[Littoral hemangioma of the spleen]. / Emantioma littorale della milza.

The authors report a rare case of littoral hemangioma of the spleen (LHS) accompanied by a revision of the literature on the argument. A male 65-year-old patient was referred to their attention with suspected ultrasonographic diagnosis of lymphoma with a splenic localisation. The complete CT diagnosis led to suspected splenic angioma. During surgery, anatomopathological analysis of the biopsy revealed LHS. The pathological anatomy showed lesions ranging in size from small foci to large nodules which almost completely replaced the splenic parenchyma. These areas were made up of vascular canals or axes that imitate splenic sinuses and have irregular lumen, often appearing as papillary projections and cyst-like spaces; they are bordered by high (cylindrical) endothelial cells that project into the vascular lumen and reveal hemophagocytosis; there is very little mitotic activity. The patient was discharged 7 days after surgery. The authors underline the extreme rarity of this neoplasm and the virtual absence of symptoms, although some cases report signs of hypersplenism, including platelet deficiency and anemia. The diagnostic iter must take care to exclude other pathologies affecting the spleen, including lymphoma, metastases and primary malignant splenic tumours. Lastly, a differential diagnosis must be made with the malignant variant, littoral hemangiosarcoma of the spleen.

[Videolaparoscopic cholecystectomy in the obese patient]. / La colecistectomia videolaparoscopica nel paziente obeso.

The difficulties which arise when performing VLC in obese patients primarily concern the induction of pneumoperitoneum and the use of normal surgical instruments. This is due to the thickness of the abdominal wall and the scarce anchorage of the cutis and subcutis to the musculo-fascia level. Two technical variations of pneumoperitoneum are proposed in order to overcome the first problem, whereas with regard to the latter the authors suggest moving the trocar insertion points towards the site of the gallbladder.

[Retroperitoneal paragangliomas. Considerations on a internephro-caval case]. / I paragangliomi retroperitoneali. Considerazioni su di un caso internefro-cavale.

A case of paraganglioma situated between right renal vein, right renal artery and inferior vena cava is here with described. The report constitutes the rise to frame with precision the tumor according with WHO classification. Moreover criteria are to be discussed for nature and seat diagnosis, as well for the choice of the best way of access.

["Prophylactic" video-laparoscopic cholecystectomy]. / La colecistectomia videolaparoscopica "profilattica".

The authors examine the prophylaxis of infections caused by cholelithiasis in kidney and heart transplant candidates as a new indication for videolaparoscopic cholecystectomy (VLC). The study included 6 patients in dialysis for chronic renal insufficiency and one patient suffering from cyanogenic congenital cardiopathy with asymptomatic gallbladder calculosis. The results obtained show that there are no substantial differences compared to patients without associated pathologies and justifies the inclusion of "prophylactic" VLC in preparatory treatment protocols for kidney and heart transplant in patients suffering from cholelithiasis. The authors emphasise the necessary technical measures to prevent hemorrhage, intraoperative loss of CO2 and postoperative laparoceles.

[Carcinoma of the gastric stump. Our experience]. / Il carcinoma del moncone gastrico. Nostra esperienza.

The authors have examined eight patients operated at the Department of Surgery "B" of the G. Bosco Hospital (Torino) from 1980 to 1992 for gastric stump cancer. All patients were male of about 72 years who were subjected to resection: 5 for gastric ulcer and 3 for duodenal ulcer. During the first operation they used the same recanalization technique after gastric resection: the semi-oral distal gastric jejunal anastomosis created by Hofmeister-Finsterer. The second operation was the subtotal gastric resection made on 6 patients, total gastrectomy in 1 case and explorative laparotomy in an inoperable case. The average of free time from disease was 32 years while it is 24 years in literature. The mean survival was 40 months. The 5-year survival was about 33%. The authors conclude that carcinoma of the gastric stump has a worst prognosis then carcinoma in normal stomach. The subtotal resection has the same results as in total gastrectomy.

[Current surgical approach in the treatment of pancreatic pseudocysts]. / Attuale orientamento chirurgico nel trattamento delle pseudocisti pancreatiche.

