[Multidetector CT urography: diagnostic role in the evaluation of patients with non-traumatic hematuria]. / Urografia-TC multidetettore: ruolo diagnostico nella valutazione del paziente con ematuria non traumatica.

Blood in the urine (hematuria) can originate from any site along the urinary tract and may be the only sign of renal or vesical malignancy. Therefore, literature recommends for the evaluation of any case of macroscopic or microscopic hematuria. Our aim was to define the diagnostic role of multidetector CT urography (MDCTu) in the evaluation of this symptom through the analysis of 181 consecutive patients from January 2003 to March 2006.

[Intraoperative quick parathyroid hormone assay in thyroid surgery: preliminary experience on 36 cases]. / Dosaggio intraoperatorio dell'ormone paratiroideo in chirurgia tiroidea: esperienza preliminare su 36 casi.

Through the analysis of our preliminary experience on 36 consecutive cases of thyroid surgery, we assessed the feasibility of the rapid intraoperative assay of the intact parathyroid hormone (iPTH) as predictive risk factor of hypocalcemia versus seric calcium level on the first post-operative day to select the patients eligible to an early discharge. Furthermore, we managed to determine if iPTH level during thyroid surgery could point out the cases in which parathyroid autotransplantation is necessary, as the macroscopic evaluation of the parathyroid gland's viability is inadequate.

[The actual role of bilateral neck exploration in the treatment of primary hyperparathyroidism]. / Il ruolo attuale della esplorazione bilaterale del collo nel trattamento dell'iperparatiroidismo primario.

Surgery is the only curative treatment for primary hyperparathyroidism (pHPT). Surgical exploration is recommended for all patients with biochemically documented pHPT and signs or symptoms of the disease. Some patients are asymptomatic, others have subtle symptoms that disappear after parathyroid surgery. Felix Mandl successfully performed the first parathyroidectomy in 1925, using a bilateral neck exploration (BNE) with examination of all four glands and this remained the procedure of choice for pHPT into the 1990s. As over 80% of pHPT cases are due to a single parathyroid adenoma, many authors have questioned the need of BNE and have proposed directed unilateral approaches, termed "mini-invasive parathyroidectomies". The aim of this report is to define which is the actual role of the conventional surgical approach to pHPT.

[Renal giant angiomyolipoma in tuberous sclerosis complex: case report and literature review]. / Angiomiolipoma renale gigante in paziente con sclerosi tuberosa: descrizione di un caso e revisione della letteratura.

The aim of this paper is to describe a typical clinical case of tuberous sclerosis complex (Bourneville disease) and discuss controversial issues about the management of this rare condition, with a short revision of the literature. Particularly, we define which is the role of the surgeon in the treatment of this very rare condition, that should be primary approached conservatively.

Neoadjuvant M-VAC (methotrexate, vinblastine, adriamycin, and cisplatin) chemotherapy and bladder preservation for muscle-infiltrating transitional cell carcinoma of the bladder.

A group of 66 patients with locally advanced T2-T4 NOMO TCC of the bladder were treated with three cycles of neo-adjuvant M-VAC chemotherapy. Of 65 evaluable patients, 18 (28%) were T2, 22 (34%) were T3a, 21 (33%) were T3b, and 4 (6%) were T4a. Patients were restaged clinically by repeat CT scan and TURB and were to undergo pathologic staging. Partial cystectomy was to be performed in patients with initial monofocal lesions who responded to therapy. As the study evolved, many patients who responded to M-VAC underwent clinical restaging only. Clinical response incorporated the results of the CT scan, cytology, and TURB. The overall clinical response rate was 82%. A cCr was attained in 28 of the 65 (43%) patients, and 25 of the 65 (38%) patients attained a cPR; 7 patients (11%) had stable disease, and 5 (8%) had progression. The median follow-up is 36(+) months (6(+)-78(+) months). The overall survival for all patients is 82% at 2 years, and 3 year survival is 73%. Of 65 patients, 44 (68%) were managed with conservative therapy (TURB or partial cystectomy). Of 44, 34 (77%) are alive, 28 (64%) with a functional bladder. Patients who had downstaging of their tumors to absence of disease (TO) or superficial disease have 2 and 3 year survival of 86 and 83%. For patients with muscle-infiltrating tumors after M-VAC, 2 and 3 year survival is 89 and 32%. Of 65 patients treated in this study, 28 (43%) have conserved normal bladder function. Response to chemotherapy may be the most important predictor of survival. Although bladder conservation is feasible in selected patients, they remain at risk for recurrence.

