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[Diagnostic value of the analysis of alpha fetoprotein levels in malignant neoplasms of the digestive system].

The concentration of alpha-fetoprotein (AFP) in serum was determined in 58 patients (35 males and 23 females) aged from 38 to 87 years treated surgically for malignant tumours of the digestive tract, including colonic carcinoma in 30, gastric carcinoma in 11, pancreatic carcinoma in 10 and oesophageal carcinoma in 7 cases. In 33 patients the tumour was disseminated (into the liver in 22 cases). On the ground of AFP concentration determinations in 40 patients (19 males and 21 females) aged 22 to 80 years operated on for non-neoplastic abdominal diseases the upper normal range was accepted as 9.42 ng/ml. Raised AFP concentration was found in only patient with advanced pancreatic carcinoma and multiple metastases to the liver and lymph nodes. The study showed that serum AFP level in cases of digestive tract malignancies is of limited diagnostic value.

Adult↗

Endosonography and endoscopic magnetic resonance imaging.

Endosonography is an important modality for the diagnosis and staging of oesophageal, gastric, colorectal and pancreatobiliary malignancy. It is also recognized as a reliable method for the evaluation of submucosal tumours of the gastrointestinal tract, for differentiating benign lesions from giant gastric folds, and for the localization of pancreatic endocrine tumours. The latest development, that of endosonographic fine-needle aspiration, provides for the cytological diagnosis of gastrointestinal tumours. This new technique may also be used for endoscopic therapy. High-frequency probes can be used to make a more accurate diagnosis of superficial carcinoma of the gastrointestinal tract, for three-dimensional imaging of gastrointestinal tumours and for intraductal ultrasonography of the bile duct and pancreatic duct. Endoscopic magnetic resonance imaging provides information not obtainable with endosonography or other modalities. It has high potential in the diagnosis and staging of gastrointestinal and pancreatobiliary tumours.

Biliary Tract Neoplasms↗

[Mortality trends caused by neoplasms of the digestive system. Soria, 1950-1985].

The deaths caused by tumours of the digestive system (oesophagus, stomach, colon-rectum, gallbladder and pancreas) recorded in the province of Soria between 1950 and 1985 have been analyzed according to risk and mortality rates. Standardized (adjusted) rates in relation to sex and site of residence (urban-rural) of the deceased were calculated for the decades 1950-1959, 1960-1969, 1970-1979 and the period between 1980 and 1985. Standard errors were calculated to establish confidence limits according to Miettinen's method. The data were obtained from the death certificates of the various registries of the Soria province, including name and surnames, sex, age and site of the tumour according to the 9th revision of the International Classification of Diseases. There is a significant decrease in the mortality risk for tumours of the stomach in both sexes (p less than 0.01) and in liver tumours in females (p less than 0.01). On the other hand, there is an increased risk in both sexes for pancreatic cancer (p less than 0.05 M, p less than 0.01 F) and for oesophageal tumours in men (p less than 0.05). Similarly, during 1980-1985 men were at a significantly greater risk of dying from oesophageal, gastric and liver cancer (p less than 0.01) as well as rectum and colon (p less than 0.05). As far as stomach tumours are concerned there are significant differences between rural and urban areas both in males (p less than 0.01) and in females (p less than 0.05).

Cause of Death↗

[Pre-operative identification of patients at risk for septic complications after surgery for neoplasms of the digestive system. A multiphasic multicenter study].

One hundred ninety-six patients undergoing surgical treatment for digestive tract cancer were recruited in a polycentric, multistep study to value significant differences of pre-operative nutritional and immunologic parameters between patients with or without post-operative infections. Such parameters might be useful for the identification of "septic risk" patients. Primarily, 63 patients were given a complete anthropometric evaluation, laboratory screening and immunologic assessment (surface marker analysis of peripheral blood mononuclear cells, polymorphonuclears in vitro chemotaxis and phagocytosis). Only a few serologic parameters were significantly reduced in patients with post-operative infections, namely: total serum proteins (p less than 0.02), albumin (p less than 0.02), beta-globulins (p less than 0.01), and C3c (p less than 0.05). These parameters were elaborated with Fisher's linear discriminant function to detect the optimal discriminant threshold able to identify "septic risk" patients. The predictivity of this discriminant function was validated in a second group of patients (n = 49) in which total serum protein with electrophoresis were pre-operatively assayed as well as skin test reactivity to intradermal injection of recall antigens (Multitest skin-testing); discriminant sensitivity was 80%, the specificity 50%, and positive predictivity 62%. This low discriminant power of the equation based only on serum proteins assessment coupled with the significant negative relationship between skin testing and post-operative infections (male, p less than 0.005; female, less than 0.025) suggested a re-elaboration of the discriminant function, including the skin-testing score. The definite assessment of this new discriminant equation was evaluated in the third sample of patients (n = 84) which showed 67% sensitivity, 88% specificity, and 76% positive predictivity, thus suggesting the high reliability of this test for the pre-operative selection of "septic risk" patients.

Aged↗

[Hepatic angioma: a bothersome presence during staging of neoplasms of the digestive system].

On reviewing a consecutive series of 1,200 ultrasonic tomographies of the liver to assess the incidence of liver angiomas, the authors describe their sonographic, tomodensitometric and angiographic characteristics. They emphasise the fact that such lesions, though usually not constituting a serious clinical or diagnostic problem, as a simple sonographic follow-up will suffice to clarify the situation, may nevertheless, in certain particular clinical situations such as in the course of tumour staging of the digestive apparatus, require full diagnostic investigation using all the techniques available (ultrasonic tomography, CAT, liver arteriography, sonographically guided thin-needle biopsy.

