency (NT), maternal serum pregnancy-associated plasma protein A (PAPP-A) and free beta-hCG, and maternal age. No clinical action was taken on these results. The gestational age, determined by scan measurement of crown rump length, ranged from 10 weeks to 13 weeks 6 days. The median maternal age was 31 years 8 months. There were 13 Down syndrome pregnancies. The risk of having an affected pregnancy was estimated from a multivariate Gaussian distribution, using commercially available software. With a risk cut-off of 1 in 350, 11 affected pregnancies were detected (detection rate 85 per cent, 95 per cent confidence interval: 56-100 per cent) with a 3.3 per cent false-positive rate. The odds of being affected given a positive result were 1 in 30. Further data are needed to determine, with greater statistical reliability, the relative performance of the combined test with current second-trimester screening.

The motility of human spermatozoa as influenced by prostasomes at various pH levels

Human semen contains several components among which spermatozoa, membranous vesicles called 'prostasomes', secreted by the prostate gland and unorganized material. Prostasomes possess an unusual lipid composition, contain a number of proteins and small molecules and have been claimed to take a part in the immune response, in seminal fluid liquefaction and in sperm motility. Since sperm may come in contact with an acidic environment in the vagina, it may be of some interest to know whether prostasomes may affect spermatozoon motility or may protect spermatozoa upon the exposure to an acidic milieu. Human semen was supplied by donors. From whole semen we collected spermatozoa by centrifugation and used the supernatant to prepare prostasomes (centrifugation at 105,000 g for 120 min, followed by purification step on Sephadex G 200); spermatozoa were then collected by a swim-up procedure and exposed to an acidic pH medium (from 5 to 7) in the presence or absence of prostasomes. Spermatozoa motility was subsequently assessed with a superimposed image analysis system (SIAS). Results indicate that the motility of spermatozoa was affected by the pH value of the medium. Acidic media reduced the percentage of motile cells and decreased the straight line velocity of spermatozoa (VLS). Prostasomes had a protective effect and increased the percentage of motile cells. However, they did not change the characteristics of motility (curvilinear and straight). Prostasomes may be considered as a system for counteracting the negative effects of acidic pH values that may be present in the vagina after coitus.

Pregnancy-induced hypertension, antihypertensive drugs and the development of fetal behavioural states

In 21 pregnancies complicated by pregnancy-induced hypertension (PIH) which was treated by antihypertensive drugs (labetalol, nifedipine), fetal behavioural recordings (quiet state, C1F; active state, C2F; no coincidence, NOC) and Doppler measurements of blood flow velocity in the umbilical artery (UA) (resistance index, RI) were made on two occasions (27-32 and 33-36 weeks of gestation). Data were compared to those of a control group of normally grown fetuses (n = 96); in 15 cases we were able to match fetuses from the study group for age (+/- 1 week) and weight (+/- 150 g) at birth with fetales from a control group. It was the aim of this study to investigate if there are disturbances in the development of fetal behavioural states and if possible disturbances are due to poor fetal growth or to antihypertensive therapy. Our results show that in PIH treated by antihypertensive drugs, there are disturbances in the development of fetal behavioural states with higher percentages of NOC and C1F, lower percentages of C2F, and higher UA RI values. These disturbances are mainly due to coexisting placental impairment and poor fetal growth rather than to nifedipine or labetalol therapy, although these drugs may cause some redistribution of states.

[Prenatal diagnosis of triploidy and trisomy 21 through fetal erythroblasts isolated from maternal blood]

BACKGROUND

A long-sought goal of medical genetics has been the development of prenatal diagnostic procedures that do not endanger the conceptus. The safety of noninvasive methods for prenatal diagnosis would be especially attractive because they could be extended to all pregnant women, regardless of their ages or histories. Noninvasive prenatal diagnosis for the entire population might be possible recovering fetal cells from maternal blood. For this purpose, we have studied fetal erythroblasts.

