Predictive factors associated with long-term survival in patients with neuroendocrine tumors of the pancreas

Background Neuroendocrine tumors of the pancreas are rare tumors. We identified predictive factors that are associated with long-term survival (≥5 years). Methods Fifty patients with a diagnosis of neuroendocrine tumors of the pancreas were retrospectively evaluated. The following factors were evaluated for disease-specific mortality: age, sex, primary tumor location, functional status, type of primary tumor treatment, presence or absence of liver metastases, timing of liver metastases occurrence, and type of liver metastases treatment. Aggressive treatment of the liver metastases included surgery, chemoembolization, or intrahepatic arterial infusion chemotherapy. Results Twenty-three patients (47%) had tumor located in the head of the pancreas, and 29 patients (58%) had nonfunctioning tumor. Thirty-nine patients (78%) had liver metastases. The median follow-up for the entire group was 35 months (range, 76–206 months). The median survival for the entire group was 40 months, and the overall 1-, 2-, and 5-year survival rates were 84%, 69%, and 36%, respectively. Factors that had a significant favorable effect on survival included curative resection of the primary tumor, metachronous liver metastases, absence of liver metastases, and aggressive treatment of the liver metastases. Conclusions Definitive surgical resection of the primary tumor, absence of liver metastases, metachronous liver metastases, and aggressive treatment of the liver metastases were predictors of long-term survival in patients with neuroendocrine tumors of the pancreas. Presented as a poster presentation at the Society of Surgical Oncology 55th Annual Cancer Symposium, Denver, Colorado, March 14–17, 2002.     

Eight-year experience with transperitoneal laparoscopic adrenal surgery

PURPOSE: Laparoscopic adrenalectomy is currently the technique of choice for removing benign adrenal lesions. Various laparoscopic techniques and approaches have been reported using the transperitoneal or retroperitoneal approach. We present our 8-year experience with and long-term results of transperitoneal laparoscopic adrenalectomy. MATERIALS AND METHODS: Between October 1992 and October 2000, 161 laparoscopic approaches to the adrenal gland were performed, including 145 unilateral and 10 bilateral adrenalectomies, and 6 conservative operations. Patients were placed in the 60-degree flank position with the bed flexed to increase the surgical field. To avoid hypertensive crisis, especially in patients with pheochromocytoma, the first step involved early ligation of the adrenal vein. RESULTS: The laparoscopic procedure was successfully completed in all except 4 cases, which were converted to open surgery. Mean operative time was 160 minutes in the unilateral, 245 in the bilateral and 90 in the conservative group. Delayed complications included hemoperitoneum in 3 patients, which was drained surgically, severe blood loss in 3 treated with blood transfusion and wound infection in 2. Patients were ambulatory on the morning of postoperative day 1 and were discharged home 2.8, 5 and 1.8 days after unilateral, bilateral and conservative surgery, respectively. CONCLUSIONS: Laparoscopic transperitoneal adrenalectomy is a safe, effective, minimally invasive approach in patients with benign functioning or nonfunctioning adrenal masses. This technique involves low morbidity, minimal postoperative analgesic requirements and a short hospital stay.     

Evaluation of the mechanical properties of human liver and kidney through aspiration experiments.

A proper mechanical characterization of soft biological tissues of the human body has a strong impact on several medical applications such as surgical planning, virtual reality simulators, trauma research, and for diagnostic purposes. Adequate experimental data are needed to describe quantitatively the mechanical behaviour of those organs. We present a technique for the acquisition of such data from soft tissues and its post processing, based on a continuum mechanics approach, to determine some parameters of the tissue's mechanical properties. A small tube is applied to the target organ and a weak vacuum is generated inside the tube according to a predefined pressure history. A video camera grabs images of the deformation profile of the aspirated tissue, and a pressure sensor measures the correspondent vacuum level. The images are processed and used to inform the fitting of uniaxial and continuum mechanics models. Whilst the aspiration test device is suitable for in vivo applications, under sterile conditions during open surgery, we hereby present first results obtained by testing cadaveric tissues.     

