[Is it possible to consider intranuclear DNA imaging analysis as a new parameter in the staging of colorectal cancer?]
Midiri G. Giovagnoli MR. Tesoriere A. Giarnieri E. Covotta L. Bertolotti A. Vecchione A. Di Paola M.
Cattedra di IV Semeiotica Chirurgica, Universita degli Studi La Sapienza, Roma.
Intranuclear DNA imaging may be considered as a marker of the biological behaviour of neoplasias. However, some questions fundamentally related to the interpretation of cytometric data, to the correlation with other histomorphological parameters and to tissue sampling concerning staging and prognostic evaluation of colon cancer patients are still unsolved. A way to solve this problem may be to perform multiple full thickness samplings.
[Transpyloric prolapse of a gastric carcinoma arising from a pedunculated hyperplastic polyp]
Brozzetti S. Gialloreti A. Cicchini C. Stazi A. Indinnimeo M.
I Clinica Chirurgica, Universita degli Studi La Sapienza, Roma.
A case of gastric carcinoma developed on a large pedunculated hyperplastic polyp prolapsed into duodenum is reported. The cases of transpyloric prolapsed primary pedunculated gastric carcinoma are rare, only 34 cases have been described in Japan during the past 35 years, including the sessile forms. These gastric polyps should be considered in the differential diagnosis of intraluminar filling defects of the duodenal bulb. Endoscopy and biopsy are essential for a correct diagnostic evaluation. Large hyperplastic polyps, especially if prolapsed, require a surgical excision.
[Appendiceal mucocele: apropos of 2 cases]
Mazzocconi G. Campli M. Stasio A. Virno VA. Sbaffi E.
Divisione di Chirurgia, Ospedale Policlinico Casilino, Roma.
Two patients affected by appendiceal mucocele underwent emergency operation in our Department. Clinical findings and surgical management of the disease are discussed as well as controversy regarding the pathologic classification of the disease. The term "mucocele" is not referred to an exact histopathologic lesion: it describes the gross enlargement of the appendix, due to the accumulation of mucus in the dilated lumen. Currently such lesions are classified as nonneoplastic or as retention appendiceal cysts or as mucous-secreting tumours; the benign forms are cured by appendectomy, the malignant ones often require right colectomy for technical reasons. Pseudomyxoma peritonei significantly decreases survival of patients suffering from mucinous cystadenocarcinoma, but it does not affect survival in case of mucinous cystadenoma.
[Post-thymectomy extrathymic tumors]
Berretta S. D'Agata A. Italia F. Marino F. Barbagallo E. Berretta M. Serra A.
Dipartimento di Chirurgia, Universita degli Studi di Catania.
The Authors report the case of a 78 year old woman affected with two synchronous primary cancers (epidermoid bronchial and rectal adenocarcinoma); 16 years previously, after the discovery of a thymoma, she underwent thymectomy. Thus, the discussion issue is if post-thymectomy extra-thymic malignancies are to be considered just a simple coincidence or a true syndrome.
[Diaphragmatic eventration in the adult: repair with Gore-Tex surgical mesh]
Cancrini A. Bellotti C. Santoro A. Stanzani GL. Ascenzi P. Cancrini G.
Istituto III Clinica Chirurgica Generale e Terapia Chirurgica, Universita degli Studi La Sapienza, Roma.
The Authors report the case of a fifty-nine-year-old patient, affected by complete eventration of the left diaphragm and cranial stomach dislocation with axial volvulus, associated with an upward movement of part of the left colon and some jejunal loops. The subclinical condition had been occasionally discovered during a routine chest X-ray at the age of eighteen and the patient remained without symptoms up to five years ago, when he began to show significant digestive and cardiorespiratory symptoms. The patient has been successfully treated via thoracotomy with phrenic alloplastic using Gore-Tex patch and has obtained an immediate remission of the symptoms. Left diaphragmatic eventration of the adult is a rare pathology, either congenital or acquired, with few and definite surgical indications such as severe digestive and cardiorespiratory symptoms. Different surgical techniques including the use of patches are herein illustrated.
