Indications for and limits of conservative surgery in breast cancer.

Improvements in diagnostic techniques and, above all, breast cancer screening campaigns - essential for early diagnosis - have enabled the objectives of conservative surgery to be pursued: disease control, no or low incidence of recurrences and an excellent esthetic result. However, to reach these objectives, it is essential to ensure a careful evaluation of the medical history of every patient, a detailed clinical examination and the correct interpretation of imaging. Particular attention should be paid to all factors influencing the choice of treatment and/or possible local recurrence: age, site, tumor volume, genetic predisposition, pregnancy, previous radiotherapy, pathological features, and surgical margins. The decision to undertake conservative treatment thus requires a multidisciplinary approach involving pathologists, surgeons and oncological radiologists, as well, of course, as the patient herself.

[Approach to male breast cancer. Our experience]. / L'approccio al cancro della mammella maschile. Nostra esperienza.

Male breast cancer is a rare neoplasia and represents only 1% of all forms of breast cancer. The etiopathogenesis of breast carcinoma is still unknown in both males and females, but an altered hormonal metabolism may play a role in its genesis. The prognosis of breast cancer is slightly worse in males, especially in cases with axillary lymph node metastases. The paper discusses the therapy administered to 8 patients with male breast cancer who were treated by the authors between January 1983 and April 1990.

[A case of spontaneous hematoma of the rectus abdominis muscle]. / Su di un caso di ematoma spontaneo del muscolo retto addominale.

The authors describe a recently observed case of spontaneous hematoma of the abdominal rectus muscle. They go on from there to a thorough examination of this rare condition in the light of the latest contributions on the subject in the literature. After describing the anatomo-pathological, aetiopathogenetic and clinical aspects of the condition, the authors deal at some length with the diagnostic possibilities afforded by ultrasound in particular and with the indications for conservative therapeutic treatment, surgery being resorted to only in complicated cases or in cases where diagnostic doubts persist.

[A case of intestinal obstructions caused by a gossypiboma]. / Su un caso di occlusione intestinale da garzoma.

The Authors explain a case of intestinal obstruction due to a gossypiboma. They stress the great importance of the prevention in surgical operations (count of surgical towels, exploration of the surgical site) and the role of the differential diagnosis.

[Clinical study of residual function and recurrence in patients undergoing partial thyroidectomy for euthyroid nodular goiter]. / Studio clinico della funzione residua e delle recidive in pazienti operati di tiroidectomia parziale per struma nodulare eutiroideo.

The different surgical options for the treatment of non toxic nodular goiter led the Authors to study the residual thyroid function following conservative surgery (subtotal thyroidectomy, lobectomy and enucleation). Follow-up showed an overall recurrence rate of 49%, with a higher rate after lobectomy and enucleation than after subtotal thyroidectomy. On the other hand, subclinical hypothyroidism was higher in patients who underwent subtotal thyroidectomy. No significative correlation was found between high plasmatic levels of TSH and recurrences.

[Gynecomastia: diagnosis and therapy update]. / La ginecomastia: attualità diagnostiche e terapeutiche.

The Authors report their experience in the management of gynaecomastia. Physiologic, pathologic and iatrogenic causes of the lesion, as well as possible interfering mechanisms, and diagnostic protocol are examined. When there is no spontaneous regression or when the precipitating factors are eliminated surgery is the therapeutical choice, also because it helps in resolving the related psychological problems affecting these patients.

[Use of endoscopic ultrasonography in the staging of esophageal tumors]. / L'impiego dell'ecoendoscopia nello staging dei tumori esofagei.

Endoscopic Ultrasound (EUS) was performed in 15 patients with esophageal and cardial carcinoma with the aim to evaluate intramural or extraesophageal invasion and regional lymph node metastases. In 10 patients the Authors correctly evaluated the tumoral depth invasion. In 5 patients mediastinal lymph node metastases were observed. It is concluded that EUS is a useful diagnostic method in the staging of esophageal carcinoma.

[Clinico-therapeutic considerations on primary gastric lymphoma]. / Considerazioni clinico-terapeutiche sul linfoma gastrico primitivo.

The Authors report four cases of primary gastric lymphomas. They stress the anatomopathological, clinical and therapeutic problems related to this disease because, at present, they are still discussed.

[Treatment of rectal carcinoma: our experience]. / Trattamento del carcinoma del retto: nostra esperienza.

Authors' experience with 53 patient operated on for adenocarcinoma of the rectum in Oncologic Surgery Department--University of Messina (Italy) was analysed. The development of mechanical devices has allowed surgeons to perform sphincter-saving in patients with medium-lower tumors of the rectum. In this experience abdominoperineal amputation was performed in cases of distal rectal tumors, local transanal excision was performed in 6 cases. There were no statistically significant differences between low anterior resection and abdomino-perineal resection with respect to local (17% vs 16.6%) and distant (16% vs 16%) recurrence.