Sequential subcutaneous thymopentin, interferon alpha-2a and interleukin-2 in metastatic renal cell cancer.

To determine the activity of sequential administration of thymopentin (TP-5), interferon alpha-2a (IFN) and interleukin-2 (IL-2) in metastatic renal cell cancer (RCC), 17 patients with RCC were treated with TP-5 50 mg/d on days 1 to 14, IFN 3 MIU/d on days 14, 15, 21, 22 and IL-2 18 MIU/d on days 16 to 20, and 23 to 27. Treatment was given subcutaneously and cycles were repeated every 6 weeks. All patients were assessed for toxicity and response. No objective responses were observed. Two patients had a short-lived disease stabilization. Median survival was 9 months. Toxicity was generally moderate. The most important side-effects were related to IL-2 administration. In view of the lack of antitumor activity, the combination of TP-5 + IFN + IL-2 in the doses and schedule used in this trial cannot be recommended. The investigation of chemotherapeutic and immunological agents that can effectively synergize with IFN or IL-2 is essential.

[Tumor markers in the early diagnosis of thyroid neoplasms]. / I markers tumorali nella diagnosi precoce delle neoplasie tiroidee.

Radioimmunological techniques were used to assay tumour markers in order to identify neoplasms in patients with thyroid nodules at the earliest possible stage. In the 7 patients with differentiated thyroid tumours, the marker findings were within normal limits. On the basis of these results it is concluded that at the present time these markers are of no value for the early diagnosis of thyroid tumours.

Stapled sutures in digestive tract surgery.

A six-year experience with mechanical sutures in digestive tract surgery is reported. Forty-nine esophageal resections during azygo-portal disconnection were performed since 1979 up to June 1986. Four patients died in the early postoperative course with no evidence of suture-related complication. One patient developed an anastomotic stricture (2.2%), which was successfully dilated. Fifty-three total gastrectomies with stapled reconstruction were performed between 1980 and June 1986. Two patients died soon after surgery for reasons unrelated to the suturing technique. Two strictures of the esophagojejunal anastomosis (3.9%) occurred two to three months after surgery and underwent successful dilation. One esophagojejunostomy (1.9%) leaked and one (1.9%) underwent uneventful remedial surgery (conversion of an omega-shaped loop to a Roux-en-Y procedure). Ten isoperistaltic jejunal interpositions, six Billroth I partial gastrectomies and 14 Roux-en-Y loops for hepatico- or pseudo-cystojejunostomy were performed since 1983 up to June 1986 in the absence of any operative morbidity or mortality. Twenty-three right colectomies were performed from 1983 to June 1986. The only complication reported was one leakage (4.3%) which spontaneously healed. Ninety-eight patients underwent formal colonic resections (anterior resection of the rectum, left hemicolectomy, subtotal and total colectomy) from 1981 to June 1986. Two patients (2%) died for reasons unrelated to the suturing technique. Three colorectal anastomoses (3%) developed a leak, one of which required surgical revision. One stricture (1%) was recorded in a recurrence-free patient three months after surgery. One patient (1%) complained of minor rectal bleeding. Two patients (2%) developed small anal fissures due to forced passage of the instrument.(ABSTRACT TRUNCATED AT 250 WORDS)

Techniques of rectal oncologic survey.

