[Rheumatoid arthritis with cervical localization. Description of a case with neurological symptomatology and review of the literature]. / L'artrite reumatoide a localizzazione cervicale. Descrizione di un caso con sintomatologia neurologica e revisione della letteratura.

A case of a patient with rheumatoid arthritis with a cranio-cervical junction involvement is presented. Medullary compression was present and was partially invalidating. Radiological and CT scan signs are explained and their relationship with a clinical symptomatology is discussed. The importance of radiological monitoring is emphasised in order to avoid dangerous neurological complications.

[Immediate reconstruction of the nipple using a portion of the areola following quadrantectomy including the nipple-areola complex]. / Ricostruzione immediata del capezzolo con porzione di areola dopo quadrantectomia comprendente il complesso areola-capezzolo.

Partial resection of the breast for cancer is often comprehensive of the nipple and ductal system. In those cases is possible the immediate reconstruction of the nipple with a portion of the areolar tissue spared during the resection. Preserving a semilunar portion of the areola opposite to the tumor site, turning and suturing each-other the two internal margins of the semilunar areolar tissue, the nipple reconstruction is feasible with good cosmetic results.

[Lymphangiosarcoma with postmastectomy edema of the arm]. / Il linfangiosarcoma su edema del braccio post-mastectomia.

A case of a lymphangiosarcoma (LAS) in a chronic postmastectomy lymphedematous arm in a 67 y.o; women is reported. The LAS was found 8 years after a radical left mastectomy for cancer and 7 years after the development of a lymphedema in the left arm. Because of a rapid spread of the disease no surgical treatment was done. The patient died 14 months after the diagnosis. Lymphangiosarcoma is a rare neoplasia that usually arise in chronic lymphedematous limbs mostly in post-mastectomy lymphedema of the arms. Chronic lymphedema is an important neoplastic stimuli decreasing the local immunity, as well leading to lymphoproliferative and degenerative changes of collagenous and fat tissues. Usually it appears as a multicentric lesion like bluish nodules, sclerotic plaques, bullous lesions. Lungs, pleura and thoracic wall are the most common sites of metastatic disease. The DD should be done with Kaposi sarcoma, hemangioma, hemangiopericytoma. The prognosis is always poor and after treatment the mean survival time is 18 months. The best treatment that gives a temporary result is the ablative surgery. Therefore because of unsuccessful therapeutic procedures a particular care should be paid to avoid postmastectomy lymphedema leaving, when possible, a reasonable lymphatic drainage of the arm.

[Extracranial aneurysm of the internal carotid artery]. / Aneurisma della carotide interna extracranica.

The Authors present a case of extracranial internal carotid aneurysm of atherosclerotic nature. They review the most common pathogenetic factors of this uncommon disease and they focus attention on its natural history. The neurological complications in untreated patients are very high (50-70%). The treatment should be carried out with a revascularization technique after removal of the aneurysm; leaving ligature for difficult situations or to memories of the past.

[Male varicocele. Analysis of the incidence of varicocele in a population of 18,800 young men]. / Il varicocele maschile. Analisi dell'incidenza del varicocele in una popolazione di 18.800 giovani.

The authors evaluate the incidence of varicocele after having examined 18,800 healthy white men members of the Italian Army Corps born in 1966 and visited in 1985. They found a varicocele in 775 patients (4.12%), in 5 was present bilaterally, and in 770 in the left side. In 45 patients the surgical treatment was already done at the time of the examination and there were 3 recurrences. The patients with varicocele were divided according to the classification of Dubin-Amelar and were: grade I n. 175 (0.93%); grade II n. 515 (2.74%); grade III n. 35 (50.18%). In 566 (73.03%) the diagnosis was done at the moment of the examination, 152 (19.62%) discovered the varicocele at the self examination; in 57 (7.37%) the diagnosis was already done by the family doctor. Infertility is sometime associated to the varicocele and with the unrelieved local discomfort are the main indications for surgery. It should be also emphasized the need of education on the infertility problems during the high school that is a time of the life in which there is the highest incidence of varicocele.

[Acute appendicitis in aged patients]. / Le appendiciti acute nel paziente anziano.

