Metachronous hepatic metastases from gastric carcinoma: a multicentric survey

BACKGROUND: The treatment of hepatic metastases from gastric cancer is controversial, due to biologic aggressiveness of the disease. OBJECTIVE: To survey the clinical approach to the subset of atients presenting with metachronous hepatic metastases as sole site of recurrence after curative resection of gastric cancer, focusing on the results achieved by different therapies and to investigate the prognostic factors of major clinical relevance. METHODS: Retrospective multi-center chart review evaluating 73 patients, previously submitted to D >or= 2 gastrectomy for gastric cancer, who developed exclusive hepatic recurrence. Prognostic factors related to the patient, to the gastric malignancy and its treatment, and to the metastatic disease and its therapy were evaluated. RESULTS: Forty-five patients received supportive care, 17 were submitted to chemotherapy, and 11 to hepatic resection. Survival was independently influenced by the variables T (p=0.019), N (p=0.05) and G (p=0.018) of the gastric primary and by the therapeutic approach to the metastases (p<0.005). In particular, T4 gastric cancer, presence of lymph-node metastases and G3 tumor displayed a negative prognostic value. Therapeutic approach to the metastases was the principal prognostic variable: 1, 2, and 3 years survival rates were 22.2%, 4.4% and 2.2%, respectively, for patients without specific treatment; 44.9%, 12.8% and 6.4% after chemotherapy (p=0.08) and 80.8%, 30.3% and 20.2% after surgical resection (p<0.001). CONCLUSIONS: Our data suggest some clinical criteria that may facilitate selection of therapy for patients with hepatic recurrence after primary gastric cancer resection. The best survival rates are associated with surgical treatment, which should be chosen whenever possible

Tailored treatment for signet ring cell gastric cancer

Gastric cancer with Laur\ue8n diffuse types is increasing in the West. The raising trend is more evident when considering signet ring cells (SRC) histology. However, to control the biologic potential of this GC subtype, some hypotheses of tailored therapeutic strategies for SRC cancers have been made. A review of the literature was performed using the key words "signet ring cells" AND "gastric cancer". Results of literature review were descriptively reported. Endoscopic submucosal dissection (ESD), according to the Japanese extended criteria, could be a therapeutic option for early SRC tumours. However, according to the evidences from more recent studies, indications for ESD to these tumours types should be carefully considered. Concerning the optimal surgical treatment, considering the high lymphotropism and infiltrating behaviour of SRC histotype, the extension of gastric resection should be wider than for intestinal type cancer and laparoscopic surgery should be performed carefully. Moreover, D3 lymphadenectomy could provide a benefit in diffuse-type and SRC histology. The role of surgery in gastric cancer with peritoneal carcinomatosis is still debated and studies on this topic should stratify the good results according to GC histotype. Finally, despite the evidences of chemoresistance in SRC, ongoing randomized trials suggest that multimodal therapy could be the best treatment. Based on the assumption that SRC tumours have specific features, they deserve a specific multimodal treatment. However, a preliminary step to generate strong evidences in this field is the standardization of terminology used to define signet ring cells carcinoma

Acute bleeding obstruction pancreatitis after Roux-en-Y anastomosis in total gastrectomy: a single center experience

Anastomotic intraluminal bleeding is a well-known complication after total gastrectomy. Nevertheless, few data are published on acute bleeding obstruction pancreatitis (BOP) due to a bleeding from the jejunojejunostomy (JJ). In this paper we describe our experience. A total of 140 gastrectomies for EGJ cancer were performed in our Institute from January 2012 to January 2017. All reconstructions were performed with a Roux-en-Y anastomosis: a mechanical end-to-side esophago-jejunostomy and a mechanical end-to-side JJ. Three patients suffered from a bleeding at the JJ with a consequent BOP. We analyzed the time of diagnosis, the treatment and the outcomes. The three patients presented anemia at the laboratory findings on postoperative day (POD) 1. In patient I laboratory findings of acute pancreatitis were found in POD 2. CT scan was performed and showed signs of BOP. Endoscopic treatment was tried without success. Therefore, patient underwent surgery: JJ take down, bleeding control and anastomosis rebuild were performed. In spite of this the patient died of MOF in POD 4. Patient II had a persistent anemia treated with blood transfusions until POD 3, when laboratory tests showed increased lipase and bilirubin levels. Patient was successfully treated with endoscopy but several blood transfusions and a prolonged recovery were necessary. Patient III had laboratory findings of acute pancreatitis on POD 1. Immediate surgery was performed and patient was discharged on POD 9 without sequelae. BOP is a rare but deadly complication after Roux-en-Y anastomosis. An early diagnosis and an aggressive treatment seem to improve the outcome

