[Comparison of plasma matrix metalloproteases 2, 3, 9 in breast carcinomas and fibroadenomas]. / Confronto dei valori plasmatici delle metalloproteasi della matrice 2, 3, 9 in pazienti con carcinomi e fibroadenomi mammari.

Tumor cell infiltration causes the remodelling of peritumoral tissues, determined by an increased lytic activity of extracellular matrix exerted by the neoplastic invasive phenotype. Among the principal lytic enzymes produced by tumor cells and mainly involved in invasion process there are the matrix metalloproteases (MMPs). The Authors compared the plasmatic values of MMPs 2, 3, 9 from patients with breast carcinomas and fibroadenomas in order to evaluate whether there was a significant difference between the two groups of patients. MMPs 2, 3, 9 values were quantified by ELISA test from plasma collected 24 hours before surgery in 50 breast carcinomas and 30 fibroadenomas. MMP2 mean value from the patients with carcinomas resulted significantly higher as compared to that from the patients with fibroadenomas; while for MMP 3 and 9 mean values was not possible to find a significant difference between the two groups of malignant and benign breast tumors. These data confirm the main role played by MMPs during the tumor invasion process. Therefore, it is possible to propose the future inclusion of MMP2 test, together to other biological and clinical data, for prognostic evaluation of neoplastic breast lesions.

[Posterior mediastinum neoplasms: a case of schwannoma]. / I tumori del mediastino posteriore: un caso di schwannoma.

The Authors report the case of a 33-year-old male affected with an asymptomatic schwannoma of the posterior mediastinum, and review the relevant Literature, discussing the difficulties in making the differential diagnosis of the posterior mediastinum lesions, particularly in the pre-clinical phase. Neurogenic tumors represent about 75 percent of all tumors of mediastinum and about one third of all tumors of the mediastinum. They can originate from the peripheral nervous system group, from the sympathetic nervous system group or, in rare cases, from the vagus nerve. In adult patients, they are usually found by chance during radiographic examination of the thorax, and they are usually asymptomatic and benign. During preoperative evaluation, a magnetic resonance examination of rachis should be done to exclude the possibility of intraspinal involvement. If there are no contraindications, the treatment of choice should be surgical resection by means of thoracoscopy or thoracotomy, when size and location of the tumors allow it in order to prevent malignant evolution.

[Neurinoma of the brachial plexus: 2 case reports]. / Neurinoma del plesso brachiale: due casi clinici.

Neurinomas, also referred to as neurilemmomas and schwannomas, are rare benign tumours of the peripheral nerves. A small percentage of these lesions arise from the brachial plexus. The Authors report two cases of schwannoma arising from the brachial plexus. Such lesions, usually asymptomatic, may cause sensitivity alterations or, less frequently, motor deficits in the involved arm. Tumour enucleation, avoiding damage to any of the nervous fascicles, is the treatment of choice.

Sentinel node role in breast cancer surgery.

Radical surgery of breast cancer includes lymphadenectomy of axilla as well as the dissection of the neoplastic tissue. However recently many works have raised doubts on the opportunity of performing routinary axillary dissection, which elevates morbidity risk, in absence of axillary metastases. However, unfortunately, information on axillary lymph node pathology, is not available with any other technique excluding complete dissection and istopathological examination. Sentinel node technique is a new methodology that consents evaluation of lymph node status in the operating theatre. It allows the surgeon to judge on the opportunity of carrying out the lymphadenectomy or not.

[The future prospects of antithrombotic therapy in peripheral vasculopathy]. / Le prospettive future della terapia antitrombotica nella vasculopatia periferica.

Peripheral vascular disease is characterized by progressive atherosclerotic deterioration of peripheral arteries and coronary and cerebral vascular complications. Antiplatelet treatment retards the progression of peripheral atherosclerosis but it is still unclear if this is associated with a reduced risk of amputation. Vasodilator prostaglandins have been administered in critical ischemia but the results have been disappointing. An alternative approach to enhance peripheral vasodilation is to increase nitric oxide production, which is reduced in peripheral vascular disease, particularly in the case of severe ischemia. Critical ischemia secondary to thromboembolism has been treated with thrombolysis within 7 days of the acute episode, but this approach is no more effective than vascular surgery in reducing amputation; earlier treatment should be planned to further investigate its clinical efficacy. The effect of antiplatelet treatment in preventing cardiovascular events was investigated in three randomized trials with negative results. A post-hoc analysis of the CAPRIE study demonstrated that clopidogrel is superior to aspirin in preventing cardiovascular disease. This suggests that antiplatelet treatment may be efficacious in this setting; future study should assess if its combination with other drugs, such as statins, that retard coronary atherosclerotic progression, could further reduce cardiovascular complications in peripheral vascular disease.

A rare case of pulmonary neurofibroma: clinical and diagnostic evaluation and surgical treatment.

The authors report a rare case of a pulmonary neurofibroma treated by surgical excision. The case report is accompanied by a review of the literature and the discussion of the diagnostic problems posed by neurogenic tumors of the thorax.

[Ambulatory phlebectomy with Müller procedure in the treatment of lower limb varices. Indications, technique and long-term results]. / La flebectomia ambulatoriale sec. Müller nel trattamento delle varici degli arti inferiori. Indicazioni, tecnica e risultati a distanza.

The authors report the results of more than five years experience of phlebectomies, according to Müller's method, performed both in general anesthesia during stripping operations and in local practice. The results confirmed the validity of this complementary surgical treatment for its radicality, execution simpleness and best respect for aesthetics.

[Acute enterorrhagia in a young adult: emergency treatment]. / Enterorragia acuta in età giovanile: trattamento d'urgenza.

A case of enterorrhagia sustained by arteriovenous malformation of the caecum in a young patient is reported. The importance of an early diagnosis to avert a serious anemia is underlined. Preminent role of colonscopy and selective visceral angiography in the diagnosis of such disease is discussed. At first a conservative urgently treatment of caecum bleeding is advised. Subsequently, when the patients is in more favourable conditions, an elective surgical operation is considered as essential.

Use of the fiberoptic bronchoscopy in the elderly.

The authors emphasize the primary role fiberoptic bronchoscopy has for diagnostic and therapeutic purposes in the elderly affected by pulmonary disease. Safety, efficacy and tolerability of the method in the elderly are obtained through a preliminary and careful evaluation of the patients, either clinical or instrumental.

[A geriatric case of colonic angiodysplasia]. / Su di un caso di angiodisplasia del colon in età geriatrica.

A case of colic angiodysplasia in an elderly patient affected by chronic renal failure is discussed. Different methods suitable for management of these vascular ectasies are briefly reported. Prominent role of colonoscopy in the diagnosis of such disease is emphasized.

[The echographic characterization of pancreatic pseudocysts]. / Caratterizzazione ecografica delle pseudocisti del pancreas.

The diagnosis of pancreatic pseudocyst is still troublesome. In 95% of cases a correct diagnostic evaluation can be achieved by means of ECT or CT scan, ERCP, NMR, EE etc.. ECT and CT scan in particular are the most specific and accurate techniques. ECT scan is currently the up-to-date method for initial diagnosis and continuous monitoring of the lesion. In fact, very interesting real-time data and exact features of the wall of the cysts may be obtained by ECT scanning also suggesting the best therapeutic choice.