Colorectal endometriosis: aggressive surgical management and practical considerations in a patient with advanced disease.

The aim of this study was to evaluate the results of bowel resection in a patient with obstructive colorectal endometriosis. The presentation will acquaint the physician with the signs and symptoms, evaluation, and surgical treatment of colorectal endometriosis. We emphasize that our findings strongly support an aggressive surgical approach with resection for all visible cases of colorectal endometriosis in women with advanced disease.

[Cystic lymphangioma of the pancreas: clinical case and review of the literature]. / Linfangioma cistico del pancreas: caso clinico e revisione della letteratura.

Cystic lymphangioma is a rare benign tumor that occurs more often in children with different localizations. Abdominal localization and its development may produce symptoms and clinical features of acute abdomen leading to problems in the differential diagnosis. The Authors report a rare case of pancreatic lymphangioma in a nine years old child resolved by surgical treatment. A review of the literature concerning problems of diagnosis and treatment is also presented.

Brain metastasis: first sign of colorectal carcinoma.

The purpose of this study was to describe the detection of a brain metastasis as the first sign of colorectal carcinoma, without any liver and/or lung involvement. This finding demonstrates primarily the need for regular central nervous system investigation in diagnosing colorectal cancer and secondly that further, more thorough research into the biomolecular events involved in metastases from colorectal cancer is warranted.

[Malignant anorectal melanoma: description of a clinical case and review of the literature]. / Mélanome malin ano-rectal: description d'un cas clinique et revue de la littérature.

Malignant ano-rectal melanoma is a rare pathology without characteristic symptoms. It is more frequent in females than in males (ratio 2:1) and represents 3-15% of anal canal tumours. A case of a woman who recently came to us complaining of painful defecation, tenesmus and rectal bleeding induced us to reconsider the diagnostic and therapeutic implications in ano-rectal melanoma. The low incidence of cases reported and the negative 5-year prognosis are due to late, often incidental, diagnosis during clinical observation for hemorrhoids, rectal polyps or rhagades, together with the aspecificity of the tumour symptoms. We hope our case report emphasizes the importance of conducting early diagnosis in patients at risk of ano-rectal melanoma.

Which kind of surgery in elderly people for colorectal cancer?

Colo-rectal cancers are of high incidence in elderly patients. Different clinical features and the peculiar behavior of the tumor may influence surgical results and should be considered in the decision making, when the surgeon has to decide whether to perform radical gut resection or less straining palliative procedures. In a retrospective study, 102 large bowel cancer patients are analyzed submitted to surgery in the period 1989-1994. Patients were divided in two age classes: Group A: above 70 years of age, 45 cases (44.2%); Group B: under 70 years of age, 57 cases (55.8%). Emergency surgery procedures were necessary in 35 patients (34.4%), 20 cases (57%) in Group A and 15 cases (43%) in Group B. Radical resections could be performed in 25 (37%) old patients, 67% of the cases underwent a curative resection. Perioperative mortality and surgical complication rates were significantly higher in Group A than in Group B. The technical and biological difficulties in performing radical curative resections, the high complication rates and the occurrence of negative results of treatments provide a reason for careful evaluation of the risk/benefit ratio in older patients, where less straining palliative therapies may sometimes offer similar results.

[Axillofemoral bypass: a potential solution of acute ischemia of the lower limb]. / Il bypass axillofemorale: una possibile soluzione dell'ischemia acuta dell'arto inferiore.

When deobstruction by Fogarty catheter fails, the axillofemoral bypass can be considered as a therapeutic solution of the acute ischaemia of the limb. The authors discuss a case occurred in their experience and focus their attention on the therapeutic potentiality of this kind of revascularization. As a matter of fact it is important to consider that the operation should not only eliminate the acute ischaemia, but also correct the atherosclerotic lesions that led to it. Therefore, if deobstruction by Fogarty catheter does not restore a good inflow, in high risk patients with acute arterial thrombosis of the limb, there is a well indication for extra-anatomic revascularization.

[Surgery in neoplasms of the low rectum. Analysis of the Knight-Griffen technique]. / La chirurgia delle neoplasie del retto inferiore. Analisi della tecnica di Knight-Griffen.

The major advantage offered by the "double stapling technique" in the treatment of low rectum cancers is sphincter preservation while respecting oncological criteria of radicality. The authors report their experience in surgical treatment of rectal neoplasms, considering a 24 patient group observed between 1989 and 1991, when new staplers were available in Italy. They also present primary results obtained with modified Knight-Griffen technique evaluating a series of 10 patients with rectal cancers placed between 5 and 10 cm from the anal verge. The authors describe surgical procedures and, analyse the complication rate, report a 10% anastomotic leak with no clinical stenosis and 20% relapses. Showing a 2-year follow-up data, a 61.1% surviving actually free of disease in the all 24-patient group is referred. The authors conclude that double stapling technique, while safe and effective, should be always performed accordingly to oncological radicality, reminding that the aim of surgery is the treatment of cancer and sphincter saving should be considered secondary.