MATERIALS AND METHODS

To evaluate the potential of the method for clinical use, we studied maternal blood samples from 11 women referred to us for prenatal diagnosis between 15 and 20 weeks of gestation. For simple and effective enrichment of fetal nucleated erythrocytes from peripheral maternal blood, we combined a triple density gradient and magnetic-activated cell sorting (MACS) of anti-CD71 transferrin receptor antibody labeled cells. The isolated cells were analysed by using dual-colour interphase fluorescent in situ hybridization (FISH) with X-, Y-, 18- and 21-specific DNA probes.

RESULTS

Chromosomal abnormalities detected on enriched fetal cells include trisomy 21 and triploidy.

CONCLUSIONS

Based on the current results it is suggested that the technique described here is a simple, fast, efficient and reliable method for non invasive prenatal diagnosis.

[Intestinal angiodysplasia: diagnosis and therapy]

On the basis of two personal cases of angiodysplasia authors describe this rare pathology and its relative diagnostic difficulties. On the grounds of their experience and the international literature on this pathology, authors considered the angiography as the selected method for the diagnosis of intestinal angiodysplasia, and they consider surgical therapy as the best curative method for this pathology.

[Biliary ileus. A report of 2 cases]

The authors starting from two observed cases of gallstone ileus, describe of these, the pathogenesis, the diagnostic difficulty, and they express their opinion with regard to surgical treatment to execute, related to the data reported by the authors and from their own experience.

Behavioural development and Doppler velocimetry in relation to perinatal outcome in small for dates fetuses

Twenty-two small for dates (SFD) fetuses and 96 fetuses from uncomplicated pregnancies were monitored on two occasions between 27 and 32 weeks and the second time between 33 and 36 weeks of gestation by studying the development of behavioural states (coincidence 1F and 2F; no coincidence) and umbilical artery Doppler waveform patterns (UA; Resistance Index, RI). Data were related to neurological outcome at 8 months after birth. The purpose of this study was to investigate if the development of behavioural state is disturbed in SFD fetuses and if SFD fetuses who needed to be delivered early and/or had abnormal neurological outcome showed different state development and RI than SFD fetuses delivered later in pregnancy or with normal neurological outcome. Finally, we studied if there was a relationship between state development and RI. At 27-32 weeks of gestation the percentage of coincidence 2F (C2F%) was lower and the percentage of coincidence 1F (C1F%) and no coincidence (NOC%) were higher in the SFD fetuses than in the control group. At 33-36 weeks C2F% was lower and NOC% was higher but not statistically different (P = 0.2 and P = 0.07, respectively). SFD fetuses who needed to be delivered early had poorer state development than SFD fetuses at lower risk and infants who were abnormal at 8 months of life showed a higher C1F% and lower C2F% at 27-32 weeks. There were significant correlations between RI on the one hand and NOC% (r = 0.62) and C2F% (r = -0.48) on the other hand at 27-32 weeks in the subgroup with abnormal neurological outcome. In conclusion, in SFD fetuses there are disturbances in the development of behavioural states as well in the distribution of the periods of coincidence (with a decrease in C2F% and an increase in C1F%). Poorest state development is present in SFD fetuses at highest risk and in this group there appears to be a significant relationship between the degree of utero-placental insufficiency (RI) and disturbances in behavioural development.

Doppler velocimetry and behavioural state development in relation to perinatal outcome in pregnancies complicated by gestational diabetes

Seventy-one pregnancies complicated by gestational diabetes and 100 healthy pregnancies were monitored on two occasions (between 27th-32nd and 33rd-36th week of gestation) by behavioural state analysis (1F coincidence; 2F coincidence) and umbilical artery Doppler velocimetry (UA) (Resistance Index, RI). The purpose of our study was to determine if the development of behavioural states and Doppler velocimetry: (1) differ between normal and gestational diabetic cases; (2) in gestational diabetic cases, are they related to the degree of abnormality of the maternal oral glucose tolerance test (OGTT)?; and (3) are they predictors of perinatal outcome? (i.e. emergency caesarean section; low Apgar scores; respiratory distress syndrome; neonatal hypoglycaemia and neurological abnormality in the neonate and/or at 4 months of age). Our findings suggest that: (1) results on behavioral state development and Doppler velocimetry were significantly different in gestational diabetic cases; (2) infants of women with gestational diabetes who are neurologically abnormal during the newborn period, had a poor development of coincidence 2F during fetal life and had neonatal hypoglycaemia more often than infants with a normal neurological outcome; (3) in cases with abnormal neurological outcome, the maternal diabetes was more severe than in those cases with normal outcome.