INTRODUCTION: The paper evaluates the role of surgery in the treatment of pancreatic pseudocysts in the light of current knowledge. The authors underline the important part played by ultrasonography and CT in monitoring the evolution of pseudocysts: ETG on account of its high levels of sensitivity and specificity and CT due to its diagnostic accuracy which is equivalent to almost 100%; these methods allow the surgeon to decide if and when to operate. MATERIALS AND METHODS: A series of operations were carried out by the authors' division in 15 patients suffering from pancreatic pseudocysts. Emphasis is placed on the high percentage of emergency operations, 40%, due to complicated pseudocysts. External drainage was always used in emergency surgery, whereas in elective surgery it was preferred to use cystojejunostomy with a Roux-en-Y loop, followed by cystogastrostomy; cystoduodenostomy was only chosen in one case. The operative mortality rate was 20%. DISCUSSION: In elective surgery the operation which currently gives the best results is cystojejunostomy with a Roux-en-Y loop, but cystogastrostomy should not be overlooked due to the ease with which it is performed. A recent acquisition is the use of needle aspiration and CT- or ETG-guided percutaneous drainage in the treatment of post-necrotic pseudocysts, therefore after 4-8 weeks' maturity, both in a rapid-growth from and in the event of suppuration. Pancreatic resection is indicated for multiple atypical pseudocysts caused by retention, and this also serves to treat the underlying pancreopathy. Duodenocephalopancreatectomy is now considered to be excessive by the majority of authors. In emergency surgery, drainage of the pseudocysts is the method of choice using either a surgical or percutaneous method.

[Palliative endoscopic treatment of esophageal neoplastic stenosis]. / Considerazioni sul trattamento palliativo endoscopico delle stenosi tumorali dell'esofago.

The authors examined a series of 231 patients suffering from unoperable neoplastic dysphagia of the esophagus and treated using prevalently palliative endoscopic methods (photocoagulation and/or intubation) during the period 1980-1991. They draw the following conclusions: a) endoscopic methods are better than surgical techniques; b) there are a greater number of indications for endoscopic intubation than for photocoagulation (approximately 2 to 1); c) some situation which are indicated for photocoagulation are not contraindicated for intubation; d) the sole contraindication for intubation is stenosis in which the proximal limit is less than 2 cm from the upper esophageal sphincter; e) contraindications for photocoagulation are long stenoses and/or those of the infiltrating type, and/or involving the upper third of the esophagus; f) sometimes the two methods may be complementary in the sense that intubation may be preceded by a few photocoagulation sessions in order to necrotize the vegetating portion of an infiltrating tumour; g) it is best to choose intubation wherever possible since this technique is less expensive and the quality of remaining life better, even if the percentage of severe and generally fatal complications (perforation) is still too high; h) the possible introduction of expandable metal prostheses might increase indications for intubation and reduce the number of severe complication.

[Intra-operative irrigation during colonic resection and anastomosis in colonic obstruction]. / Wash out intraoperatorio con resezione anastomosi in tempo unico nell'occlusione colica.

The faecal loading associated with colonic obstruction is a fundamental deterrent to constructing a primary distal colonic anastomosis. The authors describe their preliminary experience of intraoperative colonic irrigation in the management of left sided large bowel emergencies. Five patients were operated using this technique (4 cancer obstruction and one sigma volvulus). They show good results performing primary anastomosis after emergency distal resection combined with complete colonic cleansing.

[Intestinal malrotations in the adult]. / I difetti di rotazione intestinale nell'adulto.

The paper reports a case of intestinal malrotation in an adult patient with an anomalous location in the left hypochondrium of the cecum and vermiform appendix. The patient underwent explorative laparotomy for peritonitis due to acute appendicitis. Following a review of the literature, the anomaly was classified in embryological terms as a union defect during the third developmental stage of the umbilical loop. Attention is focused on the importance of an exact knowledge of the embryology of intestinal rotation in order to avoid technical surgical errors. In conclusion, the value of giving the patient precise iconographic documents is stressed in order to inform the surgeon who may have to operate on the patient's abdomen in the future.

[Lipoma of the large intestine]. / Il lipoma del grosso intestino.

A case of lipoma of the colon with a clinical picture of intestinal occlusion due to colo-colic invagination is reported. The invagination diagnosis was arrived at preoperatively by opaque clysis and echography. Surgical treatment consisted of segmentary resection owing to trouble in the affected ansa.

[Dermoid cysts of the ovary]. / Le cisti dermoidi dell'ovaio.

Primordial germinative cell differentiation anomalies give rise to a whole array of generally benign ovarian tumours which are sometimes of glandular structure and functionally active. In certain cases, they deviate from their normal proliferative line and give rise to malignant tumours of various histological nature. Attention is called to the malignant variations of dermoid cysts and to the importance of careful differential diagnosis for the purpose of correct surgical conduct.

[Biliary ileus. Presentation of 4 cases and review of the literature]. / L'ileo biliare. Presentazione di 4 casi e revisione della letteratura.

Gallstone ileus is a rare condition whose diagnosis may be puzzling. A series of 4 cases of gallstone ileus is presented. The last twenty years' literature was reviewed and compared with our results. Enterolithotomy was performed in all patients and no surgery was performed on the gallbladder and/or the fistula. The outcome was favourable in all cases, thus supporting our procedure.