[Pelvic masses in young women: a case of giant uterine fibroleiomyomatosis]. / Le masse pelviche nelle giovani adulte: un caso particolare di fibroleiomiomatosi uterina gigante.

The authors reported a particular case of giant uterine fibroleiomyomatosis in young women and describe some clinical feature and differential diagnoses.

[Use of Tachosil in splenectomy in patients with clotting and blood composition disorders]. / Impiego di Tachosil nella splenectomia in pazienti con disordini della coagulazione e della crasi ematica.

UNLABELLED: Splenectomy in patients suffering from onco-haematological conditions presents clotting-related problems which make correct haemostasis more difficult. Using operative haemostasis during splenectomy for onco-haematological conditions as a starting point, the authors report their personal clinical experience of the use of Tachosil, comparing it with other similar products and drawing some personal CONCLUSIONS: To complete their reflexions on clotting problems during splenectomy in the course of onco-haematological diseases, the comparison with its use in oncological pathologies in other parenchymas, such as the kidney and liver, which also present operative haemostatic difficulties of a technical nature, is pointed out and the soundness of the results indicated. The cases of 3 patients suffering from severe clotting disturbances and treated with splenectomy and 1 patient suffering from clear cell renal carcinoma and subjected to nephrectomy in which Tachosil was used as an aid to haemostasis are reported. In the light of these cases, it can be stated that, albeit with the persistence of difficulties related to the changed clotting capacities resulting from the basic disease, the use of Tachosil has proved effective as an aid in haemostasis and suggests the validity of its use in elective and emergency splenectomy, in these types of patient.

[Gynaecological pelvic mass. Emergency clinical assessment]. / Le tumefazioni ginecologiche dello scavo pelvico. Atteggiamento clinico in urgenza.

BACKGROUND: The authors report the gynaecological pathology of surgical interest occurring in an Emergency Department in the first half of 2000 and occasionally found during an operation in women who presented a pelvic mass or abdominal pain. METHODS: Six women, average age of 50 years, reached the Emergency Department: five of them were operated with an emergency procedure. RESULTS: Of the 6 cases, 1 patient was affected by uterine mass, 1 by uterine-ovarian mass and 3 by ovarian mass; in one patient, affected by ovarian tumour, another intervention was necessary for intestinal metastasis. CONCLUSIONS: The authors have considered the clinical aspect of the abdominal masses, the age of the patients, the diagnostic laboratory and instrumental implications, the surgical approach and the histological result, referring to literature. Their contribution is related to the need for an appropriate surgical approach in emergency where it may, sometimes, solve or, at least, stabilize an uncertain clinical case, thanks to the implicit basic knowledge of multidisciplinary surgical technique.

[Breast inflammations: clinical observations and principles of treatment]. / Le infiammazioni della mammella: considerazioni cliniche e principi di trattamento.

In this study some clinical and etiopathogenetic principles, and the most appropriate treatment for breast inflammation are discussed. In the majority of cases, differential diagnosis is made not only through clinical diagnosis but also through cytological examination and ultrasonography. Of the forms reported, we considered the different inflammatory, glandular and extraglandular, peripheral and central mastites; among the latter in particular periductal mastitis and duct ectasia. Medical treatment is the answer for some forms, while for others, as for example mammillary fistula, we prefer, in agreement with some authors, the surgery of fistulectomy and healing by first intention; for the peripheral abscesses we prefer US-guided percutaneous drainage. This article stresses the importance of clinical diagnosis, pathogenetic history, and adequate treatment in efforts to improve both the knowledge of the surgeon and the quality of life of the patient.

[Combined complex surgical procedures: cardiovascular and general surgery]. / Gli interventi chirurgici complessi combinati: chirurgia cardiaca e chirurgia generale.