Primary resection with and without anastomosis for perforation of acute diverticulitis

The results of management of perforated large bowel diverticulitis were retrospectively studied over a 7-year period. 38 patients underwent operation, 20 for generalized peritonitis, 12 for local peritonitis, 5 for colovesical fistula and 1 for colovaginal fistula. The mean age of patients was 63 years (range 30-85 years). Depending on the symptoms, the spreading of the peritonitis and associated cardiovascular and pulmonary disease and diabetes mellitus, 4 types of operation were performed: primary left hemicolectomy and anastomosis with and without defunctioning colostomy, Hartmann procedure, suture and drainage with diverting colostomy. The overall mortality was 10.5%: resection and primary anastomosis entailed 3.8% mortality (1 case), while 3 deaths were observed in the 8 patients group having underwent an Hartmann procedure (37.5%). Drainage and/or diverting colostomy performed in 5 patients entailed no hospital mortality, but was followed by a 80% complication rate, requiring reoperation and several hospital admissions. The low mortality and morbidity rates obtained in the group having primary resection and anastomosis encourage wider application of this operation for perforated acute diverticulitis. Even the Hartmann procedure allows removal of the diseased colon but in a great proportion of cases reconstitution of continuity is not performed; nevertheless staged operation entailing major mortality and morbidity, expose these aged patients to remarkable hazard. Prerequisite of safe primary excision and anastomosis is vigorous intraperitoneal lavage and drainage, by the case associated to on table large bowel irrigation if concomitant obstruction is present.

[Malignant schwannoma of the omentum. Considerations in a clinical case]

Authors describe a rare case of malignant schwannoma of the omentum. The diagnosis of schwannomas is often late because of the absence of early clinical signs. Clinical, diagnostic and histopathological considerations of these neoplasias are described in this work.

[Effects of moderate maternal drinking on some neonatal parameters]

A cross-sectional study was conducted on 2415 mother/newborn pairs, in order to evaluate the relationship between maternal alcohol consumption and birth weight. The results of this study are consistent with previous reports, that pointed out the casual relationship between maternal drinking during pregnancy, and reduction in birth weight. This reduction was evident only on the subset of smokers. A further stratification by the sex of newborn, showed a heavier effect on male newborns, who experienced a significant reduction of 6.2 grams in birth weight for each g of absolute alcohol consumed daily during pregnancy by mother. The findings of this study support the evidence of neonatal functional damages due to alcohol, even at very low doses. A strong increase of early jaundice were found among the outcome of exposed women (OD = 3.30; 95% CI 1.03-10.54).

[Plasma exchange in a case of HELLP syndrome associated with disseminated intravascular coagulation]

The Authors describe a case of HELLP syndrome associated with disseminated intravascular coagulation occurred after delivery in a patient with late hypertension without any sign or symptom of preeclampsia during pregnancy. The use of plasma exchange has contributed to the recovery from the pathology.

[Malignant neoplasms of the male breast. Our clinical contribution]

A survey of literature data on male breast cancer is reported: on this basis the authors report their experience of five cases observed between 1980 and 1989 at Ospedale "S. Corona" Pietra Ligure, out of 500 female breast cancers treated in the same period. Epidemiological data and follow-up records are analysed, reporting survival rate similar to that of larger series.

[Clinical experience with piperacillin in the prophylaxis of post-operative infections]

Ninety patients who had undergone surgery have been treated with piperacillin as a prophylaxis for hospital infections. Twenty-two (24.4%) emergency operations and sixty-eight (75.6%) elective ones have been performed. Thirty-five open drainages, seven vacuum drainages and fifty-five urinary catheters have been placed. Post-operative infections occurred in 18 patients (20%), five of them submitted to emergency operations and thirteen submitted to elective operations. In eight cases an open drainage had been placed and in three cases a vacuum rate. The Author concludes that the hospital infections rate agrees with that occurring in the quoted sources; that open drainages, especially if placed through surgical wound, have main responsibilities for infections, and that piperacillin acted as a very well tolerated antibiotic and a highly manageable and effective one, offering therefore a good prophylaxis for hospital infections.

