[Sarcoidosis and clear cell carcinoma of the kidney: the sixth case?]. / Sarcoidosi e carcinoma renale a cellule chiare: il sesto caso clinico?

The Authors report a very rare case of clear cell renal cancer associated with sarcoidosis, incidentally discovered in a 39 year-old man, admitted for a not correlated pathology (multiple left rib fractures due to automobile crash). Problems related to a proper assessment of sarcoidosis are discussed as well as potential arising of a neoplasm during the entire follow-up period: for that, it must always be complete and accurate.

[Current role of traditional endoscopy and prospects for virtual colonoscopy in the management of colorectal neoplastic lesions]. / Ruolo attuale dell'endoscopia tradizionale e prospettive della colonscopia virtuale nel management delle lesioni neoplastiche del colon-retto.

The Authors, reviewing their surgical experience with colo-rectal cancer in the last 13 years, conclude that, in the management of this condition, the routine use of traditional endoscopy will continue to have a crucial role in terms of prevention, cure and/or survival. It is possible that in the future present limits of endoscopic techniques will be seperated by routine use of endoscopic ultrasounds and virtual colonoscopy.

[Current role of endoscopic ultrasonography in the treatment of colorectal neoplastic lesions]. / Ruolo attuale dell'ecografia endoscopica nel trattamento delle lesioni neoplastiche colo-rettali.

The Authors examined the value of endoscopic ultrasounds in the tmanagement of colo-rectal lesions, particularly neoplastic ones, on the basis of their surgical experience, concluding that to date such technique cannot substitute traditional endoscopy, but surely can be a valid complementary tool for imaging diagnostics, expecially to study wall tumoral infiltration or extra-parietal relapses.

[Hereditary nonpolyposis colorectal cancer (Lynch syndrome): a review of the literature and case reports]. / Cancro colorettale ereditario non poliposico (sindrome di Lynch): revisione della letteratura e contributo casistico.

The recent observation of a new HNPCC patient case induced the Authors to review their experience with the syndrome as well as to make an up to date of the problems related to diagnosis, surgical management, surveillance and genetic counselling for such patients with a lifelong high cancer risk. Patients with HNPCC and their first-degree relatives, whose risk of early colorectal carcinoma (especially in the proximal colon) as well as a variety of extracolonic cancers (particularly endometrium, ovary, stomach, small bowel, ureter and renal pelvis) is significantly higher then that of patients with sporadic carcinoma, should be properly managed with surgery and then with endoscopic examination (ideally all life long) starting--in unaffected individuals--at early age (25 years old). Problems related to genetic counselling are considered as well.

[Gastric leiomyoma. Diagnostic and surgical problems]. / Il leiomioma gastrico. Problemi diagnostici e terapeutici.

The Authors report their three year experience with five patients suffering from gastric leiomyoma, each with different anatomical and clinical characteristics. The Authors have performed a research of the different diagnostics, clinical and therapeutic problems of these rare tumors that sometimes are asymptomatic in spite of the large size they reach, but more frequently they present with haemorrhagic symptoms which tend to point to other more frequent pathological conditions. Diagnosis can only be suspected, but cannot be reached without a histological examination, also if the classifications of these tumors have been argument of many changes, particularly by the light of the recent diagnostics possibilities offered by ultrastructural and immunohistochemical examination.

[Traditional cholecystectomy in a patient with situs viscerum inversus partialis]. / Colecistectomia per via tradizionale in paziente con situs viscerum inversus partialis.

The authors discuss the etiology of situs viscerum inversus partialis (SVIP), the associated anomalies and the malformations and the relative clinical problems, reviewing the international literature. The present a case of a 51 years old female with a diagnosis of umbilical hernia and cystocele. During hospitalization the patient complained a typical acute cholecystitis pain. The patient underwent ultrasonography, CT scan, and MNR that allowed us to diagnosis a calculous cholecystitis with SVIP and was elected for an open cholecystectomy. The Authors describe the surgical technique in relation to the anatomic anomalies, in particular vascular ones, that were discovered with the imaging studies and confirmed at laparotomy.

[An assessment of neuronal regeneration in neural anastomoses by synthetic guide and biological systems and insulin administration: an experimental study in the rat]. / Valutazione della rigenerazione neuronale nelle anastomosi nervose mediante sistemi tutoriali sintetici, biologici e somministrazione di insulina: studio sperimentale sul ratto.

The synthetic and biological nerve guide regeneration gives interesting perspective of use in making artificial conduits for peripheral nerve reconstruction. In sixty Wistar rats, under general anesthesia and with microsurgical technique, the ischiatic nerve was isolated. On the right side a segment of the nerve was removed in order to create a 10 mm gap. The defect then repaired using the conduit. Control were performed at 20, 90, 180 days and consisted in histological microscopy and electromyography investigation. The regeneration of the nerve fibers in the lumen of the conduit was not significantly different on the contralateral nerve limb.

[Synchronous and metachronous colorectal cancers: a case series contribution]. / I cancri sincroni e metacroni del colon-retto: contributo casistico.

