[Italian national register of low etiological fraction occupational cancer pursuant to art. 244 of legislative decree n. 81/2008]. / Il registro nazionale dei casi di neoplasia a bassa frazione eziologica con sospetta origine professionale istituito dall'art. 244 del D.Lgs. n. 81/2008.

Legislative decree No. 81/2008 in the article n. 244 states that ISPESL, now INAIL, realizes a register of occupational cancers with low etiological fraction by means of a data collection method based exclusively on voluntary reports by GPs, healthcare and social security agencies (ReNaLOC) and a surveillance cancer monitoring system (OCCAM) based on linkage of routinely available data (cancer registries, hospital discharge records, Italian Social Security archives). ReNaLOC has produced a partial picture of the situation, it includes 1.584 cases as of June 2011. With OCCAM many situations of known risks were identified and others are worthy to be deepen.

[Tobacco's smoke in the workplaces, webpages in the ISPESL's website]. / Il fumo di tabacco in azienda nel sito dell'ISPESL.

The authors present the section, part of the ISPESL's website, dedicated to tobacco smoke at work. In this subdivision many topics regarding problems caused by tobacco smoke in the workplaces are gathered and discussed so that different personnel responsible for health and prevention at work can find a technical answer to take part to the improvement of the psychophysical welfare of both smokers and non smokers. The general information section has collected the relative Italian and international laws regarding smoking in the workplace along with representative court cases, and some publications and essays which have been presented on this topic. Inside the section dedicated to the employers and companies, the authors have posted useful importation on smoking in the workplace which includes some tools that can turn to be interesting to those who are supposed to be involved with prevention, the updated addresses of the national public antismoking centers, experiences and activities against tobacco smoke of national and international companies, events regarding smoke at work, informative sheets and leaflets for smokers, link to other site that argue about this topic. Moreover, there is a section dedicated to a forum where Internet user can share their experiences and thoughts on workplaces free from tobacco smoke.

[Appendiceal mucocele due to mucinous cystadenoma: case report and review of the literature]. / Mucocele appendicolare da cistoadenoma mucinoso: descrizione di un caso clinico e revisione della letteratura.

Mucinous cystadenomas of the appendix are rare tumours. In this article we describe the case of a young woman who presented with abdominal pain and a clinical pattern likely to a chronic appendicitis. At laparotomy we found a dilatation of the appendix which contained an abundant quantity of mucus. Histological examination showed a mucinous cystadenoma of the appendix. This neoplasm requires a surgical treatment, usually only appendectomy and right hemicolectomy in case of involvement of the caecum. During operation, the surgeon must take care in handling the appendix because of the risk of rupture with consequent dissemination of epithelial cells in the peritoneal cavity (pseudomyxoma peritonei).

[Spontaneous rupture of common iliac artery: a case of Ehlers-Danlos syndrome and review of the literature]. / Rottura spontanea di arteria iliaca comune: descrizione di un caso di sindrome di Ehlers-Danlos e revisione della letteratura.

Authors report an uncommon case of spontaneous rupture of common iliac artery in a man 43 years old with Ehlers-Danlos syndrome. The clinical presentation was devious in the beginning and catastrophic after few hours with a haemo-peritoneum and haemorragic shock. The Ehlers-Danlos syndrome is a rare affection of the connective tissue with an incidence of 1/5000, representing one of the most common disorders of the connective tissue. This disease is characterized by the fragility of arteries, intestine and uterus. Its presentation is often catastrophic, with rupture of a big artery, rupture of uterus during pregnancy or bowel perforation. The mean age of death in subjects with Ehlers-Danlos syndrome is 45 years. This syndrome is inherited in most cases in an autosomal dominant manner; 50% of the cases are due to new mutations. A minority of cases, due to deficit of tenascina X, is inherited in an autosomal recessive manner.

Intra-abdominal inflammatory myofibroblastic pseudotumor: case report and review of the literature.

Inflammatory myofibroblastic pseudotumors (IPM) are very rare tumor characterized by unpredictable clinical behaviour. They arise in soft tissues of almost every organ and the most common site is the lung. Over 200 cases of inflammatory myofibroblastic pseudotumor of the lung have been described in literature. Intra-abdominal IMP are very rare. We describe a case of intra-abdominal IMP in a boy of 15 years old who presented symptoms and signs of acute appendicitis. Exploratory laparotomy revealed a mass in the peritoneal cavity. The mass was removed. The histologic examination showed that it was an IMP. Surgical treatment was the only therapy. Six months after the surgical operation the patient has no sign of illness.

[Splenic marginal zone lymphoma: case report and review of the literature]. / Linfoma splenico della marginale: descrizione di un caso clinico e revisione della letteratura.

Splenic marginal zone lymphomas are rare tumors which take origin from the B cells. More common in the elderly, often asymptomatic, they can present with abdominal pain, splenomegaly and cytopenia and have an indolent clinical course. We describe a case of a women 79 years old who presented with abdominal pain, fever and splenomegaly. Computed tomography demonstrated splenomegaly with an area of low density in the spleen. Only by laparotomy and splenectomy the correct diagnosis was possible. Because of the indolent course of this kind of lymphomas, splenectomy is the main treatment for patients with abdominal pain, splenomegaly and cytopenia. If there is no pain and no cytopenia, the treatment can be only wait and see. Only in case of progression of disease chemotherapy can be employed.

[Endovascular laser ablation of the greater saphenous vein for varicose veins: our initial experience]. / Coartazione laser endovasale di safena nel trattamento delle varici essenziali: nostra iniziale esperienza.

