[Locally recurrent rectal cancer. Our experience]. / Recidiva locoregionale da cancro del retto operato. Esperienza personale.

The aim of this study was to describe the personal experience in the treatment of 31 patients (19 males, 12 females) with local recurrence following surgery for rectal adenocarcinoma. The exeresis of recurrence was possible in 17 patients (6 Miles, 9 Hartmann, 1 re-resection, 1 transanal resection); of these, only 6 patients reported an improvement of the quality of life. Patients surgically treated and patients with recurrence inoperable and submitted to palliative treatment (colostomy, pain control, radio- and/or chemotherapy) showed similar survival rates.

[Gastrointestinal stromal tumors: five case reports and review of the literature]. / Tumori stromali gastrointestinali: cinque casi clinici e revisione della letteratura.

Being a rare entity, GISTs represents the most common subset of mesenchymal tumours that arise from the digestive tract. Their immunohistochemical and histopathologic features distinguish them from other gastrointestinal mesenchymal neoplasms. These tumours have been the matter of considerable debate in the literature regarding their histogenesis, criteria for diagnosis, prognostic features and treatment. GISTs express Kit protein that not only is a marker for diagnosis but has also permitted to identify a specific medical treatment. The exceptional interest aroused in the literature leads us to make a review about this subject reporting five cases treated in the last 2 years.

[Abdominal Wells rectopexy with patch micromesh PTFE (Goretex)]. / Rettopessi per via addominale secondo Wells con patch mycromesh PTFE (Goretex).

The aim of this study is to discuss the surgical treatment of rectal prolapse. The surgical therapy offers many different options. Beginning from 1970 the anterior rectopexy has been considered a technique with good results, also in the elderly patient, when the general conditions allow it. Author's experience concerns the surgical treatment of 4 patients (2 males and 2 females) with complete symptomatic rectal prolapse, treated with anterior access laparotomy with the technique of Wells, leaving 1/3 of anterior rectal wall free from suture. Patients had a regular postoperative course; only in 1 case there was a delay of the canalization. At 1 year after the rectopexy the results are satisfactory, with absence of recurrence and troubles of the evacuation. The high percentage of successes of the anterior rectopexy is founded on: 1) the mobilization of the rectum, complete or only posterior; the rectal vessels must be respected, but there isn't consent on the opportunity of the section of the lateral ligaments. It may cause a denervation of the anorectum with an alteration of the fecal evacuation; and 2) the process of cicatritation by the employment of mesh and PTFE material that fix the rectum to the sacred maintains it as in the desired position.

Peritoneal mesothelioma in a case of inguinal hernia. A review of the literature.

The peritoneal mesothelioma (PM) is a rare, benign or malignant, primary tumour, arising from the peritoneal membrane. The most frequent histological form is the malignant one with an incidence of 2-2.6 new cases per million per year. The symptomatology is insidious and poses difficult problems in the diagnosis and the treatment. Instrumental diagnostic investigations are useful only in the diagnostic orientation. Only the pathologic examination allows to distinguish a peritoneal carcinomatosis from PM. The prognosis of MPM is pour. An intense multimodal therapy, combining surgery with CT and RT, increases the survival rates in the patients with MPM. It has been proposed that hernia of abdominal wall play a role in the pathogenesis of this tumor. We believe that hypothesis seems unlikely considering the enormous discrepancy between the incidence of hernial pathology and PM.

[Compatibility, indications, and limits of nerve sparing technique in lateral pelvic lymphadenectomy for advanced rectal carcinoma]. / Compatibilità, indicazioni e limiti della nerve sparing technique nella linfadenectomia pelvica laterale per carcinoma del retto avanzato.

The aim of radical surgical treatment of rectal cancer is to control the spread and prevent recurrence of the disease. In an attempt to improve the results of treatment of locally advanced rectal cancer, we advocate an extended surgical approach consisting of total mesorectal excision, lateral pelvic lymphadenectomy and the nerve sparing technique with resection of autonomic nerves whenever these fibers are affected by locally advanced tumor. Nine cases (9.2%) in a personal series of 98 patients with rectal carcinoma, operated on over the period from January 1992 to December 1997, underwent total mesorectal excision, lateral pelvic lymphadenectomy and the nerve sparing technique procedures for locally advanced extraperitoneal disease. In 7 patients with stage II or III disease, the 5-year survival rate was 80% and the 5-year disease-free survival rate 66.7% after a mean follow-up of 55 months. None of them experienced local recurrence, but one patient died of diffuse metastatic disease 50 months after surgery. One patient with stage IV rectal cancer died of disease 13 months postoperatively, while another patient with the same stage of disease is still alive with disease 26 months after surgery. One patient underwent liver resection for a solitary metastasis 25 months after the primary operation. Two patients suffered postoperatively from urinary retention with mild irregular flow at urodynamic testing, but no long-term urinary disturbances persisted. Retrograde ejaculation occurred postoperatively in one of the two patients who experienced urinary disorders, and another patient had erection disturbances. These sexual dysfunctions did not improve during long-term follow-up. Total mesorectal excision, lateral pelvic lymphadenectomy, and the nerve sparing technique, with resection of the autonomic nerves whenever these fibers are involved, allow satisfactory results to be achieved in terms of survival and functional outcome in patients with locally advanced rectal cancer. In western subjects, however, this procedure is safe only after careful patient selection.

Evaluation of anal function after surgery for rectal cancer.

