[Echinococcus cyst of the pancreas: description of a case and review of the literature]. / Cisti da echinococco del pancreas: descrizione di un caso e revisione della letteratura.

The echinococcosis represents a common condition in many parts of the world with maximum incidence in Uruguay (32 cases/100,000/year), in Argentina (21 cases/100,000/year), and in Morocco (7.2 cases/100,000/year). Italy is among the middle-high risk countries with beyond 1000 annual surgeries for hydatid cyst. Liver (45-75%) and lung (10-50%) are the most frequent localizations of echinococcosis. The other localizations represents the 13% of total. The hydatid cyst of pancreas constitutes the 1%. The Authors report the clinical case of a 28 years old woman, admitted for abdominal pain. Abdominal ultrasound, angio-CT and angiography of celiac trunk and superior mesenteric artery have been undertaken and the presence of a 10 x 10 cm lesion in the body-tail of pancreas has been showed, and the diagnosis of pseudocyst or cystadeno-carcinoma of pancreas has been formulated. The patient underwent surgery with body-tail pancreatectomy plus splenectomy. The histopathological examination showed the presence of hydatid cyst contained clear fluid and daughter cysts. The treatment of this infrequent localization of hydatid cyst is exclusively surgical. The tactic and surgical technique must aim to radical cyst's removal, with the maximum saving of the stricken organ, maintaining a good pancreatic function, either exocrine and endocrine.

[Malignant biliary papillomatosis: a case report]. / Papillomatosi biliare maligna: caso clinico.

The aim of this study was to describe the clinico-pathological characteristics of malignant biliary papillomatosis and the diagnostic and therapeutic approach adopted in this case, which extended from the left hepatic biliary duct to the bifurcation of the 2nd and 3rd segments. The patient was studied with ultrasonography, endoscopic retrograde cholangiopancreatography (ERCP), CT scan and MRI cholangiography, which showed the morphological characteristics and the extent of the disease in the biliary tract. The malignancy of the disease was confirmed by preoperative cytological analysis of bile collected via a nasobiliary probe. The surgical treatment, preceded by intraoperative ultrasonography, consisted in a left hepatectomy, sparing the 1st segment, and a right intrahepatic jejunostomy. The final pathological analysis revealed a malignant biliary papillomatosis. Preoperative ERCP clearly documented the exact distribution of the biliary tract lesions and allowed both treatment of the cholestasis and diagnosis of the nature of the lesion through cytological analysis of the bile. Surgical treatment must be carried out and guided not only by the preoperative diagnosis, but also by perioperative ultrasonography. Finally, owing to the rarity of such cases and consequently our very limited knowledge of the disease, an intensive follow-up is recommended.

Total mesorectal excision for surgical treatment of rectal cancer.

BACKGROUND AND OBJECTIVES: The aim of our study was to retrospectively evaluate the results of 2 groups of patients admitted and treated for rectal cancer. METHODS: One hundred and fifty-one patients were available for evaluation. Eighty (group A) were radically operated with the standard technique; 71 (group B) underwent total mesorectal excision (TME). Groups were similar according to demographics, staging, and pathological data. Mean follow-up was 73.5 months. RESULTS: No operative mortality was observed. Complications were 15% in group A and 32% in group B. Local recurrence rates were 41.2% in group A and 12.6% in group B. Distant metastases occurred in 21.2% and 7.6%, respectively, in groups A and B. Cancer-related mortality was 62.5% in the non-TME group and 19.5% in the TME group. Overall 5-year survival rates were 32.4% in group A and 70.5% in group B. Disease-free survival rates were 25% in group A and 62.3% in group B. CONCLUSIONS: TME appears to lower the incidence of cancer-related mortality, with a higher incidence of postoperative complications. Further studies need to be done to assess the real benefits of TME in the surgical treatment of rectal cancer.

Superiority of laparoscopy compared to ultrasonography in diagnosis of widespread liver diseases.

The aim of the study was to compare the results of ultrasonography (US) and laparoscopy in a series of 210 patients referred to our institution for the diagnosis of widespread liver diseases. Among 205 patients, laparoscopy revealed cirrhosis in 114, chronic widespread disease in 70 (chronic persistent hepatitis in 21, chronic active hepatitis in 28, steatosis in 14, acute hepatitis in 5, fibrosis in 2), and absence of liver disease in 21. Four of these cases had minor complications. A corroborative diagnosis was obtained in 122 patients (59.5%). Overall sensitivity of US was 84% with a low specificity due to the high rate of false negatives. From the results of this study we conclude that laparoscopy is a safe and essential diagnostic tool in the final diagnosis of widespread liver diseases and that US is not a reliable screening method because of its incidence of false negatives.

[Intravenous omeprazole versus ranitidine in the treatment of hemorrhagic duodenal ulcer: a prospective randomized study]. / Oméprazole versus ranitidine intraveineux dans le traitement de l'ulcére duodénal hémorragique: une étude randomisée prospective.

This prospective randomized trial compares the results of i.v. omeprazole and i.v. ranitidine in 45 patients admitted as an emergency with an endoscopic diagnosis of bleeding duodenal ulcer. The patients were randomized to receive i.v. omeprazole, 40 mg bolus followed by 80 mg/day by continuous infusion for 3 days (group A), or ranitidine 50 mg i.v. bolus followed by 400 mg/day i.v., continuous infusion for 3 days (group B). Follow-up endoscopy on day 4 demonstrated successful therapy, except when more than 4 units of blood/day had to be transfused to maintain hemoglobin level above 10 g/l. Bleeding stopped in 20/21 patients in group A (95.2%), and in 17/24 patients in group B (70.80%) (p < 0.05). From the results of the study, it can be concluded that intravenous omeprazole seems to be effective in the control of bleeding duodenal ulcer.

