[Personal experience using radioimmunoguided surgery (RIGS)]. / L'utilizzo della chirurgia radioimmunoguidata nella nostra esperienza.

Radio Immuno Guided Surgery (RIGS) is a technique that has numerous uses in oncology. It is characterised by a multidisciplinary approach by nuclear physician and surgeon for diagnosis and treatment; it uses colloid radiotracers, monoclonal antibodies or non-immunological tracers. We adopted this technique in 281 patients: 256 (91.9%) (range 26-82) with breast disease (breast cancer or occult breast lesions) and 25 (8.9%) (range 42-84) with colorectal cancer localized or recurrent. We used monoclonal antibodies (ArcitumoMab 99mTc-labelled) for colorectal carcinomas and aggregates of human serum albumin 99mTc-labelled for Radioguided Occult Lesion Localization (ROLL) and Sentinel Lymph-Node Biopsy (SLNB). All patients were studied preoperatively by routine blood tests, instrumental exams and tumoral markers. Amongst patients with breast disease, 142 breast cancers and 114 occult breast lesions were found. Among patients with colorectal disease, 8 cases had localized colorectal cancer and 17 cases had locoregional recurrence and/or metastasis. In all cases pathologic sites were detected by probe during surgery. The RIGS is indicated for ROLL and SLNB; nevertheless it is also suggested for pre- and intraoperatively staging of primary and recurrent colorectal cancers. This method gives a chance for a radical surgical and oncologic treatment in localized and recurrent cancer. Prospective studies are needed in order to estimate survival and usefulness of this methodology.

[Gunshot wounds. Our experience]. / Ferite d'arma da fuoco. Nostra esperienza.

Abdominal gunshot wounds may result in elevated morbidity and mortality. The optimal management is still controversial. The authors report on their experience with treatment of 49 patients. In all patients the PATI score was used to identify trauma and all were treated surgically. Laparoscopy was employed only in one patient. The mortality was 2% and the morbidity 6%. The authors conclude that the PATI score correlated well with morbidity and mortality. Resuscitation with immediate surgical treatment may reduce the morbidity and mortality rates.

[Non-lactational mastitis: our experience]. / Le lesioni infiammatorie non puerperali della mammella.

The most frequent breast inflammatory diseases are lactational and non-lactational mastitis. The diagnosis of these lesions is always difficult, as they often mimic breast cancer. The Authors report on their experience about 830 clinical cases of non-lactational mastitis, 804 were superficial abscesses and 24 were phlegmons. In 379 cases an infectious cause was found: in 249 by Streptococcus/Pseudomonas and in 30 by Staphylococcus Aureus. All patients underwent surgical treatment. Diagnosis was obtained by clinical examination, routine investigations (ultrasound, mammography and cytology) and post-operatively by histological evaluation. The non-lactational mastitis are more frequent in the postmenopausal and the menopausal period, but MDAIDS (Mammary Ducts Associated Inflammatory Diseases Sequence) are particularly interesting. MDAIDS was observed in 178 cases, these are very peculiar lesions characterized by ducts ectasia, squamous metaplasia, lymphoid infiltration and strictly correlated with heavy smoking. Sometimes, only surgical treatment clarifies the nature of these lesions. Patients with inflammatory diseases of the breast present with mastalgia and secretions, symptoms which alert patients to consult quickly a specialist. Instrumental investigations often don't clarify the diagnosis and surgical treatment by incision and drainage or excision is definitive.

[Management of polytrauma: our experience]. / La gestione del politrauma: nostra esperienza.

In the advanced nations trauma represents the third cause of death after cardiovascular diseases and tumours. Recently, great importance has been given to the need to treat traumas as quickly as possible in order to reduce mortality and morbidity. Prompt management of is the gold standard in the emergency setting and the phrase "golden hour" is now commonly used. The authors report on their experience with the management of multiple trauma, through the study of 617 clinical cases. Patients were evaluated with the Revised Trauma Score (RTS), Injury Severity Score (ISS) and Abbreviated Injury Scale (AIS). Of 420 (68%) cases of major trauma only one patient had ISS > 60. Patients were admitted on average after 47 +/- 18 min. Only two deaths occurred in the emergency unit. The task of the emergency unit is to stabilise the patients, anticipate the complications, including mainly shock and multiple organ failure, optimizing time, interventions and resources to reduce morbidity and mortality.

[Sentinel lymph-node biopsy in breast cancer: five years' experience]. / Il linfonodo sentinella nel carcinoma mammario. 5 anni di esperienza.

The authors report on their experience with sentinel lymph-node biopsy in breast cancer. Sentinel lymph-node biopsy was performed in 91 patients with T1-T2 N0 M0 breast cancer using radiocolloid (99mTC radiolabelled colloidal human albumin microaggregate) injected perilesionally in 56 cases and by Blu Patent V alone in 35 cases. The sentinel lymph nodes identified were located in the axilla in 88 cases, in the internal mammary nodes in 2 cases and in a subclavicular site in 1 case. The histological examination was negative in 62 cases and positive in 29; Axillary lymph-node dissection was carried out in node-positive cases. No recurrences were observed in any of the cases treated. Lymphatic mapping and sentinel lymphadenectomy in primary breast cancer is now a feasible and useful method of avoiding routine axillary lymphadenectomy. However, the role of micro- or macrometastases in sentinel lymph nodes and the significance of identification of tumour mRNA have yet to be defined.