Laser treatment of primary varicose veins of the legs is a new mini-invasive technique which represent an alternative to the safenectomy. Endovascular laser treatment is based on the employ of laser to destroying the vascular wall and inducing fibrosis. This technique is not without complications: burns, paraesthesias, haematomas, but most of all disappear in few days. Encouraged by the promising results reported in literature, we have performed 18 laser ablation of greater saphenous vein since 2003 till today. Our patients had a good post-operative course and a follow up without troubles (3-17 months). We think that laser treatment is effective in the treatment of the primary varicose veins of the legs. It requests attention and experience in dosing the laser energy for minimizing the complications. Today there isn't long term follow up in literature.

[Acute abdomen from ruptured adrenal pheochromocytoma: case report]. / Addome acuto da rottura di feocromocitoma surrenalico.

The pheochromocytoma is a very rare neoplasm, which originates in 98% of cases in the adrenal medulla; it is often bilateral in familial syndromes. It is more frequent in syndromes like MEN2, von Hippel-Lindau disease, and neuofribromatosis type 1. In this article the Authors report a case of a young woman with a large adrenal pheochromocytoma, that presented by an acute abdomen; the treatment was explorative laparotomy with unilateral adrenalectomy. Therapy of this tumour is founded on surgery, plus chemiotherapy radiotherapy or treatment with 131I-MIBG (iodine-131-metaiodobenzylguanidine in malignant cases (10%). According with the absence of a correlation between pathological findings and clinical behaviour, a long-term follow up is indispensable.

[Diagnostic and therapeutic update on primary duodenogastric reflux]. / Attualità diagnostiche e terapeutiche nella patologia da reflusso duodenogastrico primitivo.

The authors, after some remarks on the pathophysiology of primary alkaline gastritis, analyze the main methods, available at present, for diagnosis; they particularly consider the importance of endoscopy and histology, gastroesophageal 24-hours pH-metry and 99mTc HIDA scintigraphy. Successively, they present the criteria for the identification of patients who will predictably benefit from surgical treatment, and examine advantages and limits of the two main corrective surgical techniques for the duodenogastric reflux in patients not previously operated on the gastrointestinal tract: duodenal extramucosal myotomy according to Mattioli, relatively easy to perform, and the "duodenal switch" according to De Meester, technically more complex, but pathophysiologically more acceptable, completely eliminating the duodenogastric reflux.

Colorectal cancer. Epidemiology, etiology, pathogenesis and prevention.

Colorectal cancer (CRC) is a neoplasm with a steadily growing incidence in Western countries. Moreover the age of 50 and over is a critical risk factor. The relationship between dietary, environmental factors and CRC has been evaluated. At present, a number of genetic risk factors such as the genetic susceptibility, tumor suppressor genes and oncogenes are thought to play a major role. The correlation of CRC with adenomatous polyps and chronic inflammatory disease, ulcerative colitis in particular, has been evaluated. Prevention of CRC is mainly based on a rational diet and in the adoption of mass screening programmes.

Hemifacial spasm due to peripheral injury of facial nerve: a nuclear syndrome?

Four cases of hemifacial spasm (HFS) are reported. The spasm followed a few months after injury to a peripheral branch of the seventh nerve. An EMG examination of facial muscles disclosed the typical finding of HFS: spontaneous activity, paradoxical cocontraction, and diffusion of spontaneous or provoked blinking. A nuclear involvement, secondary to the nerve lesion, is the most likely pathophysiological explanation for similar cases in HFS.

Sneddon syndrome presenting with hemicranic attacks: a case report.

The case of a young woman suffering from a rare cerebrovascular disease associated with livedo reticularis (Sneddon syndrome) is reported. Hemicranic attacks were the first symptom detected. The patient had a progressive clinical course of neurologic symptoms. Cerebral CT scan, NMR and cerebral arteriography revealed a progressive cerebral multifarctual feature involving middle-size arteries.

Familial idiopathic strio-pallido-dentate calcifications with late onset extrapyramidal syndrome.

A family with autosomal dominant inheritance of idiopathic strio-pallidodentate calcifications and late onset of extrapyramidal symptoms is reported. Clinical features consisted of parkinsonism in one member and postural tremor in two. Depression and dysarthria were present in all cases. All symptomatic members showed a peculiar biochemical abnormality consisting of reduced 25-OH vitamin D3 with normal levels of 1,25(OH)2 vitamin D3, suggesting an inborn error of Vitamin D metabolism. The biochemical, clinical, and genetic pattern of this family distinguishes this syndrome from the larger group of secondary familial basal ganglia calcifications.

Familial spasmodic dysphonia with low arylsulphatase A (ASA) level.

Two familial cases of late onset spasmodic dysphonia and low Arylsulphatase A (ASA) are reported. In one case spasmodic dysphonia was associated with negative head tremor and orthostatic tremor, both displayed postural tremor of the upper extremities. A familial predisposition for both focal dystonia and metabolic lysosomal impairment is suggested by similar observations.

Laparoscopic-assisted Hartmann's reversal with the Dexterity Pneumo Sleeve.

Several laparoscopic techniques of Hartmann reversal have been published. An alternative laparoscopic-assisted procedure, essentially aseptic, which uses the minilaparotomy for colostomy mobilization to apply the Dexterity Pneumo Sleeve device is described. This technique combines the advantages of the minimally-invasive approach with the direct access of the surgeon's hand to the patient's abdomen.