Leiomyomata of the oesophagus: report of four surgically-treated cases.

Four patients with leiomyoma of the upper or middle third of the oesophagus treated by surgical excision are reported. All operations were performed through a right thoracotomy with simple enucleation of the lesion. Two patients were asymptomatic. In one the tumour had a spiral configuration almost completely surrounding the lumen. No complications occurred. Early surgical treatment is advised although the tumour grows slowly.

[The Budd-Chiari syndrome: clinical case reports]. / La sindrome di Budd-Chiari: contributo clinico.

Two cases of Budd-Chiari's Syndrome are presented. These refer to two women aged 34 and 33 years respectively. The aetiology of the first case is linked to polycythaemia rubra and the use of oral contraceptives; that of the second case to a fibrous perihepatitis involving the outlet of the suprahepatic veins, with a tenacious action of stenosis. The surgical therapy used was a latero-terminal left porto-renal shunt in the first case, and a decapsulation and ligature of the common hepatic artery in the second case. In the discussion the aetiopathogenetic, diagnostic and therapeutic problems inherent in the Syndrome are analysed, also on the basis of the most recent experiences reported in the relevant literature.

[Long-term survival of patients operated on for carcinoma of the lung (author's transl)]. / La sopravvivenza a lungo termine degli operati per carcinoma del polmone.

The long-term fate of patients treated surgically for carcinoma of the lung is not well known. In a careful review of the literature the authors found only nine papers with a postoperative followup of at least 10 years; the mean survival was 16,3% of patients so treated. Factors making for a good long-term prognosis include small initial tumor size, absence of mediastinal lymph node invasion, a favorable histologica type, and the type of surgery performed (partial exeresis). Translated into TNM code, this means that the best candidates for prolonged survival are patients with lung carcinoma of the squamous cell type, stage I, treated by limited lung exeresis.

[Digestive hemorrhage as a complication of a pancreatic pseudocyst]. / L'emorragia digestiva quale complicanza di una pseudo-cisti pancreatica.

A study was made at the Padua University Second Surgical Clinic--located in Verona--on four cases of digestive haemorrhage in patients with pancreatic pseudo-cysts. The psysiopatological, diagnostic and therapeutic problems inherent in this pathology are discussed. In particular, attention is drawn to the need for and difficulty of marking a correct diagnosis in good time, and the utility, for such purpose, of endoscopic examinations and selective arteriography of the coeliac tripod and the superior mesenteric artery. Lastly, the various possibilities that surgery offers in the treatment of this disease are mentioned.

[Palliative treatment of liver neoplasms I: localized infusion of antimitotics: premises, technical procedure and limitations]. / Trattamento palliativo delle neoplasie epatiche nota I: L'infusione distrettuale di antimitotici: premesse, modalita' tecniche e limiti.

A hepatic localised antiblastic chemotherapic technique combining limited discomfort for patients with appreciable palliative results is illustrated; a short description of the surgical procedure of intubation of the hepatic artery itself and of some auxiliary procedures is given. Lastly the possible complications and the results are illustrated.

[Palliative treatment of liver neoplasms II: dearterialization of the liver: indications, premises, technic and limitations]. / Trattamento palliativo delle neoplasia epatiche nota IIa: la dearterializzazione del fegato: indicazioni, premesse, technica e limiti.

Hepatic arterial vascularisation, as described by Michels in 1954, is outlined; the importance of selective angiography in preparation of the hepatic de-arterialisation operation is then stressed, and its theoretical foundations and the surgical technique are illustrated; other procedures which can usefully be combined are also indicated. Lastly an evaluation of the limits and results of this therapy is given.

[Our experience wit congenital anomalies of the bile ducts (with presentation of 13 clinical cases)]. / La nosta esperienza in tema di anomalie congenite delle vie biliari.

Thirteen cases of congenital anomalies of the bile passages are described, as observed in the Verona Surgical Clinic during the period 1970-75, out of a total of 908 operations on the biliary passages and hence with a frequency of about 1.6%. They consisted of one case each of agenesis of the gall-bladder, septal gall-bladder, clepsydra gall-bladder, Hartmann's sac, diverticulum of the gall-bladder, outlet of the right hepatic in gall-bladder, outlet of cystic duct in third duodenal portion, accessory cholecystobiliary ducts, three cases of outlet of cystic duct in right hepatic duct, and two cases of common choledocho-wirsunghian canal. After a brief description of the individual types of anomaly, the main data in the relevant literature are considered, with a review of the semeiological and therapeutic aspects of the most frequent anomalies.

