Intrahepatic epidoxorubicin in metastatic and primary liver tumours: a phase II study.

Primary and metastatic gastrointestinal tumours in the liver have been treated by intrahepatic artery infusion of chemotherapeutic drugs in an attempt to increase the efficacy of the administered agents. Among the several active agents, 4' epidoxorubicin, an anthracycline analogue, was selected for this study because of the therapeutic level reached in the liver by this drug. Seven patients with primary hepatic carcinoma and twenty with metastatic adenocarcinoma of the colon to the liver received intraarterial hepatic infusion of epidoxorubicin at the dosage of 30 mg weekly. No haematological or gastrointestinal grade 3-4 toxicity was recorded, only one patient experienced transient cardiac toxicity. No objective response was observed in primary hepatic carcinoma and six objective responses, 1 complete and 5 partial (30%), were achieved in metastatic colorectal cancer patients. This results is not far from those reported with FUDR, but does not justify epidoxorubicin in colorectal cancer patients as first line intraarterial treatment.

[Alithiasic cholecystopathies. Clinical, diagnostic and therapeutic aspects]. / Le colecistopatie alitiasiche. Inquadramento clinico, diagnostico e terapeutico

The frequency of alithiasic cholecystitis is considered and the various forms are subdivided into diffuse and localized dyskinesia. Symptomatology is described and the former are indicated as being electively medical and the latter surgical forms whether the condition is congenital or acquired. The various forms of cholecystosis are also distinguished with full documentation. Symptomatological techniques and diagnostic conclusions are illustrated for all forms and personal experience with their therapy reported.

[Acute pancreatitis. Review of cases and considerations on personal experience]. / Le pancreatiti acute. Revisione di casistica e considerazioni sulla nostra esperienza

A series of cases of acute pancreatitis treated between 1-XI-1972 and 1-XI-1975 is presented. A division is made between cases acute ab initio and postoperative pancreatitis, the latter further subdivided into pancreatic necroses, oedemas, and slight affections. The question of diagnosis is examined and elements indicative of prognosis are stressed. Results obtained in the surgical and medical management of 59 ab initio, 3 necrosis, 11 oedemas, and 79 slight involvement cases are described.

[Our experience in the surgery of bile ducts]. / La nostra esperienza in tema di chirurgia delle vie biliari

After a brief review of modern techniques for correct diagnosis and therapy of bile duct pathology, a personal series of 955 operations (between 1-XI-1972 and 30-X-1975) is presented. The need for routine peroperative control of VBP and the usefulness of respecting the papilla where it is anatomo-functionally undamaged are stressed. Personal experience shows that the most rational methodology is after papillotomy the application of a prepapillary Kehr incision through a choledochotomy because this presents fewer complications than the transpapillary Kehr incision in calculosis or stenosis of the VBP where bile duct suture is not advisable. With regard to bilio-digestive anastomosis, indications and limitations are discussed and it is suggested that where the patient's general and local states permit, choledochojejunal anastomosis should permit, choledochojejunal anastomosis should be used, with choledocho-duodenostomy only in special cases. Cholecysto-gastro and cholecystoduodenostomy should be reserved for patients in very serious conditions.

[The therapy of the liver metastases of colorectal carcinoma]. / La terapia delle metastasi epatiche da carcinoma colorettale.

The treatment of liver metastases should be addressed in a multidisciplinary way, considering the manifold therapeutic options available, for each of which corresponds a particular indication. The best results are obtainable with resective surgery in cases in which there is a partial involvement of the liver (25-50%) and a variable intra-hepatic distribution (monolobar), situations that correspond to Gennari stages I and II. In the authors' experience, the extent of the liver resection does not influence possible survival and oncologically correct resections should be carried out such as segmentectomies, pluri-segmentectomies or wedge resection in compliance with the principle of removing at least 1.5 cm of healthy perineoplastic tissue. The authors reserve major hepatectomies to special situations: voluminous metastases, diffuse involvement of a single lobe, topographic localisation contraindicating segmentary resection.

[Rare primary hepatic neoplasms. Our experience in 2 cases: a primary lymphoma and a leiomyosarcoma of the liver]. / Neoplasie epatiche primitive rare. Nostra esperienza su due casi: un linfoma e un leiomiosarcoma primitivi del fegato.

In a review of personal experience of major liver surgery, 2 very rare cases of primary liver tumours, one lymphoma and one leiomyosarcoma are presented. The world literature on the subject is also reviewed and follow-up results are reported after indicating the surgical techniques adopted.

[Our experience with the surgical treatment of carcinoma of the colon]. / La nostra esperienza nel trattamento chirurgico del carcinoma del colon.

The Authors analyze a series of 441 patients affected by carcinoma of the colon operated on between June 1980 and November 1993. The incidence of the different stages of the disease according to Dukes resulted comparable to that reported in the literature as well as the incidence of morbidity and mortality. Recostruction was performed in all cases with mechanical sutures (T-L for the right colon and L-T for the left colon) and without protection enterostomy. Long-term results evaluated by actuarial methods were influenced by the stage of the disease, and not by sex or duration of symptoms. The need of early diagnosis as well as oncologically correct surgical technique is furthermore confirmed. The importance of clinical trials on adjuvant chemotherapy is emphasized in order to improve survival in patients operated for stage B and C colon cancer.

[The surgical treatment of malignant neoplasms of the pancreas: resection or palliative intervention?]. / Trattamento chirurgico delle neoplasie maligne del pancreas: resezione o intervento palliativo?

The authors retrospectively evaluate their 10-year experience in the surgical management of pancreatic cancer, and analyze their results in terms of morbidity and long-term survival. The comparison between curative and palliative surgery shows, in this series, a better long-term survival and a better performance status for the patients in the curative group, although postoperative morbidity and mortality are higher. The difficulty of an early diagnosis as well as a correct preoperative staging is confirmed. Finally, the authors propose a personal, totally mechanic technique of digestive tract restoration after gastric resection during pancreatic surgery underlining this procedure is easy, safe, fast and functional.