[Helicobacter pylori and gastric cancer. The incidence of infection in personal experience]

BACKGROUND

Helicobacter pylori is an identified carcinogen for gastric cancer, but the underlying mechanisms remain to be defined. The aim of this study is to analyze the incidence of Hp infection in our series of patients with gastric carcinoma.

METHODS

Between 1988 and 1998, 60 patients with diagnosis of gastric adenocarcinoma underwent partial or total gastrectomy. Forty-one were males and 19 females with an average age of 62 years (range 36-79). Twenty-seven cancers (45%) were localized in the lower third of the stomach, 17 (28%) in the middle third and eight (13%) in the upper third or cardias. In six patients (10%) the tumor was multicentric, while a recurrence on gastric stump after subtotal gastrectomy was present in two cases (3%). According to Lauren's criteria 39 cancers (65%) were of intestinal type, 16 (27%) of diffuse type and five (8%) of mixed type. The histologic preparations have been re-examined in order to verify the presence or not of Hp on gastric mucosa around neoplasm.

RESULTS

Hp was found in 35 (58%) of the analyzed specimens and therefore a significant percentage of patients was Hp-positive at the time of diagnosis and surgery. Between 35 Hp-positive samples, 24 were adenocarcinomas of intestinal type, nine of diffuse type and two of mixed type, with a prevalence of Hp in intestinal type cancer.

CONCLUSIONS

This study confirmed the high incidence of Hp infection in patients with gastric carcinoma, particularly in those with intestinal type cancer.

Primary diffuse malignant peritoneal mesothelioma: case report and update of therapy

BACKGROUND AND OBJECTIVES

Primary Diffuse Malignant Peritoneal Mesothelioma is a rare disease, with an incidence of 2.2 cases in 1. 000.000 in the USA. It occupies 10% of all mesotheliomas referred in literature.

METHODS

We describe a case of diffuse malignant peritoneal mesothelioma arising in a 54-year-old woman who presented a small bowel occlusion. A middle line laparotomy was done; multiple biopsies and an ileostomy were performed. There was not a history of exposure to asbestos. Histologic diagnosis was based on light microscopy, histochemistry, and immunohistochemistry.

RESULTS

Patient had no further treatment because of her poor general conditions. She died 4 months later.

CONCLUSIONS

Update of treatment is briefly described with particular attention to multimodality approach (surgery, chemotherapy, radiotherapy) and other new therapeutic options (iperthermochemotherapy, immunotherapy, gene therapy), currently in clinical trials.

[The immediate reconstruction of the breast after a mastectomy for carcinoma. Our experience]

The authors surgically treated 281 consecutive women with breast cancer by breast conservation techniques (45.2%) or by mastectomy (38.8%), during a four-year period. Forty-five of these 281 patients (16%) were treated in the same period of time by mastectomy and immediate reconstruction (IR) of the breast. IR of the breast was performed by inserting a submuscular tissue expander at the same time of mastectomy (first stage of reconstruction). A second operation allowed the replacement of the expander with a prosthesis (second stage of reconstruction) and the simultaneous symmetrization of the contralateral breast (not always performed, however). In some cases nipple-areola complex was eventually reconstructed with a delayed surgical procedure (third stage of reconstruction). In the present paper the authors analyze the results and outline the advantages of IR. This easy and safe technique slightly increased the average operative time of a mastectomy, did not interfere with routine oncological follow-up, did definitely reduce patient's psychological trauma following mastectomy. The authors conclude that IR of the breast undoubtedly plays a major role in the so called "onco-plastic"" surgical management of breast cancer.

[The sporadic use of intraoperative cholangiography during laparoscopic cholecystectomy]

The authors report their experience with 850 consecutive laparoscopic cholecystectomies performed from May 1990 to July 1997. In this series, despite a sporadic use of intraoperative cholangiography (IOC), there were no lesions of main biliary tract and there was only a biliary leaking cystic duct resolved with conservative treatment. The authors are satisfied with selective use of endoscopic cholangiography and sphincterotomy for the management of choledocholithiasis, and conclude that the use of IOC is not so essential to avoid iatrogenic lesions of main biliary tract, that could be avoid by applying a meticulous operative technique.