BACKGROUND AND OBJECTIVES: Sphincter-saving surgical procedures for rectal cancer have been legitimized if executed respecting the criteria of oncological radicalness. Our objective was to evaluate anal sphincteric continence after rectal cancer surgery. METHODS: A detailed questionnaire regarding continence was administered to 3 groups of patients. Group 1 was composed of 9 patients treated with a higher (>4 cm), stapled colorectal anastomosis; the 9 group 2 patients were treated with a low (< or =4 cm), stapled colorectal anastomosis; the 9 group 3 patients underwent coloanal anastomosis. RESULTS: The results were evaluated about 3 years after surgery. Continence was excellent in group 1 and very good in group 2. However, in group 3, we observed diminished gas/feces discrimination, reduced ability to postpone evacuation, and increased soiling and perianal rash. CONCLUSIONS: Anal sphincteric continence was better after surgery with a high or low colorectal anastomosis than after coloanal anastomosis.

[The megacolon in myotonic dystrophy: case report and review of the literature]. / Il megacolon nella distrofia miotonica: case report e review della letteratura.

Myotonic dystrophy (MD) is an autosomal dominant inherit disease, slowly progressive, involving multiple organ systems. Disorders at any level of the gastrointestinal tract are relatively common and manifest as disturbances in motility, such as impaired esophageal transport, delayed gastric emptying, and megacolon. A 51 years-old man was admitted to our surgical department with obstructive symptoms. Diagnostic evaluation showed megacolon and the typical clinical features of the MD, such as weakness, myotonia, frontal baldness and testicular atrophy. Risk of perforation and dehydration led to emergency total colectomy with ileorectal stapled anastomosis. The patient didn't suffer for compliance related to surgical treatment but, after 1 month in intensive care, died of pneumonia and myocardial infarct. The overall frequency of perioperative complications in patients with MD ranges from 8.2 to 42.9%. The risk of perioperative pulmonary complications is particularly high. Thus, we believe that the conservative treatment of motility disorders of the bowel in patients with MD is to be justified and that surgical treatment should be reserved, as last resort, performing a early diagnosis and careful monitoring during perioperative period.

[Traditional cholecystectomy in a patient with situs viscerum inversus partialis]. / Colecistectomia per via tradizionale in paziente con situs viscerum inversus partialis.

The authors discuss the etiology of situs viscerum inversus partialis (SVIP), the associated anomalies and the malformations and the relative clinical problems, reviewing the international literature. The present a case of a 51 years old female with a diagnosis of umbilical hernia and cystocele. During hospitalization the patient complained a typical acute cholecystitis pain. The patient underwent ultrasonography, CT scan, and MNR that allowed us to diagnosis a calculous cholecystitis with SVIP and was elected for an open cholecystectomy. The Authors describe the surgical technique in relation to the anatomic anomalies, in particular vascular ones, that were discovered with the imaging studies and confirmed at laparotomy.

[Synchronous and metachronous colorectal cancers: a case series contribution]. / I cancri sincroni e metacroni del colon-retto: contributo casistico.

The Authors, on the basis of their experience with neoplastic colorectal pathology and after a review of the Literature, report a reappraisal of the problems related to colorectal multiple carcinomas. They emphasize the importance of routine preoperative pancolonoscopy for the identification of possible synchronous tumors (both benign and malignant) and periodic endoscopic follow-up (ideally a life-long one) for the detection and removal of all adenomatous polyps as well as early stage metachronous carcinomas, especially for patients with HNPCC. Besides, they stress the importance of sensibilization of the population about the heritability of colorectal carcinomas.

Radiotherapy versus radiotherapy enhanced by cisplatin in stage III non-small cell lung cancer.

Between January 1987 and June 1991, 173 patients with inoperable non-small cell lung cancer, Stage III, were entered into a randomized trial comparing radiotherapy only (RT) (45 Gy/15 fractions/3 weeks) (arm A) versus RT and a daily low dose of cDDP (6 mg/m2) (arm B). An overall response rate of 58.9% was observed in arm A and 50.6% in arm B, respectively. No differences in the pattern of relapse were noted between the two treatment groups. Median time to progression was 10.6 months for arm A and 14.2 months for arm B. Median survivals were 10.3 months and 9.97 months, respectively. Toxicity was acceptable and no treatment-related death occurred in either treatment schedule. In this study no significant advantage of the combined treatment over radiation therapy only was found. The encouraging results achieved in some trials together with the intractability of the disease suggest that further efforts should be made to optimize clinical trial protocols, perhaps by reviewing the radiobiological and pharmacological basis of the combined treatment.

[Computerized tomography of the skull in children with lymphoblastic leukemia treated with prophylactic cranial radiation]. / Tomografia computerizzata del cranio in bambini con leucemia acuta linfoblastica sottoposti ad irradiazione cranica profilattica.

Thirty asymptomatic patients with acute lymphoblastic leukemia who had received prophylactic cranial irradiation (16 pts had 2400 cGy, 14 pts 1800 cGy) and intrathecal methotrexate were studied by computed tomography of the brain 60 to 148 months after initiation of prophylaxis. Three of 30 (10%) patients presented abnormal findings: widening of frontal subarachnoid space (1 patient), little area of decreased attenuation coefficient (1 patient), and intracerebral calcifications (1 patient Tomography abnormalities could be detected either in patients treated with 2400 cGy and in those treated with 1800 cGy. None of our patients showed central nervous system dysfunctions on physical examination. The results of our study suggest that tomography findings have a poor clinical significance.

[Radiotherapy of lymphomas]. / La radioterapia dei linfomi

The treatment of choice for lymphomas in general and 1st and 2nd stage Hodgkin's disease in particular in high-energy radiotherapy. This has led to improved results, especially with respect to survival. The most effective techniques are those directed to all the lymph nodes, including the spleen "total nodal irradiation". Supradiaphragmatic areas are managed by means of Kaplan's mantle technique, whereas the wide-field upside-down Y technique is used below the diaphragm. These new methods are described and statistics relating to their employment published by Stanford University and the National Cancer Institute are cited.