Over the course of 12 years (1977-1989) 40 patients aged over 50 (mean age 67 years) with acute appendicitis (Group I) were admitted to and operated in the Department of Surgery at Casalpusterlengo Hospital. Diagnosis was always confirmed by pathological examination. The following data were taken into account: the intervals between initial symptoms and admission, and between admission and surgical treatment; clinical and laboratory findings, the type of laparotomy, length of hospital stay, morbidity and mortality. Findings were also compared to two control groups composed of the same number of patients affected by acute appendicitis but aged between 1-20 years old (Group III) and between 21-50 years old (Group II). When data from all three groups were compared, it was found that there was a higher percentage (47.5%) of perforated appendices among the eldest group of patients; this may be explained by the fact that disease was more aggressive in these patients or that there was a longer interval between the appearance of symptoms and hospital admission. There was also a higher number of postoperative complications in group 1 (Group I = 27%; Group II = 7.5%; Group III = 2.5%). There was a greater incidence of complications in perforated appendicitis (Group I = 47%; Group II = 20%; Group III = 1 patient over 2) and the most common complication was wound infection (44%) followed by prolonged ileus (15%).(ABSTRACT TRUNCATED AT 250 WORDS)

[Multiple synchronous colorectal carcinomas]. / Carcinomi colo-rettali pluricentrici, sincroni.

The authors studied 118 patients with colon cancer (65 males and 53 female) admitted and operated at the Surgical Department of the Casalpusterlengo Hospital (Milan, Italy); over a period of 5 years (1986-1990). All patients were submitted to a pre-op. work-up with Barium enema, colonoscopy, abdominal ultrasound exam, and PAP-test and mammogram for females patients. We found 7 cases (5.9%) of multiple synchronous colon cancer (in 4 patients 2 cancers and in 3 patients 3 cancers). We also found extracolonic malignancy in the same patients (1 synchronous and 2 metachronous). New criteria are proposed to distinguish multiple colon cancers from multifocal colon cancers. It may be concluded that every patient with colo-rectal cancer requires a complete pre-op. examination of the colon and some tests to rule out other extracolonic malignancy.

[Gigantic liposarcoma of the retroperitoneum]. / Liposarcoma gigante del retroperitoneo.

A case of giant liposarcoma of the retroperitoneum (7.5 kg, diam. 39 x 30 x 18 cm) is reported. The most frequent sites of onset are discussed and stress is laid on the most useful diagnostic investigations. Surgical treatment, the only possibility of treatment for such large tumors, is often not radical and the recurrence rate is high.

[Acute mesenteric ischemia. Analysis of 47 cases]. / Ischemia mesenterica acuta. Analisi di 47 casi.

The authors summarized the results of surgical treatment of 47 cases of acute mesenteric ischemia observed during a period of 13 years. Clinic-etiopathogenetic correlation were done examining the data from the charts of the patients. Best prognosis is achieved through an early diagnosis and aggressive surgical treatment. The overall mortality was 72%. The conclusions are that an early angiographic work-up can get the right diagnosis to plan an appropriate surgical procedure.

[Gastrointestinal hemorrhage from solitary diverticulum of the small intestine]. / Emorragia digestiva da diverticolo solitario dell'intestino tenue.

A case of gastrointestinal bleeding in an 83 y.o. white female is reported. The source of bleeding was from a solitary jejunal diverticulum. The Authors discuss the clinical findings, the pathogenetic hypothesis, the diagnostic approach and the surgical therapy.

[Gastric carcinoid. A review of the literature and case report]. / Il carcinoide gastrico. Revisione della letteratura e presentazione di un caso.

The authors report a case of gastric carcinoid in a 69-years-old white, male. The lesion was discovered incidentally during an endoscopic examination of the stomach and an excisional biopsy was done. Because of the closeness of the cardiac to the lesion that was > 1 cm of diameter and because there was a suspicion of other microscopical lesions, the surgeon planned and carried out a total gastrectomy. The lesion was totally excised by the biopsy and no other lesions or lymph node involvement were find. After 1 year the patient is doing wall. The authors discuss carcinoids in general and gastric carcinoids in particular. They emphasize the role of the endoscopy in the early diagnosis of gastric carcinoid.

