[Intraperitoneal neoplastic dissemination of incidental gallbladder carcinoma after laparoscopic surgery]. / La disseminazione neoplastica intraperitoneale da carcinoma incidentale della colecisti dopo chirurgia laparoscopica.

BACKGROUND: Several laboratory and clinical studies have raised the concern that laparoscopic procedures might worsen the prognosis of patient with malignant disease due to premature intraperitoneal cancer cell dissemination. The aim of the study was to examine the risk of the dissemination in patients with unsuspected gallbladder cancer diagnosed after laparoscopic cholecystectomy (LC). METHODS: A retrospective clinicopathologic study was performed on 5 patients with unsuspected gallbladder cancer without preoperatively diagnosis among 1280 patients that underwent LC in the period 1993-2002. The possible neoplastic dissemination was compared to that reported in 8 patients affected from unsuspected gallbladder cancer diagnosed after open cholecystectomy. RESULTS: Two patients with unsuspected gallbladder cancer (T1a-T2) presented a port-site recurrence after respectively six and four months. There was not statistically significant difference between types of cholecystectomy (LC or OC). Survival rate did not change according to whether the operation was carried out using LC or OC. CONCLUSION: After an accurate checking of the factors indicated to explain the early neoplastic dissemination frequently observed in the patients undergone LC and an analysis of their own experience the Authors conclude that LC does not worsen the prognosis of unsuspected gallbladder cancer.

Pre and intra-operative methods of staging gastric cancer.

The aim of this paper was to examine the indications and limits of pre- and intra-operative instrumental diagnosis of gastric cancer. In order to achieve this effectively, the authors emphasized the importance of proper staging methods and obtained a detailed description of tumor diffusion. The most important diagnostic instruments considered were magnetic resonance, endosonography, intra-operative echography, pre- and intra-operative immunoscintography and a cytological examination of peritoneal lavage fluid. The authors concluded that pre- and intra-operative staging of gastric cancer is important for two major reasons: it results in the most accurate definition possible of disease evolution, enabling a proper therapeutic program; and it involves a combination of three complementary metasurgical treatments.

[Surgical problems in the aged patients]. / Problemi chirurgici nel paziente anziano.

Authors, considering the increasing of the middle duration of life and the increasing of geriatric population, examine various surgical problems in the elderly. They took in consideration not only the age, but all the other markers of surgical risk related to the surgical illness, to the associate illness and to the type of operation. After reporting their experience in the treatment of geriatric patients, they conclude that a scrupulous surgical preparation, a correct indication to the operation and an accurate overseeing after surgery are necessary to do that the elderly patient faces surgical intervention with the same capability of success of the young.

[Surgical management of hereditary medullary carcinoma of the thyroid in patients with "RET" proto-oncogene mutation]. / Strategia chirurgica nel carcinoma midollare della tiroide ereditario in portatori di mutazione del proto-oncogene "RET".

The authors report their results in 64 individuals belonging to 11 families with MEN 2 and familial medullary carcinoma of thyroid (CMT) syndromes. They show amplification and restriction techniques, type, site and incidence of genetic alteration in the observed cases; besides they illustrate the adopted surgical management related to the mutation. They stress the concept that genetic test allows to detect the population with altered gene before laboratory or clinical evidence, with the great advantage to indicate an early surgical approach. If it is shown a multi-organ disease, as in one patient with CMT associated with bilateral pheocromocytoma, the two diseases must be treated during the same operative time.

[Medullary carcinoma of thyroid gland]. / Il carcinoma midollare della tiroide.

The authors present the characteristic features of medullary carcinoma of thyroid (CMT) and underline the necessity to identify RET proto-oncogene that is the cause of hereditary transmission of CMT. Physiology of C cells and clinical syndromes are reported and the importance of a genetic screening in population at risk is emphasized; this test has shown to be reliable and easy to apply. They report their experience on techniques of amplification and restriction for RET proto-oncogene identification in relatives of patients with MEN or familial CMT syndromes. This study has allowed to recognize a population bearing the oncogene responsible of the disease and to achieve a correct prophylactic therapeutic management.

[Primary adenocarcinoma of the duodenum]. / L'adenocarcinoma primitivo del duodeno.

Adenocarcinoma of the duodenum represents a rare neoplasia characterized by an indefinite symptomatology, at least early, and deceitful, that, therefore, arrives at surgeon, almost always, in advanced stage. The Authors, taking from a clinical case, recently observed, as a starting point, review the literature, referring the etiopathogenetic hypothesis that explain the relative rarity of this neoplasia. They therefore report the diagnostic and therapeutic procedure to carry out in these patients.

[Ambulatory treatment of inguinal hernia]. / Il trattamento ambulatoriale dell'ernia inguinale.

The Authors report their experience about the inguinal hernioplasty operation by implantation of prostheses in prolene following the Licthenstein technique. Prolene mesh strengthens the inguinal canal wall, with no suture tension point. The technique is performed under local anesthesia, in day-hospital system, consenting the patient a rapid reinstatement in the social-working ambit.

[Gastric precancerous conditions]. / Le precancerosi gastriche.

The Authors examine the anatomopathological and clinical features of the main gastric precancerouses and explain the diagnostic therapeutic protocols used. The diagnostic and therapeutic strategy can not leave a strict interdisciplinary collaboration out of consideration between radiologist, endoscopist, anatomist, gastroenterologist and surgeon. They conclude, in fact, affirming that the mentioned collaboration represents the one possibility for improving the results at distance of this neoplasia.

