[Perineal sarcoma. Report of a clinical case]. / Sarcoma perineale. Presentazione di un caso clinico.

The authors report a case of perineal leiomyosarcoma treated using a combined surgical and radiotherapy protocol. Exeresis was performed through an incision in the left anterior perineum, beside the vagina. The patient then underwent TCT with excellent results.

[A case of ureteral stenosis and ureterorectal fistula secondary to sigmoid diverticulitis]. / Su di un caso di stenosi ureterale e fistola uretero-rettale secondarie a diverticolite del sigma.

The paper reports a case of ureteral [correction of urethral] stenosis with ureterorectal [correction of urethro-rectal] fistula due to diverticulitis of the sigmoid [correction of sigma] which resolved following reconstruction of the urinary tract by ureterocystostomy [correction of urethrocystotomy] using a modified version of Boari's technique, with satisfactory renal functional recovery. On the basis of an analysis of the literature, the authors comment on ureteral [correction of urethral] stenosis and its etiological diagnosis.

[Pseudocyst of the adrenal gland: diagnosis and treatment. Description of a clinical case]. / Pseudocisti del surrene: diagnosi e trattamento. Descrizione di un caso clinico.

A case of pseudocyst of the suprarenal gland in a 32-years-old woman is reported. Stress is laid on the description of the clinical case and the diagnostic and therapeutic problems involved are reviewed.

[A case report of Castleman's disease in a patient with endometrioid adenocarcinoma of the ovary]. / Su un caso di malattia di Castleman in paziente portatrice di adenocarcinoma endometrioide dell'ovaio.

The Authors report a case of Castleman's disease in a 45-year-old woman. She was admitted to hospital because of a thrombophlebitis of the left lower limb. An abdominal echotomography showed evidence of a mass with a diameter of about 6 cm at the pancreatic isthmus, and a cyst (diameter 25 mm) in the right ovary. An explorative laparotomy was performed and the masses were removed. Histological examination identified them respectively as a Castleman's disease of hyaline-vascular type and an endometrioid carcinoma of the ovary.

Cancer of the esophagus: ten years' experience.

The paper reports the authors' ten-year experience of the surgical treatment of cancer of the esophagus. A total of 625 patients with esophageal carcinoma were observed during the period 1980-89 of whom 490 were admitted to hospital and, of the latter, 172 (35.1%) were operated with a sectile rate of 86% (148 patients). Data from this period were analysed both retrospectively and prospectively using a computerised system. There were 105 radical operations (70.9%) and 43 palliative operations (29.1%). The 3-year actuarial survival rate was 21.7% and the difference between radical and palliative resections was at the limit of significance (p less than 0.1).

[Biliary cystadenoma. Discussion of a clinical case]. / Il cistoadenoma biliare. Discussione su un caso clinico.

A case of biliary cystadenoma is reported. The neoplasm was located at the left lobe of the liver and its diameter was 18 cm. It presented with abdominal swelling and palpable mass in epigastric region. A left hepatectomy was performed, to achieve a complete resection of the tumor.

[Functional study of intestinal transplants after esophagectomy]. / Studio funzionale dei visceri trasposti dopo esofagectomia.

The Authors contribute their experience covering 228 cases of esophagoplasty after esophagectomy for cancer of the esophagus and of the esophagogastric junction, from 1980 to 1989. Thirty four of these patients (24 EGP, 8 EDP, 2 ECP) underwent accurate functional investigation by X-ray, manometry, pH-metry and scintigraphy. The investigation into esophagogastroplasty in particular revealed that the transposed organ is devoid of motor activity and that emptying is therefore achieved by gravity. It was also shown that the entity of the alkaline, acid and mixed-type reflux is linked to the site of the anastomosis: greater proximity of the anastomosis translates into lower involvement. An investigation into esophagojejunoplasty, instead, highlighted normal motor function: no cases presented reflux of the alkaline type. The two cases of colon plasty investigated presented efficient emptying even though manometry could not detect the presence of motor waves of the propulsive type. The authors conclude that, although the jejunum constitutes the best prosthetic element to transpose from the functional point of view, highly inconsistent and precarious vascularization limits the use of this organ to the higher anastomoses only. Therefore the Authors claim that the stomach, despite its tendency to behave as an inert tube, is still the best choice for transpositions following esophagectomy.

[The clinical relevance of epidemiology in the surgical treatment of esophageal carcinoma]. / Rilevanza clinica dell'epidemiologia nel trattamento chirurgico del carcinoma esofageo.

The paper reports the epidemiology and causal factors of esophageal carcinoma, and compares the authors' personal experience with already published data. The clinical importance of epidemiology is stressed as a means of identifying risk factors for esophageal carcinoma, thus aiding an early diagnosis. The authors underline the central role of surgery in the treatment of esophageal carcinoma.

Clinical importance of tumour markers in the diagnosis of squamous-cell carcinoma of the esophagus.

In order to evaluate the diagnostic value of three tumour markers, CEA, CA 19-9 and TA4-scc, 50 patients affected by squamous-cell carcinoma of the esophagus were studied together with 70 normal controls and 22 patients affected by benign esophageal pathologies. The three tumour markers were assessed in all patients and data were evaluated statistically in order to reveal their sensitivities, specificities and diagnostic values. It was concluded that further studies should be carried out on the marker TA4-scc given its high specificity and sensitivity towards esophageal neoplasias at a relatively early stage.

Gastric angiography: data for oesophagogastroplasty.

