Flavonoid mixture (diosmin, troxerutin, rutin, hesperidin, quercetin) in the treatment of I-III degree hemorroidal disease: a double-blind multicenter prospective comparative study.

PURPOSE: We evaluated the efficacy of new flavonoids mixture (diosmin, troxerutin, rutin, hesperidin, quercetin) to reduce bleeding from I-III degrees hemorrhoidal disease in the short and medium time. METHODS: One hundred fifty-four consecutive patients with hemorrhoidal disease recruited in four colorectal units were enrolled to the study. Exclusion criteria were allergy to the flavonoids, inflammatory bowel disease, obstructed defecation syndrome, pregnancy and puerperium, associated anal disease or hemorrhoidal thrombosis, proctologic surgical procedures within 1 year before recruitment, contemporary cancer or HIV, previous pelvic radiotherapy, patients receiving oral anticoagulant therapy, or contemporary administration of other therapy for hemorrhoids. Patients with inability to understand the study or mental disorders were also excluded. RESULTS: Seventy-eight were randomized to receive the mixture of diosmin, troxerutin, rutin, hesperidin, and quercetin (study group, SG), and 76 a mixture of diosmin in combination with hesperidin, diosmetin, isoroifolin, and linarin in purified micronized fraction (control group, CG). Bleeding, number of pathological piles, and Golligher's grade were assessed at each scheduled visit and compared using the Chi-square test. During the study period, bleeding improved after 1 and 6 months both in the SG (79.5 and 70.5%) and in the CG (80.2 and 75%) without significant differences between two groups. Satisfaction degree after 6 months was greater in the patients of the SG (4.05) towards the CG (3.25): this result was statistical significant (p 0.003). CONCLUSIONS: Use of flavonoids mixture (diosmin, troxerutin, rutin, hesperidin, quercetin) is a safe and effective mean of managing bleeding from hemorrhoidal disease and minimal adverse events are reported.

The surgical palliative treatment of myelofibrosis. Personal experience.

We report a case of significant splenomegaly by myelofibrosis, treated in our institution, that we believe relevant to the completeness parade of symptoms and the exceptional size.

[Radiation proctitis: description of two cases refractory to pharmacological treatment]. / La proctite attinica: descrizione di due casi refrattari al trattamento farmacologico.

Radiation proctitis, is a relatively frequent complication resulting from the direct or collateral irradiation of the rectum in radiotherapy treatment for genito-urinary or anorectal malignancies. The main symptoms are diarrhoea, tenesmus, proctorrhagia, anal pain, mucorrhoea and faecal incontinence. The evolution of chronic radiation proctitis requires treatment for related anaemia, anal incontinence and micturition disorders. The approach and type of treatment depend on the severity of the symptoms and on the endoscopic aspect, in relation to the response to previous medical therapy performed. In our experience, endoscopic treatment is the best choice in the presence of ongoing bleeding and the possible development of severe anaemia. The surgical option is mandatory in patients at high risk of sepsis, requiring a faecal diversion constructed using the Hartmann technique. We report two cases, observed during the last two years, one treated with endoscopic bipolar coagulation and the other with a double urinary and faecal diversion.

[Treatment of liver metastases from colorectal carcinoma: our experience]. / Trattamento delle metastasi epatiche da carcinoma colorettale: nostra esperienza.

The latest hepatic surgical strategies enable liver resections to be performed on a larger number of patients, improving the survival rate. Moreover, the contribution of radiological techniques and chemotherapy to surgery has led to the multidisciplinary management of patients suffering from liver metastases, involving surgeons, radiologists and oncologists. If surgical treatment is not considered curative, it is appropriate to advise alternative strategies in order to down-stage the disease and make it resectable.

[Stapled transanal rectal resection (STARR) in the treatment of rectocele: personal experience]. / La S.T.A.R.R. nel trattamento del rettocele. Esperienza personale.

Rectocele is an organic cause of chronic constipation, with a prevalence ranging from 8.95% to 12% in Europe and United States. Necessarily, the approach for rectocele repair is a surgical operation. Stapled transanal rectal resection (STARR) is safe and effective in the treatment of obstructed defecation syndrome. The authors' experience suggests that the surgical operation needs to be combined to rehabilitation exercises, before and after the surgical treatment, in order to strengthen the muscles of the pelvic pavement. From January 2005 to January 2007, 20 patients with outlet obstruction underwent STARR. Patients were selected for operation based on a strict diagnostic protocol: anamnesis, clinical examination, coloproctological and urogynaecological examinations, defecography, anorectal manometry, transrectal ultrasonography and peritoneal electromyography. The therapeutic protocol consists of 3 parts: phase I: rehabilitation of the pelvic pavement; phase II: surgical operation; III phase: post-surgical rehabilitation of the pelvic pavement; The clinical result was classified into: excellent (6 patients), when all constipation symptoms disappeared, good (11 patients), when patient has 1 or 2 obstructed defecation episodes treated with a laxative, fairly good (2 patients), more than 2 episodes, and poor (1 patient), when surgical operation doesn't improve any of the symptoms. Our results, confirmed by the literature, suggest that Longo's technique should be considered as gold standard for rectocele treatment.

[Urachus' carcinoma: a case report]. / Carcinoma dell'uraco. Case report.

Urachus' carcinoma represents a rare oncologic disease with an unfavourable prognosis due to the usual delay of correct diagnosis for its anatomical localization. Its surgical treatment varies from radical cystectomy to segmentary resection of the bladder with pelvic lymphadenectomy. We report a case occurred in a ninety years old female, in which the diagnosis was achieved only at laparotomy. The patient was submitted to surgery with the only generic diagnosis of "lower abdominal mass", and treated with segmentary resection.