[Intracystic papillary carcinoma of the breast. Personal experience]

The Authors, on the base of three cases of intracystic papillary carcinoma of the breast, discuss about the diagnostic means and the modalities of treatment of such rare cancer. They stress the value of cytology by fine needle aspiration, which gives more detailed informations than mammography or ultrasonography. As far as the treatment concerns, the Authors, according to the data of the literature, suggest for this tumor, still at an "in situ" stage, a conservative surgical treatment such as a quadrantectomy or tumorectomy plus lymphadenectomy followed both by radiotherapy. Finally, they remark that the intracystic papillary carcinoma of the breast, mainly arising in old women (7th, 8th decade), was found within their series (two out of three) in young women in the 5th decade of life.

[A rare case of acute abdomen: perforated acute diverticulitis of the cecum]

The Authors report a rare case of perforated diverticulitis of the cecum. The patient was a 68-year-old man who was referred to the Authors attention with the classic symptoms of acute appendicitis. During laparotomy a perforated "omentum-sealed" diverticulum was found on the lateral wall of the cecum, whereas the appendix appeared to be completed unaffected. A right hemicolectomy was performed. The Authors analyse the similarities and peculiarity of the case. Special attention is drawn to the problems of differential diagnosis raised by this pathology. A preoperative diagnosis is arduous because the disease is difficult to distinguish from acute appendicitis and may be even difficult to distinguish it intraoperatively from a carcinoma of the cecum. There is no characteristic clinical pattern pointing to this diagnosis. Diagnostic maneuvers are usually unrewarding. Right hemicolectomy is a safe procedure when the diagnosis is doubtful.

[Bilateral adrenal pheochromocytoma. A clinical case and review of the literature]

The authors present a case of bilateral adrenal pheochromocytoma that occurred at their observation and surgically treated with a bilateral adrenalectomy. The authors review the literature in order to discuss the diagnostic and therapeutic option to treat these cases. They stress the importance of preoperative abdominal TC an MIBG scintigraphy and the importance of pre and intraoperative assessment to exclude extra adrenal localization of pheochromocytoma.

Cataract surgery in the patient with dementia: justified paternalism?

Paternalistic decision making for the incompetent patient involves many ethical and legal issues. In the ophthalmic surgery setting, cataract surgery on the patient with dementia is a potentially harmful act that requires justification on the part of the delegated decision maker. Does the potential outcome of improved vision outweigh the patient's right to self-determination? This discussion covers some of the moral, legal, and ethical issues to be considered in analyzing this dilemma.

A comparison of three theories of nursing used as a guide for the nursing care of an 8-year-old child with leukemia

This article evaluates three nursing theories that can be used to provide a framework for holistic pediatric oncology nursing practice: the Roy Adaptation Model, the Neuman Systems Model, and the Orem General Theory of Nursing. Each theory is compared in terms of its view of man, health, environment, nursing, and the nursing process. Critique of each theory is presented. The decision of which theorist to use as a basis for practice is left to the individual nurse. This article explicates the similarities and differences in the three theories.

The Roy Adaptation Model used as a guide for the nursing care of an 8-year-old child with leukemia

Roy's Adaptation Model provides a framework for holistic oncology nursing practice. In this article, an overview of Roy's model is provided. It is used to assess the behaviors and stimuli influencing the behaviors of an 8-year-old boy with acute lymphocytic leukemia. Planning and evaluating the nursing care of this child is based on the model. A comprehensive list of nursing diagnoses is categorized according to Roy's four adaptive modes, and a nursing care plan for two of these diagnoses is presented.

Nonanastomotic pseudoaneurysm of expanded polytetrafluoroethylene axillofemoral bypass graft

A case of nonanastomotic pseudoaneurysm of a unilateral axillofemoral bypass graft is reported. The graft material used in this particular instance was an 8 mm, reinforced, thin-walled, fluorinated ethylene-propylene-ringed, expanded polytetrafluoroethylene (ePTFE). The pseudoaneurysm occurred 1 year after insertion of the graft and was not associated with any direct trauma. It manifested with a painful tender mass at the top of the body of the axillofemoral bypass graft at the level of the nipple line. There were no symptoms of localized or diffuse sepsis. Immediate surgical exploration confirmed the diagnosis of a pseudoaneurysm of the ePTFE graft. Successful repair of the disrupted segment was accomplished by use of an interposition, nonringed, reinforced, thin-walled, 8 mm ePTFE graft. To our knowledge this is the first case of a nonanastomotic pseudoaneurysm of a ringed, ePTFE, axillofemoral bypass graft not associated with direct trauma.