BACKGROUND: Aim of the paper is to evaluate the surgical indication in patients with cardiac and concomitant pathology. METHODS: In this study, are examined ten combined surgical sessions performed from 1992 at 1999, in patients affected by both cardiac and neoplastic disease with surgical indication. Eight men and two women, mean age 59.4 (range 50-68 years), eight affected by thoracic or abdominal tumour, one affected by hypersplenism and one by pulmonary cystic dysplasia with recurring pneumothorax. Anatomic resection and in two patient wedge-resection were performed except one woman who was splenectomized and one man who underwent atypical resection and pulmonary decortication. All subjects required extracorporeal circulation. RESULTS: No peri-operative deaths were observed and mean survival was 34 months (range 6-72 months). Moreover, there were no hemorrhages due to coagulation values of extracorporeal circulation. This approach proved useful both from the economic point of view and hospitalization time. CONCLUSIONS: According to personal experience this can be considered a successful therapeutic choice in selected patients. These observations suggest further considerations on combined operations surgery risk and mortality-morbidity appears to be reduced by a better myocardial revascularization.

[Rupture of the urinary bladder caused by trivial trauma. Case report]. / Lo scoppio della vescica repleta da trauma banale. Contributo clinico.

The urinary bladder occupies the deep pelvic cavity and is well protected from the bacin: this is the reason why it can rarely be traumatized. Anyway it could suffer traumas, which can cause extraperitoneal and intraperitoneal ruptures. A classification of traumas that can injure the urinary bladder and the treatments of these lesions are presented. A clinical case personal observed regarding a 78 year-old female patient is described. An accidental fall and direct trauma in the hypogastrium caused a rupture of her urinary bladder. In this case, the patient was anuric, though the macrohematuria and microhematuria can be present in the 85% of the urinary bladder lesions. This is an interesting case since it deals with a urinary bladder wall rupture, due to a trivial trauma on the bladder.

[CT pulmonary density mapping: surgical utility]. / Mappe TAC di isodensità polmonare: significato chirurgico.

BACKGROUND: The present paper considers the technique of CT scan maps of pulmonary isodensity, examining lung density differences as a function of the type of disease and considering their significance for the purposes of refined, useful diagnosis in a surgical context. METHODS. The method is used to examine 3 groups of subjects selected on a clinical/anamnestic basis and a further group already admitted for surgery. For each patient we obtained 2 thoracic density scans during the phase of maximum inspiration and expiration. On each scan we constructed 50 isodensity maps, the equivalent of more than 2500 measurements: the preliminary standard was represented by 100 wide windows to produce total "illumination" of the pulmonary fields. The isodensity windows were then codified differently. Subsequently, the density scans were analysed with the technique of scalar decomposition. RESULTS: The CT scan maps of lung isodensity proved useful for certain lung diseases in which early diagnosis, topographic extent of the pathology and the refined definition of the pathological picture provide important solutions as regards the indication and planning of surgical treatment and for the evaluation of the operative risk and prognosis. CONCLUSIONS: We consider that the technique is rapidly performed, not complex and inexpensive and is able to supply detailed information on the lung parenchyma such as to be used not only as a routine technique but also in emergencies.

[Hemorrhoids: epidemiology and correlation with chronic constipation]. / Malattia emorroidaria: inquadramento epidemiologico e correlazione con la stipsi cronica.

Following a review of international literature, AA report main results and refer their opinion about the correlation of hemorrhoidal disease with constipation, considering some variants as well as age, sex, breed, social-economic condition and geographic distribution in USA, England and Wales. Epidemiologically ten millions of people, in USA, are affected by hemorrhoidal disease; the incidence rate is 4.4% with an age distribution that shows a prevalence between 45-65 years old subject while constipation has an exponential increase with aging. Hemorrhoidal disease is significantly influenced by sex and geographic distribution that is in white breed more than in black, in social high class and in men more than women. In black breed constipation and hemorrhoidal disease present especially in lower social classes. Based on these results hemorrhoidal disease shows on epidemiological pattern that differ from constipation's one. Many questions are still present about correlations between hemorrhoidal disease and chronic constipation regarding etiopathogenesis. Only future case-control studies will solve the problem.