[Acute diverticulitis of the right colon. Report of 3 cases]. / La diverticolite acuta del colon destro. Descrizione di tre casi.

Three cases of acute diverticulitis of the right colon are described and a review of the international literature about this rare disease is made. Diverticulitis of the ascending colon is an uncommon disease which mimics appendicitis or perforated neoplasm. The correct diagnosis is rarely made, but can be suggested by signs and symptoms and confirmed by the barium enema. It should be treated conservatively, like left-colon diverticulitis. Isolated diverticula can be managed by simple excision and primary closure. Local resection may be necessary if the involved area is too large. Right hemicolectomy is performed when carcinoma is strongly suspected.

[Surgical treatment of parathyroid hyperplasia]. / Il trattamento chirurgico dell'iperplasia delle paratiroidi.

BACKGROUND: To review a series of 11 patients affected by hyperplasia of parathyroid glands and to discuss diagnostic and therapeutic tools. METHODS: A series of 11 patients out of 44 (= 25%) with primary hyperparathyroidism has been retrospectively reviewed. They underwent surgery in I surgical Department of OORR of Bergamo. All 11 patients were submitted to ultrasound and computed tomography examination before surgery, without any localisation of hyperplastic or adenomatous tissue. An exploring cervicotomy was performed with subtotal parathyroidectomy after the anatomopathological result of hyperplasia. RESULTS: No adverse effects related to surgery were observed. All patients could be considered as cured with a median follow-up of 36 months. CONCLUSIONS: Among hyperparathyroidism, hyperplasia is an underhand form and even if the laboratory diagnosis is simple, the imaging techniques cannot always localise the pathologic tissue. Personal experience shows the role of subtotal parathyroidectomy (removal of 3 parathyroid glands and a half of the last one) confirmed by the absence of adverse effects or relapse with a median follow-up of 36 months.

[Multifocal carcinoid of the stomach]. / Il carcinoide multifocale dello stomaco.

Carcinoid tumors are among the most frequently reported neuroendocrine neoplasms of the gastroenteropancreatic system. They occur more commonly as benign diseases but malignant ones can also be found. Gastric carcinoid is an uncommon pathology which accusin 2% of the carcinoid tumors of various districts and 0.5% of the gastric carcinomas. The authors report a case of gastric malignant multifocal carcinoid, diagnosed in a 63 year-old female patient. Diagnosis was confirmed at histologic analysis of the operating piece. The aim of this paper has been to review the frequency, prognosis and treatment of this neoplasm in the literature.

[Epidemiological behavior of perforated peptic ulcer before and after the introduction of the antisecretory drug therapy. Our experience]. / Il comportamento epidemiologico dell'ulcera peptica perforata prima e dopo l'introduzione della terapia medica antisecretiva.

The diagnostic iter and treatment of peptic ulcer have evolved considerably over the past 20 years. The capillary spread of endoscopy has permitted secure and precise diagnoses to be made, in terms of both the site and size of the anatomic lesion, on the one hand, and on the other, the introduction of antisecretory drugs has led to the resolution of the majority of ulcers, so much so that the ulcer is no longer managed using strictly surgical methods but is now treated medically and only emergency cases, such as perforations, undergo surgery. Complications, such as digestive hemorrhage, penetration and stenosis, may lead to the need for surgery. In particular, perforation seems to be the only complication which has not been significantly influenced by the introduction of antisecretory therapy, the point that its status as a "complication" has been questioned leading to the suspicion of its nosological autonomy. The authors review the series of ulcer patients admitted to hospital during the period 1968 to 1991, paying special attention to the correlation with the use of antisecretory drugs which were introduced during the period 1978-1981, the trend of ulcer complications over the entire period, the duration of symptoms and the epidemiology of peptic and perforated ulcers.

[Diagnostic findings and the surgical treatment of liver metastases: our experience]. / Orientamenti diagnostici e trattamento chirurgico delle metastasi epatiche: nostra esperienza.

