Solitary fibrous tumour of the liver with IGF-II-related hypoglycaemia. A case report.

INTRODUCTION: We report a rare case of solitary fibrous tumour (SFT) of the liver associated with non-islet cell tumour hypoglycaemia (NICTH), which caused a hypoglycaemic coma due to over-production of big-insulin-like growth factor-II. DISCUSSION: Although generally benign, SFTs are better characterised, lately due to Western blot, but less than 40 cases have been reported where the liver is the target organ. In only two benign cases has hypoglycaemia been a feature. CONCLUSION: We report for the first time a demonstrable relationship between benign liver SFT and NICTH.

Minimally invasive management of insulinomas. A case report.

BACKGROUND: Recently, preoperative endoscopic ultrasonography (EUS) was shown to be less time consuming, posing less risk of adverse events than other more invasive diagnostic procedures used for locating insulinomas. Furthermore, laparoscopy can be part of a less aggressive approach in the management of such tumors, avoiding open surgery, which is used all out of proportion for benign small-size lesions, as insulinomas frequently are. CASE REPORT: The reported case of pancreatic insulinoma involved a 45-year-old woman suffering from a neuroglycopenic syndrome. Tumor location was possible with endoscopic ultrasonography, which detected a hypoechoic 10 x 10-mm mass in the pancreatic tail. Tumor enucleation was accomplished laparoscopically. CONCLUSIONS: Insulinomas may be managed with videolaparoscopy, but this approach, which is not applicable for multiple or malignant tumors, must be contraindicated also in single insulinomas located on the posterior wall or deeply in the head of the pancreas. The disadvantages of the laparoscopic approach, as compared with conventional surgery, are the absence of palpation and difficulty exploring the whole pancreas, which is partly overcome, but not completely eliminated, by EUS. The advantages are the absence of a parietal incision and good postoperative comfort. The reported low-invasive EUS laparoscopy sequence may be successful in selected cases of pancreatic insulinomas. However, it seems this treatment could be proposed for many patients affected by this benign disease.

Results of laparoscopic and open splenectomy for nontraumatic diseases.

The medical records of patients who had undergone splenectomy for nontraumatic diseases of the spleen between 1997 and 2000 were reviewed. The aim of the study was to evaluate the short-term outcomes of open and laparoscopic splenectomies and to determine whether some well-known benefits of laparoscopic surgery could be observed in patients who underwent laparoscopic splenectomy for nontraumatic splenic diseases. The data of 44 patients were available for analysis and included 20 patients (45.5%) who underwent laparoscopic splenectomy and 24 patients (54.5%) who underwent open splenectomy. Various parameters were reported for open and laparoscopic procedures separately, including associated surgical procedures, spleen weight, postoperative mortality and morbidity rates, perioperative blood transfusions, use and length of abdominal drainage, accessory spleen removal, operative times, length of hospital recovery, and hematologic parameters on admission to and discharge from the hospital. Laparoscopic splenectomy was successfully completed in all 20 considered patients with no conversion to open splenectomy. The supine position and four trocars were adopted in all patients. Accessory spleens were found in four (9.0%) patients: two (4.5%) during open splenectomy and two (4.5%) during laparoscopic splenectomy. The postoperative mortality rate was 2.7% (a case of myocardial infarction). The morbidity rate was 9% (four patients), but no postoperative complications occurred after laparoscopic splenectomy. A significant statistical difference was shown by the increase in platelet counts after open versus laparoscopic splenectomy. The open and laparoscopic mean operative times (73.70 +/- 13.42 minutes and 78.42 +/- 14.63 minutes, respectively) were comparable. These times were comparable also considering patients who underwent only splenectomy. Mean recovery time was shorter after laparoscopic splenectomy (3.95 +/- 0.60 days) than after open splenectomy (7.0 +/- 1.68 days). After open procedures, however, the mean recovery time was shorter in uncomplicated cases (6.68 +/- 1.49 days) than in the open group as a whole. Authors conclude that many well-known advantages of the laparoscopic approach. especially those related to its low invasiveness, can be observed in patients requesting splenectomy for nontraumatic diseases of the spleen, without lowering the efficacy of this operation. They suggest that such advantages can be entirely displayed when selection criteria of the patients are applied.

Bilateral lumbar hernia associated with abdominal hernias. A case report.

Multiple abdominal hernias constitute a quite rare event in surgical practice. Lumbar hernias are even rarer and, to our knowledge, this is the first report in the English literature of its association with abdominal hernias. A case of multiple abdominal hernias, namely an epigastric hernia and a left inguinal hernia together with a bilateral lumbar hernia in a 65-year-old man attending the Out-patient department of Hoima Hospital-Uganda is described. A one-stage repair under local anaesthesia was chosen. The patient recovered uneventfully and no recurrence was noted at 1 year follow-up. This case report supports that a "one-stage" procedure under local anaesthesia can be appropriate as surgical treatment of multiple abdominal hernias when abdominal defects are of a small size. A minimal surgical approach to lumbar hernias seems also suitable when transverse muscle aponeurosis defect can be carefully repaired and covered with adjacent muscles.

[Urogenital sequelae in surgery of rectal carcinoma]. / Sequele urogenitali nella chirurgia del carcinoma rettale.

Seventeen consecutive patients with rectal cancer underwent surgery at our institution between January 1988 and December 1990. The aim of this study was to assess the urogenital symptoms after radical resection of the rectum. Ten of these patients were suitable for the study, 9 of whom had an Anterior Resection (with colorectal anastomosis in 7 cases and with coloanal anastomosis in 2) and 1 a Miles operation. We observed urogenital disturbances in 2 patients (20%), 1 male with urinary tract dysfunction and 1 female with difficulties of sexual activity. The disease-free interval, at 36 months, was 100%. We suggest that curative surgery for rectal cancer can be associated, in overall cases, with a low incidence of urogenital disturbances. This allows the improvement of quality of life without evidence of loco-regional recurrence. A resective approach of rectal cancer, able to preserve nervous fiber of pelvic plexus but providing at the same time a radical excision of the tumor, seems to be a determining factor.

[Acquired phimosis due to lichen sclerosus et atrophicus]. / La fimosi acquisita da lichen sclero-atrofico.

From January 1986 to December 1991, 6 cases of acquired phimosis secondary to balanitis xerotica obliterans were observed. The authors report their experience in the diagnosis and treatment of this disease. Five patients were treated with plastic of the foreskin, one was circumcised and treated with local instillation of corticoids. The authors conclude that the histological study of the specimen is very important to demonstrate the nature of the lesion.