A report is presented on an angiographic study of the gastric arterial system conducted on 20 human stomachs taken from cadavers during routine autopsies. The aim of the study was to define the anatomical bases for the supply of blood to the isoperistaltic gastric tubule in oesophagogastroplasty operations. The study reveals that on its own the right gastroepiploic artery cannot ensure adequate vascularisation of the gastric fundus. The importance of pressuring the right hand section of the vascular arch along the small curve was also noted and is due to the constant presence of major anastomoses at antral level with the right gastroepiploic artery. The study also revealed the constant presence of a direct intramural anastomotic circulation between the right and left gastroepiploic arteries.

[Endogastric migration of an Angelchik prosthesis. A case report and review of the literature]. / Migrazione endogastrica di una protesi di Angelchik. Descrizione di un caso clinico e revisione della letteratura.

At first, the authors mention indications and way of placement of the Angelchik prosthesis. Then after a wide review of the literature, they describe the complications and results. Finally a case of penetration into the stomach of an Angelchik prosthesis is reported. It was favourably resolved by an operation.

Respiratory function during oxygen administration in chronic obstructive pulmonary disease.

Patient with severe chronic obstructive pulmonary disease (COPD) can develop respiratory muscle weakness and fatigue. Arterial hypoxemia can predispose to this condition. To assess whether O2 administration improved respiratory muscle function and respiratory pattern in COPD 11 patients with chronic hypoxemia were examined. Each patient was first submitted to respiratory function studies, including lung volumes, in normal and recumbent position, respiratory frequency, Ti/Te, Ti/Tot, maximal inspiratory and expiratory pressures (Pimax, Pemax) and arterial gas analysis breathing room air. All these tests were repeated during oxygen Administration through a nasal cannula. The arterial PO2 improved from 50 +/- 7 mmHg to 81 +/- 28 mmHg but the breathing pattern, Pimax and Pemax as well as lung volumes remained unchanged. It is concluded that oxygen, in short term administration, doesn't influence respiratory pattern and muscle function.

[Sequential study of the immunologic picture in neoplasm patients before and after surgical intervention]. / Studio sequenziale del quadro immunologico in pazienti neoplastici prima e dopo intervento chirurgico.

The results obtained in the study of the pre- and postoperative immunological picture in 25 patients suffering from carcinoma of the pavement epithelium of the oesophagus are reported. From this study it emerges that in the preoperative period, the serum levels of immunoglobulin and complement as well as the lymphocyte subpopulations do not present significant changes, whereas 44% of the patients present cell-mediated immunity certified by the skin test. On the other hand, in the postoperative period there is a sharp reduction in the OKT4/8 ratio due in the main to a relative increase in suppressor lymphocytes. In conclusion, the value of skin tests in "in vivo" anergic patient research is underlined, evidencing the need for a programme of immunostimulation in the postoperative period.

Cardiac arrhythmias following lung resection in patients treated and untreated with digitalis prophylaxis.

Cardiac arrhythmias and failure following lung resection in patients treated and untreated with digitalis prophylaxis have been evaluated. In 82 patients without digitalis (1st group) 11% tachyarrhythmias and 5.7% cardiac failures were noted. In 100 patients treated with digitalis (2nd group) 7% arrhythmias and no cardiac failures were registered. Among cardiac complications only one death in the first group was observed. The mean period of incidence of arrhythmias appears dilated in the digitalis group (3rd vs. 5th postoperative day) and this could be attributed to the early suspension of the drug.

[Determination of serum neuron-specific enolase in bronchial tumors of neuroendocrine origin]. / Determinazione della enolasi neurone specifica sierica nei tumori bronchiali di origine neuroendocrina.

Neurone-specific enolase, a serum marker of neuroendocrine tumours has been determined in small-cell anaplastic bronchial carcinomas, in typical and atypical carcinoid. The marker presents good sensitivity in small-cell tumours and in atypical carcinoids, while blood levels are within normal limits in cases of typical carcinoid. The low serum levels of neurone-specific enolase found in typical carcinoid suggest a failure of the enzyme to express itself in the circulation owing to the poor or lack of cellular necrosis.

[Ca 19-9 and Ca 50 in the diagnosis of bronchial carcinoma: comparison with CEA]. / CA 19-9 e CA 50 nella diagnosi del carcinoma bronchiale: comparazione con il CEA.

The search for early tumour markers has brought to light CA 19-9 and CA 50, glycoproteins recognised by monoclonal antibodies. Since these markers are mainly used on the digestive tract it was thought useful to investigate their value in the diagnosis of lung cancer which is only rarely identified by markers in its early stages. The two markers were compared with the better known CEA on 43 healthy volunteers, 42 patients with chronic lung conditions, 26 people with localised non-neoplastic lung shadows and 255 patients with staged and histologically identified lung tumours. The results obtained reveal the two markers to be of little use in lung cancer since though satisfactorily specific they are not at all sensitive even in the advanced stages of the disease. They could however be used to advise against surgery if positive.

[Respiratory function evaluation in esophageal surgery. Predictive value of tests]. / Valutazione funzionale respiratoria nella chirurgia esofagea. Valore predittivo dei tests.

In the context of major surgery the predictive significance of respiratory function tests in relation to postoperative pleuro-pulmonary complications is assessed. A statistical analysis is performed on a series of 85 oesophagectomy after thoracotomy and laparotomy. The most significant respiratory function indices are found to be those relating to volume restriction and the Mottley index.