[Urgent management of obstructing colo-rectal cancer: authors' experience]. / Trattamento in urgenza delle occlusioni intestinali da cancro del colon-retto: nostra esperienza.

PURPOSE: The aim of this retrospective study is to compare the different surgical approaches in obstructing colo-rectal cancer in terms of mortality, morbidity and quality of life. MATERIALS AND METHODS: We observed 379 patients with colorectal cancer, 354 of which underwent surgical treatment, 189 M (53.4%) and 165 F (46.6%), with a median age of 72.6 years. Complicated tumors were 150 (42.4%), with 126 obstructions (84%). For 95 obstructing left-sided colorectal cancers we performed: 9 defunctioning colostomies; 62 two-stages operations: 55 Hartmann's procedures, 5 primary anastomosis with colostomy; 2 primary anastomosis with on table wash-out and ileostomy; 24 single-stage operations: 17 primary anastomosis with on table wash-out and 7 colectomy. RESULTS: The overall operative mortality rate was 8.7% (11/126). The overall leak rate was 8% (5/62), 12.9% (4/31) in left colon and 3.2% (1/31) in right colon, all treated conservatively. The wound infection rate was 23.8% (30/126). DISCUSSION AND CONCLUSIONS: Obstructing colo-rectal cancer is associated with a high operative mortality and a worse prognosis. Defunctioning colostomy can be regarded as a valid option only in extreme circumstances. Hartmann's operation has indicated in case of metastatic disease, unsure anastomosis, simultaneous colonic perforation. The gold-standard is primary anastomosis, as colonic resection with on table wash-out or subtotal/total colectomy, in case of largely distended colon or synchronous lesions.

[Conservative treatment of a large retroperitoneal hematoma following extracorporeal shock wave lithotripsy (ESWL): case report and literature review]. / Trattamento conservativo di voluminoso ematoma retroperitoneale (ERP) secondario a litotripsia renale ad onde d'urto (ESWL): case report e revisione della letteratura.

Retroperitoneal and subcapsular renal hematomas, following extracorporeal shock wave lithotripsy (ESWL) occur rarely, but the large number of this treatment performed has to be considered. The knowledge of risk factors, natural history and complications represents a crucial factor in the correct management of these lesions, that generally must be treated conservatively, monitoring clinical parameters and eco-TC diameters of the hematoma. Surgical approache is indicated only in case of haemodinamic instability not responsive to medical therapy and, after 1-2 months, to try to improve renal disfunction due to compression. In this paper we present a case of retroperitoneal hematoma after ESWL and review the literature, so as to define the management of these lesions.

[Abdominal lymphoma with abscess and thoracic perforation: en-bloc resection]. / Linfoma addominale ascessualizzato e perforato in torace: resezione "en-bloc".

The authors compare a rare case of acute onset Gastric Lymphoma with that present in the literature. The patient, a white 67 year-old man, was admitted to hospital in severe general condition. On CT scan an opacity of the pleura and a subtotal collapse of the left lung associated with a mass infiltrating the diaphragm, the gastric fundus and pancreas were seen. After 48 hours from the admission an operation was performed. The abdominal mass infiltrating the stomach, the spleen and the left thorax was resected en-bloc by laparotomy. A Boulau drainage was inserted. The histology showed an high malignant, diffused, big cell lymphoma. The patient was discharged 23 days later after a regular postoperative course. Surgery can be necessary, sometime curative in gastric lymphomas while long term result and quality of life could be improved by chemotherapy.

[Primary anastomosis in the neoplastic colonic obstruction]. / L'anastomosi primaria nell'occlusione colica neoplastica.

The authors report their own experience on the treatment of large bowel obstruction caused by a neoplastic stenosis. During a 36-month period 110 operations for emergency large bowel obstructions were performed: 59 (53.6%) underwent primary anastomosis without colostomy (28 right colectomy, 16 left colectomy, 9 sub-total and 6 total colectomy). Total group post-operative mortality was 2.9% as a result of cardio-pulmonary complications. Morbidity was 19.8%, included a 3% of anastomotic leak underwent surgical treatment. Our results suggest that resection and primary anastomosis can be performed with acceptable morbidity and mortality in a high proportion of cases of emergency large bowel obstructions.

[Acute cholecystitis: timing of surgery]. / Le colecistiti acute: timing of surgery.

The authors report their own experience about 156 cases of acute cholecystitis observed between January 1991 and October 1992. The most part of the patients were between 30 and 65 years old (84 cases observed). In 27 cases, for the positive evolution of the pathology, it was put on practice a non operative treatment. The other 129 cases were treated surgically. The patients with lithiasic cholecystitis were 148; those affected by non lithiasic cholecystitis were 5; and 3 of them presented an acute cholecystitis as a manifestation of a carcinoma. Between the various diagnostic methods, the echography, executed in emergency, is considered as an indispensable one, for having changed completely the diagnostic approach. It is discussed, particularly, the timing of surgery, an aspect able to influence considerably the therapeutic iter and its results. There are analysed the criteria for whom some authors are favourable to a medical treatment of the acute cholecystitis, postponing the operation, while other of them are favourable to an early surgical treatment. The authors' casuistry put in evidence 110 operations effectuated in emergency (< 12 hours), 19 operations after an 12-72 hours interval, no operations at a long distance (1-10 months). The results are to be considered satisfactory: 1 deceased (on 129 operated cases, 0.78%); 10 immediate complications (7.75%): 8 suppurations of the wound, 1 biliar fistula and 1 internal hemorrhage after video-laparoscopic operation; 2 late complications (1.55%): they were relapsing gallstones. The aim of this work is to offer a contribution to codification of the treatment of the acute cholecystitis, on the ground of the acquired experience.

[Giant benign and malignant pathology of the ovary]. / Patologia gigante benigna e maligna dell'ovaio.

After a discussion of ovarian tumour classification, two cases of giant neoplasm, one benign the other malignant are reported. Ultrasonography and CA125 research represent two irreplaceable investigations, for preoperative balance and for therapeutic strategy.