[Leakage of colorectal anastomosis after neoadjuvant therapy with bevacizumab. Case report]. / Deiscenza di anastomosi colorettale dopo terapia neoadiuvante con bevacizumab. Case report.

BACKGROUND: Despite progresses achieved in last decades in treatment of rectal cancer, anastomotic leakage remains the main complication. PATIENTS AND METHODS: We report two cases of patients affected by distal rectal cancer. Both patients received neoadjuvant therapy according to ROCHE ML 18522 experimental protocol (Xeloda, Avastin and radiotherapy). After about respectively one and two months after anterior resection of the rectum, with transanal anastomosis and temporary colostomy, presacral abscess occurred. Patients were hospitalized and started antibiotic therapy. In one case it was necessary TC-guided drainage placement. RESULTS: Both patients had a favourable course and, after respectively 6 months and 1 year, underwent closure of colostomy. DISCUSSION: "Spontaneous" gastrointestinal microperforation (small leakage) is reported during treatment with bevacizumab, a monoclonal antibody against Vascular Endothelial Growth Factor (VEGF), also in patients with non gastrointestine tumours. Probably this results from inhibition of neoangiogenesis induced. CONCLUSIONS: Surgeons have to pay attention to adverse effects of combined neoadjuvant treatment of rectal cancer, considering temporary colostomy in presence of particular risk factors.

Total mesorectal excision with radiofrequency in rectal cancer.

AIM: The aim of this study was to compare the safety, the efficacy and the oncologic results in rectal cancer with total mesorectal excision using Ligasure (LS), a modern bipolar vessel sealing system, with monopolar electrocoagulation or stitches (ME). METHODS: From July 2005 to December 2007 one hundred twenty-nine patients underwent colon resection for cancer at the San Martino Hospital of Genoa (Italy); 43 patients underwent rectal resection. All patients underwent laparotomy rectal resection with total mesorectal excision; 9 (21%, group LS) underwent total mesorectal excision with radiofrequency, 34 (79%, group ME) with monopolar electrocoagulations, vessels ligation or stitches. Patients of group LS were similar to patients of group ME in age, gender, weight and body mass index. Cancer stage was for group A 3 stage B, 5 stage C and 1 stage D, for group B 4 stage A, 15 stage B, 8 stage C, 6 stage D and 1 non-staged tumor. RESULTS: There were no differences in intraoperative or postoperative complications. Operating time was similar in both group. Oncological results was similar in both groups. The major cost in group LS were attributable to cost of service. CONCLUSION: The Ligasure device does not reduce operating time in laparotomy rectal cancer resection but permit correct oncological results in patients submitted to total mesorectal excision. The costs of device reserved its use to surgery of low-rectal cancer or laparoscopic approach.

A new ruthenium black dye design with improved optical properties for transparent dye sensitized solar devices.

We report here on the preparation and on the electronic properties of a panchromatic Ru(ii) sensitizer based on a new ligand which allows for higher molar extinction coefficients in the visible and better performances (32% efficiency improvement) over conventional "black dye" in transparent DSSC.

[Femoro-femoral crossover bypass in monolateral obstructions of the iliac artery]. / Il bypass femoro-femorale cross over nelle ostruzioni monolaterali dell'arteria iliaca.

The Authors report the result of their ten-years experience with femoro-femoral crossover bypass in 26 patients affected with unilateral occlusion of the iliac artery. This bypass is an easy and quick procedure, useful in both short and long term. The patency rate after 58 months is 84.6%. Thus, its use indicated in a high number of patients, not only for a limb salvage treatment of a disabling claudication. The indications for this bypass can be extended to low surgical risk subjects, and it does not have to be considered only for the high-risk patients, instead of major surgery procedure on the aorto-iliac axis. The minimal necessary conditions of the limbs for performing the femoro-femoral crossover bypass are a pressure gradient of 35 mmHg and the angiographical demonstration of the unilateral occlusion. If the contralateral axis appears patent, but there are also multiple atherosclerotic sites, we consider other bypasses as therapeutical choices: aorto-bifemoral, ilio-femoral and the femoro-femoral cross-over itself; in the latter case we previously perform a transluminal angioplasty or an endarterectomy of the donor iliac artery. In these situations is essential to evaluate of the benefit/risk rate for every single patient.

[Hepatic cysts: a case report and anatomicopathological and clinico-therapeutic considerations]. / Le cisti epatiche: presentazione di un caso e considerazioni anatomo-patologiche e clinico-terapeutiche.

The recent observation of a case of non-parasitic cyst of the liver brought the authors to a literature review. A 62 year old male, affected by type 2 diabetes and hypertension, after a CT scan and ETG, underwent resection and "capitonnage" of the cyst. Three months after surgery a CT scan showed a complete repletion of the cavity previously occupied by the cyst as a consequence of regeneration and reorganization of the hepatic parenchyma. In conclusion, hepatic cysts are rare and clinically relevant only when huge. The diagnosis is possible with the use of ETG and CT scan of the abdomen, however, in some cases angiography is also useful. The intervention of choice is the "capitonnage" of the cyst.

[Adenocarcinoma of the small intestine. A case report and the clinico-therapeutic considerations]. / L'adenocarcinoma dell'intestino tenue. Presentazione di un caso e considerazioni clinico-terapeutiche.

Adenocarcinoma of the small bowel is a rare tumor. The diagnosis is often tardy and surgical treatment is still palliative in most cases. A major interest toward this kind of tumor as well as an early diagnosis may give the opportunity to perform a radical operation allowing better results in terms of survival.

[Adenocarcinoid of the appendix: a case report and anatomo-pathological and clinico-therapeutic considerations]. / L'adenocarcinoide dell'appendice: presentazione di un caso e considerazioni anatomo-patologiche e clinico-terapeutiche.

The Authors underline the most important pathological, clinical and therapeutic aspects of appendiceal adenocarcinoid. Appendiceal adenocarcinoid is quite a rare tumor, presently considered as a single entity; it differs from typical carcinoid of the appendix because of its well definite histology, its aggressive behaviour and its poorer prognosis. There are no precise prognostic and therapeutic criteria to direct the operative choice between appendectomy and hemicolectomy. In particular the tumor diameter is of no use since the tumor often present diffuse rather than nodular growth. According to most Authors appendectomy is not sufficient in the following cases: liver lymph-node or retroperitoneal metastases; cecal meso-appendiceal or peritoneal spreading; histological poorly differentiated tumors, with nuclear atypia and high mitotic count. Some Authors performed hemicolectomy and bilateral oophorectomy in all case with peritoneal involvement since the ovaries are a frequent site of metastases.

[Intestinal infarct: a critical review of the cases observed in the decade of 1981-1991]. / L'infarto intestinale: revisione critica dei casi osservati nel decennio 1981-1991.

The authors consider the causes of bowel infarction and report the up-to-date diagnostic tools for optional treatment. They verify management and outcome of 97 cases treated during the last decade.