[Association between breast and colorectal cancer and polyps. Screening and epidemiological study]. / Associazione tra cancro della mammella e polipi e cancro del colon-retto. Studio epidemiologico e di screening.

BACKGROUND: Studies regarding the associations between different types of cancer in the same patient are very few and not always come to the same conclusions. Several hypothesis are suggested and particularly genetic and socioeconomical ones seem to offer an interpretation of this issue. Early detection of a second neoplasm allows to improve prognosis and survival. The knowledge of correlations between tumors help to select a population, with a high risk to develop a second cancer, to be included in a screening program. Nowadays thanks to early detection of breast cancer, ten years survival is more than 75%. Women who had breast cancer now live longer and so could have a higher risk to develop a second cancer. METHODS: From September 1998 to September 1999 in our Department 71 patients operated for breast cancer, underwent screening colonscopy. No patients refused to be included in the study. Mean age was 61 years (range 36-87). Each patient had a clinician interview in order to explain the goals of the study. RESULTS: Results show that among all patients 3 (4.2%) presented a history of colon cancer, 18.3% (13 cases) presented large bowel polyps. In 84.60% patients (11 cases) polyps were found not over 40 cm. This study shows that 93% of patients (66 cases) had a relative with cancer history. CONCLUSIONS: Our results compared with those of other authors seem to show an increased risk for breast cancer patients in developing polyps or colon cancer, so we suggest to insert sigmoidoscopy in standard follow-up of breast cancer patients.

[Intestinal perforation caused by a chicken bone: apropos of a clinical case]. / Perforazione intestinale da osso di pollo: a proposito di un caso clinico.

Ingestion of foreign bodies (FB) seems to be a relatively common occurrence in certain classes of people. The majority of ingested objects reach the stomach end 80% of these pass spontaneously without complications. However nearly 20% of FB that pass from the stomach result in complication distally such to required a surgical operation. The authors report a case of chicken bone perforation of the ileus, which was diagnosed by surgical operation. The case reported is of interest for several reason. The lack of condition that can predispose patients to accidental ingestion of FB, no specific history of FB ingestion and the impossibility to detect chicken bones on plain radiography.

[Non visible carcinoma of the gallbladder. A strategic problem after video laparoscopic cholecystectomy]. / Il carcinoma non visibile della cistifellea. Un problema strategico dopo videolaparocolecistectomia.

A formal contraindication to laparoscopic cholecystectomy is gallbladder cancer. Sometimes its first appearance is intraoperative finding or microscopic examination of gallbladder removed for presumed benign disease. These patients with "inapparent carcinoma" may be long-term survivors if definitive and curative therapy is performed. We present the case of 56 y. woman which presented a T2 unsuspected carcinoma that was reoperated and cured by wedge liver resection, extended lymph node dissection and large excision of tissue of trocar wounds.

Biofragmentable anastomosis ring (BAR) in intestinal surgery: review of 21 cases and evaluation of postoperative morbidity.

The authors report their experience with the use of biofragmentable anastomosis ring in intestinal anastomosis: 21 patients underwent intestinal resection and anastomosis by BAR. There was no operative mortality. One patient developed an anastomotic leak and three patients had symptoms of intestinal obstruction. The endoscopic follow up showed no late complications. Technical factors regarding the BAR are discussed. Advantages appear to be a safe, rapid and easy alternative to hand and stapled intraperitoneal large bowel anastomosis.

[Primary hyperaldosteronism caused by monolateral adrenal hyperplasia]. / Iperaldosteronismo primario da iperplasia surrenalica monolaterale.

We have reported two patients with unilateral adrenal hyperplasia as a rare cause of primary aldosteronism, and discussed the literature on this subject. When diagnosed by NMR-CT imaging and selective sampling from adrenal veins, the treatment of this disorder appears to be surgical. Whether its pathogenesis is related to the more common varieties of primary aldosteronism is open to speculation according to metabolic findings.

[Is surgery duration really a complication factor?]. / Il tempo operatorio è realmente un fattore di complicanza?

Of the numerous factors which may cause postoperative complications, some authors sustain that the durations of surgery plays a fundamentally important role. On the basis of a retrospective survey and analysis of cases operated, the authors observe that this factor, if considered alone, does not appear to cause a significant increase in septic complications, anastomotic dehiscence or mean postoperative hospital stay. Four homogeneous groups of patients were examined. Two groups included 100 who had undergone abdominal surgery which had not contaminated the peritoneal cavity. The other two groups included 150 patients who had undergone partially polluting colorectal surgery. The general preparation of patients was similar, with the exception of antibiotic prophylaxis. The mean time was calculated by analysing anesthesiological records. From an analysis of the most recent data, which are characterized by the absence of anastomotic dehiscence and operative mortality, it can be seen that the incidence of sepsis has fallen to 4% even if mean operating time was long. Mean postoperative hospital stay was also reduced from 17.3 days to 13 days. The prolongation of operating times does not depend on the complexity of surgery, intraoperative complications or the surgeon's inexperience, but may be the result of the meticulous implementation of procedures and steps taken to prevent complications which, given that they require extreme care and attention, necessarily contribute to increasing the duration of surgery. With regard to antibiotic prophylaxis and the duration of surgery, it was observed that if antibiotic prophylaxis preceded the operation by more than one hour, the incidence of sepsis was about 20%. If treatment coincided with the induction of anesthesia or the start of surgery, then the incidence of sepsis fell to 13%.(ABSTRACT TRUNCATED AT 250 WORDS)