The Authors, on the basis of their experience with neoplastic colorectal pathology and after a review of the Literature, report a reappraisal of the problems related to colorectal multiple carcinomas. They emphasize the importance of routine preoperative pancolonoscopy for the identification of possible synchronous tumors (both benign and malignant) and periodic endoscopic follow-up (ideally a life-long one) for the detection and removal of all adenomatous polyps as well as early stage metachronous carcinomas, especially for patients with HNPCC. Besides, they stress the importance of sensibilization of the population about the heritability of colorectal carcinomas.

[Our experience in the recurrence of rectal cancer operated with radical intention in light of a case load treated in a homogeneous manner]. / La nostra esperienza delle recidive di cancri rettali operati con intento radicale alla luce dei risultati di una casistica trattata in maniera omogenea.

A reappraisal of the results obtained after potentially curative resection for rectal cancer compared with "historical" results is reported. An increase of the overall survival rates was registered as well as a corresponding lowering of the pelvic recurrences: 4.54% in the group of patients with a-two-year follow up. As for relapse surgery, however, reviewing the series from January 1991 to December 1994, the results are still poor because relapses were not resectable in 85.7% of the cases.

[The endoscopic treatment of postoperative stenoses of the upper digestive tract]. / Trattamento endoscopico delle stenosi post-operatorie del tratto digestivo superiore.

The authors compare their experience in dilatation of postoperative benign esophageal strictures. A total of 60 patients (37 males, 23 females: mean age 52), all with severe dysphagia, from January 1985 to September 1995, underwent endoscopic dilatation: 32 of these with Savary dilators and 28 with balloon dilators. Dilatation was effective in 93% in both groups. Two severe complications were recorded (1 heart attack and 1 perforation) in the group that underwent endoscopic dilatation with Savary dilators. During endoscopic management, pain recurred in 43% and 87% of cases after balloon or Savary dilatations, respectively. The authors believe balloon dilators are more effective, better tolerated and with less complications than Savary dilators. They reserve the management with Savary dilators to the extremely severe esophageal strictures.

[The intraoperative visualization of the bile ducts by the use of fluorescent substances. A feasibility study]. / Visualizzazione intraoperatoria delle vie biliari mediante impiego di sostanze fluorescenti. Studio di fattibilità.

Iatrogenic bile duct injury during cholecystectomy is the most serious complication of this surgical procedure. Initial reports suggest that this complication is particularly problematic during laparoscopic cholecystectomy. Proper identification of biliary anatomy in the subhepatic region is the only way to avoid this severe complication. The potential benefit from a simple, reliable method for intraoperative delineation of biliary anatomy is self-evident. In this experimental work the Authors-study the possibility and the feasibility of intraoperative biliary tree imaging with two fluorescent molecules (rolitetracyclin and fluorescin).

[H mesh prosthesis in the treatment of ventral hernia]. / La protesi reticolata ad "H" nel trattamento del laparocele mediano.

The Authors report their experience in the treatment of ventral hernias using a Marlex mesh moulded in an original way with a technique partially derived from plastic surgery. The complete mobilization of the umbilicus through a circular incision allows to fit this prosthesis symmetrically below the rectus abdominis muscles for the entire extension of the hernia.

[Cholecystectomy and colorectal cancer: a retrospective study of a sample of 285 operated patients]. / Colecistectomia e cancro colo-rettale: studio retrospettivo su un campione di 285 pazienti operati.

A review of 285 patients operated for colo-rectal cancer in order to evaluate cholecystectomy rate in their pathologic history is reported. A surprisingly high rate (9.47%) was registered also when compared with Literature data. Although not definitely conclusive for a positive correlation between cholecystectomy and colo-rectal cancer, the Authors believe that this study identifies a subgroup of patients potentially at risk for colo-rectal cancer. In these subjects a prophylactic, periodic colonoscopy could be useful.

[Sialomucins in the follow-up of patients surgically treated for colorectal cancer: preliminary results of a prospective study]. / Le sialomucine nel follow up dei pazienti operati per cancro colo-rettale: risultati preliminari di uno studio prospettico.

Preliminary results of a prospective study on sialomucin content found either at resection margins of colo-rectal cancer after curative surgery or in endoscopic biopsy specimens of colonic mucosa in thirteen patients selected for the follow up are reported. Though not statistically significant because of the small number of cases enrolled, preliminary data indicate that clinical application of differential mucin staining in colo-rectal neoplasms is potentially useful to predict subgroups of patients at risk for local recurrence as well as metachronous colo-rectal cancers.

[Indications and limitations of endoscopic sclerosis in esophageal varices: our current approach]. / Indicazioni e limiti della sclerosi endoscopica delle varici esofagee: i nostri attuali orientamenti.

From January 1987 to December 1993, 171 patients affected by portal hypertension with bleeding complications underwent endoscopic variceal sclerotherapy. Results show that this technique is particularly effective for the hemostasis, therefore in high generic or specific risk patients is becoming a good alternative to traditional surgery.

[Surgical repair of laparocele with expanded PTFE: technicalities]. / Correzione chirurgica dei laparoceli con PTFEe: particolari di tecnica.

Surgical repair of ventral hernias may often be quite difficult; however, the use of prosthesis, now generally accepted by many surgeons, has improved the results of such type of surgery. The Authors experience confirm the safety of the expanded PTFE and its versatility of employment, obtaining good functional and aesthetic results.