[Management of patients with non-functioning gastroentero-pancreatic neuroendocrine tumours]. / Management di un paziente portatore di neoplasia neuroendocrina non fiunzionante del tratto gastro-entero-pancreatico (GEP).

The Authors examine the feasibility of diagnosing non-functioning gastroentero-pancreatic neuroendocrine tumours preoperatively or intraoperatively, with particular reference to laboratory examinations and octreoscan scintigraphy, which are capable of conditioning the surgical treatment and subsequent follow-up. Of the 4 cases reported here: three presented multiple intestinal localizations, and in only one case the origin of the primitive carcinoma was undefined. The suspicion of a non-functioning neuroendocrine tumour must be considered when yellowish or ochre-coloured intestinal lesions are found intraoperatively. Determination of specific markers and octreoscan scintigraphy must be performed without awaiting histological confirmation. Surgery plays a fundamental role in the debulking of these carcinomas. However, medical therapy with the aid of specific laboratory examinations and octreoscan scintigraphy may improve the long-term survival.

[Preoperative radio-chemotherapy in the treatment of locally advanced rectal cancer]. / Radio-chemioterapia preoperatoria nel trattamento del carcinoma del retto localmente avanzato.

Rectal cancer is characterised by a substantial incidence of recurrences despite radical surgical treatment. The combination of preoperative radio- and chemotherapy has afforded functional and prognostic advantages through the prospect it offers of performing a greater number of conservative operations and the enhanced control of locoregional recurrences it allows. In our institute we treated 27 patients with locally advanced rectal cancer over the period from January 1997 to December 2002. All 27 patients underwent preoperative radiochemotherapy (45 Gy on the pelvis and 5-fluorouracil administered on the first and last 5 days of radiotherapy). The patients were then submitted to surgery consisting in 12 abdomino-perineal resections of the rectum, 14 anterior rectal resections and 1 Hartmann's resection. Tumour regression was complete in 22.22% of cases and minimal in 14.81%; 50% reduction was achieved in 22.22% and 50-80% reduction in 40-70% of cases. The toxicity was 14.91%. The incidence of local failure was 3.7% with a follow-up of 52 months. In this series, preoperative radio-chemotherapy proved to be a powerful means of downstaging the tumours and of controlling local failure.

The treatment of breast cancer in one day surgery. A four year experience.

The number of short-stay surgery procedures has progressively increased since the concept of short-stay surgery was first introduced. Initially this type of surgery was reserved for patients undergoing inguinal hernia repair, proctological surgery, and various minor procedures. Careful patient selection makes it possible to apply one-day surgery to other surgical specialties including breast cancer surgery. Reducing the length of hospital stay lowers health care costs, and shortens waiting lists. The most important benefits for patients are a more rapid return to work and positive psychological effects. Exclusion criteria for one-day surgery are the lack of home care, excessive distance from place of treatment and the presence of any concomitant pathology that is a contraindication to this type of surgery. We report our experience in oncological surgery of the breast in one-day surgery.

Ileocecal-colonic intussusception caused by cecal adenocarcinoma A case report.

INTRODUCTION: Intussusception in adults is an infrequent cause of intestinal occlusion that is usually due to neoplasm lesions. The unspecific nature of the clinical presentation often delays diagnosis. It is most commonly emergency explorative laparotomy which clarifies the etiology of the occlusion. The authors report a case of intestinal occlusion caused by ileocecal-colonic invagination with a small cecal adenocarcinoma as lead point, in a 74-year-old woman. CASE REPORT: A 74-year-old woman came to the Emergency Department, complaining of crampy pain in the mid- and lower abdomen. An abdominal ultrasound revealed a "pseudokidney sign" apparently involving the cecum. Because there were no clear signs of occlusion, the patient was dicharged on the same day. Three days later, upon admission, the patient complained of episodes of abdominal pain with intervals of moderate well-being, associated with nausea, vomiting and an inability to pass stool (but not gas) for 36 hours. On clinical examination her abdomen was distended and tender on palpation in all quadrants, especially in the right iliac fossa where a large mass could be felt. Standard abdominal x-Ray documented gaseous distension of some loops of the jejunum-ileum with some air-fluid level. The patient underwent an abdominal CT scan which showed advanced intussusception that appeared to be ileocolic and multiple enlarged lymphnodes were found in the invaginated mesentery at the base of which there appears to be a thickening of the intestinal wall that is probably neoplastic in nature. The patient underwent explorative laparotomy. Ileocecal-colonic intussusception caused by a cecal growth 5 cm in diameter was found on examination of the surgical specimen. Histology showed that the cause of the large swelling of the ascending colon was a vegetating ulcerated adenocarcinoma (medium grade differentiation: G2), measuring 6.5x 4.0 cm, arising from a tubulovillous adenoma infiltrating the submucosa. CONCLUSIONS: Most cases of intussusception are caused by structural lesions, a large percentage of which are malignant, especially in the colon. In our patient the lead point was a small cecal polyp which, together with the last loop of the ileum and the ileocecal valve, was pulled into the ascending colon. Although most cases of intussusception in adults are diagnosed at the operating table, noninvasive diagnostic tools like ultrasonography and CT scanning are very useful. Treatment in adults is usually surgical and involves en bloc resection of the lesion. Manual reduction of the intussusception is not advisable because of the risk of dissemination if the lead point is malignant. KEY WORDS: Cecal adenocarcinoma, Itestinal resection, Intussusception in adults.