Squamous cell carcinoma of the renal pelvis with stones and inferior vena cava infiltration. Case report.

We report a rare case of a 50 year old man with renal squamous cell carcinoma (SCC) who first came to our attention with renal colic and fever not responding to antibiotic or analgesic treatment. He had a long history of kidney stones, but had not undergone any imaging in the last 5 years. Physical examination revealed tenderness and a palpable mass in the right flank and lumbar region. A whole body CT scan was performed, revealing an 11 cm mass in the right kidney infiltrating the inferior vena cava. There were areas of calcification within the mass and multiple stones within the renal pelvis. The tumor was considered unsuitable for resection according to radiological and clinical criteria. The mass was biopsied percutaneously under CT guidance and histological examination revealed squamous cell carcinoma of the renal pelvis. The patient was treated with neoadjuvant chemotherapy and embolization of the renal artery. He died one month after diagnosis. To our knowledge this is the second reported case in the world of renal SCC infiltrating the inferior vena cava and with kidney stones.

Subfascial endoscopic perforator surgery (SEPS) in chronic venous insufficiency. A 14 years experience.

INTRODUCTION: Subfascial Endoscopic Perforator Surgery (SEPS) enables the direct visualization and section of perforating veins. Morbidity and duration of hospitalization are both less than with conventional open surgery (Linton's or Felder's techniques). PATIENTS AND METHODS: A total of 322 legs from 285 patients with a mean age of 56 years (range 23-90) were treated at our Department from May 1996 to January 2010. In 309 cases, an endoscope (ETM Endoskopische Technik GmbH, Berlin, Germany) was introduced through a transverse incision approximately 1.5 cm in length and 10 cm from the tibial tuberosity, as with Linton's technique. A spacemaker balloon dissector for SEPS, involving a second incision 6 cm from the first, was used in only 13 cases. RESULTS: The procedure used in each case was decided on the basis of preoperative evaluation. SEPS and stripping were performed in 238 limbs (73.91%), SEPS and short stripping in 7 limbs (2.17%), SEPS and crossectomy in 51 limbs (15.84%), and SEPS alone in 26 limbs (8.07%). 103 patients presented a total of 158 trophic ulcers; the healing time was between 1 and 3 months, with a healing rate of 82.91% after 1 month and 98.73% after 3 months. CONCLUSION: Subfascial ligature of perforating veins is superior to sclerotherapy and minimally invasive suprafascial treatment for the treatment of CVI. It is easy to execute, minimally invasive and has few complications.

Angiomegaly and arterial aneurysms.

Angiomegaly is characterized by an alteration in the elastic component of arterial and venous vessels determining their elongation and tortuousness. This involves an increased risk of thromboembolism and aneurysmal degeneration in affected subjects, even if they have been asymptomatic for a long time. The aim of this study is to demonstrate the correlation between angiomegaly and aneurysmal disease. A total of 163 patients suffering from a peripheral arterial aneurysm were included, 74 of these with an iliac aneurysm, 41 with a femoral aneurysm and 48 suffering from popliteal aneurysm. All patients were examined by color Doppler ultrasonography (CDU) and angio-CT with contrast medium. Eighteen cases of arteriomegaly were diagnosed, and the prevalence in the examined population was 11%. This study demonstrates the close association existing between aneurysms in peripheral arteries and arteriomegaly. Peripheral arterial aneurysms in association with arteriomegaly involve an increased risk of complications like thrombosis, embolism and rupture. The showed familiarity in the arteriomegaly incidence leads to predisposition of screening programs, using CDU, among relatives of patients affected by arteriomegaly and/or peripheral arterial aneurysms.

['Incidentaloma' in inguinal hernia surgery]. / 'Incidentaloma' nella chirurgia dell'ernia inguinale.

Adult Granulosa-Cell Tumor (GCT) is an uncommon ovarian malignancy. The clinical course is characterized by slow growth with late recurrence. A variety of clinical and pathologic parameters have previously been evaluated for prognosis with inconclusive results. The aim of this study was to report a case of a granulosa-cell tumor of the ovary that recurred 25 years after first surgery. The clinical course and histopathology of the case were reviewed and a literature search for other reported cases was performed.

[Sigma's stenosis. Clinical, diagnostic and therapeutical problems]. / Le stenosi del sigma. Problematiche cliniche, di diagnostica e terapeutiche.

Sigma's stenosis represent a frequent pathology, but its very difficult to have a pre-operatory diagnosis about the nature of these stenosis, not withstanding the introduction of more sophisticated instruments of diagnosis. In this work we present 9 cases of sigma stenosis; some of these with a common etiology and other very interesting for their rare and unusual origins. The patients were underwent to a different timing of diagnosis and therapy based on clinical history and diagnostic hypotheses; our experiences demonstrate that the clinical intuition is really useful for a correct diagnosis in the patients with a sigma's stenosis and consequently, in order to plan the correct therapy.

[Hyperhomocysteinemia and thrombosis: clinical case and literature's review]. / Iperomocisteinemia e trombosi: caso clinico e revisione della letteratura.

Patients with homocystinuria have an increased risk for both venous and artherial thrombosis but it has been found that even moderate increase in homocysteine levels are associated with heightened risk of thromboembolism. The Authors report a case of juvenile vasculopathy in a patient with hyperomocysteinemia. In this case the patient presented both venous and artherial thromboembolism in the absence of the most important risk factors. The opportunity is stressed to perform clinical tests for the correct diagnosis of hyperhomocysteinemia because it is possible, with the use of folic acid and vitamin B12, to correct the elevated levels of homocysteine.

