[Conservative treatment of chyle fistula of the neck following a reintervention of cervical bilateral lymphectomy for medullary carcinoma of the thyroid. Case report]. / Trattamento conservativo di fistola chilosa del collo in paziente sottoposta a reintervento chirurgico di linfectomia bilaterale per carcinoma midollare della tiroide. Case report.

Chyle fistula is an uncommon serious complication of neck surgery, occurring in 1-3% of radical neck dissections. An untreated chyle leak is a potentially dangerous condition that may rarely lead to hypovolemia, hyponatremia, hypochloremia, hypoproteinemia and lymphopenia. Anatomic variants of the terminal portion of the thoracic duct and suction drainage in the neck wound play a primary role in causing this kind of lesion. Poor is the literature concerning chyle fistula, due to its rarity, and mostly case reports; still debated--prevalently empiric--is the management of this disease. The Authors report a case of chyle fistula following a reintervention of cervical bilateral lymphectomy for medullary carcinoma of the thyroid in a 75 years old female. In the reported case the chyle fistula was successfully treated conservatively, in early post-operative period with a low-fat diet and total parenteral nutrition, definitely followed by sclerosant therapy. The injection of a sclerosant agent (4 g of sterile medical talc diluted in isotonic sodium chloride solution) into the supraclavicular wound bed, through the drainage tube (clamped for 2 hours), determined rapid decline in fistula output, hence obviating surgical intervention.

[Diagnosis, surgical treatment and follow-up of the hyalizing trabecular adenoma of the thyroid]. / Diagnosi, trattamento chirurgico e follow-up dell'adenoma trabecolare ialinizzante della tiroide.

In the last twenty years, we submitted 853 patients to thyroid surgery. We found only in ten patients a hyalinizing trabecular adenoma at the (histological control), as a confirmation of the rarity of this tumour. The authors report a retrospective analysis of this cases to document the clinical features and the evolution through a long-term follow-up that has showed no recurrent disease. In conclusion the hyalinizing trabecular adenoma represents a low malignant potential tumour. However, the uncertain clinical behaviour doesn't be undervalued and patients must be subjected to accurate follow-up.

[Diagnosis, surgical treatment and follow-up of the hyalizing trabecular adenoma of the thyroid]. / Diagnosi, trattamento chirurgico e follow-up dell'adenoma trabecolare ialinizzante della tiroide.

In the last twenty years, we submitted 853 patients to thyroid surgery. We found only in ten patients a hyalinizing trabecular adenoma at the (histological control), as a confirmation of the rarity of this tumour. The authors report a retrospective analysis of this cases to document the clinical features and the evolution through a long term follow-up that has showed no recurrent disease. In conclusion the hyalinizing trabecular adenoma represents a low malignant potential tumour. However, the uncertain clinical behaviour doesn't be undervalued and patients must be subjected to accurate follow-up.

[Correlations between splenectomy and allergic symptoms. Preliminary results of a study concerning IL-4 and IgE serum level]. / Correlazioni tra splenectomia e insorgenza di manifestazioni allergiche. Risultati preliminari di uno studio previo dosaggio sierico di IL-4 e IgE.

The Authors, studying the condition of immunodepression observed in patients who underwent splenectomy for traumatic lesion, noticed that a significant part of them complained of allergic symptoms. These seemed to appear only in subjects whose Th2 lymphocytes functionality was preserved--as witnessed by normal or increased IL-4 serum level--showing an increased level of IgE too, thus confirming the role of Th2 lymphocytes in stimulating IgE synthesis. On the contrary splenectomized patients with functional harm of the Th2 lymphocytes--proved by low IL-4 serum level--did not show increase of haematic IgE level nor allergic manifestations. The Authors stress that, despite the small numerical of the series not allowing definitive judgment, preliminary data are suggestive for an hypothesis--reported below--that needs further confirmation. The ablation of the spleen, organ devoted to remove from the blood antigens--many of these potentially allergic factors--, allows the prolonged persistence of such sensitizing agents, thus promoting the onset of allergic manifestations in splenectomized patients whose Th2 lymphocytes function is preserved.

[Chronic abdominal pain and peritoneal mesothelioma: case report]. / Dolore addominale cronico e mesotelioma peritoneale: caso clinico.

Chronic abdominal pain syndrome is becoming increasingly important. The main symptom is persistent abdominal pain, which may vary intensely and be associated with constipation and episodes of vomiting, evolving towards sub- or total occlusion of the bowel. A 65-year old man presented with malignant peritoneal mesothelioma, with environmental asbestos exposure and chronic abdominal pain for more than one year. Due to his poor general condition, only palliative surgery was performed to resolve small and large bowel obstruction.