Antonio Licata

Nonproteic Antioxidant Status in Plasma of Subjects with Colon Cancer

Reactive oxygen species (ROS) could be important causative agents of a number of human diseases, including cancer. Thus, antioxidants, which control the oxidative stress state, represent a major line of defense regulating overall health. Human plasma contains many different nonenzymatic antioxidants. Because of their number, it is difficult to measure each of these different antioxidants separately. In addition, the antioxidant status in human plasma is dynamic and may be affected by many factors. Thus, the relationship between nonenzymatic antioxidant capacity of plasma and levels of well-known markers of oxidative stress (oxidized proteins, lipid hydroperoxides, decreases in thiol groups) better reflects health status. The present study considers antioxidant capacity and oxidative stress in human plasma of patients with colon cancer or precancerous lesions, as well as before and after surgical removal of tumors and/or chemo/radiation therapy. Healthy blood donors were used as controls. Colon cancer patients demonstrated a significant decrease in nonproteic antioxidant status and in total thiol groups with respect to healthy controls, whereas oxidized proteins and lipid hydroperoxide levels were significantly increased. In patients with precancerous lesions, the only unmodified parameter was the thiol group level. After surgery, the levels of oxidized proteins, lipid hydroperoxides, and total thiol groups were restored to those seen in healthy subjects, whereas nonproteic antioxidant capacity remained unmodified from that determined before surgery. Conversely, chemo/radiation therapy increased both nonproteic antioxidant capacity and levels of oxidized proteins and lipid hydroperoxides and significantly decreased total thiol groups. These results further support the hypothesis that oxidative stress correlates to the risk of some forms of cancer, not only in the initial stages but also during progression.

Colorectal Follow-Up Planning Modified on the Basis of Our Personal Experience

Background: The authors, evaluating the disappointing follow-up results in patients suffering from colorectal carcinoma who had undergone surgery for cure, tried a more rational follow-up. Methods: In a retrospective review about 232 patients who adhered to the follow-up protocol, we evaluated the accuracy rates of CEA, liver ultrasonography and abdominal CT. In the same group of patients, we evaluated the type of correlation between the neoplastic recurrence rate and Astler-Coller’s classification. Results: (1) In detecting hepatic metastases CEA levels furnished sensitivity and negative predictive value more than liver ultrasonography (83.3 vs. 77.8% and 98.4 vs. 98%, respectively); (2) in our series, we obtained a lower recurrence rate in classes A+B1 (7.5%) and B2 (20.8%) and higher in C1+C2 (44.4%) and D (66.7%) (p < 0.01). Conclusion: According to these data we decided to eliminate postoperative liver ultrasonography and customize follow-up protocol on tumor staging and timing of cancer relapse. The authors believe that these changes will not modify the results, but cause less psychophysical stress for the patients and reduce costs by 50%.

Favourable anatomical variation for the resection of a Klatskin tumour

The liver and the biliary tract are rich in anatomical variations, knowledge of which is important for the surgeon. A case of an anatomical variation is reported, which allowed easy and oncologically correct resection of a Klatskin tumour. The variation consisted of abnormally long right and left extrahepatic ducts and an abnormal distal bifurcation, with a cystic duct joining the distal end of the right duct. A favourable modification of surgical strategy could be obtained by an oncologically correct resection of a Klatskin tumour avoiding a liver resection and also allowing easy reconstruction. Complete biliary exposure was necessary to reveal the rare, pre-operatively unrecognized, but favourable situation. In the absence of clear contraindications extended biliary dissection is to be recommended to avoid errors in the evaluation of the resectability of hilar biliary cancers.

Malignant sigmoid-duodenal fistula: case report and review of the literature

Background Colonic-duodenal fistulas are rare, and may be secondary to benign or malignant conditions. Malignant duodenocolonic fistulas may also develop in patients with right colon or hepatic flexure carcinoma or duodenal malignancy. The sigmoido-duodenal malignant fistula is exceptional and, to our knowledge, only two previous cases have been reported. The first case was treated in our Institution in 1981 and published by Russello [1] and the second was reported by Melissas in 2002 [2] in the literature. We present the third case of malignant fistula between the duodenum and sigmoid colon in a 84-years-old male patient.

