F Rulli

Systemic acute-phase response after laparoscopic and open cholecystectomy.

Background: Cytokines are the main mediators of inflammation and the response to trauma. The purpose of this study was to compare variations in cytokine levels following laparoscopic cholecystectomy (LC) and minilaparotomy cholecystectomy (OC), since these two types of operations were considered to be a unique model for examining the role of local tissue injury in postoperative inflammatory reactions. Methods: A total of 40 patients were studied. Eighteen of them underwent LC; the remaining 22 were operated on using the open technique. Systemic concentrations of interleukin- 6 (IL-6), interleukin-1 (IL-1), tumor necrosis factor (TNF), and C-reactive protein (CRP) were measured before and after the operation. In addition, we compared pre- and postoperative white blood cell (WBC) counts, postoperative body temperature, and length of postoperative hospitalization. Results: There was no difference between the two groups in IL-1 and TNF response. The rise in plasma IL-6 levels (18.86 ± 9.61 vs 5.00 ± 0.0 pg/ml, p < 0.0001) and CRP (8.40 ± 5.81 vs 1.43 ± 1.30 mg/dl, p < 0.001) were more marked after open cholecystectomy than after the laparoscopic procedure. There was no correlation between serum CRP concentrations and the other postoperative parameters. Conclusion: The magnitude of the acute-phase response was less pronounced following laparoscopic cholecystectomy, consistent with a reduction in tissue trauma.

Clusterin in stool: a new biomarker for colon cancer screening?

OBJECTIVES:The identification of useful markers for early diagnosis of human colon cancer is a major goal still in progress. Clusterin is a pleiotropic protein with a broad range of functions. It has recently drawn much attention because of its association with cancer promotion and metastasis. It is involved in prosurvival and apoptosis processes that are carried out by two different isoforms. Secreted clusterin isoform (sCLU) is cytoprotective and its prosurvival function is the basis of the current phase I/II clinical trials against prostate, lung, and breast cancers. We have already shown that in colorectal cancer (CRC) there is an increased expression of sCLU. In this report, we investigated whether sCLU is released in the blood and stool of colon cancer patients in order to study sCLU as a potential diagnostic molecular marker for colon cancer screening.METHODS:The quantitative expression of sCLU was determined by dot blot immunodosage in the serum and stool of CRC patients (n=63) and age-matched controls without clinical history of neoplasia, CRC, or systemic or bowel inflammatory disease (n=50). Unpaired t-tests and Mann–Whitney U-tests were used for continuous variables. The diagnostic performance of clusterin was appraised by means of receiver operating characteristic (ROC) curves.RESULTS:We found a significant increase of sCLU in the serum and stool of CRC patients (P=0.0002 and P<0.000, respectively) as compared with controls. ROC curves provided cutoff points showing a trade-off between sensitivity and specificity. With a cutoff point of 88.5 μg/ml, sCLU in blood showed a 55.6% sensitivity and 100% specificity, and with a cutoff point of 34.6 μg/g, the stool test reached 66.7% sensitivity and 84% specificity in discriminating between nonneoplastic and colorectal neoplastic lesions. Human cancer xenografts in nude mice indicated a positive correlation between increasing serum clusterin level and tumor size.CONCLUSIONS:This study highlights the potential of clusterin detection in stool to be a valuable tool to improve the effectiveness and efficiency of large-scale clinical cancer screening.

Helicobacter pylori and gastroesophageal reflux disease

BackgroundThe nature of the relationship between Helicobacter pylori and reflux oesophagitis is still not clear. To investigate the correlation between Helicobacter pylori infection and GERD taking into account endoscopic, pH-metric and histopathological data.MethodsBetween January 2001 and January 2003 a prospective study was performed in 146 patients with GERD in order to determine the prevalence of Helicobacter pylori infection at gastric mucosa; further the value of the De Meester score endoscopic, manometric and pH-metric parameters, i.e. reflux episodes, pathological reflux episodes and extent of oesophageal acid exposure, of the patients with and without Helicobacter pylori infection were studied and statistically compared. Finally, univariate analysis of the above mentioned data were performed in order to evaluate the statistical correlation with reflux esophagitis.ResultsThere were no statistically significant differences between the two groups, HP infected and HP negative patients, regarding age, gender and type of symptoms. There was no statistical difference between the two groups regarding severity of symptoms and manometric parameters. The value of the De Meester score and the ph-metric parameters were similar in both groups. On univariate analysis, we observed that hiatal hernia (p = 0,01), LES size (p = 0,05), oesophageal wave length (p = 0,01) and pathological reflux number (p = 0,05) were significantly related to the presence of reflux oesophagitis.ConclusionBased on these findings, it seems that there is no significant evidence for an important role for H. pylori infection in the development of GERD and erosive esophagitis. Nevertheless, current data do not provide sufficient evidence to define the relationship between HP and GERD. Further assessments in prospective large studies are warranted.

Prevalence of Thyroid Cancer in Hyperthyroid Patients Treated by Surgery

A retrospective study has been carried out to evaluate the prevalence of malignant thyroid tumors in 202 patients submitted to surgery for hyperthyroidism. Thyroid cancer was diagnosed in 12 cases (5.9%); the final histologic examination revealed nine papillary carcinomas, one follicular carcinoma, and two Hürthle cell carcinomas. Concurrence of hyperthyroidism and thyroid cancer was more frequent in patients with single toxic adenomas than in those with toxic diffuse or multinodular goiters. In five cases thyroid malignancy was detected in the context of the hyperthyroid lesion (three toxic adenomas and two diffuse goiters). In eight patients the malignant lesion showed a maximum diameter of less than 1 cm, although in five of these cases unfavorable histologic features, such as minimal capsular invasion or multifocality, were present. All patients presenting with thyroid cancer are currently alive and apparently free of residual disease. It is concluded that hyperthyroid patients, particularly those with single toxic adenomas, should be carefully evaluated to exclude the presence of an associated malignancy and to plan the most appropriate therapeutic options.