Adult↗

[Evaluation of the effectiveness of screening for tumors of the digestive system].

Some features of digestive cancers encourage screening programs, even though no such program has been shown so far effective in reducing mortality rates. The visual inspection of the oral cavity and pharynx, with the addition of flexible endoscopy and, possibly, blue-toluidine staining, can be easily performed by specialists and dentists. The strong association with smoking habits and alcohol consumption favours the organization of screening programs but primary prevention maintains the highest priority. For cancer of the colon-rectum two different screening approaches are under close scrutiny: fecal occult blood testing, on an yearly basis, and once-in-a-life sigmoidoscopy at 55-60 years of age. Only one of five ongoing randomized prospective studies on occult blood testing has reported, so far, a significant reduction, around 33%, of mortality from colorectal cancer, with, however, a large burden of sigmoidoscopies.

Colorectal Neoplasms↗

[The role of GABA-ergic system in carcinogenesis].

The gamma-aminobutyric acid (GABA) is the major and the best known neurotransmitter with inhibitory properties in the central nervous system (CNS). Outside the CNS, GABA acts as a regulator of muscle tension and controls the secretion of hormones. In the peripheral region, as in the CNS GABA's function is known to be mediated by GABAA and GABAB receptors. Several recent reports have suggested a relationship between the GABA-ergic system and oncogenesis. It has been confirmed that both GABA content and GAD activity are increased in material from colon, breast, digestive tract, and ovarian cancer. In the light of theory of dynamic balance between stimulating and inhibitory amino acids, disturbances in GABA metabolism may be a sign of the cell's defensive reaction during carcinogenesis.

Breast Neoplasms↗

[Primary lymphoma of the small intestine].

INTRODUCTION: Small bowel neoplasms are relatively rare, considering digestive system neoplasms. The aim of this case report was to point to clinical manifestations, significance and treatment patterns of small bowel lymphomas. MATERIAL AND METHODS: This is a case report of a sixty-eight year old patient who had undergone surgical treatment due to clinical and radiological findings of small bowel obstruction. RESULTS: Histological findings revealed a malignant lymphoma. Primary small intestine lymphomas are treated by radiochemotherapy followed by surgical treatment (partial resection).

Aged↗

Digestive system malignancies in the eastern province of Saudi Arabia: an analysis of 158 patients.

Retrospective evaluation of 158 patients with digestive system neoplasms was carried out. The disease pattern was compared to that noted in other parts of Arabia, other Middle East countries, Africa, and the West. An attempt was made to analyze potential aetiological factors in the Saudi population. At all cancer sites of the digestive system the male to female ratio was 3:1. Generally more younger patients with advanced cancer were encountered than reported in series from the Western hemisphere. The poor results of therapy were generally attributed to the advanced stage at presentation. The high frequency of GIT cancer and in particular the apparently rising incidence rate of colorectal cancer was attributed to dietary habits and the changing lifestyle of the population. Hepatitis B viral infection was the likely cause of primary hepatocellular cancer (PHC) although dietary factors could not be ruled out. Schistosomiasis was found not to play a role in the causation of either PHC or colorectal cancer.

Adult↗

Workplace risk factors for cancer in the German rubber industry: Part 2. Mortality from non-respiratory cancers.

OBJECTIVES: To determine the mortality from non-respiratory cancers by work area among active and retired male workers of the German rubber industry. METHODS: A cohort of 11,633 male German workers was followed up for mortality from 1 January 1981 to 31 December 1991. Cohort members were active (n = 7536) or retired (n = 4127) on 1 January 1981 and had been employed for at least one year in one of five study plants producing tyres or technical rubber goods. Work histories were reconstructed from routinely documented "cost centre codes" and classified into six categories: I preparation of materials; II production of technical rubber goods; III production of tyres; IV storage and dispatch; V general service; VI others. Standardised mortality ratios (SMRs) and 95% confidence intervals (95% CIs), controlling for age and calendar year and stratified by work area (employment in respective work area for at least one year) and time related variables (year of hire, lagged years of employment in work area) were calculated from national mortality rates as the reference. RESULTS: Significant increases in mortality were found for pharyngeal cancer in work area IV (three deaths, SMR 486, 95% CI 101 to 1419), oesophageal cancer in work area III (11 deaths, SMR 227, 95% CI 114 to 407), and leukaemia in work areas I (11 deaths, SMR 216; 95% CI 108 to 387) and II (14 deaths, SMR 187; 95% CI 102 to 213). Furthermore, increased SMRs were found for stomach cancer in work area I (22 deaths, SMR 134; 95% CI 84 to 203), colon cancer in work area II (27 deaths, SMR 131, 95% CI 86 to 191), prostatic cancer in work area V (27 deaths, SMR 152, 95% CI 99 to 221), and bladder cancer in work areas IV (six deaths, SMR 253; 95% CI 93 to 551) and V (12 deaths, SMR 159, 95% CI 82 to 279). Mortality from cancer of the liver or gall bladder, pancreas and kidney, and from lymphomas was not substantially increased in any of the work areas. CONCLUSIONS: Mortality from cancer of several sites was associated with specific work areas. Some of these associations have been reported previously. Future analyses of our study will have to determine the role of specific exposures in the aetiology of these cancers.

Adult↗