[Primary gastric lymphomas: analysis and considerations on 7 cases]
Naldini G. Tassi W. Voltolini F.
Unita Operativa Chirurgia II, Presidio Ospedaliero di Piacenza, Azienda Unita Sanitaria Locale di Piacenza.
The Authors report on 7 cases of primary gastric lymphoma. Some considerations about the diagnosis and the surgical treatment of these tumors are illustrated.
[Hydatid cysts of the right lobe of the liver treated with total pericystectomy using a transparenchymal approach]
Amicucci G. Sozio ML. Sozio A. Bocchio M. Rizzo FM.
Dipartimento di Discipline Chirurgiche, Universita degli Studi de L'Aquila.
The Authors report on 2 cases of hydatid cyst of the right hepatic lobe. A transparenchymal approach with total pericystectomy was the treatment of choice.
[The rational use of prosthesis in laparocele]
Varoli M. Colucci G. Carretti A. Bruni R. Begossi G.
Divisione di Chirurgia Generale, Ospedale Civile S. Agostino di Modena.
The Authors report their cases of incisional hernias observed from 1990 to 1995 involving 142 patients treated either in emergency or under normal conditions. A guideline in the choice of prosthetic materials of current use, considering the relative chemo-physical characteristics, the biocompatibility and the costs is outlined. Although not entering into the merit of the surgical technique some general criteria that should guide the surgeon facing the incisional hernial pathology are ruled out.
[Esophageal perforations. Diagnosis and treatment]
Giani L. Nobili P. Annolfi B. Rossi B. Chiarelli M.
Divisione di Chirurgia Generale, Ospedale di Desio, MI.
Perforation of the esophagus was retrospectively analysed in six patients. The age span was 30 years to 81 years, and the male to female ratio was 2 to 1. Each case was studied with regard to presentation, etiology, treatment and complications. The diagnosis was made at postmortem examination only in 1 patient. The perforation was iatrogenic in 1 of the patients and spontaneous in 5. Management was nonoperative in 3 cases and primary repair with drainage was performed in 2 patients. Overall mortality rate for the series was 33%. This series accumulated from a review of the literature emphasizes the importance of the influence of different methods of treatment and time lapsed between occurrence and therapy.
[Acute hepatic necrosis in a patient treated with cyproterone acetate]
Lombardi A. Ferrazza P. Castaldi F. Covotta L. Tesoriere A. Urbano V. Midiri G.
Istituto di IV Clinica Chirurgica, Universita degli Studi La Sapienza, Roma.
The Authors report a case of prostatic carcinoma in a 84 year old male, treated with cyproterone acetate (CPA), complicated by a fatal fulminant hepatitis. He was admitted with a mixed jaundice followed by a derange of all liver function tests. Serological markers for hepatitis were negative. Ultrasonography and CT revealed no hepatic abnormality but gallstones and dilatation of principal bile duct with a terminal stricture. By the endoscopic retrograde cholangiography and sphincterotomy we put an external drain tube. He died 9 days after admission. Fatal hepatis due to CPA is a very rare complication but all patients on anti-androgenic drugs should have liver function closely monitored. CPA must be discontinued immediately at the first derange of liver function tests.
[Adenocarcinoid of the appendix: a case report and anatomo-pathological and clinico-therapeutic considerations]
Fornaro R. Secco GB. Terrizzi A. Boaretto R. Fardelli R. Canaletti M. Baldi E. Pastorino A. Ferraris R.
Cattedra di Semeiotica Chirurgica I, Universita degli Studi di Genova.
The Authors underline the most important pathological, clinical and therapeutic aspects of appendiceal adenocarcinoid. Appendiceal adenocarcinoid is quite a rare tumor, presently considered as a single entity; it differs from typical carcinoid of the appendix because of its well definite histology, its aggressive behaviour and its poorer prognosis. There are no precise prognostic and therapeutic criteria to direct the operative choice between appendectomy and hemicolectomy. In particular the tumor diameter is of no use since the tumor often present diffuse rather than nodular growth. According to most Authors appendectomy is not sufficient in the following cases: liver lymph-node or retroperitoneal metastases; cecal meso-appendiceal or peritoneal spreading; histological poorly differentiated tumors, with nuclear atypia and high mitotic count. Some Authors performed hemicolectomy and bilateral oophorectomy in all case with peritoneal involvement since the ovaries are a frequent site of metastases.
