Breast cancer. A review of 144 cases.

From 1970 to 1980 144 cases of breast cancer were diagnosed in this Department. Patient's age varied between 25 and 83 years with an average age of 51.5 years. 49 (42.98%) patients were in fertile age and 65 patients (57.01%) were in menopause. The incidence of cancer increased after 41 years and the maximal incidence was between 51 and 55 years. Married (117; 81.45%) and pluriparous (75; 65.78%) women prevailed. In the pluriparous the average parity was 4, and 35 (30.70%) pluriparous had greater than or equal to 4 siblings. In 38 cases (27.08%) the patient was nulliparous. In 100 cases (69.64%) diagnosis was made without evident cutaneous alteration. Left and right breasts were affected in 73 (50.69%) and 68 cases (48.21%) respectively. Cancer was bilateral in 3 cases (2.08%). The most frequent cancer localization was ESQ (70 cases; 48.61%). 1st stage was diagnosed in 64 cases (44.44%), 2nd stage in 57 cases (39.58%) and 3rd stage in 23 cases (15.97%). The 5 year survival rate after operation was 86.79% (46 cases), 48.97% (24 cases) and 26.31% (5 cases) in patients at 1st, 2nd and 3rd stage respectively. 13, 8 and 4 patients were lost at follow-up.

Antifeedant constituents from Fagara macrophylla.

Analysis of the polar fractions of an EtOH extract obtained from the bark of the African medicinal plant Fagara macrophylla led to the isolation and identification of the alkaloids oblongine (6), tembetarine (7) and magnoflorine (8) and the flavonoid hesperidin (9). These compounds, together with other metabolites (1--5) previously isolated from F. macrophylla, were tested for antifeedant activity in a binary-choice bioassay. The acridone alkaloid xanthoxoline (4) was found to have a potent antifeedant activity against larvae of both Spodoptera frugiperda and S. littoralis. 1-Hydroxy-3-methoxy-N-methyl-acridone (2), arborinine (3), tembetarine (7) and magnoflorine (8) were antifeedant against S. frugiperda.

[Absence of sexual dysfunction does not mean that the couple does not need sexual counseling]. / La assenza di disfunzione sessuale non significa che la coppia non necessiti di consulenza sessuologica.

Two-hundred women with sexual dysfunction were compared with 160 without. The number of the practising religious (46.0% vs 28.8%; p less than 0.05), of married women (58.0% vs 47.8%; p greater than 0.05), widows (4.0% vs 0%; p less than 0.01) or the separated were found in significantly higher numbers. Nulliparity does not appear to be a risk factor in sexual dysfunction. The use of contraceptive technique such as the pill and the intrauterine device is significantly lower in women with sexual dysfunction. Also significantly higher is the number of women with sexual dysfunction who report that they are not satisfied with their sexual relationship (63.0% vs 6.2%; p less than 0.001) or who would like to change the sexual behaviour of their partner (50.0% vs 7.5%; p less than or equal to 0.001) or whose husband would like a change in the sexual behaviour of the partner (64.0% vs 10.0%; p less than or equal to 0.001). 7.5% of women without sexual dysfunction consider their relationship with the current partner to be unsatisfactory. Most of these women experience their partner's request as a "problem". In conclusion, the presence of sexual dysfunction is unacceptable to women in the majority of cases as it is accompanied by a negative opinion on the quality of the sexual relationship. It is the Authors' opinion that anamnesis of the sexual life of the couple should be offered to all women who have a gynaecological examination. The absence of sexual dysfunction does not necessarily mean that the women or the couple consider their sexual relationship to be sexually satisfactory or that they do not need or would not accept, if expressly asked, sexual counseling.

[Breast feeding and pleasure]. / Allattamento materno e piacere.

Thirty-six Sicilian women (mean age 26.2 years, range 18-34) who had chosen to breastfeed their newborn babies were included in the study. A semi-structured questionnaire was used by a pediatrician to interview all subjects 4 months after the birth. 94.7% of the women interviewed (36 cases) said that they had derived pleasure from breastfeeding while 5.3% (2 cases) stated that they had not. 44.7% (15 cases) experienced strong uterine contractions (described ad "cramps") during breastfeeding (these were described as occurring "often" in ten cases and "rarely" in five cases); in 6 (35.3%) out of 17 patients "uterine cramps" were a cause of "pleasure", whereas in the rest (64.7%) they were described as "bothersome" (5 cases), "painful" (2 cases) or "indifferent" (4 cases). If sexual pleasure is derived from the breastfeeding one's offspring, it may be to a certain extent represent, together with the joy of bringing up children, a compensatory substitute for the couple's sex life following the change of the woman's centre of attention from the sexual pole to that of the continuation of the species.

[Survey of the frequency of routine diagnostic tests in term pregnancies]. / Studio sulla frequenza con cui vengono eseguiti gli accertamenti diagnostici routinari in gravide a termine.

