Diffusion-weighted magnetic resonance for prediction of response after neoadjuvant chemoradiation therapy for locally advanced rectal cancer: preliminary results of a monoinstitutional prospective study.

PURPOSE: To evaluate diffusion-weighted imaging (DWI) for assessment of treatment response in locally advanced rectal cancer (LARC) 8 weeks after neoadjuvant chemoradiotherapy (CRT). METHODS AND MATERIALS: A total of 28 patients with LARC underwent magnetic resonance imaging (MRI) prior to and 8 weeks after CRT. Tumor volume (TV) was calculated on T2-weighted MRI scans as well as the apparent diffusion coefficient (ADC) was calculated using Echo-planar DWI-sequences. All data were correlated to surgical results and histopathologic tumor regression grade (TRG), according to Mandard's classification. Post-treatment difference ADC (%ΔADC) and TV (%ΔTV) changes at 8 weeks were compared complete response (CR; TRG1) and non-complete response tumors (non-CR; TRG2-5). RESULTS: The mean % ADC increase of CR group was significantly higher compared to non-CR group (77.2 ± 54.63% vs. 36.0 ± 29.44%; p = 0.05). Conversely, the mean % TV reduction did not significantly differ in CR group from non-CR group (73.7% vs. 63.77%; p = 0.21). Accordingly, the diagnostic accuracy of the mean % ADC increase to discriminate CR from non-CR group was significantly higher than that of the mean % TV reduction (0.913 vs. 0.658; p = 0.022). No correlation was found between mean % TV reduction and TRG (rho = 0.22; p = 0.3037), whereas a negative correlation between mean % ADC increase and TRG was recorded (r = -0.69; p = 0.006). CONCLUSION: The mean % ADC increase appears to be a reliable tool to differentiate CR from non-CR after CRT in patients with LARC.

[Laparoscopic deroofing of non parasitic posterolateral liver cyst. Technical considerations]. / Fenestrazione laparoscopica di cisti non parassitaria posterolaterale del fegato. Considerazioni tecniche.

Laparoscopic deroofing of the solitary non parasitic cysts of the liver is a safe and effective procedure. This technique allows a wide access for surgical treatment of cysts localized in segments II, III, IVb, V, and VIII of the liver. On the contrary, the posterior segments, VI and VII, and the segment IVa, are difficult to approach laparoscopically. This report describes a laparoscopic technique used in treating 3 cases of symptomatic solitary cysts of the posterior segments of the liver. The patients were placed in the left lateral position. The fenestration treatment was easy and the mobilization of the right hepatic lobe was not required. At one year follow-up, neither postoperative complications nor recurring episodes were observed.

[Splenectomy for hematologic disease. Mini-invasive versus traditional technique]. / La splenectomia per malattie ematologiche. Tecnica mininvasiva e tradizionale.

BACKGROUND: This study aimed to compare the safety, efficacy and clinical benefits of laparoscopic splenectomy (LS) to open splenectomy (OS) in patients with hematologic disorders. EXPERIMENTAL DESIGN: prospective study; SETTING: II Department of Surgery, Santa Maria Nuova Hospital, Reggio Emilia and III Department of Surgery, Santo Spirito Hospital Pescara; PATIENTS: 48 consecutive adult patients underwent splenectomy; 30 patients under-went LS and 18 OS. Perioperative characteristics, outcomes, complications and costs were comparatively analyzed. RESULTS: Mean age was 35.3 years in the LS group, and 40.8 in the OS group. Mean spleen size was 11.7 cm in the LS group and 15.2 cm in the OS group. Accessory spleens were found in 5 patients in the LS group and in 4 patients in the OS group; 4 conversions to laparotomy occurred in the LS group. A total of 4 complications occurred in 3 patients of the LS; 9 complications occurred in 5 patients of OS group. Mean surgical time was 141.5 minutes for LS and 89.7 minutes for OS (p<0.005). Mean postsurgical stay was 5.8 days in the LS group and 8.5 days in the OS group (p<0.005). Response rates were similar in both groups. CONCLUSIONS: LS is comparable to OS in terms of efficacy and safety and it is associated with a shorter hospital stay. LS should become the technique of choice for treatment of intractable benign hematologic disease.

[Colorectal cancer in pregnancy. A case report]. / Il cancro del colon-retto in gravidanza. Descrizione di un caso.

Carcinoma of the colon-rectum during pregnancy is rare (0.1-0.001%). Prognosis is severe as it is generally made at an advanced stage. The Authors report a case of adenocarcinoma of the recto-sigmoid junction in a 26-year-old pregnant woman. In this patient diagnosis was occasionally made after delivery by cesarean section. Early diagnosis is difficult because symptoms of colorectal cancer (vomiting, constipation, anemia, rectal bleeding, abdominal pain and distension, etc.) can be related to pregnancy. Gestational age and operability of the tumor are discussed by current medical and surgical management.

[Biliary cystadenoma. A report of 2 cases]. / Il cistoadenoma biliare. Osservazione di 2 casi.