[Nephrogenic metaplasia. A particular clinical and anatomopathologic entity]. / La metaplasia nefrogenica. Una particolare entità clinica ed anatomopatologica.

Two cases of nephrogenic adenoma are presented. The authors consider nephrogenic metaplasia as a reaction to inflammatory agents and point out the importance of differential diagnosis with nephrogenic adenocarcinoma, in which a different surgical procedure is requested.

[Endoscopic surgery of chronic venous insufficiency (CVI)]. / La chirurgia endoscopica nell'insufficienza venosa cronica (IVC): risultati preliminari.

The endoscopic technique in chronic venous insufficiency is simple and almost complication free. Our preliminary results due to a good postoperative course and to a quick return to social activity induce the Authors to indicate this type of procedure as the best treatment in chronic venous insufficiency.

[Role of total thyroidectomy in benign multinodular benign goiter]. / Il ruolo della tiroidectomia totale nella tireopatia nodulare plurifocale benigna.

The Authors report a review of the Literature and their personal series to evaluate the role of total thyroidectomy in the surgical management of non-toxic multinodular goiter. On the basis of the data obtained, the Authors consider total thyroidectomy the therapy of choice for this pathology.

[Ambulatory surgery of varices: our experience]. / La chirurgia ambulatoriale delle varici: nostra esperienza.

The Authors, on the basis of their experience with 196 patients aged from 18 to 45, affected by relapsing varicose veins, stress the advantages of the outpatient treatment according to Muller's technique. For these lesions excellent aesthetic and functional results, easy surgical technique, low incidence of complications, prompt resumption to work were registered.

[Ambulatory phlebectomy: our experience]. / La flebectomia ambulatoriale: nostra esperienza.

The Authors report their experience of out-patient phlebectomy. Over a period of 5 years they have examined 186 patients (156 females, 30 males): 166 had micro- and extra-saphenic varicosities, while 20 had recurrent varices. Patients with ostium failure were excluded. Muller's out-patient phlebectomy implies an accurate mapping of varicosities, local anaesthesia, microincisions which are only exceptionally sutured. The Authors consider that an accurate elastic pressure bandage is indispensable and useful in order to improve the dynamics of the PVC and to avoid haemorrhages. Such a surgical technique bears aesthetic, economic and haemodynamic advantages.

[Male infertility due to varicocele: their diagnosis and treatment. Our experience]. / L'infertilità maschile da varicocele: diagnostica e terapia. Nostra esperienza.

The Authors have examined, over a period of two years, 110 patients presenting with varicocele and infertility. Varicocele has an incidence of 40% in male sterility, causing oligozoospermia and asthenospermia. Patients first underwent non-invasive tests such as Doppler and echo-Doppler tests. According to the Authors experience, Doppler speedometry is decisive for the diagnosis of both idiopathic and subclinical varicocele, for the post-operative control of microsurgical anastomosis, and for the intra-operative detection of accessory spermatic veins. The surgical technique used by the Authors is the modified Palomo technique, but other techniques are investigated as well. Post-operative results, concerning both spermiogram and relapses are also evaluated.

[Peroperative endoscopic papillotomy in a patient with an abdominal aortic aneurysm and biliary calculi]. / Papillotomia endoscopica peroperatoria in paziente con aneurisma dell'aorta addominale e calcolosi biliare.

The authors report a case of abdominal aortic aneurysm associated with biliary tract lithiasis. The need to simultaneously treat both diseases is stressed. A technique which involves endoscopy during open surgery in order to prevent contamination is illustrated. The technique used together with other manoeuvres is part of a methodology aiming to broaden indications to the treatment of abdominal diseases associated with vascular diseases, limiting at the same time the risks of prosthetic infection.

[Infection of the vascular prosthesis. The diagnostic, preventive and treatment protocols: preliminary results]. / L'infezione di protesi vascolare. Protocollo diagnostico, di prevenzione e di trattamento: risultati preliminari.

A number of strategies for the management of vascular graft infections are described in literature. Nevertheless, this serious compliance is still burdened with high rates of morbidity and mortality. At the present the principal efforts are therefore directed towards prevention and early diagnosis. In this view, the authors propose their protocol of study, on the basis of the encouraging results till now obtained.

[Posttraumatic pseudoaneurysms of the anterior tibial artery: a review of the literature and a clinical case report]. / Pseudoaneurismi post-traumatici dell'arteria tibiale anteriore: revisione della letteratura e presentazione di un caso clinico.

The authors after a review of the literature report a case of anterior tibial artery false aneurysm in a seventeen year old male, due to traumatic sprained ankle during a basketball match. Surgical techniques used in repairing the lesion as well as microsurgical technique for the direct suture of the artery, which allowed to resolve the problem, are discussed.

[Juvenile vascular pathology due to homocystinuria. A clinical case report]. / Patologia vascolare giovanile da omocistinuria. Presentazione di un caso clinico.

The authors report a case of juvenile vasculopathy in a homocystinuria patient. They point out that thromboembolism may be the only symptomatic expression of this genetically determined metabolic disease. Diagnostic approach and surgical therapy of the vascular lesions as well as medical therapy to prevent further complications are analysed. The opportunity to perform clinical tests for the diagnosis of homocystinuria in all those young patients presenting vascular lesions without other risk factors is finally stressed.

[Formation of calculi on a double J catheter]. / Formazione di calcoli su catetere a doppio J.

A case of lithiasis due to indwelling double J ureteral stent is described. Pathogenesis and possibilities of prevention are discussed.