From 1985 to 1996, we observed 38 cases of isolated atrophy of the infraspinatus muscle in athletes; all were involved in volleyball at a competitive level. There were 20 men and 18 women with a mean age of 26 years (range, 15 to 27). At the time of the first examination, 35 of these athletes had no pain and were treated with exercises to strengthen the external rotators. The remaining three patients underwent surgery because of pain at the posterior aspect of the shoulder. Sixteen of the 35 players treated nonoperatively were reviewed at a mean follow-up of 5.5 years (range, 3 to 10). Thirteen were still involved in volleyball and three had retired symptom-free at the end of their careers. On physical examination, atrophy of the infraspinatus muscle was unchanged in all cases. The patients treated surgically were reviewed at a mean follow-up of 2 years. All of them were able to play volleyball at their preinjury levels, but one had pain at the anterior aspect of the shoulder after strenuous activity. Physical examination showed a notable reduction of the atrophy in one patient. Entrapment of the suprascapular nerve at the spinoglenoid notch is a usually painless syndrome that is frequently observed in volleyball players. Surgical treatment is indicated in the rare cases of painful neuropathies after careful patient selection.

Background Whether patients who are resected for ampullary adenocarcinoma have a survival benefit from adjuvant chemotherapy is currently not known. The aim of this study was to compare propensity score-matched survival between patients with and without adjuvant chemotherapy after resection of ampullary adenocarcinoma. Methods An international multicentre cohort study was conducted, including patients who underwent pancreatoduodenectomy for ampullary adenocarcinoma (2006-2017) in 13 centres in six countries. Propensity scores were used to match patients who received adjuvant chemotherapy to those who did not; both in the entire cohort and in two subgroups (pancreaticobiliary/mixed and intestinal subtype). Survival was assessed using the Kaplan-Meier method and Cox regressions. Results Overall, 1163 patients underwent pancreatoduodenectomy for ampullary adenocarcinoma. After excluding 179 patients, median survival in the resulting 976 patients was 67 months (95 per cent confidence interval 56-78), of which a total of 520 (53 per cent) patients received adjuvant chemotherapy. In a propensity-matched cohort (194 vs 194 patients), median survival was better after adjuvant chemotherapy compared to those without adjuvant chemotherapy (median survival not reached vs 60 months, respectively; p=0.051). In the pancreaticobiliary/mixed subtype a survival benefit was seen; median survival was not reached in patients receiving adjuvant chemotherapy vs 32 months in the group without chemotherapy, p=0.020. The intestinal subtype did not show survival benefit from adjuvant chemotherapy. Conclusions Patients with resected ampullary adenocarcinoma may benefit from gemcitabinebased adjuvant chemotherapy, but this effect may be reserved for those with the pancreaticobiliary and/or mixed subtype.

<b><i>Background:</i></b> The most appropriate nodal staging system for non-functioning pancreatic neuroendocrine tumours (NF-PanNETs) remains unclear. Despite some evidence is available for pancreaticoduodenectomy, the adequate nodal staging is still unknown for distal pancreatectomy (DP). The aim of the present study was to evaluate the prognostic impact of the number of positive lymph nodes (PLNs) after DP for NF-PanNETs and to define the minimal number of lymph nodes to be harvested for an appropriate nodal staging. <b><i>Methods:</i></b> Data were retrospectively collected from patients who underwent DP with curative intent (R0-R1) for sporadic well-differentiated NF-PanNETs in 4 European high-volume centres. NF-PanNETs with nodal involvement (N+) were subclassified into N1 (1–3 PLNs) and N2 (4 or more PLNs). Univariate and multivariate analyses of disease-free survival (DFS) were performed. <b><i>Results:</i></b> Of 271 patients in the study, 62 (23%) had nodal involvement (N+). A higher probability of N+ was associated with the following factors: grading, resection margin status, perineural and microvascular invasion, and the number of examined lymph nodes. Three-year DFS rate for N0, N1, and N2 patients was 92, 72, and 50%, respectively (<i>p</i> &#x3c; 0.001). At multivariate analysis, independent predictors of DFS were grading, T stage, presence of necrosis, and nodal status. For patients with ≥12 examined/resected lymph nodes, the N status remained a significant predictor of disease recurrence (<i>p</i> &#x3c; 0.001), while it failed to predict recurrence in patients with &#x3c;12 lymph nodes examined/resected (<i>p</i> = 0.116). <b><i>Conclusions:</i></b> A minimal number of 12 nodes should be harvested in case of DP for NF-PanNET for an appropriate nodal staging. The number of positive lymph nodes is an independent predictor of DFS after DP for NF-PanNET, and the N0/N1/N2 nodal classification seems to be more relevant than the current N0/N+ staging.

Various histologic classification systems have been proposed as prognostic factors for gastric cancer. We assessed the prognostic value of Goseki classification as well as the TNM staging system, histological tumour grading, Lauren, WHO, Goseki and Siewert classifications in 100 patients with cardia carcinoma undergoing curative surgery. Two patients were lost at follow-up. The median time of follow-up in the remaining patients was 32.9 months after surgery (range: 0.1 -142.1 months). No differences in survival rates were observed according to tumour grading, Lauren or WHO histologic or Siewert topographical classification. No differences were found according to Goseki classes, when considering either the mucin content of the carcinoma (types I and III vs II and IV) or the differentiation grade (types I and II vs III and IV). Multivariate analysis showed that the only lymph node positivity was a significant predictor of survival: 7.2% of patients with, but 41.5% of those without nodal involvement were alive after five years (P ¼ 0.0001). In conclusion, we found no prognostic role for Goseki or the traditional histological indexes, while the TNM staging system and particularly lymph node positivity were the main predictors of survival in patients with cardia adenocarcinoma.