The authors report their experience of the use of mechanical staplers in total gastrectomy. The advantages of their use can above all be seen in anastomosis, in particular in high-risk areas like esophago-jejunal anastomosis, in which there is a lower incidence of dehiscence and mortality than when manual suturing techniques are used.

Adenocarcinoma↗

PubMedDate not supplied

[The prognostic indices of cancer mortality in the elderly].

Although cardiovascular disease is still the main cause of mortality and morbidity in the elderly, numerous epidemiological studies have disclosed an increased incidence of neoplastic disease in this age group over the past few years. A population of 3282 > or = 65-year-old subjects taking part in the Cardiovascular Study in the Elderly was monitored to discern whether a number of variables, already recognized as predictive factors of overall and cardiovascular mortality, could also affect neoplastic mortality. Apart from age, which was the chief risk factor for neoplastic mortality, sex, cigarette smoking, the presence of respiratory symptoms and the blood levels of some enzymes were predictors of cancer mortality. These results must nevertheless be regarded with caution as a number of non-neoplastic diseases typical of the elderly may mimic the signs and symptoms of cancer.

Age Distribution↗

PubMedDate not supplied

[Management of ventricular arrhythmia in chronic congestive heart failure].

PURPOSE: To evaluate efficacy and indications of therapy for ventricular arrhythmias in patients with chronic congestive heart failure. DESIGN: A review of most significant and recent clinical trials was performed. RESULTS: In patients with severe left ventricular dysfunction, the desirable actions of antiarrhythmic drugs are attenuated and their negative inotropic and proarrhythmic actions are enhanced. Treatment should be limited to patients with malignant ventricular arrhythmias, or to patients considered at high risk. When indicated, amiodarone is usually well tolerated and safe. The prevention of sudden death in patients with heart failure should be based on optimized therapy of pump failure, reducing left ventricle work load and modulating neurohormonal systems with ACE-inhibitors and betablockers drugs. Further, an important role is held by anti-ischemic therapy, revascularization procedures, anticoagulant therapy and prevention of electrolytes unbalances. Patients with sustained of high risk arrhythmias, resuscitated from a cardiac arrest, should be considered for transvenous Implantable Cardioverter Defibrillator (ICD) implant. CONCLUSIONS: Ventricular arrhythmias are common in heart failure patients, represent an important cause of sudden death and the choice of treatment is difficult because of the complexity of underlying mechanisms, frequency of adverse reactions and the severity of left ventricular dysfunction.

Anti-Arrhythmia Agents↗