BACKGROUND: Because more than 90% of local recurrences after curative surgery for rectal cancer appear within the first 36 months after surgery, an intensive and strict follow-up program during this period could improve early diagnosis and, thus, prognosis of patients. METHODS: Of the 216 patients who underwent surgery for rectal cancer, 127 entered an intensive follow-up program (median follow-up: 42 months); the clinical outcome of the remaining 89 patients was reconstructed with the help of their general practitioners. RESULTS: Fifty eight (26.8%) of the 216 patients who were treated with curative surgery alone developed a local recurrence; pelvic recurrences were prevalent. Eleven (30.5%) of the 36 patients who had recurrence during follow-up, and 6 of the 22 who had not undergone follow-up, had a reoperation with curative intent; the median survival was 19 months vs. 8 months, respectively (P = ns). Four (44.4%) curative reoperations were performed on the 9 asymptomatic patients and in 13 (26.5%) of the 49 cases with symptomatic local recurrences. Median survival was 15 months vs. 14 months, respectively (P = n.s). All patients except one (living after 42 months from reoperation) died within 48 months. CONCLUSIONS: In our study, adherence to a strict follow-up program unfortunately proved to be ineffective for improving long-term survival for patients who underwent reoperation with curative intent.

Adenocarcinoma↗

PubMedDate not supplied

[Renal hemangiopericytoma. Anatomo-pathologic and clinico-therapeutic considerations. A case report].

The Authors report a case of renal hemangiopericytoma, whose interest is related to the extreme rarity (24 cases reported until today), its insidious growth, the late in diagnosis, its uncertain clinical-biological evolution, not always predictable. Considering chemotherapy and radiotherapy ineffectiveness, an adequate treatment for such a neoplasm requires the surgical therapy, which must be followed by a careful follow-up.

Adult↗

PubMedDate not supplied

Prognostic indicators of local recurrence in patients operated for rectal cancer.

BACKGROUND/AIMS: To identify subgroups of patients at high risk of local relapse after curative surgery for rectal cancer. METHODOLOGY: Thirty-five variables of 216 patients observed from January 1987 to December 1995 were retrospectively analyzed according to univariate and multivariate methods. Median follow-up was 38 months. RESULTS: High and moderate grade (P = 0.0001), Size > or = 5 cm (P = 0.013), lymph nodes involvement (P = 0.002) and patients with locally advanced rectal cancer underwent extensive surgery and postoperative radiation significantly increased local relapse; whereas surgical procedure and experience of surgeons had no influence. CONCLUSIONS: The above-mentioned prognostic factors of rectal cancer that show a risk of local relapse 2- to 3.5-times higher than comparative conditions could be useful in identifying subgroups of patients at high risk for local recurrence. These patients should undergo a careful selection according to risk factors of relapse in order to increase local control of disease performing "optimal" primary surgery, effective postoperative radiation and tailored follow-up.

Adenocarcinoma↗

PubMedDate not supplied

[The clinical importance of physiopathological studies of the bile salts performed using the gamma-emitting bile acid SeHCAT].

The availability of the gamma-labelled bile acid 75SeHCAT, that allows a non-invasive assessment of the enterohepatic circulation of bile acids, has prompted in the last 10 years the implementation of several studies involving wide series of normal subjects and patients with various organic and functional bowel disorders. The clinical indications for performing a SeHCAT test have been clearly defined: the test can identify with high accuracy, in the setting of the irritable bowel syndrome, the patients with bile acid malabsorption that can be confidently and successfully treated with cholestyramine; it can also assess whether, and to what extent, the diarrhoea presenting in patients with intestinal organic disorders is due to bile acid malabsorption, permitting an optimal therapeutic strategy to be designed. The parameters of the hepatic handling of SeHCAT after bolus intravenous administration have been characterized in normals, and studies on various chronic hepatic disorders are now in progress. Interesting results are emerging from studies performed in patients with chronic non-obstructive cholestatic disease, where a specific defect in the excretion rate of SeHCAT is present: these studies may cast more light on the abnormalities of bile secretion and on the mechanism of action of drugs used to treat this condition, forming the rationale for the use of intravenous SeHCAT for hepatobiliary dynamic scintigraphy as a sophisticated liver function test. In conclusion, the SeHCAT test has become an important diagnostic tool for the gastroenterologist studying the diarrhoea, and awaits more studies to be used also by the hepatologist. The relatively long physical half-life of 75Se (180 days), preventing a wider use of the test, could theoretically be overcome by the synthesis of a similar gamma-labelled bile acid with a shorter half-life.

Bile Acids and Salts↗

PubMedDate not supplied

[A case of small-cell carcinoma of the rectum].

A case of oat-cell carcinoma of the rectum prompted the authors to undertake a review of the literature. The main histological aspects allowing an accurate diagnosis are stressed. This is a rare form of highly malignant neoplasm of uncertain origin (probably similar to that of carcinoids) with a very marked tendency to metastasize, even to distant organs; it is characterized by substantial cellular polymorphism with small-sized elements, very little cytoplasm, a large hyperchromic nucleus, barely visible nucleoli and histochemical reactions typical of neuroendocrine cells.

Carcinoma, Small Cell↗

PubMedDate not supplied

[The ileocecal valve as a prognostic factor in extensive resection of the small intestine].

The aim of the study was to examine the role of the ileocaecal valve in relation to the nature and extent of symptoms following extensive bowel resection (EBR) in 13 patients with short bowel syndrome (SBS) referred to our department over the period 1962-1988. The results obtained do not allow us to assess the effective role of the ileocaecal valve in determining the severity of SBS. The factors conditioning the extent of the aftermath of EBR and effectively affecting prognosis are, in fact, multiple and act in various interrelated ways, thus making it difficult to define the precise role of any one of them. The ileocaecal valve, however, does play a substantial role, in that, on the one hand, it performs sphincter and barrier functions against ileocolic reflux of bacteria, while, on the other, its removal involves excision of the right colon (reserve area for reabsorption of water and ions) and of the terminal ileum (a site specialized in absorption of vitamin B12 and bile salts).

Adult↗

PubMedDate not supplied

[Diagnosis of bacterial contamination of the small intestine using the 1 g [14C] xylose breath test in various gastrointestinal diseases].

The prevalence of the small intestine bacterial overgrowth syndrome has been assessed in 109 in-patients affected by various gastrointestinal disorders using the 1 g [14C]-xylose breath test; 18 healthy subjects acted as a control group: none of them showed abnormal results (100% specificity). None of 14 patients with colonic disease had abnormal results, whereas in 44 patients with ileal diseases the test was positive in 12% to 39% of the cases. Abnormal results were found in 46% of patients who underwent partial gastric resection greater than 20 years before, 29% of patients with irritable bowel syndrome without diarrhoea (faecal wet weight less than or equal to 600 g/72 h), 56% of those with diarrhoea of obscure origin, and 25% of celiac patients. Eight out of 8 patients with altered results showed normalization of the test after antibiotic therapy. Despite its high diagnostic value in the setting of clinical research, the 1 g [14C]-xylose breath test cannot as yet be proposed as a routine investigation.

Breath Tests↗

PubMedDate not supplied

[Leiomyosarcomas of the small intestine].

The main clinical and anatomico-pathological aspects of small bowel leiomyosarcomas are stressed. These are rarely observed malignant tumours, which sometimes prove difficult to diagnose and have a poor prognosis. Also characteristic is the substantial difficulty often encountered in defining the malignancy grade histologically.

Humans↗

PubMedDate not supplied

[Acute thrombocytopenic purpura and hypergammaglobulinemia in Whipple's disease. Description of a clinical case].

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Acute Disease↗