Fast track in colo-rectal surgery. Preliminary experience in a rural hospital.

BACKGROUND: "Fast Track surgery" is a therapeutic program of large application, despite some doubts about its applicability and real validity. Literature review shows that this approach to colo-rectal surgery, particularly video-assisted, can allow a rapid recovery, better performance and a faster postoperative functional autonomy of the work, which can be discharged without cause additional welfare costs; in addition it can be reproducible in different health reality. PURPOSE: To analyze the possibility to apply the Fast Truck protocol in patients undergoing colorectal surgery in a rural hospital and non specialistic Unit of Surgery. PATIENTS AND METHODS: We have conducted a prospective, randomized study on 80 patients subjected to colorectal surgery in the last year. RESULTS: The protocol was observed in 95% of cases, compliance with the Fast Track was high and general morbidity was limited (7.8%). CONCLUSION: This "aggressive" approach, which has fundamentally altered the usual surgical behavior, seems to allow a mean length of stay significantly lower than in controls (p < 0.05) with positive implications for patients and containment of health care costs, even after discharge (no need for home care in 92% of cases, no early re-admittance to the hospital). Homogeneous protocols are desirable, as well as an increased enrollment, to consolidate these rehabilitation programs in order to provide a reference for all hospitals.

[Liver haemangioma: current surgical indications. Our experience]. / Gli angiomi epatici: attuali indicazioni al trattamento chirurgico. Revisione casistica.

Hemangiomas are the more frequent benign liver tumours. Therapeutic approach at these neoplasms is changed in the last years because has resulted that massive haemoperitoneum from a spontaneous rupture of the hemangiomas is a rare occurrence. From a personal review of 124 liver resection performed for traumatic and organic, benign and malignant, pathologies, the Authors present two cases of symptomatic liver haemangioma surgically treated Excluding emergency induced by tumour hemorrhage, actually indications to surgical treatment are controversial. In all patients the right approach is choice by the integrated evaluation of general conditions of the patient, liver functionality and from anatomical location of the neoplasm.

[Appendicectomy: laparoscopic versus open treatment. A case survey]. / Appendicectomia: laparoscopica versus laparotomica. Analisi della casistica.

AIM: Laparoscopy is actually the gold standard approach in many surgical procedures: this consideration is still controversial as to appendectomy. METHODS: From 2000 to 2004 we have performed 257 appendectomies: 51 (20%) in laparoscopic approach. Preoperative diagnosis has been formulated on blood parameters, abdominal or, sometimes, transvaginal ultrasonography. RESULTS: Two hundred and fifty-seven surgical operations, 62 laparoscopic, have been performed for suspicious appendicitis. In the laparoscopic procedures, 11 revealed various diseases without appendicitis. In the remaining 51 cases, appendectomy has been performed totally intra-abdominal and none case turned to laparotomic conversion. Operative times were between 27 and 105 min in the laparoscopic appendectomies (LA) and between 18 and 46 min in the laparotomic appendectomies (OA). In 7.3% of OA and in 3.9% of LA wall infections occurred, as well as abdominal abscesses in 1% of OA and in 4% of LA. Postoperative discharge was after 3.3 days and bowel canalization appeared at 10-18 hours from the surgery, in OA and in LA. CONCLUSIONS: On the basis of these results, the conclusion is drawn that, although discordant opinions in the literature, the advantages of the laparoscopic approach compared to laparotomic approach is still to be demonstrated, both in advantages for the patient and in costs. Laparoscopy is the better surgical technique when the preoperative diagnosis is not clear, particularly in young women or in elderly, in whom a colic neoplasm may be suspected.

[Malignant carcinoid of the last ileal ansa. Report on 2 consecutive clinical cases]. / Il carcinoide maligno dell'ultima ansa ileale. Presentazione di due casi clinici consecutivi.

Carcinoid tumors are very rare neoplasms, arising from enterochromaffin cells, classified in Apud system, exhibiting an intermediate malignancy, because of their long lasting clinical silence and low evolution to advanced stage. At the same time, these features unfortunately cause a high incidence of lymphatic and liver metastases, visible at first diagnostic approach, which are also determined by aspecific symptoms and signs, especially involving jejunal and ileal carcinoids, as the two cases described, and by very frequent absence, in current clinical practice, of pathognomonic carcinoid syndrome. Two carcinoids located into the distal ileal ansa, strictly adjacent to the ileocecal valve, are reported; the first tumor, accompanied by lymphonodal positivity, the second by a solitary hepatic metastasis, requiring segmentectomy of the liver, in addition to right hemicolectomy.

[Carcinoma of the male breast: difficulties of differential diagnosis in a case of bleeding atypical gynecomastia]. / Il carcinoma della mammella maschile: insidie della diagnosi differenziale in un caso di ginecomastia atipica sanguinante.

Male breast cancer represents a sporadic oncological disease (0.2-1.5%), with a very rare incidence (200 times lower) compared to omologous condition in women. Low incidence, early metastasizing chances, due to particular anatomic structure of the male gland, offering a high invasiveness rate to surrounding tissues are responsible of a late diagnosis, for which an histopathological response in case of malignant suspect, should be mandatory as well as poor prognostic expectations, in case of lymphnodes positivity (5 year-survival, after radical mastectomy: 17-60%), which unfortunately accounts for 50% of the patients at diagnosis. The difference with the success obtained in the treatment of female breast cancer, is striking, caused by the absence of a standard therapy and, on the other hand, of any screening programs.