CT-guided radiofrequency ablation in the treatment of recurrent rectal cancer.

OBJECTIVE: Locally recurrent rectal adenocarcinoma remains a therapeutic challenge that is unsatisfactorily managed by surgery and radiation therapy or chemotherapy. Palliative CT-guided radiofrequency ablation was used in 14 patients with recurrent rectal adenocarcinoma who had been previously treated with abdominoperineal resection and radiation therapy. Follow-up CT or MRI was performed at 3, 6, 12, and 24 months. Pain palliation was monitored by the brief pain inventory (BPI). CONCLUSION: One month after radiofrequency ablation, 11 patients reported satisfactory BPI mean scores reduction compared to baseline (from 7.6 to 3.4 and from 5.1 to 1.6 for worst and average pain, respectively). In two unresponsive patients, retreatment was successfully performed at 3 months. After 24 months, worst and average pain scores further decreased (to 2.6 and 0.8, respectively) in 10 patients, who, at imaging, showed an ablation zone covering the entire original lesion in two patients and incomplete ablation in eight. In our experience, radiofrequency ablation is a safe and effective palliative treatment for patients with recurrent rectal adenocarcinoma.

[Preservative surgery of the kidney for haemorrhagic angiomyolipoma: a report of two cases]. / Chirurgia conservativa del parenchima renale per angiomiolipoma emorragico: due casi clinici.

Renal angiomyolipomas are very rare benign tumours (3% of renal tumours) that may present as isolated tumours or tumours associated with other pathologies, particularly tuberous sclerosis (40%), neurofibro-matosis, or Sturge-Webers disease. Clinically, renal angiomyolipoma is asymptomatic until the tumour becomes larger than 4 cm, causing urinary symptoms such as pain, infection, and microhaematuria. Rarely, in cases of large hypervascularised lesions, the clinical picture at onset may consist in spontaneous haemorrhage due to vessel rupture. The therapy consists in non-operative treatments for small tumours (< 4 cm) and surgical treatment, probably preservative, for larger tumours. In complicated haemorrhagic cases, an angiographic approach or surgical treatments, possibly conservative, are possible, offering the opportunity for further elective treatment. On the basis of case reports starting with haemorrhage and treated in urgency and of a review of the literature, we conclude that it is possible and mandatory to perform emergency preservative treatments of the kidney with an angiographic or surgical approach, and to ensure haemostasis. Treatment of the disease can be postponed when clinical and environmental conditions are better. Furthermore, we stress the need, once the clinical urgency/emergency is over, to submit the patient to suitable examinations to detect possible associated pathologies (tuberous sclerosis, neurofibromatosis, Sturge-Webers disease) in other parts of the body.

[Treatment of splenic trauma in paediatric age]. / Trattamento del trauma splenico in età pediatrica vs età adulta. Nostra esperienza.

The splenic trauma in children presents some peculiarity that differentiates it from that one in adult age. Therefore we have see again our relative experience on splenic trauma, in the period 2001-2006, confronting two groups of patients, one of inferior age to fourteen years (A Group) and one of advanced age (B Group). We have estimated the following parameters: aetiology, type of lesion, association with others trauma, type of treatment, compliance, mortality, number of transfusions and hospital stay. On a total of 75 splenic trauma (M:52, F:23 of age comprised between 5 and 71 years) 18 belongs to the A group (medium age of 9.2 years) and 57 to the B group (medium ages of 47.4 years). The prevailing aetiology in the A group is domestic accident (39%) and the fall from bicycle (33%), while in the B group it is the street accident (69%). The lesions found in pediatric age are of smaller gravity if compared with B group, for lesion gravity and for association with abdominal and/or extra-abdominal others trauma. In the children group we have performed nonoperative management or conservative surgery in the 83% of cases versus the 26% in the B group. The rate of conversion from a nonoperative treatment in to an operative treatment has been of 7%. The post-operative complicance are absent in the A group and of 5.5% in the B group. The mortality rate in the surgical patients has been of the 14.3% for serious toraco-abdominal trauma in A group and of 11.1% in B group. No mortality is detected in the groups with nonoperative treatment. The medium number of transfusions is of 1.8 units in the paediatric patients and of 2.5 units in the adults. The medium stay in hospital is of eighteen days in the A group and of thirteen days in the B group. In conclusion the marked difference in the two groups examines stays in the type of treatment, more often nonoperative or conservative in the children group.

[Surgical treatment of complicated sigmoid diverticulitis: our experience]. / Trattamento chirurgico della diverticolite complicata del sigma: nostra esperienza.

Traditionally, surgical sigmoid diverticular emergencies used to be treated in stages, but more recently there has been a trend towards definitive surgery with immediate resection plus anastomosis under certain conditions. The aim of this study was to define the morbidity and mortality of resection plus anastomosis with on-table antegrade irrigation and of the Hartmann procedure for complicated sigmoid diverticulitis in relation to the type of peritonitis and to the American Society of Anesthesiologists (ASA) grade of the patients. From April 1999 to April 2002, 38 emergency operations for complicated sigmoid diverticulitis were performed at the San Sebastiano Hospital in Caserta. Six patients underwent operations for obstructions and 32 for perforation (19 Hinchley stage III and 13 Hinchley stage IV). Surgical therapy for obstruction consisted in 4 resections plus anastomosis, 1 subtotal colectomy and 1 Hartmann procedure. Surgical therapy for perforation consisted in 14 resections plus anastomosis and 18 Hartmann procedures. There was 1 case (5%) of anastomotic dehiscence out of 19 primary anastomoses versus 2/19 surgical complications (10%) after the Hartmann procedure. The mortality amounted to 1 death out of 38 (2.6%) in a patient treated with the Hartmann procedure. Left-sided colonic obstruction should be treated by resection plus anastomosis or by subtotal colectomy for ASA II-III patients and by Hartmann's procedure for ASA IV-V patients. ASA II-III patients with localised or generalised non-faecal peritonitis should be treated by resection plus anastomosis, while a Hartmann procedure should be the reasonable option for generalised faecal peritonitis and for ASA IV-V patients with localised or generalised non-faecal peritonitis.