[Radiological study of anastomotic leakages following colorectal surgery]

The anastomotic leakage is one of the most serious complications following colorectal surgery. The incidence rate is between 3% and 21% considering the different experiences, pathology and surgical techniques. Our aim is to verify the role of radiological study in 45 patients with clinical and subclinical colorectal anastomotic leakage total anastomoses = 252). In 31 patients at risk, the operation was concluded with a loop ileostomy. The radiological study gastrografin enema was performed in all patients (26 symptomatic and 19 asymptomatic patients with loop ileostomy). The dehiscence incidence resulted 5.5%: 14 of 252 patients. In our experience the radiological study of selected colorectal anastomoses allowed to show the site and the flow of the leakage and to plan the proper management. In asymptomatic patients the study allowed to programme a specific follow up in patients with higher risk of postinflammatory stenosis or perhaps neoplastic relapse.

[Primary duodenal adenocarcinoma: report of three cases, prognostic factors and therapeutic approach]

Three cases of histologically proven primary non-ampullary adenocarcinoma of the duodenum, observed in our Department from 2001 to 2004, are described. The cases were treated by pancreaticoduodenectomy, duodenal resection and transduodenal excision, respectively. The rarity of this pathology is documented by few retrospective studies and justifies discussion about the main prognostic factors and the best therapeutic approach. We analyze diagnostic, therapeutic and prognostic factors after a revision of literature.

Human mammaglobin mRNA is a reliable molecular marker for detecting occult breast cancer cells in peripheral blood

Occult carcinoma cells in peripheral blood of breast cancer (BC) patients is generally associated with poor disease prognosis. Reverse transcriptase-polymerase chain reaction (RT-PCR) is a sensitive method for revealing rare circulating cancer cells. The target mRNA must be carefully chosen, as it must be expressed only by malignant cells. In this study, we developed a nested RT-PCR assay for mammaglobin (hMAM) and assessed both its specificity and its sensitivity in the detection of cancer cells in peripheral blood of BC patients. hMAM mRNA was detected by RT-PCR in 156/165 (95%) of fresh BC tissues analyzed. All samples from 66 healthy blood donors and 151 patients with benign breast disease were hMAM negative as assessed by nested RT-PCR. In contrast, hMAM was detected in 16/137 (12%) of peripheral blood samples deriving from BC patients: 0/9 in stage 0, 1/50 (2%) in stage I, 3/33 (9%) in stage II, 1/18 (5%) in stage III and 11/27 (41%) in stage IV. Using nested RT-PCR, we were able to amplify hMAM transcript of one tumour cell/10(6) normal cells. Our data demonstrate that hMAM mRNA detection by RT-PCR is a specific assay potentially suitable for identification of occult cancer cells in peripheral blood of BC patients.

The use of prosthesis in abdominal and thoracic wall defect, 15 year experience: evaluation of tissue reactions and complications

Synthetic prosthesis (Polypropylene, Dacron and expanded Polyterafluoroethylene) is now widely used in abdominal and thoracic wall reconstructive surgery. Many surgeons have reported great success with various types of prosthetic implants but tissue reactions and other complications have never been well defined. The aim of this study was to determine which molecules react upon tissue contact, which synthetic materials result in less complications and whether some non-specialized prosthetics are correlated with certain types of complications. We studied 54 patients from 1982-1997 who had each been re-operated on for prosthetic complications. Our clinical data was then compared to data collected from animal models. Twenty-one pigs received one or more prosthetic implants: 14 of these pigs received their implants with a "proper surgical technique" while 8 underwent "improper surgical technique". The results from both the clinical and animal study were significantly similar. From a microscopic point of view, we can conclude that different tissues react in the same way with the same or similar types of prostheses. The reactions begin to differ when the thickness and rigidity of the material is considered. A PTFE-polyporpylene combination (Composix Mesh) seems to be the most effective solution, especially in abdominal defect repair which involves peritoneal organ contact. We would also like to emphasize that prosthetic complications can be quite serious and this type of procedure should only be performed by experienced and qualified surgeons.

[Colonic perforation during diagnostic and surgical endoscopy. Experience with 5500 colonoscopies]

The authors report on their experience of 5500 colonoscopies with two cases of perforation of the colon; the rarity and low morbidity and mortality of this complication, related to the experience and the technique of the endoscopist, are discussed. The renal importance of diagnostic and therapeutic colonoscopy is underlined.

[A case of Crohn's disease associated with ankylosing spondylitis and digital hippocratism]

Some comments are made on the association of chronic intestinal inflammatory conditions and articular manifestations on the basis of a case of Crohn's disease associated with ankylosing spondylitis and digitalic hippocratism. The clinical case is described and the literature on associations observed during Crohn's disease reviewed. Special attention is paid to associations involving ankylosing spondylitis, enteropathic synovitis and hypertrophic osteopathy, particularly as regards the presence of clubbed fingers.