Gastrointestinal stromal tumours. Our experience ten years later.

AIM: To analyze GISTs behaviour observing their clinical evolution and outline the best approach to this neoplasia. MATERIAL OF STUDY: In a period between December 1999 and October 2009 came to our observation, at the Institute of General Surgery, 37 patients with GIST. We conducted a retrospective study evaluating the anatomo-pathological aspects, the clinical situation and the tumour characteristics of the 37 patients with GIST. RESULTS: The 37 patients included 21 women (57%) and 16 men (43%), the mean age was 67 years. GISTs originated from the stomach (27), jejunum (5), ileum (3), anus (1) and transverse mesocolon (1), the symptom most frequently found was acute anaemia and in 5 cases the diagnosis was occasional; 36 patients underwent surgical treatment. Based on tumor size, mitotic count, presence of areas of necrosis and/or haemorrhage, GISTs were classified according to the categories of potential high-grade malignancy (13 pts), intermediate grade (8 pts), low grade (16 pts). DISCUSSION: According to international literature, surgery remains the cornerstone of treatment for patients with primary resectable GIST without evidence of metastasis and should also be utilized when surgery has minimal risk of morbidity for the patient. The goal of surgery is complete surgical resection with negative margins (R0). The follow-up for some patients is still ongoing; only 10 patients underwent to adjuvant therapy with Imatinib. CONCLUSIONS: In the last decade, GISTs have become an emblematic example of the possibility of pharmacologically interfering with the molecular mechanisms of carcinogenesis.

Ruptured aneurysm of replaced left hepatic artery.

Hepatic artery aneurysm is an uncommon and potentially fatal form of vascular disease. We report the case of a 53-year-old man with an isolated, nontraumatic rupture of an aneurysm of a replaced left hepatic artery originating from the left gastric artery. This case is unusual because the ruptured aneurysm involved an hepatic artery with a rare vascular pattern.

Abdominal wall desmoid tumors: A proposal for US-guided resection.

BACKGROUND: Desmoid tumors (DTs) is a benign tumor with high tendency to infiltrative evolution and recurrence. Nowadays, in abdominal localization, the standard approach is surgery with R0 condition. The need to repair post-surgical wide wall defect requires conservative technique to decrease the incidence of incisional hernia and to obtain better quality of life (QoL). METHODS: We perform an abdominal wall desmoid resection using ultrasound guide. This technique ensures to spare a wide wall area and to obtain a multilayer reconstruction minimizing postoperative risk. This approach allows good oncological results and better managing abdominal wall post-resection defect. RESULTS: We use US guided surgery to get radical approach and wall tissue spare that allows us a multilayer reconstruction minimizing post-operative complications. No recurrences were observed in one year follow up period. CONCLUSION: Our experience represents first step to consider ultrasound mediated technique usefull to optimize wall resection surgery and to minimize following complications.

Necrotizing fasciitis: a surgical emergency.

Accurate assessment and timely interventions are critical in the treatment of patients affected with necrotizing fasciitis, a rare, fulminating, potentially life-threatening, infectious process of the soft tissues. Understanding the natural history and unique characteristics of this disease is crucial to achieve early recognition, effective management and a favorable patient outcome. Classic symptoms include severe pain, erythema, mottling, crepitus, skin anesthesia, warmth, tenderness, bullous formations and edema in the affected area and fever. This article aims at reviewing the information known about this disease, collected from various sources. Radical surgical debridement, broad-spectrum antibiotics, negative pressure wound therapy and hyperbaric oxygen therapy are considered to be the cornerstones of treatment.