Rectal prolapse treatment in elderly patients

Background Rectal prolapse in elderly patients can cause considerable discomfort causing bleeding, itching, wet anus and tenesm. In older patients the gold standard treatment uses a perineal approach. Success obtained by using circular staplers in the treatment of internal prolapses, associated or not with haemorroids or obstructed defecation, may represent a new method of choice if applied with the appropriate modifications, to the external rectal prolapse, for its speed, simplicity and possibility to be performed under local anesthesia, and even in elderly patients with debilitated conditions.

Appendiceal-sigmoid fistula presenting in a man with ulcerative colitis: a case report.

IntroductionUlcerative colitis is a chronic disease characterized by diffuse mucosal inflammation limited to the colon. It mostly affects young adults, yet a large number of middle-aged and older patients with ulcerative colitis have also been reported.Case presentationA 58-year-old Caucasian man presented to our hospital in August 2006 with continuous and diffuse abdominal pain, meteorism, fever and bloody diarrhea. He had a two-year history of ulcerative colitis. Our patient was treated with intravenous medical therapy. As his condition worsened, he underwent surgery. An explorative laparotomy revealed that the entire colon was distended and pus was found around an appendiceal-sigmoid fistula.ConclusionsTherapy for ulcerative colitis is a rapidly evolving field, with many new biological agents under investigation that are likely to change therapeutic strategies radically in the next decade. Indications for surgery are intractability (49%), stricture, dysplasia, toxic colitis, hemorrhage and perforation. To the best of our knowledge, this is the first case of an appendiceal-sigmoid fistula in a patient affected by ulcerative colitis reported in the literature. Fistulae between the appendix and the sigmoid tract are rarely reported in cases of diverticular disease and appendicitis.

Oesophageal stent in unresectable cancer in elderly

In our department we prefer to use nitinol self-expanding stents (Esophacoil, Instent Inc., USA) for the radial force that allow complete and rapid expansion even in the presence of thigh stenoses, the rapid relief of dysphagia, adaptability of the spirals to the strictures with consequently greater adhesion to the neoplasia and lower percentage of dislocations, the lower percentage of tumoural ingrowth due to the serrated matching to the spirals.

Prognostic factors of gastric cancer in the elderly

Hypertension, heart disease and malnutrition were found to be the most frequently comorbidities. In our series the most common localization of the cancer was in the lower third (43.7%). So we performed total gastrectomy in 45 patients (56.9%) and partial gastrectomy in 34 patients (42.1%). Perigastric lymphadenectomy was performed in 38 patients (48.6%) while D2 gastrectomy was performed in 41 patients (51.4%).

Thermic ablation with RF of liver metastases from colorectal cancer

Aim of this study was to evaluate the role of radiofrequency ablation in the treatment of the hepatic metastasis of colorectal cancer. From November 1997 to July 2002 49 radiofrequency ablations have been performed in 19 patients (11 male and 8 female; mean age 65 years: range 50-78 years). The disease-free period was between 5 and 32 months. Nodules had a diameter <3 cm in 4 cases while in 3 cases a single lesion was present. One patient had a single lesion after 2 courses of intravenous systemic chemotherapy which had a reduced greater lesion (from 6 to 3 cm) while a 2 cm lesion had disappeared. In the remaining 12 patients the mean number of lesions is 3 (range 1-13) with a diameter between 3 and 12 cm. The radiofrequency ablation has been performed during laparotomy and vascular exclusion through clampage of the liver hilum in 4 cases and percutaneously under ultrasound guide in the remaining 15 cases. All patients underwent follow up by computed tomography, CEA level and ultrasound every 3 months. One patient only has completed a 4 year follow up and is alive without local recurrence but with a cerebral metastasis. The other 18 patients have a 32 months follow up with a survival of 50% (9 on 18). In conclusion in our experience the radiofrequency ablation is a valid alternative method in the treatment of the hepatic metastasis of colorectal cancer.

Calibration of Papillotomy in the Surgical Treatment of Papillary Stenosis : the "Little Train"

Although laparoscopic and endoscopic surgery have brought about an indisputable revolution in biliary surgery, many surgeons still prefer open surgery for lithiasis of the common bile duct, and if it is associated with a papillary pathology, they perform a papillotomy. However, great controversy regarding the site, modalities, and extension of the papillary section has now developed among surgeons. Our technique is not original; however, we do propose a “calibration” of the papillotomy, carried out by constructing a “little train” made up of several consecutive Nélatons of increasing caliber to identify the sphincter fibers and to obtain sections proportionate to the size of the bile duct. Of the 115 patients in this series who were treated by open papillotomy, only 1 developed acute pancreatitis; 2 demonstrated bleeding, 1 of whom required surgical exploration.