[Our experience on the treatment of epigastric hernia]. / Nostra esperienza sul trattamento dell'ernia epigastrica.

The epigastric hernia represents a rare surgical affection, sometimes insidious, whose pathogenesis has been discussed for a long time, revealing, in the course of the years, multiple predisposing and responsible factors of its appearance. From our experience and the data reported in the literature, it is clear that a standard surgery does not exist for this pathology, and it is often necessary to perform preliminary uncommon diagnostic exams. Our retrospective study consists in the analysis of the surgical treatments executed, from 2003 to 2006, on 37 patients suffered from epigastric hernia, for everyone of which, on the basis of the clinical features, of the preoperative diagnostic results and of the characteristics of the hernia defect, it has been encouraged a personalized surgical procedure,obtaining therefore, for the same pathology, different treatment protocols (open or laparoscopic procedures, ordinary hospital stay or day-surgery, prosthetic or not surgical repair).

[The use of dermic substitutes in the repair of cutaneous defect due to a phlebostatic wound]. / L'utilizzo di sostituti dermici nella riparazione del difetto cutaneo da ulcera flebostatica.

The use of dermic substitutes is a valid and effective choice in the treatment of the cutaneous defects with loss of substance. In our experience, the aesthetic and functional results of dermic substitutes is really positive and encouraging, with better tolerance by patients than the autologue grafts.

[Surgical treatment of hemorrhoids in day-surgery]. / Il trattamento chirurgico delle emorroidi in day-surgery.

The Authors report their own experience with day-surgery treatment of haemorrhoids and underline the advantages in terms of patients' compliance and reduction of the sanitary management in order to the cost that this way suggests. The serie here reported includes 72 patients treated, by two years, with day-surgery haemorrhoidectomy. Here are indicated criteria of selection of the patients, related to the state of the illness, association of other pathologies and social factors. All the patients, moreover, have been treated according to a scheme that generally includes: a careful preoperatory valuation, local anaesthesia, standardized surgical method (Milligan-Morgan intervention), dimission few hours after the operation, control of the patients at their own home. The results obtained, careful examinted through an objective valuation (complications, relapses, time or reability) and subjective one (index of satisfaction of the patients), can be considered extremely positive.

[Total versus subtotal thyroidectomy for multiple node goiter: experience with 350 surgically treated cases]. / Tiroidectomia totale vs tiroidectomia subtotale per gozzo plurinodulare: esperienza su 350 casi operati.

The surgical treatment of benign thyroid pathology and in particular the multinodular form is controversial. This controversy exists and one must choose either perform conservative surgical therapy such as lobectomy or sub-total thyroidectomy or total thyroidectomy. From January 1985 to July 1999, the Authors observed 534 cases of benign thyroid pathology. Of these 534, 330 were diagnosed with primitive goiter, and 20 with recurrent goiter; 13 cases of the primitive goiter type were found to have microfoci of carcinoma inside the goiter on the definitive histologic exam. There were 275 patients who underwent total thyroidectomy and the remaining 75 cases with ultrasound proven multinodular goiter were treated with lobectomy or sub-total thyroidectomy, depending on the appearance at the time of the operation as well as the macroscopic and microscopic exams of the integrity of the glandular parenchyma performed while in the operating room. The Authors demonstrated that in multinodular goiter there is a high percentage of cases with disease involving the entire gland. Many areas of apparently healthy tissue are found to be microscopically involved with a variable grade of chronic lymphocytic thyroiditis or follicular hyperplasia or even lobular dysplasia with the tendency to form nodules. These signs of disease of this organ tend to recur if not treated.

[Systemic neoadjuvant chemotherapy in locally advanced gastric carcinoma: phase II study with 5-fluorouracil, epirubicin and etoposide]. / Chemioterapia neoadiuvante sistemica nel carcinoma gastrico localmente avanzato: studio in fase II con 5-fluorouracile, epirubicina ed etoposide.

Locally advanced gastric adenocarcinomas have a poor prognosis, particularly when the tumours are bulky, located in the cardia or when they present local/regional lymph node involvement. Neoadjuvant chemotherapy for locally advanced gastric cancer is an experimental treatment strategy that may increase resectability and improve survival in patients suffering from an almost uniformly fatal neoplasm. At our institution 11 patients younger than 70 years of age in good physical and mental condition with non-resectable adenocarcinomas of the stomach as determined by endoscopy, computed tomography scans and pathology examinations, were treated with combination chemotherapy [5-fluorouracil (375 mg/m2 i.v. for 5 days, epirubicin (60 mg/m2 i.v. on day 1), etoposide 80 mg/m2 on days 1, 2 and 3, leucovorin 100 mg/m2 for 5 days] every 4 weeks as neoadjuvant chemotherapy. The response to chemotherapy was evaluated after three courses. After three courses, we had one complete response, 8 partial responses or stable disease, and no response in two cases. One patient was still alive 36 months postoperatively. These preliminary results suggest that this protocol is an effective form of neoadjuvant chemotherapy for locally advanced gastric carcinoma.

[The echo-guided percutaneous treatment of dysontogenetic cysts of the liver]. / Il trattamento percutaneo ecoguidato delle cisti disontogenetiche del fegato.

Congenital cystic disease of the liver include two different entities, in the last years more frequently and easily recognized by ultrasonography or computed tomography: the simple, nonparasitic or biliary or solitary cysts of the liver and the polycystic liver disease. Our experience concern 153 patients affected by nonparasitic hepatic cysts and 17 patients affected by polycystic liver disease. 10/153 patients (6.5%) with symptomatic simple cysts have been treated by percutaneous US-guided aspiration and intracystic instillation of ethanol. All the patients were discharged asymptomatic after 24 hours with no complications; only in 2 patients a second treatment was necessary. Repeated follow-up examination showed non recurrence. The same procedure was also used for 3/17 symptomatic patients affected by polycystic liver disease in order to give temporary relief of the symptoms due to compression (pain, dyspnea, vomit, jaundice). A 45-years-old lady, with previous several surgical fenestrations, was treated for 10 years by 20 sessions of percutaneous aspiration and instillation of ethanol with no complications. We conclude that the percutaneous aspiration and intracystic instillation of ethanol would be recommended as primary treatment of patients affected by non parasitic cysts of the liver, because it offers good relief of the symptoms due to compression with good patients compliance and without complications.

[Castleman disease: a clinical case report]. / Malattia di Castleman: presentazione di un caso clinico.

Castleman's disease is an enigmatic lymphoid disease of unknown etiology and has different clinical manifestations. The authors present a case of a young woman with cervical localization of Castleman disease, asymptomatic. The disease was misdiagnosed and was treated for five years as thyroiditis, diagnosis confirmed by ultrasonography, scintigraphy and cytology. The particular size of the neoformation and its constant growth leaded the authors to the surgical treatment. The thyroid was normal both macroscopically and with biopsy. The neoformation was 10 cm of diameter and covered the left side of the thyroid.