Ruptured Baker's cyst causes ecchymosis of the foot. A differential clinical sign

Three consecutive patients with ruptured Baker's cysts, verified by duplex scan, were found to have ecchymosis on the dorsum of the foot. The appearance of ecchymosis can be helpful in differentiating a ruptured cyst from cellulitis or deep-vein thrombosis.

Orem's theory used as a guide for the nursing care of an eight-year-old child with leukemia

Orem's general theory of nursing provides a framework for holistic pediatric oncology nursing. In this article, an overview of Orem's theory is provided. The theory is used to assess the self-care deficits of an 8-year-old boy who has been diagnosed with leukemia, the ability of the mother to meet the son's self-care demands, and the nursing system needed to assist the mother to meet her son's self-care demands. The theory is used to plan and evaluate the nursing care of this child. A comprehensive list of nursing diagnoses and a nursing care plan for two of these diagnoses are presented.

Neuman systems model used as a guide for the nursing care of an 8-year-old child with leukemia

The Neuman Systems Model (NSM) provides a framework for holistic pediatric oncology nursing practice. In this article, an overview of NSM is given. This model is applied to an 8-year-old child with leukemia for the comprehensive assessment, planning, and evaluation of nursing care. A comprehensive list of nursing diagnoses is categorized by primary and secondary prevention.

Human monoclonal antibodies to glycolipid A that exhibit complement species-specific effector functions

Two human IgM monoclonal anti-glycolipid A antibodies (MAbs) were evaluated for their abilities to bind to various endotoxins and pathogenic gram-negative bacteria and to activate complement pathways, thereby accomplishing bactericidal and opsonic effector functions. Both MAbs cross-reacted with glycolipid A mutant lipopolysaccharides from rough colony-forming gram-negative bacteria and with selected endotoxins from smooth colony-forming bacteria. However, MAb 10235 bound to all clinical isolates of Escherichia coli and Klebsiella pneumoniae tested but only very weakly to Pseudomonas aeruginosa, whereas MAb 10058 bound to all three genera. Several strains of serum-insensitive organisms were selected for evaluation of antigen-specific, complement-mediated effector functions for the two MAbs. Assessment of bactericidal and opsonic activities showed that neither MAb was able to activate complement from nonprimate species (mouse, rat, rabbit, guinea pig, or sheep). However, both MAbs were highly effective in using primate sources of serum complement to mediate these effector functions.

Hope, social support and self-esteem of patients with spinal cord injuries

A descriptive study was conducted to determine if a relationship among the variables of hope, social support and self-esteem existed in persons with spinal cord injuries. A demographic data sheet and three instruments were used: Miller Hope Scale (MHS), Personal Resource Questionnaire Part II (PRQ) and Rosenberg Self-Esteem Scale (RSES). Of the 83 inpatients and outpatients who agreed to participate, 77 sets of questionnaires were usable. Ages of subjects ranged from 18-73 (mean 34.8) years and levels of injury ranged from C4-L3. The mean scores on the tools were: MHS-153.51 (40-200 possible range), PRQ-137.42 (25-175 possible range) and RSES-29.59 (10-40 possible range). There was a statistically significant relationship between hope and social support, hope and self-esteem and social support and self-esteem. By multiple regression analysis, the best predictors of hope in the subjects were self-esteem, social support and education.