Adherence to Guidelines for Diagnosis, Staging, and Treatment for Gastric Cancer in Italy According to the View of Surgeons and Patients

Background: Despite the strong declining trends in incidence and mortality over the last decades, gastric cancer (GC) is still burdened with high mortality, even in high-income countries. To improve GC prognosis, several guidelines have been increasingly published with indications about the most appropriate GC management. The Italian Society of Digestive System Pathology (SIPAD) and Gastric Cancer Italian Research Group (GIRCG) designed a survey for both surgeons and patients with the purpose of evaluating the degree of application and adherence to guidelines in GC management in Italy. Materials and Methods: Between January and May 2022, a questionnaire has been administered to a sample of Italian surgeons and, in a simplified version, to members of the Patient Association “Vivere Senza Stomaco” (patients surgically treated for GC between 2008 and 2021) to investigate the diagnosis, staging, and treatment issues. Results: The survey has been completed by 125 surgeons and 125 patients. Abdominal CT with gastric hydro-distension before treatment was not widespread in both groups (47% and 42%, respectively). The rate of surgeons stating that they do not usually perform minimally invasive gastrectomy was 15%, but the rate of patients who underwent a minimally invasive approach was 22% (between 2011 and 2022). The percentage of surgeons declaring to perform extended lymphadenectomy (&gt;D2) was 97%, although a limited lymph node dissection rate was observed in about 35% of patients. Conclusions: This survey shows several important discrepancies from surgical attitudes declared by surgeons and real data derived from the reports available to the patients, suggesting heterogeneous management in clinical practice and, thus, a not rigorous adherence to the guidelines

Visual perception during mirror-gazing at one&apos;s own face in patients with depression

In normal observers, gazing at one's own face in the mirror for a few minutes, at a low illumination level, produces the apparition of strange faces. Observers see distortions of their own faces, but they often see hallucinations like monsters, archetypical faces, faces of relatives and deceased, and animals. In this research, patients with depression were compared to healthy controls with respect to strange-face apparitions. The experiment was a 7-minute mirror-gazing test (MGT) under low illumination. When the MGT ended, the experimenter assessed patients and controls with a specifically designed questionnaire and interviewed them, asking them to describe strange-face apparitions. Apparitions of strange faces in the mirror were very reduced in depression patients compared to healthy controls. Depression patients compared to healthy controls showed shorter duration of apparitions; minor number of strange faces; lower self-evaluation rating of apparition strength; lower self-evaluation rating of provoked emotion. These decreases in depression may be produced by deficits of facial expression and facial recognition of emotions, which are involved in the relationship between the patient (or the patient's ego) and his face image (or the patient's bodily self) that is reflected in the mirror

Desarrollo de un alimento cárnico embutido saludable con el agregado de extracto acuoso de propóleo (EAP) como conservante

En los últimos años los consumidores han mostrado interés por productos cárnicos saludables que aporten ingredientes de origen natural, evitando las altas cantidades de sal, grasas y aditivos. Por consiguiente, el objetivo de este trabajo fue producir un embutido saludable reducido en sodio y nitritos con el agregado de extracto acuoso de propóleo (EAP), manteniendo las características similares a un producto tradicional. Se modeló un embutido cárnico reducido en su contenido de NaCl y sin materia grasa adicionada, el cual presentó en la mayoría de los parámetros analizados similitudes con embutidos comerciales. La disminución del contenido de nitrito produjo alteraciones en el color, afectando significativamente el valor del parámetro a* y algunos parámetros de textura. El EAP mostró una buena acción bacteriostática pero no así fungistática, implicando la adición de otro conservante, ya sea natural o no, que ejerza acción sobre dichos microorganismos para alcanzar la vida útil esperada (42 días). Sensorialmente, el producto presentó diferencias significativas con el comercial, pero acaparó la atención de los consumidores. Es factible producir un embutido de bajo contenido en sodio, sin grasa añadida y remplazando el NaNO2 como conservante, que se asemeje a un producto industrializado con buena aceptación del consumidor

Desarrollo de un alimento cárnico embutido saludable con el agregado de extracto acuoso de propóleo (EAP) como conservante

En los últimos años los consumidores han mostrado interés por productos cárnicos saludables que aporten ingredientes de origen natural, evitando las altas cantidades de sal, grasas y aditivos. Por consiguiente, el objetivo de este trabajo fue producir un embutido saludable reducido en sodio y nitritos con el agregado de extracto acuoso de propóleo (EAP), manteniendo las características similares a un producto tradicional. Se modeló un embutido cárnico reducido en su contenido de NaCl y sin materia grasa adicionada, el cual presentó en la mayoría de los parámetros analizados similitudes con embutidos comerciales. La disminución del contenido de nitrito produjo alteraciones en el color, afectando significativamente el valor del parámetro a* y algunos parámetros de textura. El EAP mostró una buena acción bacteriostática pero no así fungistática, implicando la adición de otro conservante, ya sea natural o no, que ejerza acción sobre dichos microorganismos para alcanzar la vida útil esperada (42 días). Sensorialmente, el producto presentó diferencias significativas con el comercial, pero acaparó la atención de los consumidores. Es factible producir un embutido de bajo contenido en sodio, sin grasa añadida y remplazando el NaNO2 como conservante, que se asemeje a un producto industrializado con buena aceptación del consumidor