Treatment of advanced non-small cell lung cancer (NSCLC): the "Umbria" cooperative study

One hundred fifty-six patients with metastatic or locally advanced non-small cell lung cancer (NSCLC) were randomized to 3-week cycles of treatment with either: (A) cisplatin (120 mg/m2 on day 1); (B) cisplatin (120 mg/m2 on day 1) plus etoposide (VP-16) (100 mg/m2 on days 1-3; and (C) the cisplatin plus etoposide (VP-16) regimen plus mitomycin C (10 mg/m2 on days 1, 21, and 42; then every 6 weeks for a maximum dose of 100 mg). The overall objective response rates for the combination regimens (30% with two drugs and 26% with three drugs) were superior to that obtained with one drug (4%). Likewise, the median duration of survival with the combination therapy arms (8 to 9 months) was superior to that obtained with the single agent (5 months). Both performance status and limited disease were correlated with response in all groups, and with survival in the combined chemotherapy arms. The dose-limiting toxicity was myelosuppression, especially for the group receiving the three-drug regimen. In summary, combination chemotherapy using cisplatin and etoposide (VP-16) appears to be the most active and safest regimen in NSCLC.

Prenatal diagnosis of a rare heteropagus

The prenatal diagnosis by ultrasound of an unusual case of supernumerary head is reported. The problems of differential diagnosis, the pathological findings after voluntary interruption of the pregnancy, and the problems of obstetric management are presented.

Gastric cancer: a review of 400 consecutive cases

Four hundred out of 422 patients with primary gastric cancer seen from 1965 to 1979 underwent surgical treatment and were studied retrospectively. Fifty-eight percent underwent curative procedures. The five year survival rate was 19.14%. Subtotal and total gastrectomy gave survival rates of 35.8% and 9% respectively (p less than 0.05). Postoperative mortality (24.2%) was influenced by both the type of procedure performed (p less than 0.001) and the stage of the neoplasis (p less than 0.001). This study confirms the influence of staging on short, intermediate and long term survival and demonstrates the importance of the early diagnosis of gastric cancer in carrying out effective surgical treatment.

[Degree of parietal penetration of gastric cancer in relation to medium- and long-term survival]

The Authors analysed their experience about gastric carcinoma, with particular reference to short, middle and long time survival in relation to the degree of parietal penetration. In the patients without remote metastases, the survival till 5 years depends mainly on this factor, whereas the lymphonodal spreading plays a secundary rôle, especially in the cases where the tumour deeply infiltrated the gastric wall. Lymphoadenectomy, therefore, seems essential in cases of neoplasm with low degree of parietal penetration, whereas in those with high degree it does not seem determinant on the remote results.

[Validity of distal subtotal gastroresection in the treatment of tumors of the lower 1/3 of the stomach]

The Authors analysed the results of a casuistry of 75 patients subjected to radical subtotal gastroresection for carcinoma of the distal third of stomach, with the purpose to verify the validity of such operation, as compared to the total gastrectomy on principle. The postoperative mortality reached 8% and morbidity 8.7%. The survival after 5 years reached 42%. 85% of the patients, at checkings, resulted in good or excellent conditions (Visik 1-2). On the basis of these data, the Authors conclude the distal subtotal gastric resection should be considered the choice treatment for tumours of the lower third of stomach.

"Jumping" satellites in three generations: a warning for paternity tests and prenatal diagnosis

Prominent intensely fluorescent satellites on one chromosome 22 seem to have been transferred, during gametogenesis of a male carrier of a balanced 10/22 translocation, from the normal 22 to the translocated 22 in his daughter and son, both carriers of the translocation. Prenatal diagnosis was performed in the carrier daughter and in the chromosomally normal female foetus the satellites have jumped back to one normal chromosome 22. The phenomenon is probably due to exchanges between the short arms of chromosome 22 at meiotic pairing in the father and in his daughter. These observations give a warning for caution in the use of marker variants for paternity tests and prenatal diagnosis.