Effects of two chest tube clearance protocols on drainage in patients after myocardial revascularization surgery

The purpose of the study was to determine the effects of two methods of clot clearance on chest tube drainage in patients undergoing myocardial revascularization. Two hundred adult patients immediately after myocardial revascularization were randomly assigned to a specific chest tube manipulation group. The dependent variables were drainage, incidence of cardiac tamponade, incidence of surgical reentry, hemodynamic values, and number of manipulation episodes. Statistical analyses revealed no difference in any of the dependent variables when milking and stripping were used. Of the 200 patients, 78 did not require any manipulation of the chest tubes in the first 8 hours after surgery. One patient had signs of cardiac tamponade and six other patients required surgical reentry. Positioning of the connecting tube in a nondependent position assisted with the removal of drainage from the chest cavity. In conclusion, patients having myocardial revascularization did not need their chest tubes manipulated the first 8 hours after surgery. Visible drainage in the chest tube did not cause a lack of patency.

[Pharmacologic treatment of migraine. Critical review of the literature]

The current aim of migraine treatment is to control attacks and reduce their frequency and intensity. Numerous drugs have been experimented in the pharmacological treatment of migraine, often with positive results. Almost always, only the main action mechanism can be hypothesised and sometimes drugs seem to act with very different mechanisms. Here mention is made of the principles, symptomatic and preventive, on which the pharmacological treatment of migraine is based. The drugs used in the two types of treatment are examined in terms of their action mechanism and their pharmacological group. Particular attention is paid to indications, contraindications and limitations of each treatment and the results reported in the literature are reviewed. For optimal treatment, prevention is considered indispensable for controlling symptomatology and preventing the pain becoming chronic. Correct preventive action also serves to avoid constant resort to symptomatic drugs, particularly analgesics, for which the risk of developing dependence or headache upon suspension of treatment is described.

The Neuman Systems Model: application to a patient with a cervical spinal cord injury

Neuman's Systems Model provides a framework for holistic neuroscience nursing practice. Utilizing Neuman's assessment format, results are presented for a patient who sustained a cervical spinal cord injury. Nursing diagnoses are identified and a sample plan of care is included.

[Plasma beta-endorphin and caffeine consumption in chronic hemicrania]

Thanks to recent biochemical and neuroendocrine findings, migraine belonging to the group of primary headaches appears as a pathology of the antinociceptive system with evolutive character. It has been demonstrated, in fact, that right at the early stage of migraine, there is a significant reduction in liquoral concentrations of beta-endorphin (beta-E), endogenous opioid peptide followed by a similar change in the plasma opioid system. The opioid system deficiency is even more evident after stimulation tests that point to reduced reactivity of the hypothalamo-hypophyseal system with respect to stimuli that in normal subjects trigger hypophyseal beta-E incretion. Caffeine, a member of the methyl-xanthine group, is an interesting molecule in the study of migraine patients because the chronic intake of this substance, contained in numerous analgesics, has been related to the chronic nature of the pain. The purpose of the present study is to assess the relationship between caffeine consumption and plasma opioid system. With the administration of a single oral dose of caffeine, normal subjects present an increase in plasma concentrations of beta-E, while in patients with chronic migraine, the response is significantly lower. These data confirm the poor reactivity of the plasma opioid system to pharmacological stimuli in migraine. Average daily consumption of caffeine has also been determined. It was not possible to establish a correlation between consumption of caffeine and plasma concentrations of beta-E whether basal or after stimulus with caffeine.

Roy's adaptation model: a guide for rehabilitation nursing practice

Roy's Adaptation Model provides a framework for holistic rehabilitation nursing practice. In this article, the model is applied to a rehabilitation patient with a spinal cord injury for the assessment of behaviors and stimuli influencing the behaviors and also for planning and evaluating nursing care.

Hope, self-esteem and social support in persons with multiple sclerosis

A descriptive study was conducted to determine if a relationship among the variables of hope, self-esteem and social support existed in persons with multiple sclerosis. A demographic data sheet and three instruments were used: Miller Hope Scale (MHS), Rosenberg Self-Esteem Scale and Part II of the Personal Resource Questionnaire (PRQ). Of 75 individuals contacted by mail asking them to participate, 40 sets of questionnaires were returned. The subjects' ages ranged from 32 to 70 with a mean of 48.2. The mean scores on the 3 instruments were: MHS--157.9 (40-200 possible range), self-esteem--29.68 (10-40 possible range), and PRQ Part II--141.13 (25-175 possible range). A statistically significant relationship was found between hope and self-esteem, hope and social support and social support and self-esteem. Additionally, findings were reported and conclusions and nursing implications identified.