Clinical outcomes of patients with complicated post-operative course after gastrectomy for cancer: a GIRCG study using the GASTRODATA registry

Gastrectomy for gastric cancer is still performed in Western countries with high morbidity and mortality. Post-operative complications are frequent, and effective diagnosis and treatment of complications is crucial to lower the mortality rates. In 2015, a project was launched by the EGCA with the aim of building an agreement on list and definitions of post-operative complications specific for gastrectomy. In 2018, the platform www.gastrodata.org was launched for collecting cases by utilizing this new complication list. In the present paper, the Italian Research Group for Gastric Cancer endorsed a collection of complicated cases in the period 2015–2019, with the aim of investigating the clinical pictures, diagnostic modalities, and treatment approaches, as well as outcome measures of patients experiencing almost one post-operative complication. Fifteen centers across Italy provided 386 cases with a total of 538 complications (mean 1.4 complication/patient). The most frequent complications were non-surgical infections (gastrointestinal, pulmonary, and urinary) and anastomotic leaks, accounting for 29.2% and 17.3% of complicated patients, with a median Clavien–Dindo score of II and IIIB, respectively. Overall mortality of this series was 12.4%, while mortality of patients with anastomotic leak was 25.4%. The clinical presentation with systemic septic signs, the timing of diagnosis, and the hospital volume were the most relevant factors influencing outcome

Desarrollo de un alimento cárnico embutido saludable con el agregado de extracto acuoso de propóleo (EAP) como conserva

En los últimos años los consumidores han mostrado interés por productos cárnicos saludables que aporten ingredientes de origen natural, evitando las altas cantidades de sal, grasas y aditivos. Por consiguiente, el objetivo de este trabajo fue producir un embutido saludable reducido en sodio y nitritos con el agregado de extracto acuoso de propóleo (EAP), manteniendo las características similares a un producto tradicional. Se modeló un embutido cárnico reducido en su contenido de NaCl y sin materia grasa adicionada, el cual presentó en la mayoría de los parámetros analizados similitudes con embutidos comerciales. La disminución del contenido de nitrito produjo alteraciones en el color, afectando significativamente el valor del parámetro a* y algunos parámetros de textura. El EAP mostró una buena acción bacteriostática pero no así fungistática, implicando la adición de otro conservante, ya sea natural o no, que ejerza acción sobre dichos microorganismos para alcanzar la vida útil esperada (42 días). Sensorialmente, el producto presentó diferencias significativas con el comercial, pero acaparó la atención de los consumidores. Es factible producir un embutido de bajo contenido en sodio, sin grasa añadida y remplazando el NaNO2 como conservante, que se asemeje a un producto industrializado con buena aceptación del consumidor.Fil: Oroño, Alexis D.. Universidad Nacional de Entre Ríos. Facultad de Bromatología; ArgentinaFil: Giacopuzzi, Nicolás Martin. Universidad Nacional de Entre Ríos. Facultad de Bromatología; ArgentinaFil: Acosta, Silvina Alexandra. Universidad Nacional de Entre Ríos. Facultad de Bromatología; ArgentinaFil: Muchiutti, Gabriela Silvina. Universidad Nacional de Entre Ríos. Facultad de Bromatología; ArgentinaFil: Cámera, N. G.. Universidad Nacional de Entre Ríos. Facultad de Bromatología; ArgentinaFil: Correa, S.. Universidad Nacional de Entre Ríos. Facultad de Bromatología; ArgentinaFil: Vallejos, Omar. Universidad Nacional de Entre Ríos. Facultad de Bromatología; ArgentinaFil: Larrosa, Virginia Judit. Universidad Nacional de Entre Ríos. Facultad de Bromatología; Argentina. Consejo Nacional de Investigaciones Cientificas y Tecnicas. Centro Cientifico Tecnologico Conicet - Santa Fe. Instituto de Ciencia y Tecnologia de Los Alimentos de Entre Rios. - Universidad Nacional de Entre Rios. Instituto de Ciencia y Tecnologia de Los Alimentos de Entre Rios.; ArgentinaFil: Pancrazio, Gastón Ignacio. Universidad Nacional de Entre Ríos. Facultad de Bromatología; Argentin