Hiatal hernia in old age

Following a review of the literature on the topic, the Authors examined all patients admitted to the Institute of Surgical Pathology 1st at the University of Pavia between 1-1-1974 and 31-12-1988 for hiatus hernia, paying special attention to those aged over 65. From an analysis of the results, it was possible to evaluate the influence of collateral pathologies and age-dependent biological changes on the basic disease and the outcome of the operation in elderly patients. In conclusion, this pathology, although not strictly confined to old age, affects a large number of elderly patients, particularly females. It rarely causes acute attacks and it is therefore possible to time the operation to coincide with the patient's best conditions. This is the reason for the excellent results achieved, whereas complications are not related to chronological age but above all to the biological age of the patient.     

Nuclear size and chromatin concentration in transitional cell carcinoma of the human urinary bladder.

Feulgen-stained cell nuclei from 25 specimens from transitional cell carcinoma of the human bladder were examined by means of cytophotometric scanning measurements. The mean values of nuclear area, DNA-content and chromatin concentration after scanning of a hundred nuclei per specimen were compared with those from a control group consisting of 10 specimens of normal transitional cell epithelium. Within the same ploidy class the more differentiated carcinoma cells showed nuclear enlargement and decrease of mean chromatin concentration. Undifferentiated tumours could have the same or higher mean chromatin concentration as the control group owing to the many highpolyploid nuclei. Undifferentiated tumours contained numerous giant nuclei, whereas these were rare in well differentiated carcinoma. When allowances were made for variations due to fixation and staining measurement of the nuclear area could serve as means of differentiating between normal and cancer nuclei with a high degree of statistic probability. The question whether nuclear enlargement and decreased chromatin concentration represent physiological changes or are entirely or partly the result of chemical carcinogenesis is discussed.     

Effect of parental age on fertilization and pregnancy characteristics in couples treated by intracytoplasmic sperm injection

The purpose of this study was to investigate any influence of maternal and/or paternal age on gamete characteristics and pregnancy outcomes in intracytoplasmic sperm injection (ICSI) cycles. In all, 821 consecutive ICSI cases were analysed retrospectively. While a significant linear decline in semen volume was detected, no significant differences in the concentration, motility or morphology of the spermatozoa were found with paternal ageing. A significant decline in the number of oocytes retrieved and the number of mature oocytes obtained was found with advancing maternal age. An increase in the occurrence of digyny was noted with parental ageing, while no difference in single or bipronuclear fertilization was found. Older women had a decreased incidence of single pronucleus formation and an increase in digyny, but no significant difference in the percentage of oocytes that underwent two-pronuclear fertilization was detected with regard to maternal ageing. Pregnancy outcomes were not influenced by the age of the male partner, while a strong negative correlation was found with maternal ageing. To better analyse male partner ageing as a factor affecting pregnancy outcome, we analysed a subgroup of patients with a female partner aged <35 years who underwent ICSI. No paternal influence on ICSI pregnancy outcome was found in this subgroup of patients. We conclude that the influence on pregnancy outcome after ICSI is related mostly to maternal and not paternal age.      

Bone sarcomas in Paget disease: a study of 85 patients

This is a comprehensive review of 85 patients who had bone sarcoma associated with Paget disease and who were seen at Memorial Sloan-Kettering Cancer Center between 1927 and 1982. There was an almost equal distribution of tumors in the axial and the appendicular skeletons. The pelvis, humerus, femur, and skull were the tumor sites in 80% of cases. The tumors were bulky large soft tissue masses. Lytic lesions were more common than sclerotic lesions. Mixed lytic and sclerotic lesions were much less common than either single type. Periosteal reaction was uncommon and found in less than 7%. Methylene diphosphonate scans of the bone often showed a cold area that was associated with marked increase in uptake on the gallium scan. Angiography, which was performed in 13 patients, was useful, but CT was much more helpful in showing the soft tissue mass as well as the extent of bony disease. Only three patients in this study survived for five years. Present chemotherapy protocols were disappointing in the treatment of this highly lethal tumor.     

Gastric carcinoma in the aged

After examining the literature on the subject, all patients aged over 60 and admitted to the Surgical Pathology Department of Pavia University from 1-1-1974 to 31-12-1985, suffering from gastric carcinoma have been considered. From the results obtained it is concluded that stomach cancer is a disease that preferentially affects the IIIrd age, usually occurring with atypical symptomatology that leads the patient to underestimate the seriousness of the disease, and impeding early diagnosis that would be effective for therapeutic purposes. It is therefore essential for the necessary examination to be carried out at the first warning symptoms. Further, the general state of these patients has to be controlled and appropriate treatment sought to treat the various accompanying conditions and so prepare the patient for operation.