Two cases of cystadenoma of the biliary tract are presented. This is a rare tumor that represents less than 5% of non parasitic cysts of biliary origin. It usually occurs in middle-aged women. Ultrasound (US) and Computerized Tomography (CT) are most important for tumor diagnosis, but differential diagnosis with other cystic tumors of the liver is very difficult preoperatively. Malignant degeneration to biliary cystadenocarcinoma is documented. Surgery is always indicated and has included aspiration, sclerosis, marsupialization, internal drainage, but the complete removal of lesion with enucleation or liver resection is the treatment of choice.

[Laparoscopic treatment of biliary cysts]. / Trattamento laparoscopico delle cisti biliari.

Here comes presented three cases of biliary cysts treated with laparoscopic technique. In the first case the discovery of a single cyst of small size on the hepatic margin have consented the total removal. In the second case was about a voluminous unique cyst, while in the third has been found an hepatic polycystosis. In both of them has been applied Lin's procedure with videolaparoscopic technique.

[Primary gastric lymphoma. Personal experience]. / Il linfoma gastrico primitivo. Nostra esperienza.

The authors report their experience regarding primary gastric lymphoma. The series presented consists of 5 cases: a correct preoperative diagnosis of primary gastric lymphoma was made in one case, whereas pseudolymphoma was hypothesised in a second patient. The remaining three cases were all maltomas. After examining the histological characteristics and classification of primary gastric lymphomas, the authors underline the importance of an early preoperative diagnosis of gastric lymphoma. The repeated use of endoscopic techniques with biopsy compared to radiological examination increases the possibility of diagnosing lymphoma from 20% to 85%. The success rate is further increased if ultrasonic endoscopy is used instead of endoscopy alone, thus making it possible to achieve a 97% diagnostic success rate. The authors then emphasise the fundamental role played by surgery in the treatment of gastric lymphoma. Depending on the depth of neoplastic infiltration, the dimensions of the neoplasia and its multifocality, in localised forms of the antrum (IE, IIE with a low degree of malignancy) surgery consists of resection with partial gastrectomy, provided the resection margins are undamaged, or total gastrectomy in those forms involving the fundus and body of the stomach.

[Antropyloric lithiasic obstruction: a variant of Bouveret's syndrome]. / Ostruzione litiasica antropilorica: una variante della sindrome di Bouveret.

Bouveret's syndrome is a rare complication of a biliodigestive fistula, where a big stone occludes the pyloro-duodenal region. The authors describe a case with obstructive variant at antropyloric level. With the help, of the literature they speak about this matter with particular attention to the clinic symptomatology and diagnostic and therapeutic procedure.

[Lumbar hernia of Grynfeltt's quadrilateral space. Apropos a case]. / Ernia lombare del quadrilatero di Grynfelt. A proposito di un caso.

The authors discuss a case of Grynfeltt's quadrilateral lumbar hernia in an 85-year-old patient. These rather rare hernias can be classified as Grynfeltt's hernias of the superior lumbar space, as Petit's inferior lumbar space and as diffused hernias concerning the whole hip. In our case this hernia was located in the superior lumbar space and it was delimited on the upper part by the 12th rib and by the serratus posterior-inferior muscle; in the lower part by the internal oblique muscle and by the lumbar quadratus muscle. Surgical treatment was effected by plastic surgery with synthetic material put in the extra-peritoneum space and fixed by serum-muscular stitches. Postoperative control effected after a month from the operation proves a good keeping of the plastic surgery reconstruction with total disappearance of the hernia.

[Latero-terminal anastomosis in colorectal surgery using a mechanical stapler. Technical note]. / L'anastomosi latero-terminale con suturatrici meccaniche in chirurgia colo-rettale. Nota tecnica.

Following a discussion of the various methods of colorectal anastomosis in cancer surgery, the Authors describe a technical variant using a mechanical stapler in a high rectal location. The rapidity of anastomosis as well as the decreased risk of dehiscence, fistula and stenosis are underlined.

[The role of angiography in cryptogenic submesocolic digestive tract bleeding]. / Ruolo dell'angiografia nelle emorragie digestive sottomesocoliche criptogenetiche.

Three cases of chronic gastrointestinal bleeding are described; the Authors emphasize the important role of mesenteric arteriography in establishing site and nature of bleeding. The review of international literature shows a success rate between 41 and 73% of cases studied with this method after negativity of other diagnostic procedures.

[Short-term antibiotic prophylaxis in cholecystectomy]. / La profilassi antibiotica "short-term" nella colecistectomia.

After describing the stages of surgical infection and the efficacy of short-term antibiotic prophylaxis in surgery, the paper reports a trial in which a single dose of Ceftriaxone was administered in 50 cases of cholecystectomy, with excellent results in terms of efficacy and tolerability.

[Prognostic factors in gastric carcinoma]. / Fattori prognostici del carcinoma gastrico.

A personal experiment conducted on 80 gastric carcinoma patients requiring radical surgery at the Special Surgical Pathology Institute is reported. The aim of the study was to identify and assess the factors capable of influencing prognosis e.g. sex, age, TNM, type of operation, symptoms etc and to make a comparison with data from the international literature.