[Cystic adventitial disease of the popliteal artery. Report of 2 cases and review of the literature]. / Malattia avventiziale cistica dell'arteria poplitea. Presentazione di due casi e revisione della letteratura.

Two cases of cystic adventitial degeneration of the popliteal artery are reported and aetiopathogenetic theories, diagnosis and treatment discussed. One of the cases presented is of special interest because, at surgery, it was possible to observe the relationships of the artery with the articular capsule of the knee through a genicular vessel which, when sectioned, showed an exit of mucinous material the equivalent of that contained in the vasal cyst. This observation gives even more credence to the so-called "articular" aetiopathogenetic theory. The two cases were treated surgically with resection of that segment of the artery and contralateral saphenous vein graft giving an excellent short-term and long-term result and protecting from recurrences.

[Diagnosis of breast carcinoma. Comparison of clinical, mammographic, echographic and cytological aspiration diagnosis in a group of 50 patients]. / Diagnosi del carcinoma mammario. Confronto tra esame clinico, mammografico, ecografico e citoaspirato in un gruppo di 50 pazienti.

The study assesses the sensitivity of clinical, mammographic, echographic and needle biopsy tests in a sample group of 50 women some of whom were examined and operated by the Surgical Division of Casalpusterlengo Hospital, whereas others were examined and operated at Crema Hospital. Data were compared with those from larger studies recently reported in the literature. Patients had a minimum age of 42 years and a mean age of 64.3 years; all were symptomatic. Clinical examination, mammography and echotomography showed an increased sensitivity in parallel with the increased size of tumour and the patient's age. The sensitivity of mammography in T1 cases was higher than that of clinical examination and ultrasound tests. Diagnosis was made on cytological grounds alone in 2% of cases, but was negative in 14% (benign/inadequate sample) in spite of the presence of a positive clinical examination and mammography. A 90.4% sensitivity rate was achieved using a combined clinical examination and mammography.

[Pure and primary squamous cell carcinoma of the breast]. / Carcinoma squamocellulare puro e primitivo della mammella.

A case of a pure squamous cell carcinoma (SCC) of the breast is a 75 y.o. white female is reported. The cancer was discovered at the clinical exam requested by the patient for a growing mass in the left breast. Mammogram and an ultrasound exam showed a big cystic mass (4 cm x 4 cm) with a liquid content and a small polypoid mass of 0.5 cm x 0.5 cm arising from the inner surface of the cyst. A fine needle aspiration was done and the cytological report was consistent with squamous cell carcinoma. A left modified radical mastectomy was carried out. The skin was not involved and the lymph nodes were negative, and no other cutaneous tumor elsewhere was found. The stage was II (T 2a N o M o). The patient did well and was discharged 10 days post-op and now she is still doing well with no signs of recurrences or metastasis. This cancer should not be confused with a much more largely manifest metaplastic changes in a usual breast cancers. The criteria to define "pure" a squamous cell Ca of the breast are: 1) that no other neoplastic element such as ductal or mesenchymal ones are present in the tumor; 2) that the tumor is independent of adjacent cutaneous structure; 3) that no other distant epidermoid tumor exists in the patient. The origin of this tumor is controversial; it has been stated as arising from dermatoid cyst of the breast, chronic abscesses, complete metaplasia of glandular breast tissue. Despite the rarity of this neoplasia it should be kept in mind that in a cystic mass of the breast in older patient could arise a squamous cell carcinoma.

[The repair of inguinal and/or crural hernias with giant Mersilene prostheses in the preperitoneal position]. / La riparazione delle ernie inguinali e/o crurali con protesi gigante in mersilene in posizione preperitoneale.

The authors present 44 patients operated for hernias (inguinal and/or femoral) with a median pre-peritoneal approach positioning a mersilene mesh with Stoppa's technique. The results are very interesting considering that the hernias treated are all at high risk of recurrence. We had 4 complications (1 bleeding and 3 wound infections) that were conservatively treated, no mortality at all. The follow-up was of 12 months (mean) and no recurrence was discovered.