Randomized clinical trial on Harmonic Focus shears versus clamp-and-tie technique for total thyroidectomy

BACKGROUND The Harmonic Focus is the last ultrasonic device designed for thyroid surgery. The aim is to assess its efficacy and safety compared with traditional dissection in a prospective randomized trial of total thyroidectomy procedures. METHODS Total thyroidectomy was performed in 34 patients using the Harmonic Focus, and in 34 patients using the clamp-and-tie technique. RESULTS In the Harmonic Focus group, relative reductions of 29% and 46% were observed in surgical time and blood loss, respectively. The number of intraoperative instrument exchanges also decreased by 70%, and use of specific materials required to achieve hemostasis decreased significantly. Safety was found to be similar in both patient groups. CONCLUSIONS Our study showed beneficial effects of Harmonic Focus use in thyroid surgery. Further studies therefore are needed to evaluate cost in the light of savings made in surgical time, materials needed for hemostasis, and human resources.

Long saphenous vein stripping reduces local level of reactive oxygen metabolites in patients with varicose disease of the lower limbs.

Long saphenous vein (LSV) stripping is the most common surgical procedure in patients affected by varicose disease of the lower limbs. Reactive oxygen metabolites (ROM) generation plays a crucial role in chronic venous insufficiency (CVI). The aim of this study was to investigate whether ROM generation is increased in patients affected by varicose disease versus healthy controls and whether LSV stripping has a positive effect on the local production of ROM. The local production of ROM was assessed measuring hydroperoxides in the blood collected from the leg of 30 patients consecutively undergoing LSV stripping and 30 controls. In both the patient group and the control group, the test was repeated 30 days later. We found that ROM levels before surgery are higher in varicose vein patients than in controls (p < .0001) and that ROM are significantly reduced 30 days after LSV stripping (p < .0001). At that time point, no significant differences between patients and controls was found. We also found that sex and age do not affect ROM concentration in patients and controls, either before or after surgery. In conclusion, our data indicate that CVI is characterized by significant oxidative stress and that LSV stripping is able to normalize local production of ROM in patients with varicose disease of the lower limbs. We suggest that measurement of ROM might be useful to test the positive effects of LSV stripping in these patients.

Synchronous Bilateral Testicular Germ Cell Tumor with Different Histology

A rare case of synchronous bilateral testicular germ cell tumor of different histological type is described. We report the case of a 39-year-old man with this unusual condition and discuss the value of the histopathological diagnosis in therapy and prognosis. A thorough review of the literature is also presented, and for the first time the precise histological subtype of each reported tumor, as diagnosed by the authors of the original paper, is illustrated.

Primary Malignant Fibrous Histiocytoma of the Duodenum

Background/Aim: We report on a case of primary malignant fibrous histiocytoma of the duodenum. Methods: Report of a case and review of the literature on the occurrence of this tumor in the alimentary tract. Results: The neoplasm was detected incidentally at the time of diagnostic workup for upper gastrointestinal bleeding. Curative surgery using the Whipple procedure was carried out with uneventful postoperative course; no evidence of liver metastases was detected during intraoperative ultrasonography. The patient died of diffuse metastatic liver disease 2 months after surgical resection. Up-to-date review of the literature has added only 3 cases to those previously reported, including that reported by us. Conclusions: The biological behavior of malignat fibrous histiocytomas is extremely aggressive and mainly conditioned by size and histological grading. The treatment of choice, whenever possible, is based on early and complete surgical excision of the tumor.

Buerger's Disease: Is It a Rickettsiosis?

A serologic study using the direct seroagglutinate method described by Babudieri and Zardi was carried out in 31 patients affected by Buergers disease, to determine the positive antibody reaction level against rickettsial disease. In 41.9% of the cases there was a positive test for R. burnetii, in 6.4% a positive test for R. mooserii, and in one a positive test for R. conorii. The results lead us to believe that these pathogenic agents are largely responsible for the development of thromboangiitis obliterans.

Diagnostic Lobectomy for Unilateral Follicular Nodules of the Thyroid Gland

We describe our technique of diagnostic lobectomy (DL) and the rationale it is based on. We define DL as a minimally invasive procedure consisting of total lobectomy and isthmusectomy, with preservation of the omolateral recurrent laryngeal nerve and parathyroid glands, but without digital exploration of the contralateral lobe. The fact that re-entry into the previously explored field to complete thyroidectomy increases the risk of complications must be taken into consideration. The subjects were 63 consecutive patients who underwent surgery for unilobar follicular neoplasms of the thyroid gland between January 1997 and December 2002. There were 49 follicular adenomas and 14 carcinomas. In the 14 patients with thyroid cancer, total thyroidectomy was performed within 2 weeks after the first operation in a sterile environment with normal anatomical cleavage plains, avoiding any risk of injury to the laryngeal nerves and parathyroid glands. It is concluded that DL is a safe and suitable surgical procedure for patients with follicular-structured lesions of the thyroid gland.