[Schwannoma of the ultimate ileal loop. Case report and review of the literature]. / Schwannoma dell'ultima ansa ileale. Case report e review della letteratura.

The paper reports a rare case of malignant ileal schwannoma. A review of the most recent literature confirms the diagnostic and therapeutic procedures used by the authors. Minimal resection or necessary resection in relation to the site and local situation are the only real therapy apart from palliative surgery. It is vital to identify any possible polycentric manifestation since schwannoma is often associated with Recklinghausen's disease. Radiotherapy and chemotherapy are completely ineffective. Responses were obtained in around 30% of cases in the most common trials; the gastrointestinal localization also appears to be even less responsive. The most active drugs are decarbazine, doxorubicin and ifosfamide, associated with CIVADIC or MAID polychemotherapy protocols. It is often difficult to diagnose malignancy; the overall survival rate (taking grading into account) is 7-10% after 10 years and 50% after 5 years for those forms with the lowest degree of malignancy. Antoni classified schwannoma into: type A with a solid component, and type B with a microcystic component. Treatment and prognosis are identical.

Our operative technique for inguinal hernia.

The most commonly used methods of hernia repair are either Bassini repair or modifications of Bassini repair in fact each sutures, with different methods, the three anatomical coats (transversalis fascia, transversus abdominis and internal oblique muscles, external oblique muscle aponeuroses). Here we propose a different operative technique that sutures only two aponeurotic coats (transversalis fascia and over external oblique muscle aponeuroses). The second sutured coat supports the posterior wall of the inguinal canal. Between 1984 and 1989 we operated about 1100 patients with this method and the recurrence rate is in accordance with the incidence of the other usual types of hernia repair.

[A rare complication of obstetric pathology: uretero-uterine fistula]. / Una rara complicanza in patologia ostetrica: la fistola uretero-uterina.

Accidental iatrogenic injuries of ureters and bladder in patients with abdominal and pelvic pathology are described as a possible lesion of a surgical or gynaecologic treatment. The ureteral lesion is less frequent in obstetric surgery, but the young age of the patients and the gravity of the consequences, impose a very serious problem for a early diagnosis with a conservative surgical treatment. On the contrary, this important injury, bears an important surgical management with possible functional damage of the reno-urinary tract. The Authors report the experience about the observation and treatment of a case of a young woman, 29 years old, who had a uretero-uterine fistula, after a cesarean section for the first pregnancy.

[Breast carcinoma in the elderly patient: which treatment?]. / Carcinoma mammario nell'anziano: quale trattamento?

We here describe our experience of the treatment of "breast cancer" in the elderly. The results in this group of patients (37 over 75 years) are like the younger group if: the local control is done; hormonotherapy is prescribed; chemotherapy is done even in the 70-80-year-old group. If a radical mastectomy isn't impossible in the patients over 80, even a simple mastectomy is safe. In this patients a conservative local treatment of the breast is not mandatory. Our over-75-year-old patients have no psychological problem related to mastectomy. They often don't accept obligatory radiotherapy after the conservative treatment of breast cancer, and moreover the breast cancer in the elderly is usual smaller, fibrotic and bigger than 3 cm. Lymph nodal status isn't important for overall survival, but only for the eventual chemotherapeutic treatment, so in patients over 80 year-old simple mastectomy is sufficient because we don't use chemotherapy for the general conditions of the same. The local control of axillary lymph nodes is obtained with radiotherapy if necessary. Screening for breast cancer must also include 70-75-year-old patients. Why is the breast cancer in elderly like the others patients? Some authors have seen that the immuno-reaction around the cancer in elderly is less than the same reaction observed in younger patients. So in the elderly there is a smaller production of "growth factors" important for the growth of the tumor and of "angiogenesis factor", fundamental for the initial growth of the cancer.(ABSTRACT TRUNCATED AT 250 WORDS)

Local control in breast cancer. Old and new lines and analysis of our experience.