[Preoperative treatment with interleukin-2 in colorectal carcinoma]
Vecchio R. Latteri F. Di Martino M. Lanteri E. Cacciola E.
Dipartimento di Chirurgia, Universita degli Studi di Catania.
Thirteen surgical patients affected by colorectal cancer have been evaluated to study the effectiveness of a short-term preoperative therapy with interleukin-2 (IL-2). Seven patients have been treated for three days before surgery with subcutaneous administration of IL-2 (9.000.000 U.I. b.i.d.). Six patients have been treated with placebo and have been considered as control group. All the patients have been operated upon 36-48 hours after the last administration of IL-2 or placebo. The assays of CD-3+, CD-4+, CD-8+ e CD-56+ lymphocytes, evaluated preoperatively and 7 days after the operation, have showed a postoperative increase of CD8+ and CD56+ and a decreased ratio of CD4+/CD8+. The results of this study, although not conclusive, suggest a positive antitumoral response in patients treated preoperatively with IL-2. Further studies could be performed to evaluate the survival after such a treatment.
[Surgical therapy of metabolic liver diseases (glycogenosis, hypercholesterolemia)]
Meriggi F. Forni E. Bismuth H.
Clinica Chirurgica Generale, Universita degli Studi di Pavia.
Up-to-date, most patients with serious chronic hepatic disease are best treated by liver transplantation. It has been confirmed the striking benefit of liver transplantation also for patients with glycogen storage disease or homozygous familial hypercholesterolemia who were refractory to medical treatment. Nevertheless, the advantage of achieving palliation without transplantation, thereby avoiding the need for chronic immunosuppression, is obvious. With reference to the mentioned above diseases, end-to-side portacaval shunt was used. A favourable effect was noted on body growth and a number of metabolic abnormalities. Hepatic failure did not occur, although in a few patients blood ammonia concentrations and serum alkaline phosphatase levels increased relative to preoperative values. To avoid an incomplete palliation provided by portacaval shunt, appropriate case selection is a problem. The Authors report their personal experience with portacaval shunt for the treatment of glycogenosis and familial hypercholesterolemia.
[Rare complications of biliary sepsis]
Fimmano A. Rondinone G. Miglio R. Masone S. Balsamo A. Tesauro B.
Istituto di Chirurgia Generale e Scienze Gastroenterologiche, Universita degli Studi di Napoli Federico II.
The surgical approach to the acute biliary pathologies also today is often controversial. The choice of the right time to operate an acute patient is based either on personal clinical experiences, either under the statement that waiting for the resolution of the acute process could be preferable in the aim of reduce the surgical risk. This is the almost general tendency. Recently, some interesting articles issued by Swedish and German schools conducted as controlled trials on a great base of cases, try to emphasize the advantages of an early surgical therapy, particularly in the elderly patients. In these ones, in fact, the concomitance of cardiovascular, metabolic and immunodepressive pathologies makes more serious the complications too. In this article, the Authors refer on three clinical cases, all of which were quite different, and in which it was possible to identify a former septic hepato-biliary pathology. All the patients, upon hospital admission showed an acute pattern. In two cases it was an hepatic abscess, accompanied in one case by a "satellite" pulmonary abscess on the right lung. These two were treated conservatively, although by a TC-guided drainage of the liver abscesses. The third case, a localized choleperitoneum (biloma saccatus), underwent an operation. The accurate investigation on the clinical records of Authors' Department since 1980 to 1995 and in particular on the three referred cases seems to confirm that the importance of some complications after acute biliary pathology and their great morbidity must stimulate the surgeons to investigate always on the real causes of all clinical patterns, even if uncommon.