Pathological features as predictors of recurrence after radical resection of gastric cancer

BACKGROUND: The aim of this study was to investigate the pattern and timing of recurrence and to determine associated risk factors after radical resection of gastric cancer including D2 dissection. METHODS: A total of 274 patients who had undergone radical resection of gastric cancer with nodal involvement or T3-4 tumour were randomized to receive chemotherapy or no further treatment (control group). Locoregional recurrence and distant metastasis were analysed in a competing risks framework, by estimating the crude cumulative incidence in each group. Multiple regression models were used to investigate the influence of treatment and pathological features on the risk of recurrence. RESULTS: Overall, the 7 year rate of locoregional relapse was 15.8 per cent and that of distant recurrence was 34.5 per cent. There was a significant association between pathological node (pN) stage and distant relapse (P < 0.001), and between pathological tumour (pT) stage and locoregional recurrence (P = 0.024). Chemotherapy had no significant effect on either locoregional or distant recurrence. CONCLUSION: The rate of locoregional recurrence after radical surgery for gastric cancer was lower than that in studies based on more conservative surgery. The pT stage was related to the rate of locoregional recurrence whereas pN stage had an impact on distant recurrence.     

Antibacterial effect of plant extracts against Helicobacter pylori

The aim of this work was to evaluate the antibacterial effect of plant extracts as alternative and[sol ]or as active agents supporting antibiotics for treating Helicobacter pylori infection. The effect of either, ethanolic or aqueous extracts from 17 plant materials were studied against one H. pylori standard strain and 11 clinical isolates using a disc diffusion test and by evaluating the minimum inhibitory concentration (MIC) on solid media. An inhibitory activity against H. pylori strains was recorded in a large percentage of tested plants. MIC values of ethanolic extracts were from two to four concentration steps lower than the aqueous ones. In particular, ethanolic extracts of Cuminum cyminum L. and Propolis expressed MIC90 values of 0.075 mg/mL. The results show a significant in vitro effect of plant extracts against H. pylori that could be considered a valuable support in the treatment of the infection and may contribute to the development of new and safe agents for inclusion in anti-H. pylori regimens.     

Short- and midterm results after hybrid treatment of chronic aortic dissection with the frozen elephant trunk technique

Objective: The purpose of this study was to examine our experience with the frozen elephant trunk in patients with chronic aortic dissection. Methods: In our Institution, between January 2007 and August 2010, 49 patients (mean age: 59.6 ± 9.0 years) underwent total arch replacement with the frozen elephant trunk technique for chronic aortic dissection (type A, n = 2; residual type A, n = 37; type B, n = 10). Forty patients (81.6%) patients had undergone previous cardiovascular procedures. Associated cardiac procedures were indicated in 21 (42.8%) patients. Brain protection was achieved with antegrade selective cerebral perfusion in all cases. Results: Hospital mortality (n = 5) was 10.2%. Postoperative serious complications included coma (n = 3; 6.1%), paraplegia (n = 2; 4.1%), respiratory failure (n = 6; 12.2%), and definitive dialysis (n = 2; 4.1%). Follow-up was 100% completed (mean period: 12.9 ± 11.7 months). The estimated 1- and 3-year survival rates were 91.2 ± 4.2% and 81.6 ± 6.5%, respectively. Endovascular extension was required in 11 (22.4%) patients, with technical success of 100%. Complete thrombosis of the peri-stent false lumen was achieved in 82.9% of cases, with significant reduction of the false lumen diameter (preoperative: 36 ± 11 mm; postoperative: 24 ± 17 mm; p = 0.001) and increase of the true lumen diameter (preoperative: 15 ± 5 mm; postoperative: 26 ± 6 mm; p = 0.001). Conclusions: The frozen elephant trunk technique, allowing treatment of extensive disease of the thoracic aorta, was associated with encouraging short- and midterm results. Longer-term follow-up is warranted.     

Electroanatomic remodeling of the left atrium in patients undergoing repeat pulmonary vein ablation: mechanistic insights and implications for ablation

Introduction: There is limited information describing late changes in the electroanatomic characteristics of the left atrium (LA) associated with recurrence after an anatomical circumferential pulmonary vein ablation (CPVA) for atrial fibrillation (AF).
Methods and Results: Forty-seven patients (57 ± 8 years) undergoing a repeat ablation after CPVA were included. Using an electroanatomic mapping system, we measured the bipolar voltage by averaging points in the pulmonary vein (PV)-LA junction and four other LA sites. Conduction velocity and AF cycle length (AFCL) were also measured and the results are compared with the first procedure. After an initial decrease observed at the end of the first procedure, voltage and conduction velocity returned to intermediate values in all LA sites, with lower voltage at the LIPV antrum (P = 0.004), and lower conduction velocity across the LIPV and RSPV (P < 0.001). Conduction gaps were more prevalent at the septal aspect of the right PV encircling lines (85%), between the left atrial appendage (LAA) and the LSPV (70%) and lines at the posterior wall (71%). There was a nonsignificant increase in AFCL, with a more widespread distribution of organized electrograms (32.4% vs 46.6%).
Conclusion: Recurrence after CPVA is associated with a reverse process of voltage and conduction velocity increase across ablated areas, especially the PV-LA junction, and is related to the presence of conduction gaps, which are distributed mostly at the septal aspect of the lines encircling the right PVs and at the LAA-LSPV area. Organization of atrial electrograms seen during AF ablation is maintained at a repeat procedure.     