The great interest in early breast cancer is caused by hope in the future of treating especially early cancers, extending the indications to a local conservative treatment of the breast with a more and more efficient general treatment. The GIVIO work has proved that the major part of Italian surgeons and gynaecologist don't accept the FIGO protocol. We report our experience (similar to the major part of general surgical division like GIVIO experience) and our results. W. Wood, at ASCO 1991, has indicated the role and optimal techniques for breast conservation in early breast cancer. New lines and our experience have induced us to draw up a new protocol in early breast cancer: we did not carry out Halsted mastectomy because a local invasion of muscle or muscle aponeurosis are treated with local excision and radiotherapy; if the tumour's size is more than 3 cm we did a radical mastectomy because like many authors these cancers have a worse prognosis; under 3 cm we carried out the lumpectomy with the techniques indicated by W. Wood at ASCO 91; we remove the lymph nodes of level 3 only if the axillary lymph nodes are clinically suspected. So we think the same results of local and general control with a lower morbidity are obtained; we are considering introducing neoadjuvant chemotherapy, to increase the indication for a breast conservation treatment.

Seminom cicatrice. About a case of spontaneous testicular regression.

This is a case of spontaneous regression of a tumour. Only the French Authors speak about this type of seminoma called them "seminome cicatrice". Probably the immunological defences are fundamental for the complete or partial spontaneous resolution of this type of tumour. Here we describe our clinical and surgical approach. The last control was normal with a relapse-free patient.

[The pre- and postoperative and follow-up use of the tumor markers MCA, CA-125 and CA-19-9]. / Utilizzazione pre- e postoperatoria e nel follow-up dei markers tumorali MCA, CA 125, CA 19,9.

The paper describes the authors' personal experience of the use of tumour markers, above all during postoperative follow-up as well as during the evaluation of the response to adjuvant and other forms of chemotherapy. The authors affirm that the use of these markers is fundamental for a correct evaluation and rapid treatment, above all in the identification and treatment of recidivation.

[Choleperitoneum following Kehr's T-tube removal: conservative treatment with culdocentesis associated with sphincterotomy and endoscopic drainage of the bile ducts]. / Coleperitoneo conseguente a rimozione di tubo a T di Kehr: trattamento conservativo a mezzo di culdocentesi associata a sfinterotomia e drenaggio perendoscopico della via biliare.

The Authors present a case of bile peritonitis due to a biliary fistula developed after T tube removal from the common bile duct. Highlighting poor clinical manifestations they report an alternative conservative treatment, by drainage of the bile leakage with culdocenthesis and successive endoscopic spincterotomy and transpapillary drainage.

[Intestinal invagination caused by submucous pedunculated lipoma of the large intestine]. / Invaginazione intestinale da lipoma peduncolato sottomucoso del grosso intestino. Caso clinico.

A case of colo-colic invagination caused by lipoma of the splenic flexure which led to emergency operation is reported. Colon lipomas are benign neoformations of the submucosa with prevalence of the right colon and with a frequency of from 0.3% to 5.8% in the whole population depending on clinical or autoptic series. Radiological and endoscopic investigations provide orientative elements for diagnosis. The most frequent complications are bleeding and intussusception in 50% of cases. Surgical removal may be carried out, preferably segmentary resection, so as not to be forced to operate on a complication in emergency conditions.

[Use of computerized axial tomography and transrectal echography in the preoperative evaluation of cancer of the rectum]. / Impiego della tomografia assiale computerizzata e della ecografia transrettale nella valutazione preoperatoria del cancro del retto.

Eight patients were subjected to two types of preoperative investigation in the attempt to stage cancers localised in the final 13 cm of the rectum: CT scan and transrectal echography. CT scan was used to assess infiltration of perirectal tissues and any lymph node metastases. Echography was used to examine the degree of infiltration of the rectal wall. Patients were then submitted to surgery. The predictivity of these studies proved sufficiently high. 7 Miles amputations and 1 anterior resection were carried out. One case only in which the scan did not show signs of parietal lesions presented two perirectal lymph node metastases. If refined further, these evaluations will therefore influence surgical tactics.

[Primary duodenal lymphoma. Communication of a case]. / Linfoma primitivo duodenale. Comunicazione di un caso.

Primary malignant lymphoma of the duodenum is a rarity. A case of primary non-Hodgkin lymphoma of the duodenum is reported. Symptoms, signs, radiographic and endoscopic findings are discussed. C.T. with C.V.P. were performed in addition to subtotal pancreatico-duodenectomy Follow-up, after one year, did not show any signs of recurrence.