[Our experience in the use of "traction" endoprosthesis as a palliative treatment of cardial carcinoma]. / La nostra esperienza nell'uso delle endoprotesi "a trazione" quale trattamento palliativo del carcinoma cardiale.

The Authors review the methods of palliative treatment of cardial carcinoma, and particularly report some results obtained through the application of oesophageal endoprostheses (by Celestin and by Haring), following the traction method, in 38 patients. The global mortality amounted to 8 cases (21%). In 12 patients (31%), complications such as stoppage or dislocation of the prosthesis were observed. In two cases the perforation of oesophageal wall occurred, with spontaneous resolution in one of the two patients and serious mediastinitis and exitus in the other. The Authors' present trend is toward the use of push type endoprosthesis, because of the lower mortality reported in literature.

[Behavior of calcemia in breast malignancy. Note I (author's transl)]. / Sul comportamento della calcemia nelle neoplasie della mammella. (Nota 1).

The authors report a statistical investigation conducted in 95 patients with mammary carcinoma, designed to show the behavior of calcemia in the course of this malignancy. The data were analyzed statistically by the binomial test, the scatter of values (F test of Snedecor), and the t test of Student. The authors confirmed the existence of a statistically significant alteration of calcemia only in the group of patients with metastasis to bone versus control subjects; conversely there was no significant difference of distribution in the various groups in regard to values beyond those given as normal.

[A case of duodenal schwannoma (clinical study)]. / Su un caso di schwannoma duodenale (contributo clinico).

Taking a case of duodenal schwannoma, that they had observed, as a starting point, on the base of their experience and the data of literature, the authors discuss the epidemiological, of classification and anatomo-pathological aspects of this rare neoplastic form. They particularly outline the clinical aspect, the diagnostic pre-operating iter and the correct and radical surgical behaviour that must be practiced during laparatomy.

[Primary lymphoma of the breast (apropos of a clinical case)]. / Il linfoma primitivo della mammella (a proposito di un caso clinico).

Taking as their starting point the observation of a case of primary lymphoma of the breast, the Authors point out that this tumour constitutes a rare disease in the context of non-Hodgkin lymphomas arising in sites other than the lymph nodes. They emphasize the clinical and instrumental diagnostic difficulties which the disease poses, as well as the uselessness of radical surgical therapy and the need for radio-chemotherapeutic management along with periodic follow-up. The Authors go on to explain how difficult it is to formulate a reliable prognosis for this type of tumour in view of the lack of homogeneity and the limited numbers of cases reported in the literature.

[Spontaneous rupture of the stomach (case report)]. / La rottura spontanea dello stomaco (presentazione di un caso).

The Authors show a case of a 68 year old woman underwent a successful operation for spontaneous stomach heavage. The linear solution of continuity, 5-6 cms long, was sutured on the small gastric curve. The treatment consisted in suturing the lesion and performing a decompressive gastrostomy.

[Respiratory function after traumatic rupture of the diaphragm]. / La funzionalità respiratoria dopo rottura traumatica del diaframma.

In eight patients who underwent surgical treatment for diaphragmatic rupture, pulmonary function and differential ventilation of the lungs were evaluated four months-one year after surgery. The results of the study show that diaphragmatic rupture produces only a small reduction in total ventilatory function. Moreover our data indicate that the ventilation estimated to be contributed by the side injured, is decreased in a larger extent in abdominal than in thoracic trauma.

[Treatment and prevention of postmastectomy lymphedema (our experience)]. / Il trattamento e la prevenzione del linfedema postmastectomia (nostra esperienza).

The authors consider the incidence of arm lymphedema after mastectomy. Considering the temporary results which come from surgical practices, either from excision operations or lymphovenous anastomosis, they stress out the importance of the prevention measures and of the physiotherapeutic treatment. This is essential to keep lasting as long as possible the results of the operation when it is necessary because of serious functional deficit. Two cases of Thompson's operation are shown.

[Benign pathology of the breast. Diagnostic protocol and therapeutic indications]. / La patologia benigna della mammella. Protocollo diagnostico ed indicazioni terapeutiche.