[Biodegradable anastomotic rings in colonic emergency surgery]. / Impiego di anelli biodegradabili nell'esecuzione di anastomosi coliche in chirurgia d'urgenza.

In this work, the authors describe their own experience concerning emergency surgery on large bowel. Frequently, in emergency surgery, the primary disease is associated with a picture of heavy peritonitis that in most cases needs very difficult and immediate operation including intestinal derivation (temporary colostomy). The possibility of restoring the intestinal continuity during the first surgical operation, is the primary aim of the surgeon. Therefore, availability of tools such as BAR (Biodegradable Anastomotic Rings) in performing intestinal anastomosis characterized by strong reliability if compared to stapler suturations avoids temporary colostomy otherwise necessary. This work refers to retrospective study in a group of patients who underwent colic resection with immediate restoration of the intestinal continuity without a protection colostomy. Actually, using biodegradable anastomotic rings like BAR when performing the anastomosis, has some technical advantages, such as low incidence of intra and postoperative complications, short hospitalization period and better management of the patient.

[Biliary scintigraphy vs. ultrasonography in the etiological diagnosis of acute pancreatitis]. / Biliscintigraphie contre échographie dans le diagnostic étiologique de la pancréatite aiguë.

Etiology of acute pancreatitis has important implications in the treatment of the disease as gallstones pancreatitis requires the correction of the underlying biliary disease. The usefulness of ultrasonography in the detection of stones in emergency has been questioned, and HIDA biliscintigraphy has been reported to be a possible indicator of biliary pancreatitis. This study compares the value of HIDA colesscintigraphy and ultrasonography in the etiologic diagnosis of 35 patients admitted and treated for acute pancreatitis in our Institution. All patients underwent ERCP for the confirmation of the findings. Cholescintigraphy showed no visualisation of the gallbladder, suggesting biliary tract stones, in 25 patients. In all of them ERCP confirmed the presence of gallbladder and/or common bile duct stones, and endoscopic sphincterotomy and later elective cholescystectomy was performed. Ultrasonography failed to demonstrate biliary stones in 11 of those patients. HIDA cholescintigraphy showed a sensitivity and a negative predictive value of 1 vs 0.56 and 0.45 for ultrasonography. From the results of our study it can be concluded that HIDA biliscintigraphy is more reliable than ultrasonography in the discrimination of biliary vs non-biliary acute pancreatitis in emergency.

[Localized pleural mesotheliomas. Clinicopathological considerations on a case report]. / Mesoteliomi pleurici localizzati. Considerazioni clinicopatologiche su di un caso osservato.

Pleural mesotheliomas are rare, and their diagnosis and treatment not clear. The case observed in our Department leads us to an analysis of the literature. This showed that differential diagnosis with pulmonary carcinoma is very difficult, even in cases of parietal mesothelioma; however local treatment may be performed even in malignant mesothelioma.

Surgical treatment of immune thrombocytopenic purpura.

The role of surgery in the treatment of immune thrombocytopenic purpura (ITP) is still discussed. The aim of this study was to verify our criteria of patient selection for splenectomy, to analyze the results of a protocol for the evaluation of the hemorrhagic risk, and to discuss long-term results of 70 patients with ITP who underwent surgical treatment from 1984 to 1990. All patients received steroid therapy. Sixty-two patients were given high doses of IgG (600 mg/kg/iv bolus) pre-operatively in order to obviate the need for intra-operative platelet transfusions. Forty-three patients showed a significant increase in the platelet count, 8 a moderate increase, while 11 patients did not respond. No operative mortality was observed, however postoperative minor complications occurred in 14 (20%) patients. Accessory spleens were found in 11 (15.7%) patients. Mean follow-up was 21 months. Response to splenectomy was considered as complete (platelets greater than 150,000 mm3 with no need for medical treatment) in 63 (90%) patients. No response was observed in 7 patients. In 2 of the non-responders postoperative indium-111 scan revealed accessory spleens and ITP remitted after accessory splenectomy. All non-responders were in the group of patients who did not respond to the pre-operative infusion of high dose IgG. It can be concluded that splenectomy is a safe and effective treatment for ITP and that response to pre-operative infusion of IgG may be considered as predictive for the outcome after splenectomy.

Surgery in primary gastric lymphoma: impact on clinical staging and long-term survival.

This study analyzes the value of surgery in the treatment, staging and long-term survival of 17 patients affected with primary gastric lymphoma. In 7 patients the neoplasm was localized to the lower third of the stomach, in three to the middle third, in two to the upper third, while in 5 patients there was involvement of the entire stomach. Patients were classified according to the Ann-Arbor classification. Nine patients were stage Ie, five stage Ile, and three stage IVe. A partial gastrectomy was carried out in ten patients and total gastrectomy in 7. In all cases surgical excision of the gastric lymphoma was performed together with intraoperative staging including bilateral hepatic biopsies, and exploration of all abdominal lymph nodes. Two postoperative deaths occurred among the 7 patients who underwent total gastrectomy but no major complications were observed in the remaining 5 patients. No deaths occurred among the 10 patients who underwent partial gastrectomy, but in one case an acute complication developed. Staging laparotomy permitted the correction of clinical staging, and showed that three cases were understaged and one overstaged. All patients received adjuvant chemio-radiotherapy. All but one patient are currently alive, well and free of disease. Survival was correlated significantly with the stage of the disease and extent of gastric involvement, but there was no correlation between survival, histological grade, and the type of gastrectomy performed.