In 420 pregnant women who delivered during the third trimester at the "Istituto di I Clinica Ostetrica e Ginecologica", University of Catania, routine blood tests were performed in 95.5% of cases (401 women), urine tests in 95.5% (401), Hb-phoresis in 42.6% (179), HBsAg in 51.4% (216), TORCH and urine cultures in 37.8% (159), cardiotocograph in 73.1% (307), plasma RIA of E3 and/or HPL in 35% (147), maternal ECG and pseudocholinesterasemia in 83.6% (351) and 37.6% (158) respectively. No routine diagnostic tests were performed in 4.5% (19 women) of cases. Diagnostic tests are less frequently performed in women, plurigravida, and in pregnancies which follow a physiological course. Several diagnostic tests, except for TCTG and HBsAg, are performed more frequently in pregnancies with complications. Lastly, there is a marked difference between the number of diagnostic tests performed and the individual woman's place of residence.

Fecal peritonitis in pregnancy.

The Authors report a case of fecal peritonitis caused by perforating appendicitis in a patient in the 16th week of pregnancy. Appendectomy was performed and the patient successfully delivered a normal sibling weighing 2850 grams in the 37th week.

[Intestinal invagination caused by colonic lipoma]. / Invaginazione intestinale da lipoma del colon.

The observation of a case of intestinal intussusception caused by lipoma of the colon prompted the authors to review the literature on the subject and to examine the main characteristics of lipoma of the colon which represent the most frequent benign neoplasia of the large intestine after adenomatous polyps. Lipomas of the colon are localised in 90% of cases at the submucous level, are usually solitary, of varying size and may be sessile or pedunculated. They are almost always asymptomatic; only when they are of a reasonable size do they become manifest following alterations of the alveus, rectorrhagia, abdominal pain or the occupation of the colic lumen by the mass, or intestinal intussusception caused by the progression of the pedunculated lipoma. This difficult diagnosis may be aided by colonscopy with biopsy and dual contrast opaque enema. The prognosis of the disease depends on the presence or absence of complications and, in the case of the former, on early diagnosis and treatment. Lipoma of the colon of less than 2 cm may be electively removed endoscopically, those greater than 2 cm by laparotomy or laparoscopy. In emergency cases, it is advisable to perform a more or less extensive resection of the colon depending on the size of the tumour. In the case reported by the authors, an intussusception manouevre was first performed followed by left segmentary colectomy.

[The use of Dacron prostheses in laparoceles]. / L'impiego di protesi in Dacron nei laparoceli.

BACKGROUND: Purpose of the study was to evaluate indications and efficacy of Dacron prostheses in the treatment of incisional hernias. METHODS: The study has been carried out in a retrospective way; mean follow-up has been 20 months. Surgical setting has been the Institute of Emergency Surgery at the University of Catania, where about 500 abdominal operations are performed every year. Thirty patients affected by incisional hernias have been considered (mean age 66.8 years). In 12 patients the Mayo technique was performed, whereas a Dacron prosthesis was placed in 18 patients. Other than early postoperative complications, patients have been followed by periodical clinical exams in order to find out possible recurrences as well as other late complications. RESULTS: Among 18 patients treated with insertion of Dacron prosthesis no infection, recurrence, bowel fistula, haematoma or dislocation have been observed. Only in one case an intestinal occlusion secondary to adhesions between prosthesis and bowel has occurred; in this patient a new operation has been necessary to remove the prosthesis. CONCLUSIONS: Considering that prostheses have been used in large incisional hernias or in patients with a weak abdominal wall, the high successful percentage (94%) obtained suggests the use of Dacron prostheses which guarantee long stability and minimum risk of recurrences.

[Current views concerning the etiopathogenesis of reflux esophagitis in children]. / Attuali vedute sulla etiopatogenesi dell'esofagite da reflusso nell'età infantile.

Esophagitis is caused by a gastro-esophageal reflux sometimes reflecting anatomical inadequacy of structures that secure the relationships between the cardia and the diaphragm, fundus of the stomach, and other surrounding viscera, but more often due to functional deficiency of lower esophageal sphincter (LES), this representing the main factor for maintenance of the mechanism of cardial continence. Manometric studies of intraluminal pressures in the esophagus have revealed the presence of a high-pressure segment in the distal esophagus, where a mean pressure of 12-13 mm Hg obtains over a length of 3 or 4 cm. In the first two weeks of extrauterine life the LES is between 0.5 and 1 cm long, with a pressure of 3 mm Hg; pressure values in the LES equal adult values at about one month of age, showing that neuromuscular control of the sphincter has been achieved. Gastro-esophageal reflux, however, is very common in the newborn and not enough by itself to cause peptic disease of the esophagus; this requires the concomitance of morphological defects of the esophageal mucosa and/or dynamic-functional disturbances. This, according to the authors, is why esophagitis actually occurs in only about 60% of patients with radiologically and pHmetrically demonstrated gastro-esophageal reflux.

[Our experience in laparoscopic diagnosis in general and emergency surgery (author's transl)]. / La nostra esperienza nella diagnostica laparoscopica in chirurgia generale e d'urgenza.

After a brief review of the history of laparoscopy starting from the first endoscope, the authors remark on the great usefulness, ease, and essential harmlessness of the procedure. They list all the possible uses of laparoscopy in general and emergency surgery, exemplifying their claims with the illustration of personal cases and recommending widespread use of the method in surgery.