The frequency of benign mammary disease and the need to differentiate between benign and malignant tumors without the indiscriminate use of instrumental examinations and biopsies have prompted the Cooperative Interdisciplinary Group on Mammary Neoplasms to adopt the diagnostic protocol and propose a number of therapeutic indications. Though involving a progressive reduction in biopsies, the use of the protocol has not led to failure to recognize carcinomas, the number of identified malignancies being maintained within the anticipated limits.

[Bullous emphysema of the lung (our experience)]. / Le bolle enfisematose del polmone (nostra esperienza).

Ten patients (9 males and 1 female; mean age: 44.8 yrs) with bullous lung disease were treated. Frequent patient-history findings were smoking and spontaneous pneumothorax. Nine cases were treated surgically either by bullectomy or atypical resection. In one case, an attempt at endobullous aspiration failed owing to the patient's very poor general condition. Among the postoperative complications in three cases we observed difficult pulmonary re-expansion and infection of the surgical wound with consequent pleural empyema in another.

[Esophagogastroplasty in the treatment of squamous carcinoma of the esophagus (our experience)]. / L'esofagogastroplastica nel trattamento del carcinoma squamoso dell'esofago (nostra esperienza).

The authors report on their experience with 42 cases of squamous carcinoma of the oesophagus subjected to oesophagectomy and oesophagogastroplasty. The patients' mean age was 55.2 years (range: 41-70) with a 13:1 male/female ratio. A positive history of cigarette smoking and of alcohol consumption was found in 87% and 80% of patients respectively. The sites of the neoplasms were as follows: 24 in the mid 3rd of the oesophagus, 9 in the lower 3rd, 6 in the upper 3rd of the thoracic oesophagus and 3 in the cervical oesophagus. In 39 patients the operation was performed in two stages according to Lewis and in 2 cases it was performed in 3 stages according to McKeown, while one patient was treated with a pull-through operation according to Akiyima. Six patients died during the first 30 days postoperatively as a result of circulatory complications or ARDS. Fistulization of the anastomosis as observed in 5 cases, though this was clinically manifest only in two. Mean survival was 5.9 months, 18.6 months and 10.5 months according to the period considered.

[Gastric metastasis of melanoma (report of a clinical case)]. / Metastasi gastrica da melanoma (presentazione di un caso clinico).

The Authors report a case of gastric metastasis from melanoma of the skin, occurring 6 years after removal of the primary neoplasm. The metastasis, which was characterized by conspicuous alimentary tract haemorrhage, called for emergency surgery consisting in a total gastrectomy with oesophago-jejunal anastomosis according to Roux. The Authors then go on to review the literature on the subject, stressing the frequency of gastrointestinal metastases in skin melanomas with an incidence affecting up to 60% of cases in autopsy series. After examining the main clinical aspects, endoscopic appearances and r-ray findings, the Authors deal at some length with prognosis, pointing out that isolated metastases may constitute a surgical indication in view of the cases of fairly good long-term survival reported in the literature.

[Behavior of TBII (TSH receptor binding immunoglobulins) in multinodular struma]. / Sul comportamento delle TBII (TSH receptor binding inhibitory immunoglobulins) nello struma multinodulare.

The authors consider the behaviour of TBII (TSH receptor binding inhibitory immunoglobulins) in multinodular goiter, in relation to the functional status of the thyroid classified on the basis of T3, FT4, TSH IRMA. The samples were collected from 53 patients with normal T3, FT4 and TSH; 14 patients with T3 and FT4 in normal range and TSH less than 0.15 milli U/l; 8 patients with T3 and/or FT4 above the superior limits of normal range and TSH less than 0.15 milli U/l and from a control group of 10 patients with Grave's disease. TBII was measured by radioreceptor assay and the index resulted less than 15% in all the patients with eufunctioning or hyperfunctioning multinodular goiter. Mean value in biochemically hyperthyroid patients was 6.25% and in euthyroid patients was 5.69%. The difference was statistically not significant. Moreover, significantly elevated levels of TBII were found in 60% of patients with Grave's disease.

[Carcinoma of the male breast (our experience and a review of the literature)]. / IL carcinoma della mammella maschile (nostra esperienza e revisione della letteratura).

The authors consider their experience in male breast cancer. Making a review of the literature they point out the risk factors and the prognosis of this disease.