Sentinel lymph node identification in breast cancer: feasibility study.

The aim of the study was to evaluate in our institute the technique of sentinel node (SN) identification and biopsy in the surgical treatment of early breast cancer. Between June 1998 and November 1999 54 patients (age range, 31-75 years) where studied. Inclusion criteria were age less than 75 years, indication for conservative surgery, absence of palpable axillary nodes, Karnofksy index >70. Lymphoscintigraphy was performed 16-18 hours prior to surgery, following injection of 0.1-0.2 mL of 99mTc-Nanocoll: the administered activity was 3-4 MBq in group A (44 pts) and 7-8 MBq in group B (10 pts). The colloids were administered by transdermal supralesional injection in 49 patients with palpable nodules and by intraparenchymal ultrasound-guided injection in five patients with non-palpable nodules. Planar projections were performed starting from the 5th until the 80th min (or 180th in the event of late migration). In 10 patients further projections were acquired 14-18 h following tracer administration. All nodes identified by gamma probe (MR 100 Pol.Hi.Tech) were histologically evaluated by immunohistochemistry and standard histology. Scintigraphic visualization of the SN was obtained in 49 patients: in 38 of these patients there was only one SN while in 11 patients there were two or three SNs. The delayed scan made in 10 patients did not show any further nodes. In all patients given US-guided perilesional injections migration was late (after at least 60 min). Our study confirms the validity of the scintigraphic procedure, its safety for patients and health care workers, and the feasibility of interdisciplinary collaboration.

[Role of total parenteral nutrition (TPN) in the treatment of pseudomembranous colitis in surgical patients. Our experience]. / Ruolo della NPT nel trattamento della colite pseudomembranosa nel paziente chirurgico. Nostra esperienza.

The authors describe their experience using TPN (total parenteral nutrition) associated with specific drugs in the treatment of antibiotic-associated pseudomembranous colitis in surgical patients. They discuss the benefits and the possible complications of the above mentioned treatment. Three different cases observed during a three year period are reported; one of these is carefully analysed in order to better explain the methods and procedures used during TPN.

[Use of computerized axial tomography and transrectal echography in the preoperative evaluation of cancer of the rectum]. / Impiego della tomografia assiale computerizzata e della ecografia transrettale nella valutazione preoperatoria del cancro del retto.

Eight patients were subjected to two types of preoperative investigation in the attempt to stage cancers localised in the final 13 cm of the rectum: CT scan and transrectal echography. CT scan was used to assess infiltration of perirectal tissues and any lymph node metastases. Echography was used to examine the degree of infiltration of the rectal wall. Patients were then submitted to surgery. The predictivity of these studies proved sufficiently high. 7 Miles amputations and 1 anterior resection were carried out. One case only in which the scan did not show signs of parietal lesions presented two perirectal lymph node metastases. If refined further, these evaluations will therefore influence surgical tactics.

[Intestinal invagination caused by submucous pedunculated lipoma of the large intestine]. / Invaginazione intestinale da lipoma peduncolato sottomucoso del grosso intestino. Caso clinico.

A case of colo-colic invagination caused by lipoma of the splenic flexure which led to emergency operation is reported. Colon lipomas are benign neoformations of the submucosa with prevalence of the right colon and with a frequency of from 0.3% to 5.8% in the whole population depending on clinical or autoptic series. Radiological and endoscopic investigations provide orientative elements for diagnosis. The most frequent complications are bleeding and intussusception in 50% of cases. Surgical removal may be carried out, preferably segmentary resection, so as not to be forced to operate on a complication in emergency conditions.

[Our experience on intestinal infarct. 21 cases]. / Nostra esperienza in tema di infarto intestinale. Ventuno casi.

Five years experience in the field of acute intestinal ischaemia, a total of 21 cases, is examined and it is concluded, in agreement with the literature, that most patients undergo simple laparotomy (70%) because diagnosis is made late or there is an operative surprise. In the event of diagnostic suspicion leading to operation in the early hours, therapeutic successes quoad vitam leave a short intestine syndrome with metabolic complications that are hard to manage. The possibility of large-scale employment of diagnostic tools such as selective arteriography that makes early diagnosis possible is therefore necessary.

[Anorectal lesions in Crohn's disease. Our experience]. / Lesioni ano-rettali nel Crohn. Nostra esperienza.

Nine years experience of anorectal surgery for Crohn-related lesion have been analysed. The series regards only 14 cases with pathology including ragade, abscesses and anocutaneous and retrovaginal fistulas. Treatment was as conservative as possible except for cases in which fistulizations led to sepsis as a result of which some adjustments had to be made and proctectomies in incontinence.

[Spontaneous rupture of the spleen caused by primary amyloidosis. Description of a clinical case]. / Rottura spontanea di milza da amiloidosi primaria. Osservazione di un caso clinico.

Spontaneous rupture of the spleen in primary amyloidosis is an uncommon event. After a review of the pertinent literature (10 case-reports between 1948 and 1987) a case of spontaneous splenic rupture with hemoperitoneum is presented. The diagnosis depends on the demonstration of amyloid deposit in splenic and hepatic tissues.