[Celiac artery aneurysm: a case report]. / Aneurisma del tronco celaco: presentazione di un caso clinico.

The aneurysms of the celiac trunk are extremely rare. The authors describe a case of aneurysm of the celiac trunk dealt with aneu-rysmectomy and reconstruction by means of protesic graft made in Dacron. The patient was asymptomatic, and the aneurysm was discovered accidentally during abdominal computerized tomography (CT) for the stadiation of hepatic cirrhosis. The aneurysmectomy and the reconstruction have been executed by means of a prosthetic graft finish-terminal in Dacron, succeeding in preserving the three arteries originating from the celiac trunk (left gastric, hepatic, splenic). The histologic examination documented the degeneration of the medium trunk with loss of elastic fibers and atherosclerotic lesions. The postoperative course was complicated by hepatic ascites, and severe renal insufficiency. As a result of paracentesis and diuretic dose titration, the blood parameters and the conditions of the patient improved progressively until allowing the discharge on XL postoperative day in good conditions. Six months after, abdomen CT documented the integrity of the prosthetic graft and the absence of perianastomotic leak.

[Gastrointestinal stromal tumors (GIST). Our experience]. / I tumori stromali gastrointestinali (GIST). La nostra esperienza.

Nine cases of gastrointestinal stromal tumors (GISTs) observed in the period between 1993 and 1999 and treated with radical surgery are presented. Patients were studied with instrumental examinations (ultrasonography, TC, EGDS, RSCS, endoscopic ultra-sound) which permitted to make a temporary diagnosis of "suspect gastric or bowel neoplasm". Only after surgical resection of the neoplasm it was possible to make a definitive diagnosis, based on histologic examination of the operating piece. According to personal experience and literature data, we could affirm that GISTs' clinical manifestations are extremely heterogeneous and so these tumors are often diagnosed casually. Prognosis isn't correlated as much to neoplasm histologic and cytologic characteristics, as to next organs infiltration, which represents a sign of particular aggressiveness of lesions.

[Malignant neoplasia of the small intestine. Apropos of 7 cases. Clinical discussion and review of the literature]. / Neoplasie maligne dell'intestino tenue. A proposito di 7 casi. Discussione clinica e revisione della letteratura.

The authors report seven cases of primary malignancies of the small intestine observed and treated between 1989 and 1995 at the First Surgical Division of Treviglio Hospital. Three patients were affected by adenocarcinomas (two involving the duodenum and one the jejunum), two patients had non-endocrine carcinoid tumors of the ileum, one presented a jejunal liposarcoma and one a lymphoma of the ileum. Four patients died (respectively at three months, 15 months, 18 months and five years after surgical intervention). Three patients are still alive. The early clinical features of these malignancies are typically vague and non specific and for this reason the disease is often diagnosed at an advanced stage. The prognosis of these lesions is generally poor owing to the diffusion of the disease at the time of diagnosis. In fact these neoplasms are preoperatively identified only in 27-72%. The percentage of surgical removal ranges between 65 and 80% according to the recent literature. This study is aimed at analysing the clinical and pathologic characteristics of the observed cases and the difficulties of the diagnostic procedure. The adopted surgical techniques and the outcome of the operative treatment are also examined.

A case of asymptomatic giant aneurysm of the common hepatic artery.

The authors are presenting a case of asymptomatic giant aneurysm of the common hepatic artery in a 72 year-old woman. The patient came under our observation with a complete, recent diagnosis. However, two years earlier in another clinic, a para-hilar hepatic mass with partially calcified walls was incidentally found during an abdominal ultrasound. An abdominal TC without contrast medium showed the mass to be hepatic hydatid cysts. TC images after 2 years showed a growth in diameter from 7 to 12 cm. Having undergone an hysterectomy and a rectal prosthesis, technical difficulties occurred because of the aneurysm's characteristics. The authors would like to emphasize that the rarity of the lesion must not exclude it from the diagnostic protocol of abdominal masses: ultrasound must be accompanied by a Doppler and the TC must be made using a contrast medium. Furthermore, revascularization surgery may create difficulties that cannot be previously prevented.

[Surgical treatment of lithiasis of the common bile duct: our experience]. / Il trattamento chirurgico della litiasi della via biliare principale: nostra esperienza.

On the basis of their personal experience of biliary pathology, the authors present their opinion of surgical treatment of benign diseases of the common bile duct. From 1980 to 1988 a total of 930 patients were assessed, 140 of whom were affected by choledocholithiasis. Data confirmed that, with the exception of choledochotomy as a direct approach for removing stones, good results were achieved using papillosphincterotomy, since this technique best restores the physiology of the biliary tract. In cases where common duct dilation exceeded 20 mm or where the patient was in poor clinical condition, bile was drained into the gut forming a side-to-side choledochoduodenostomy.

[Current indications for percutaneous transhepatic cholangiography (PTC)]. / Indicazioni attuali alla colangiografia percutanea transepatica (PTC).

Percutaneous transhepatic cholangiography (PTC) showed its widest diffusion during the late '70s while since the early '80s it was gradually replaced by endoscopic retrograde cholangiopancreatography (ERCP). Anyway, a well definite role for PTC still exists. PTC was performed in 60 of 131 cases of obstructive disease of the biliary tree: the indications are illustrated in detail. The statistical indicators utilized to choose this examination were: echographic determination of the diameter of the biliary tree, bilirubinemia, alkaline phosphatase (ALP) and serum gamma-GT. Data collected during this study showed that biliary dilation has a significant correlation to serum levels of ALP, while bilirubin has not. Biliary dilation is currently well established by echography: in some instances, however, biliary obstruction is earlier suggested by elevated serum enzymes of biliary stasis, while it is clearly demonstrated that biliary dilation is a precursor of jaundice, better defined as an expression of biliary hypertension. Based on these observations and on the review of the literature, the Authors believe that PTC still remains a second choice examination as compared to ERCP: when the latter be not effective for diagnosis or decompression of the biliary tree, then PTC can be resolutive.