[Endothoracic goitre: anatomoclinical and therapeutic considerations]. / Gozzo endotoracico: considerazioni anatomocliniche e terapeutiche.

Substernal goitre is a clinical condition in which the masin bulk of the enlarged gland is firmly located in the chest. The incidence of this pathology ranges in literature from 1.7% and 30%. This study examines 230 cases of substernal goitre out of a total 5.362 operations performed from 1965 to 2000, for thyroid gland pathologies (4.36%). According to their experience the Authors propose a classification based on the anatomical location of the goitre: right, left, anterior and posterior goitre are therefore identified. The surgical procedures performed include 136 subtotal thyroidectomies (59.1%), 59 emithyroidectomies (25.7%) and 23 total thyroidectomies (10%). In 12 cases the operation was confined to removal of the mediastinal mass (5.2%). The cervical approach was the only surgical access route used in all the patients, regardless of the different anatomical variants. Appreciable venous stasis, due to the mediastinal mechanical obstruction exerted by the goitre, was always evident at the operation. In order to limit the risk of bleeding during operation, careful hemostasis of the major vascular pedicles must be performed. Any attempt to legate the smallest vessel, should be avoided since it is a difficult, useless and time-consuming procedure. Minor bleeds promptly stop as soon as the pathological mass is removed. Ligation of the vascular pedicles can be easily achieved; in this way, the goitre is freed from its anatomical connections and the surgeon can safely manage the substernal portion of the mass. The mortality reported in this study was 0.43% (one patient died 30 days postoperatively due to respiratory complications), whereas the morbidity rate was 2.6%.

[Adenocarcinoma arising on colo-rectal endometriosis: clinico-pathological considerations]. / Adenocarcinoma insorto su endometriosi colo-rettale: considerazioni clinico-patologiche.

Colo-rectal endometriosis represents a rare pathological event. Exceptionally, a malignant colo-rectal endometrioid carcinoma arising from endometriosis has been reported. In the present case, we describe a 32 year-old woman with clinical and radiological signs of large bowel sub-occlusive syndrome. Histologically, a sigmoid endometrioid adenocarcinoma associated with submucosal foci of eutopic endometrium was observed. Moreover, endometriotic tissue was observed at the level of the colonic left flexura and appendix. Colo-rectal endometriosis must be considered among risk factors for the development of large bowel adenocarcinoma in young female patients.

[Insulinoma. Clinical and surgical considerations concerning a case]. / Insulinoma. Considerazioni clinico-chirurgiche su di un caso.

Insulinoma is the most common endocrine tumor of the pancreas. It arises from the beta-islet cells of Langerhans. Insulinomas synthesize and secrete insulin autonomously in the presence of low blood glucose levels, causing spontaneous hypoglycemia and characteristic clinical symptoms. The authors examined data the from the most important international research projects on this topic during the past 20 years. Insulinomas are rare, with an annual incidence of 0.5 per million population. Up to 90% patients have benign solitary pancreatic insulinomas. People of all ages can be affected with this neoplasm. The authors reported a case of a large insulinoma of the body and tail of the pancreas, with atypical psychic symptoms. A distal pancreatectomy with splenectomy was performed. No surgical complications occurred in the postoperative course. The psychic symptoms were emphasized with refusal of food. The patient underwent Parenteral Nutrition and was discharged 24 days after the operation. The surgical removal of the tumor permitted the patient to recover completely, with glucose and insulin blood levels in normal range.