Left unilateral neglect as a disconnection syndrome

Unilateral spatial neglect is a disabling neurological conditionthat typically results from right hemisphere damage. Neglectpatients are unable to take into account information comingfrom the left side of space. The study of neglect is importantfor understanding the brain mechanisms of spatial cognition,but its anatomical correlates are currently the object of intensedebate. We propose a reappraisal of the contribution of disconnectionfactors to the pathophysiology of neglect based on a reviewof animal and patient studies. These indicate that damage tothe long-range white matter pathways connecting parietal andfrontal areas within the right hemisphere may constitute a crucialantecedent of neglect. Thus, neglect would not result from thedysfunction of a single cortical region but from the disruptionof large networks made up of distant cortical regions. In thisperspective, we also reexamined the possible contribution toneglect of interhemispheric disconnection. The reviewed evidence,often present in previous studies but frequently overlooked,is consistent with the existence of distributed cortical networksfor orienting of attention in the normal brain, has implicationsfor theories of neglect and normal spatial processing, opensperspectives for research on brain–behavior relationships,and suggests new possibilities for patient diagnosis and rehabilitation.     

Screw vs cement-implant-retained restorations: an experimental study in the beagle. Part 2. Immunohistochemical evaluation of the peri-implant tissues

Crestal bone loss has been reported to occur around dental implants. Even if the causes of this bone loss are not completely understood, the presence of a microgap between implant and abutment with a possible contamination of the internal portion of the implants has been suggested. The aim of this study was to see if there were differences in the vascular endothelial growth factor (VEGF) expression, microvessel density (MVD), proliferative activity (MIB-1), and inflammatory infiltrate in the soft tissues around implants with screwed and cemented abutments. Sandblasted and acid-etched implants were inserted in the mandibles of 6 Beagle dogs. Ten 3.5- x 10-mm root-form implants were inserted in each mandible. A total of 60 implants (30 with screwed abutments and 30 with cemented abutments) were used. After 12 months, all the bridges were removed and all abutments were checked for mobility. A total of 8 loosened screws (27%) were found in the screwed abutments, whereas no loosening was observed in cemented abutments. A gingival biopsy was performed in 8 implants with cemented abutments, in 8 implants with screwed abutments, and in 8 implants with unscrewed abutments. No statistically significant differences were found in the inflammatory infiltrate and in the MIB-1 among the different groups. No statistically significant difference was found in the MVD between screwed and cemented abutments (P = .2111), whereas there was a statistically significant difference in MVD between screwed and unscrewed abutments (P = .0277) and between cemented and unscrewed abutments (P = .0431). A low intensity of VEGF was prevalent in screwed and in cemented abutments, whereas a high intensity of VEGF was prevalent in unscrewed abutments. These facts could be explained by the effects induced, in the abutments that underwent a screw loosening, by the presence of bacteria inside the hollow portion of the implants or by enhanced reparative processes.     

Comparative evaluation of recombinant human thyrotropin-stimulated thyroglobulin levels, 131I whole-body scintigraphy, and neck ultrasonography in the follow-up of patients with papillary thyroid microcarcinoma who have not undergone radioiodine therapy

CONTEXT: Although the prognosis of papillary thyroid microcarcinoma (PTMC) is usually excellent, the optimal follow-up strategy has never been investigated. OBJECTIVE: The objective of the study was to investigate the role of neck ultrasonography (US), whole-body scintigraphy (WBS), and serum thyroglobulin levels (Tg) after recombinant human (rh) TSH in the follow-up of very low-risk PTMC patients. DESIGN: The study was a 5-yr observational study based on a 6- to 12-month follow-up after near total thyroidectomy. SETTING: The study population consisted of ambulatory patients. PATIENTS: Eighty consecutive patients diagnosed with PTMC, who had not undergone postoperative radioiodine treatment because of unifocal tumor without lymph node metastases and who did not have anti-Tg antibodies, were included. MAIN OUTCOME MEASURES: WBS and Tg after both rhTSH and neck US were measured. RESULTS: rhTSH-Tg was 1 ng/ml or less in 45 (Tg-) and more than 1 in 35 (Tg+) patients. WBS showed no pathological uptake in any patient. US identified node metastases in two Tg (+) and one Tg (-) patients. rhTSH-Tg levels positively correlated with thyroid bed iodine uptake (r = 0.40, P < 0.0001). To date (32 +/- 13 months after surgery), all node-negative patients have undetectable Tg levels on LT(4) treatment and negative US. CONCLUSIONS: For the initial follow-up of PTMC patients without risk factors and anti-Tg antibodies and who did not undergo radioiodine treatment: 1) WBS is useless; 2) US is highly sensitive in detecting node metastases; and 3) detectable rhTSH-Tg levels mainly depend on small normal tissue remnants. In this subgroup of PTMC patients, neck US might be regarded as a primary tool for the initial follow-up.