Carbon dioxide laser in scalp tumor surgery

The widespread application of the CO₂ laser in surgical treatment of tumor led us to verify its usefulness in selected cases of scalp tumor. Twelve selected patients underwent CO₂ laser surgical excision plus vaporization of the wound base for infiltrating tumors during 1980–82. All patients showed associated pathologies that interfered with the traditional surgical excision and with anesthesiological practices. Our experience has confirmed the effectiveness of the laser technique under these conditions and with respect to subsequent plastic restoration.     

Haemodynamic effects of pressure support and PEEP ventilation by nasal route in patients with stable chronic obstructive pulmonary disease.

BACKGROUND--Intermittent positive pressure ventilation applied through a nasal mask has been shown to be useful in the treatment of chronic respiratory insufficiency. Pressure support ventilation is an assisted mode of ventilation which is being increasingly used. Invasive ventilation with intermittent positive pressure, with or without positive end expiratory pressure (PEEP), has been found to affect venous return and cardiac output. This study evaluated the acute haemodynamic support ventilation by nasal mask, with and without the application of PEEP, in patients with severe stable chronic obstructive pulmonary disease and hypercapnia. METHODS--Nine patients with severe stable chronic obstructive pulmonary disease performed sessions lasting 10 minutes each of pressure support ventilation by nasal mask while undergoing right heart catheterisation for clinical evaluation. In random order, four sessions of nasal pressure support ventilation were applied consisting of: (1) peak inspiratory pressure (PIP) 10 cm H2O, PEEP 0 cm H2O; (2) PIP 10 cm H2O, PEEP 5 cm H2O; (3) PIP 20 cm H2O, PEEP 0 cm H2O; (4) PIP 20 cm H2O, PEEP 5 cm H2O. RESULTS--Significant increases in arterial oxygen tension (Pao2) and saturation (Sao2) and significant reductions in arterial carbon dioxide tension (PaCO2) and changes in pH were observed with a PIP of 20 cm H2O. Statistical analysis showed that the addition of 5 cm H2O PEEP did not further improve arterial blood gas tensions. Comparison of baseline values with measurements performed after 10 minutes of each session of ventilation showed that all modes of ventilation except PIP 10 cm H2O without PEEP induced a small but significant increase in pulmonary capillary wedge pressure. In comparison with baseline values, a significant decrease in cardiac output and oxygen delivery was induced only by the addition of PEEP to both levels of PIP. CONCLUSIONS--In patients with severe stable chronic obstructive pulmonary disease and hypercapnia, pressure support ventilation with the addition of PEEP delivered by nasal mask may have short term acute haemodynamic effects in reducing oxygen delivery in spite of adequate levels of SaO2.     

Psychological kinship, love, and liking: preliminary validity data

Psychological kinship refers to valuing significant others as though they were members of one's own family. This construct has many implications for human relationships, including the client-therapist relationship (Bailey, 1988). A 60-item Kinship Scale was developed and administered to 63 undergraduates (39 females; 24 males), along with several other independent measures of sociality (Rubin Love and Liking scales; EPPS Affiliation, Nurturance, and Succorance scales; abbreviated UCLA Loneliness Scale) and the Spiritual Well-Being scales. Subjects took the Kinship, Love, and Liking scales under two cognitive sets, "closest family member" and "acquaintance," while the other scales were taken in regular fashion. The Kinship, Love, and Liking scales were all sensitive to the cognitive sets and appropriately yielded higher mean values and higher correlations with the independent measures vis-à-vis the "closest family member" as opposed to "acquaintance." Significant sex differences were noted, with stronger correlation patterns for males than females. Overall, the Kinship Scale performed very well and shows considerable promise for future research.     

Anorectal fistulous abscesses. Long-term follow-up of the 1st operation, in 287 cases]

A review of a series of 287 operations for peri-anal fistulous abscess in patients admitted for the first time, to the 1st Surgical Division of the Fatebenefratelli Hospital, Milan, is reported. Surgical management adapted as far as possible to the anatomy of the anal canal and to the aetiopathogenesis of the fistula, resulted in a recurrence rate of only 13%. There were no instances of faecal incontinence. Two cases of partial gas incontinence were observed.