Our study confirms that lymph node involvement is an extremely important prognostic factor. For this reason, the therapeutic strategy of our surgical units is as follows: 1) D2 gastrectomy is the standard treatment even in early gastric cancer (EGC); 2) endoscopic mucosal resection (EMR) could be considered first in types I, IIa and IIb tumours that are diagnosed as limited to the mucosal layer.

A retrospective study of 223 patients treated for early gastric cancer (EGC) is reported, representing 21.2 per cent of the 1051 patients with gastric cancer treated over the same period. Two main types of surgical procedure were used: subtotal resection of the stomach for EGC of the two lower thirds and total gastrectomy for lesions of the upper third. A lymphadenectomy of groups 1 and 2, according to the procedure of the Japanese Research Society for Gastric Cancer (R2 resection), was performed in all patients. The mean duration of follow-up was 7.5 years. Univariate analysis showed a significant difference in survival rates only between patients with and without involved nodes (log rank = 6.05, P = 0.0139). Other prognostic factors were not identified. A bivariate analysis was performed to evaluate the joint effect of node status and the Kodama classification: survival rates for patients with EGC of the penetrating (Pen) A type and node positive falls to around 57 per cent within 6 years. This group of patients has a tumour that should probably be considered as a 'non-early' lesion. To improve the survival of patients with a Pen A, node positive lesion, adjuvant chemotherapy may be appropriate.

Basidiobolomycosis is a chronic subcutaneous infection of the trunk and limbs due to Basidiobolus ranarum.The disease is well known in tropical areas, although recent cases of gastrointestinal basidiobolomycosis have also been reported in Arizona. We describe a young immunocompetent women who had presented with eosinophilia and lung infiltrates. She subsequently died, and diagnosis of disseminated basidiobolomycosis was made on the basis of histological features at autopsy. CASE REPORTA nonsmoking, 40-year-old housewife was admitted to the hospital with sudden acute dyspnea and hypotension; she died a few minutes after admission to the emergency room due to cardiorespiratory arrest.Three days before, the patient noted the appearance of shortness of breath; hard subcutaneous and painless swellings localized to the back of the shoulders and arms were also noted. For 4 months she had been monitored as an outpatient with low-grade fever and increasing eosinophilia (white cell counts were 13.800 and then 28.280; eosinophils, 11% and then 30%), an elevated erythrocyte sedimentation rate (43 mm/h) and C-reactive protein (3.9 mg/dl), and increased immunoglobulin E (2,583 kU/liter). At that time, pulmonary function tests documented airflow obstruction and chest radiographs revealed a right upper lobe infiltrate. The oxygen saturation was 98% while on room air. Laboratory tests, including percentage of lymphocytes and total count of peripheral blood, hepatitis B virus and hepatitis C virus serological markers, and human immunodeficiency virus status, didn't reveal any form of immunosuppression. She did not suffer from diabetes mellitus or peptic ulcer disease. Symptoms persisted despite antibiotics (macrolide, penicillin-cephalosporin), inhaled corticosteroids, and long-acting ␤2 agonist treatment.A high-resolution computed tomography showed patchy subpleural infiltrates with a halo sign in the right lung (Fig. 1). Enlarged mediastinal lymph nodes, right pleural effusion, and two cysts in the liver were also detected. Bronchoscopy documented a nodular submucosal infiltration involving the distal trachea and proximal right bronchial system.Mucosal biopsies from the right main bronchus showed only eosinophil infiltration and necrosis. There were no organisms, granulomas, or evidence of neoplasm. Subsequently a surgical lung biopsy was taken from the middle right lobe. The histologic findings were similar to those of the transbronchial biopsy: eosinophil infiltration and necrosis with no organism identified. Skin biopsy from subcutaneous nodules, performed 1 day before death, showed eosinophilic panniculitis, in which scattered hyphal elements were present.Autopsy report. The macroscopic examination revealed necrotic small white-yellow opacities (3 to 4 mm in diameter) in the pericardium, parietal pleura of the right hemithorax, visceral surface of the right lung, liver, spleen, kidneys, adrenal glands, pancreas, uterus and peritoneum; the stomach presented fungating necrotic mucosal lesions. Small yellowish nonulcerated nod...

Nowadays, we can consider surgery a safe and justifiable option for elderly patients. Careful preoperative work-up and selection are mandatory to gain satisfactory results. Good long-term results were achieved in elderly patients with early stage who underwent lobar or sublobar lung resection. The role of surgery or other alternative therapies, in patients with advanced stages, extensive nodal involvement and/or requiring extensive surgical resection for curative intent, is still unclear and further studies are certainly needed.

In our experience, surgery is a safe and justifiable option for octogenarian patients with early stage NSCLC. Sublobar resection provides an equivalent in-hospital mortality and long-term survival in comparison with open lobectomy but with less postoperative morbidity. Further large-scale randomized studies are necessary to confirm our results.