[Cystic lymphangioma of the retroperitoneum. A case report]. / Linfangioma cistico del retroperitoneo. Contributo clinico.

Cystic lymphangioma of the retroperitoneum is a primary mesodermal derived benign neoplasm, arising from retroperitoneal lymphatics. The Authors report a case of cystic lymphangioma of the retroperitoneum recently observed, and a review of the international literature registering 181 cases from 1958 up to nowadays. Retroperitoneal localization, sub-clinic evolution and the impossibility to preoperatively define the histological type of the tumour, in spite of the modern diagnostic techniques, explain the difficulties to reach a correct differential diagnosis. The authors conclude that surgery only allows to exactly localize the tumour, yet the definition of cystic lymphangioma is an histological goal.

[Significance of prognostic parameters in acute pancreatitis]. / Significato degli indici prognostici nella pancreatite acuta.

The diagnostic and therapeutic approach to Acute Pancreatitis (A.P.) is directly related to the clinical presentation. The Authors reviewed the data of 66 patients, hospitalized between October 1989 and December 1991, to verify the effectiveness of the prognostic criteria suggested by Ranson (1974), Mercadier (1977) and Imrie (1978). A.P. was of biliary origin in the majority of the patients (63.5%); five patients (7.5%) had an acute alcoholic pancreatitis, while the aetiology was traumatic or unknown in the remaining cases. A complicated clinical course was defined by the development of pseudocyst, pancreatic abscess, digestive haemorrhage, death or prolonged hospitalization (more than 20 days). The 28.8% of the patients developed complications during hospitalization. There were seven pancreatic pseudocysts, six pulmonary complications, three renal insufficiencies, two vascular complications, two sepsies and a gastrointestinal haemorrhage. The mean hospitalization period was 15.1 days (range 1-112). The Authors conclude that the three different prognostic criteria are equally useful to test the severity of A.P. attacks allowing to identify patients with the higher risk to develop complications during hospitalization.

[Somatostatin in the treatment of acute pancreatitis and prevention of postoperative acute pancreatitis. Personal experience]. / La somatostatina nel trattamento della pancreatite acuta e nella prevenzione della P.A.P.O.--esperienza personale.

Authors' personal experience is reported in the use of somatostatin for the treatment of acute pancreatitis and after bilio-pancreatic surgery. The drug has proved to be highly effective in reducing the pain and in controlling the biohumoral balance. The preliminary results appear to confirm the opinion that somatostatin is a major therapeutic tool in the treatment of bilio-pancreatic diseases.

[Toxic adenoma of the thyroid gland: personal experience]. / L'adenoma tossico della tiroide: esperienza personale.

The Authors analyzed the thyroid diseases series of the Institute of 1a Clinica Chirurgica of the University of Catania which includes 1022 patients over the last 17 years, reviewing clinical and laboratory tests usually used in a register of diagnosis for autonomous adenomas of the thyroid. The Authors discuss pathogenesis, likely etiology and epidemiology of Plummer's adenoma, taking into consideration the therapy and the complications related to the therapy itself. They conclude stating that the adenoma is a pathology where the surgical operation solves the dismetabolic condition in a lasting way.

Carcinoma of the male breast and ocular metastases.

Breast carcinoma in males associated with ocular metastases is not often observed. A case is reported with review of the literature. Medical management is satisfactory in case of metastases and enucleation is suggested for severe pain.

Intestinal perforation caused by non specific idiopathic ulcer of the small intestine. A case report.

A case of non specific idiopathic ulcer of the small intestine in a 79-year-old patient is reported. On admission he presented with acute abdomen and was submitted to wide intestinal resection. The features of this rare disease (only 370 cases described until 1987), which has an undefined etiopathogenesis, severe symptoms, and poses diagnostic problems, are discussed.

Leiomyosarcoma of the spermatic cord. Case report and review of the literature.

An additional case of leiomyosarcoma of spermatic cord which brings the total reported number to 49, is described. The case is compared with the others and further data on histogenesis and histological behaviour of the tumor, are given. Surgical treatment and role of radiotherapy and chemotherapy, are discussed.

Doppler test after microvascular anastomoses and evaluation of somatostatin administration in segmental canine pancreas autotransplantation. A preliminary study.

Segmental pancreatic transplantation still involves a certain number of possible technical complications. The experimental studies in dogs reported here evaluate the effectiveness of vascular microanastomoses using doppler velocimetry in two groups of dogs which underwent segmental pancreatic autotransplantation. One group was protected by intraoperative somatostatin infusion, while the other was kept as control. The obtained results indicate that the doppler-test revealed early vascular complications (2/20 animals) and that somatostatin administration may play a major role in the prophylaxis of pancreatitis.