The authors report their 10 year experience of 32 consecutive hepatic resections for metastases. All patients were preoperatively evaluated with US and CT, however, in 9 cases the diagnosis was obtained at laparotomy. In the first years there were no codified criteria for indications to surgery, while recently these were restricted, because of more favourable prognostic evaluations, to the metastases from colorectal carcinoma, endocrine or carcinoid tumours, digestive system neoplasms invading adjacent liver (in this case usually with palliative goal). The low mortality and morbidity registered explain the safety and efficacy of this procedure, also taking into account the fact that currently surgery is the only effective procedure with curative purpose. Criteria for patients selection, particularly in case of colorectal cancer, are referred and discussed and consequently prognostic factors are proposed: hepatic involvement extent, stage of primary tumour, absence of extrahepatic metastases, disease free interval between resection of primary tumour and hepatic resection for metachronous metastases.

Hyponatremic hypertensive syndrome and massive proteinuria in a patient with renin-producing leiomyosarcoma.

We report a case of renin-producing leiomyosarcoma associated with the hyponatremic hypertensive syndrome and nephrotic-range proteinuria. Extremely high levels of active renin and, to a greater extent, of prorenin were found in plasma and tumor tissue. Immunohistochemical and in situ hybridization studies demonstrated that the neoplastic cells were the source of renin production. The hyponatremic hypertensive syndrome and proteinuria promptly responded to treatment with angiotensin-converting enzyme inhibitors, suggesting an angiotensin II dependency of these disorders. After removal of the leiomyosarcoma, plasma concentration of active renin, but not of prorenin, normalized and the hypertension, proteinuria, and electrolyte abnormalities disappeared. However, 5 months after operation, the patient presented once again with hypertension, hypokalemia, proteinuria, and markedly increased plasma levels of both active renin and prorenin that heralded the relapse of neoplastic disease.

[Surgical treatment of liver trauma: our experience]. / Il trattamento chirurgico dei traumi epatici: nostra esperienza.

The Authors report their ten-year experience in the surgical treatment of liver injuries. Thirty-five patients underwent emergency laparotomy for hepatic trauma: 14 showed associated injuries, mostly of the spleen, while 21 had isolated liver lesions. Emergency surgical operation was performed for those patients with hypovolemic shock due to massive haemoperitoneum, while for all stabilized patients a preoperative ultrasonography or a computerized tomography was diagnostic. With a correct diagnosis, nowadays possible thanks to the overmentioned radiologic means, a group of patients was not treated by laparotomy, but strictly monitorized. For the patients who underwent laparotomy, good results with a low mortality rate were obtained using a surgical conservative treatment.

[The diagnostic and therapeutic problems of endocrine tumors of the digestive system: our experience]. / Problematiche di diagnosi e terapia dei tumori endocrini dell'apparato digerente: la nostra esperienza.

The authors experience in the surgical treatment of endocrine tumours of the digestive tract is reported. Particularly, they emphasize that in spite of the several syndromes associated with these neoplasms, diagnostic and therapeutic concepts herein analyzed are similar.

[Quandrantectomy in the conservative treatment of breast carcinoma]. / La quadrantectomia nel trattamento conservativo del carcinoma della mammella.

Two years after the first evaluation, the authors review the results of quadrantectomy in the conservative treatment of breast carcinoma. Local control of the disease by quadrantectomy with axillary lymphadenectomy and radiotherapy has been more difficult in the T2 patients (4 local relapses out of 41 patients) compared T1 patients (3 local relapses out of 52 patients). Nodal involvement appears to be not crucial for the prognosis (7 patients out of 10 with remote metastases were N- at the time of surgery).

[Primary malignant lymphoma of the parotid gland. Report of a case]. / I linfomi maligni primitivi della parotide. A proposito di un caso.

Primary malignant lymphoma of the parotid gland is often correlated, in literature data, with inflammatory autoimmunological disease of the salivary gland. Finding of blasticlymphoid cells in myoepithelial scialoadenitic areas in a case of parotid disease is described by the Authors. Needle may be useful in detecting these high radio-chemosensitive neoplasms to reduce the occurrence of complications of total parotidectomy.