[Neurinoma of the vagus nerve. Description of 2 cases and review of the literature]. / Neurinomi del nervo vago. Descrizione di due casi e revisione della letteratura.

The Authors report two rare cases of schwannoma of the cervical and thoracic portion of the vagus nerve. Schwannomas of the vagus nerve are particularly uncommon; patients suffering from these neurogenic tumors typically exhibit a paucity of symptoms and in the majority of cases they present with an asymptomatic mass noted on incidental chest X-ray. Chest pain and cough may occur with tumors arising next to and compressing the trachea or major bronchi. In the cases observed, schwannomas appeared like a mass whose size had increased during the last months without producing any clinical symptom. Clinical features of the mass, laboratory tests, ultrasound, CT scanning, magnetic resonance imaging were useful only to define its extension and relationships with the adjacent structures. Needle aspiration of these lesions is not indicated because of the paucity of the material obtained for the exact diagnosis. Surgery, with preservation of the vagus nerve when possible, is the treatment of choice also for a correct diagnosis of nature and to prevent further growth and compression on adjacent structures. When the individual fibers of the vagus nerve are displayed over the surface of the tumor within a discrete capsule nerve preservation is possible. On the contrary, when it is technically difficult to preserve the nerve trunk microsurgical procedures allow to reanastomose the cut ends. Injury of homolateral recurrent nerve often is the complication of a radical removal. Recurrence of benign lesions is not usual; malignant tumors carry a poor prognosis with patients rarely surviving beyond 1 year.

[Extraskeletal retroperitoneal osteosarcoma. A case report and review of the literature]. / Osteosarcoma extrascheletrico retroperitoneale. Presentazione di un caso e revisione della letteratura.

Extraskeletal osteosarcomas, localized in the retroperitoneal space, are very rare neoplasms (only 200 cases have been described); the case indicated is the second one observed in Literature. The extraskeletal osteosarcomas are very malignant mesenchymal neoplasms reproducing osseous and cartilaginous tissue disconnected from the skeletal system. From a histological point of view, the extraskeletal osteosarcomas are constituted of osseous and cartilaginous tissue with osteo-fibro-chondroblastic cells: the different representation of three types of cells define the variety of extraskeletal osteosarcomas (osteoblastic, chondroblastic, fibroblastic). Histological and ultrastructural study failed to find differences between skeletal and extraskeletal osteosarcomas. In the clinical history of some patients traumas or irradiation has been referred; although extraskeletal osteosarcomas etiology is frequently unknown. Diagnosis is generally delayed because symptoms are often absent of uncertain. Prognosis of these neoplasms is always very poor, and specially in relation to the dimension and to the possibility of its radical removal. All patients died until 2-3 years after surgery.

[Endobronchial lipoma: endoscopic resection or surgical excision? Report of a case and review of the literature]. / Lipoma endobronchiale: resezione endoscopica o exeresi chirurgica? Descrizione di un caso e revisione della letteratura.

The Authors report a case of endobronchial lipoma, a rare, benign lung lesion. Literature data show that a correct preoperative diagnosis of nature is possible in less than 50% of all the cases and a thoracotomy is mandatory in 85% of the patients because FNAB or brushing rarely allow a certain cytological diagnosis. When a benign tumor is suspected, an endobronchial resection is the treatment of choice, allowing a correct histological diagnosis and in the same time a definitive therapy with resolution of symptoms. Surgical option is reserved for the not certainly determined benign or malignant lesions.

Thoracic desmoid tumors: a rare evolution of rib fracture. Etiopathogenesis and therapeutic considerations.

The Authors report a case of thoracic desmoid tumor. The strict correlation between a previous chest injury and the site of desmoid tumor in this patient seems to strengthen the possible etiological role of trauma, as already suggested.

[Treatment of differentiated carcinoma of the thyroid and its limitations]. / Il trattamento dei carcinomi differenziati della tiroide ed i suoi limiti.

The Authors report their experience in the management of differentiated thyroid cancer (DTC) with extrathyroidal extension including nodal and distant metastases. Twelve patients were included in the review: 11 of them were previously and elsewhere considered not curable. On the contrary, integrated treatment (surgery, radioiodine and radiation therapy) allowed to control the disease in 10 patients with a survival ranging from 14 years to 29 months. Cytopathologic analysis, in the two patients who died, showed a differentiated thyroid cancer with anaplastic areas. Integrated treatment, therefore, represents the treatment of choice for advanced DTC only in total absence of anaplastic cells.

[The sternotomy and thoracotomy approaches in the treatment of differentiated thyroid cancer in an advanced phase]. / Approccio sternotomico e toracotomico nel trattamento del cancro differenziato della tiroide in fase avanzata.

The authors report their experience in the treatment of well-differentiated thyroid cancer. The analysis of 5 cases treated with extensive surgery give the opportunity to discuss about the use of sternotomy or thoracotomy to eradicate mediastinal lymph nodes. The importance of preoperative assessment, especially by histological examination is stressed as well as the role of surgery in the multidisciplinary approach for the treatment of the disease.

[Short-term antibiotic prophylaxis in surgery. Our experience with the use of piperacillin in 261 patients]. / La profilassi antibiotica "short term" in chirurgia. Nostra esperienza con l'uso della piperacillina in 261 pazienti.

Personal experience of short-term chemoprophylaxis with piperacillin in 261 consecutive "clean" and "non-contaminating" operations is reported. Piperacillin was employed in a dose of 2 g i.m. every 8 hours for a total of 48 hours, the first administration being carried out at the same time as pre-anaesthesia. Results of the study showed 8 cases (3.06%) of hyperpyrexia (greater than 38.5 C for at least 3 days) and no cases of wound, bronchopulmonary or urinary infection or systemic sepsis were encountered. It is concluded that the use of piperacillin enables "clean" and "non-contaminating" general surgery interventions to be carried out almost without risk of infection.

[Diagnosis and treatment of hepatic echinococcosis with fistulas of the major bile ducts]. / Diagnostica e trattamento dell'echinococcosi epatica fistolizzata nelle vie biliari maggiori.

The authors report their experience of secondary major biliary fistula (MBF) for hepatic echinococcosis. The analysis of the results of the surgical treatments showed that "conservative" operations have major mortality than "radical" operations. The importance of an exact preoperative diagnosis of presence, side and size of MBF, in order to a correct choice of the most suitable operations, is underlined. Endoscopic retrograde cholangio-pancreatography seems to be a reliable diagnostical technique, also if compared with traditional methods (U.S., C.T.).

[Morphological and functional study of the liver using scintigraphy with 99m-Tc-HIDA before and after major resection for echinococcosis]. / Studio morfologico e funzionale del fegato mediante scintigrafia con 99m-Tc HIDA prima e dopo resezioni maggiori per echinococcosi.

Personal experience in the monitoring of liver function and morphology after resection using hepatobiliary HIDA 99mTc scintigraphy is reported. This investigation provides useful functional and morphological data. In three patients subjected to right hepatectomy for echinococcosis the examination performed preoperatively and 25 and 90 days after surgery revealed functional normalisation of the residual liver and biliary excretion. On the basis of this experience and data from the literature the value of the technique is confirmed and it is suggested that it might be usefully adopted in the study of other liver conditions such as neoplasms, traumas as well as in the monitoring of transplanted livers.