[Role of suture materials in the treatment of inguinal hernia]. / Il ruolo dei materiali di sutura nel trattamento dell'ernia inguinale.

The Authors evaluated the role suture materials have in recurrent groin hernia. According to the Literature and to their experience, it is concluded that suture materials seem not to have a significant influence on relapse.

[Biliary peritonitis caused hy hydatid disease]. / Peritonite biliare da malattia idatidea.

After specifying that rupture of a hydatid cyst in the peritoneal cavity is one of the most serious and rarest complications of hepatic hydatidosis, attention is paid to the peritoneal hydatid (o chole-hydatid). The aetiopathogenetic mechanisms and the anatomo-pathological features of this type of lesion are described in brief. Finally, the personally employed diagnostic protocol and therapeutic strategy in the face of this feared complication are reported.

[Malignant melanoma of the skin: current diagnostic and therapeutic approaches]. / Il melanoma maligno cutaneo: attuali orientamenti diagnostici e terapeutici.

The Authors claim that the treatment of malignant melanosis of the skin is a problem of undiminished topical interest owing to its highly aggressive characteristics. Risk factors and pre-neoplastic lesions are reviewed, and the signs of malignant transformation are described along with the appropriate treatment. The Authors stress the importance, for therapeutic and prognostic purposes, of accurate clinical staging and macro- and microscopic study of the primary tumour. They also describe their own therapeutic approach, which involves the use of a CO2 laser for resecting the primary tumour. They present their patient population and conclude by observing that the progress achieved over the past decade is due both to earlier diagnosis and to improvements in the various therapeutic means available.

[Conservative surgical treatment of acute hemorrhagic necrotizing pancreatitis]. / II trattamento chirurgico conservativo della pancreatite acuta necrotico-emorrgica.

The Authors though in theirs' opinion medical treatment is the primary therapeutical approach to Acute Necrotizing Haemorrhagic Pancreatitis (A.N.H.P.), state that the surgical treatment is indicated as soon as the necrotizing haemorrhagic evolution of the disease is strongly suspected. It should be conservative in type acting on the evolution of the disease and saving the anatomic integrity of the pancreas. The surgical technique adopted is described which consists in removing cellular debris as well as highly toxic necrotic pancreatic apparatus and it is completed by the endo-retroperitoneal perfusion for a continuous washing of the peritoneal cavity. In conclusion, they report their personal experience with 16 patients affected with A.N.H.P.

[Clinical remarks on acute volvulus of the cecum]. / Considerazioni cliniche sul volvolo acuto del cieco.

On the basis of a case of acute volvulus of the caecum, the rarity of the condition is stressed and its aetiopathogenetic and clinical aspects analysed, particular emphasis being laid on therapy.

[Indications and limitations of subcutaneous mastectomy in the treatment of breast carcinoma]. / Indicazioni e limiti della mastectomia sottocutanea nel trattamento del carcinoma mammario.

The reasons that led to subcutaneous mastectomy in some initial stage breast cancer patients are reported. After removal of the mammary gland, this surgical technique provides for prosthetic reconstruction and should therefore be confined to women with initial stage cancer who for psychological or aesthetic reasons refuse more destructive operations. The technique is described and results obtained discussed, recalling that this type of non-destructive operation will be increasingly in demand in the future but needs preclinical diagnosis of the local disease and its systemic diffusion.

[Sequential therapy with antiestrogens and progestational drugs in carcinoma of the breast in an advanced stage]. / La terapia sequenziale con antiestrogeni e progestinici nel carcinoma della mammella in fase avanzata.

After discussing the mechanism of action of antioestrogens and medroxy-progesterone-acetate, the authors report on their experience with the sequential use of these two hormones in a group of patients with advanced cancer of the breast. After illustrating the results of their study, the authors conclude by stressing that the sequential use of these drugs appears to improve the quality of life of the patients with a significant increase in rates of complete or partial remission of the neoplastic disease.

[Aminoglutethimide in the treatment of metastasizing breast carcinoma in old age]. / L'aminoglutetimide nel trattamento del carcinoma mammario metastatizzante in età geriatrica.

After first analyzing the basic pathophysiological aspects and the mechanism of action of aminoglutethimide, the authors report on their experience with the use of this steroid biosynthesis inhibitor in a group of geriatric patients with advanced cancer of the breast. After illustrating the results of their study, the authors conclude by stressing that the use of this drug appears to improve the quality of life of the patients with a significant increase in rates of complete or partial remission of the neoplastic disease.

[Use of tumor markers in monitoring thyroid carcinoma]. / L'impiego dei markers tumorali nel monitoraggio del carcinoma tiroideo.

The authors report on their experience regarding the use of tumours markers for the pre-operative monitoring and subsequent follow-up of patients suffering from thyroid carcinoma. All patients were subjected to radio-immuno-assay for circulating thyroglobulin, a valuable indicator of residual and metastatic thyroid tissue. The patients suffering from medullary carcinoma of the thyroid and their immediate families were also monitored by periodic thyrocalcitonin assay. A further tumour marker assayed was CEA, levels of which are raised in the presence of thyroid neoplasms at an advanced or metastasizing stage. The authors conclude by presenting the results obtained and confirm the usefulness of these tumour markers in the study and follow-up of patients with thyroid carcinoma.