[Surgical treatment of non-metastatic gastric GIST: two cases and review of the literature]. / Trattamento chirurgico dei GIST gastrici non metastatici: due casi significativi e revisione della letteratura.

Gastro-Intestinal Stromal Tumors (GISTs) represent an evolving field in oncological surgery and must be approached with specific prognostic and therapeutic criteria. In the GIST's suspicion the surgeon has to consider all the therapeutic possibilities, also for the impossibility to predict the biological behaviour and the aggressiveness of the tumor. The presence of a GIST has to be suspected in patients observed for gastrointestinal bleeding, when another pathology isn't demostrable. Surgical strategy must consider a limited resection as the best treatment, differently from what we do for adenocarcinoma. The extension of the resection can changes, regarding tumor volume and position, from extremely invasive surgery to laparoscopic operations with a partial removal of the gastric wall. Lymphadenectomy is not indicated because these tumors rarely spread to the nodes. We present the clinical case of two patients observed for gastrointestinal bleeding and with preoperative diagnostic suspicion of GIST, submitted to surgical resection. In the first case we performed a superior polar gastrectomy with esofago-gastric anastomosis for the mass proximity to the cardias. In the second patient the intervention has been a limited resection of the fundus of stomach including the tumor.

[A case of amputation neuroma of the bile duct following video-laparoscopic cholecystectomy]. / A proposito di un caso di neuroma d'amputazione della via biliare dopo colecistectomia laparoscopica.

We report a case of neuroma of the common hepatic duct arising five years after cholecystectomy (laparoscopic then converted in laparotomy). A 73-years-old patient was admitted for obstructive jaundice. Ultrasonography, TC and cholangiography showed a nodular lesion of the common hepatic of 1 cm in diameter, causing a regular and important stenosis of the main bile duct. Histologic examination demonstrated neuroma. By the analysis of this and 42 other previously published cases, the following features of bile duct neuroma were outlined: 1) variable interval between cholecystectomy and the onset of jaundice (2 months to 40 years); 2) the same incidence after laparoscopic or laparotomic cholecystectomy; 3) the generally complicated postoperative course after first surgical approach; 4) the various localizations on the biliary tree (cystic, main bile duct, intrahepatic ducts); 5) the circumstances of onset are almost the same (obstructive jaundice); 6) the histologic examination is mandatory for a correct diagnosis; and 7) the best treatment is resection of the bile duct tract involved in neuroma and reconstruction of biliary tree with hepaticojejunostomy.

Association of multiple granular cell tumors and squamous carcinoma of the esophagus: case report and review of the literature.

This report describes the case of a man who underwent subtotal esophagectomy for the concomitant presence of a multifocal esophageal squamous carcinoma and a granular cell tumor (GCT); he had been previously affected by another metachronous esophageal GCT excised endoscopically. This is the sixth case described in the literature detailing other cases of a combination of malignancies involving additional organs. We emphasize the need for a prolonged surveillance of patients with multiple GCTs in order to promptly recognize the possibility of associated neoplasms.

[Staging of lung cancer by computerized tomography: evaluation based on surgical experience]. / La stadiazione del cancro polmonare con tomografia computerizzata: valutazioni emergenti dall'esperienza chirurgica.

One hundred seventy patients with M0 bronchogenic carcinoma were preoperatively evaluated by CT staging whose results were correlated with surgical findings. A number of over and understaging were observed in assessing mediastinal nodes involvement, chest wall invasion, mediastinal pleura and vessels invasion as well as pulmonary vessels involvement. In conclusion, the Authors believe that no patient surgical indication should be excluded on the basis of CT evidence of intrathoracic invasion, in the light of the demonstrated potential for false-positive diagnoses.

Factors affecting prognosis in acute intestinal ischemia.

The anamnestic, clinical, laboratory, radiological and intraoperative data on 34 consecutive patients affected by acute intestinal ischemia or infarction, caused by superior mesenteric obstructive and nonocclusive pathology were collected and assessed. The aim of this study is the identification of the factors influencing the prognosis which in this disease is still really displeasing, with a mortality of over 90% in many surveys, and 73.5% in this report. The mean age of the 34 patients was 73. Cardiac ischemic disease and or arrhythmias were present in 83.8% of the patients. The most significant prognostic factors were those related to the evolutive stages of the intestinal ischemia. Among the anamnestic ones, the interval between the onset of the symptoms and diagnosis (mortality of 50% if less than or equal to 24 hrs., 86.4% if greater than 24 hrs.). Among the clinical factors, the presence of peritoneal signs was followed by a mortality of 82.3%, in contrast with the 33.3% when the same signs were absent. Also significant was the presence of shock (100% mortality), in contrast with 50% in patients presenting systemic systolic pressure greater than 100 mmHg. Extensive intestinal infarction caused a 100% mortality rate, while early revascularization allowed the survival of 81.8% of the patients treated in the absence of infarction or when irreversible ischemic damage was limited to less than 1 meter of bowel.

Cytoxan, epirubicin, methotrexate and 5-fluorouracil with hormonal synchronization (tamoxifen/premarin) in advanced breast cancer. Preliminary results.

Thirty-three patients with advanced breast cancer were treated with combination chemotherapy and hormonal synchronization in an attempt to increase the overall response rate generally obtained with traditional modalities of treatment. Among the 31 evaluable patients 1 complete (3%), 7 partial (22%), 13 stable disease (42%) and 10 progression of disease (53%) were obtained. Side effects were quite manageable although there were two episodes of life-threatening hematological toxicity. Taking into account the poor prognostic characteristics of our patients (high percentage of dominant visceral disease, 21/31 previously treated patients), our preliminary results with this regimen are interesting and the treatment deserves further evaluation.

Treatment of advanced breast cancer with 5-fluorouracil and high-dose folinic acid: preliminary results.

Twenty-eight patients with advanced breast cancer, all previously treated with hormonotherapy and/or chemotherapy, entered this study. Treatment was comprised of 5-day courses of folinic acid (200 mg/m2/day by i.v. bolus injection) and 5-fluorouracil, given immediately afterwards at a dose of 340-370-400 mg/m2/day according to toxicity. Cycles were repeated every 28 days. The remission rate was 60.7% (17/28): 10.7% CR (complete) (3/28), 50% PR (partial) (14/28), while 35% (1/28) had no change. Fourteen out of 23 patients previously treated with 5-FU also responded. The median duration of remission was about 6 months. Hematological toxicity was mild, while gastroenteric and ocular side-effects were important, even if not life-threatening. These data suggest that 5-FU combined with high-doses of folinic acid is effective in advanced breast cancer.