The possibility of constructing very low anastomoses using stapling devices led many surgeons to reduce the length of the distal clearance to 1-2 cm. This made it possible to perform a low anterior resection instead of an abdominoperineal resection of the rectum in a greater number of cases. Furthermore, the enthusiasm in preserving sphincteric function induced some Authors to perform a local excision for tumors of the distal portion of the rectum. On the other hand, in order to improve patients' survival after curative operations for cancer, either of the rectum or rectosigmoid junction, other surgeons have adopted a more aggressive approach, extending exeresis to the peri-aortocaval and pelvic nodes, and to the possible liver metastases as well. On the basis of our experience (374 cases from 1972 to March 1989) and a critical review of the literature, indications, techniques, and results of curative operations for both rectal and recto-sigmoid junction cancer are examined. The role of extended abdomino-pelvic lymphadenectomy is also discussed. The Authors believe that in the absence of a reliable evaluation of the potential of these tumors, an aggressive approach is required. Local excision is reserved to very selected cases, which should undergo an intensive follow-up in order to detect recurrences at a very early stage.

[Extension of total thyroidectomy to the cellulo-lympho-thymic tissue of the anterior superior mediastinum]. / Allargamento della tiroidectomia totale al tessuto cellulo-linfo-timico del mediastino anterior-superiore.

Stress is laid on the importance of the cellulo-lympho-thymic tissue of the anterior-superior mediastinum in demolition surgery for thyroid cancer. For this reason, a straightforward, reliable technique for removing the thyrothymic lamina by the cervical route has been prepared. Experimented on cadavers, this method has been used for superior mediastinic lymphnode exeresis in all cases where it was indicated.

[Orthotopic replacement of the bladder in the female]. / La sostituzione ortotopica della vescica nella donna.

Orthotopic substitution of the bladder in females is a procedure which is increasing worldwide. Patients with tumours of the bladder neck or the trigon, or with multifocal tumours, expanded carcinomas in situ or massive pelvic adenopathies are not eligible for the procedure. The main consideration should be the risk of urinary incontinence or hypercontinence. Our experience relates to 8 patients, the neobladder being constructed using the Studer technique. Six months postoperatively daytime continence was 100% and night-time continence 75%.

[Aneurysm of the popliteal artery: diagnostic and therapeutic considerations]. / In tema di aneurisma dell'arteria poplitea: considerazioni diagnostiche e terapeutiche.

The authors settle the roles of the most recent diagnostic methodologies useful to frame the popliteal aneurysm pathology namely digital arteriography, N.M.R., and doppler-flowmetry. They emphasize, in an observed case, the adopted therapeutic criteria, that is basically interventional. The thinness of saphenous veins draws toward the employing of "Goretex".

[Mechanical staplers in orthotopic ileal neo-bladder using the Studer and Zingg method: our experience]. / Le suturatrici meccaniche nella neovescica ileale ortotopica sec. Studer e Zingg: nostra esperienza.

Detubularized orthotopic low-pressure bladder substitute following radical cystoprostatectomy allows micturition per urethram and urinary continence. We performed the Studer and Zingg procedure with ileal reservoirs in 26 bladder cancer patients, using staplers in 11 cases. A reduced operating time and a low postoperative complication rate were observed in these cases. Furthermore, functional results were comparable to those obtained with manual sutures and lithiasis was never observed.

[Postoperative sacrocele: prevention and surgical considerations]. / Sacrocele post-operatorio: prevenzione e considerazioni chirurgiche.

In the Authors experience with surgical management of sacral chordomas, an unusual complication represented by posterior herniation of the rectum was observed. Weakness of the posterior pelvic floor is at the basis of this complication, which the Authors defined "sacrocele". Posterior herniation of the rectum highly impairs the patient quality of life and may contraindicate radiation therapy. Therefore, the Authors routinely reconstruct the posterior pelvic floor by using a polyglactin mesh following any sacrectomy. This technique is simple and safe. Authors' experience on a limited series is presently reported.

[Anterior approaches to the spinal column: considerations of the surgical technic]. / Vie di accesso anteriori alla colonna vertebrale: considerazioni di tecnica chirurgica.

The anterior approach to the vertebral column is indicated in the tumors or traumas of the vertebral body with prevalent anterior expression. This method allows to control easily all the structures in front of the rachis. Furthermore, the current reconstructive techniques require the exposure of a long tract of the vertebral column. The Authors report their experience with the anterior approach in 22 patients (9 males, 13 females) affected by different pathologies: 10 primary tumors divided as follows: 4 sacral chordomas, 1 L1 chordoma, 2 sacral neurinomas, 1 L5 malignant melanotic schwannoma, 1 D9 osteoblastoma, 1 D6 intraspinal cavernoma, and 1 D3 myeloma; 4 metastatic tumors (2 D10, 1 L4 and 1 L5); 5 fractures of the vertebral body (1 L1, 1 L1-L2, 2 L4 and 1 L5); 2 echinococcal cysts respectively arising from the D11 body, the sacrum and ilium. The Authors overall performed 8 thoracotomies, 6 for dorsal location; in 1 case of L1-L2 fracture a thoracophrenolaparotomy was performed; in 7 cases involving the L3-L5 segment an abdominal anterolateral extraperitoneal approach was followed; finally in 6 cases a transperitoneal laparotomy to approach the sacrum and ilium was performed.

[Anomalies of the inferior vena cava: observations on the anterior approach to the vertebral column]. / Anomalie della vena cava inferiore: osservazioni nell'approccio anteriore alla colonna vertebrale.

The inferior vena cava is formed through a complex process of embryogenesis from the sixth to the tenth week of gestation. Improper completion of the process of embryogenesis may result in four anatomic anomalies: 1) duplication of the inferior vena cava; 2) left-sided inferior vena cava; 3) retroartic left renal vein and 4) circumaortic left renal vein. The Authors report the cases of two patients in which duplication of the inferior vena cava and retroartic left renal vein were respectively observed. The importance to avoid injuries and subsequent bleeding from these anomalous structures during surgical operations is stressed. Moreover, a correct preoperative diagnosis may reduce these complications.

[Mesorectal resection in oncologic surgery]. / L'asportazione del mesoretto in chirurgia oncologica.

A surgical technique to "en bloc" resect the mesorectum while performing an anterior resection is here described. The procedure aims at preserving those nerves whose injury is responsible for a series of neurological sequalae, which affect the patient's quality of life. Fifteen dissections were carried out in order to demonstrate the possibility to perform an accurate mesorectal lymphadenectomy while preserving, in most cases, the nervi erigentes and, in some cases, the hypogastric plexus.

[Primary non-Hodgkin's lymphomas of the stomach]. / I linfomi primitivi non-hodgkin dello stomaco.

Histological and staging classifications of gastric non-Hodgkin lymphomas are reported. On the basis of their experience and taking into account the above mentioned principles, the authors dwell upon the advantages and limits of endoscopy for the diagnosis of such neoplasms. The primary role of surgery in the management of gastric lymphomas is also confirmed.

[Abdominal aortic aneurysm and rectal cancer: what surgical strategy?]. / Aneurisma dell'aorta addominale e cancro del retto: quale strategia operatoria?

The incidence of abdominal aortic aneurysm and colorectal cancer association is 0.5-1%. This concomitance of two potentially lethal diseases creates a decision making problem regarding priority of treatment. The Authors report a case in which colorectal cancer and abdominal aortic aneurysm were present. This patient first underwent surgery for colorectal cancer, then for aortic aneurysm. Moreover, the Authors review the Literature and discuss their decisional principles about treatment priorities.

[The osseous location of echinococcal cysts: comments on a clinical case]. / La localizzazione ossea della cisti da echinococco: considerazioni su un caso clinico.

Primary bone location of hydatid disease is extremely rare. The clinical case herein reported represents a primitive bone location of echinococcus in the ileal and sacral area. The aspecific symptoms did not allow for a preoperative diagnosis. The latter was possible only after a CT scan performed for other reasons. The patient underwent a CT scan and MIR which showed a diffuse involvement of the ilium and sacrum along with the presence of two cysts (anterior and posterior). Surgery was performed through an anterolateral extraperitoneal and posterior access in the gluteal region. Asportation "en bloc" of the cysts was not possible. Therefore, they were opened, aspirated and washed with hypertonic solution (33% NaCl). Following surgery Albendazole was prescribed to the patient. At 22 days from surgery, a CT scan confirmed the disappearance of the cysts along with the presence of bone lesions.