Techniques of rectal oncologic survey.

The possibility of constructing very low anastomoses using stapling devices led many surgeons to reduce the length of the distal clearance to 1-2 cm. This made it possible to perform a low anterior resection instead of an abdominoperineal resection of the rectum in a greater number of cases. Furthermore, the enthusiasm in preserving sphincteric function induced some Authors to perform a local excision for tumors of the distal portion of the rectum. On the other hand, in order to improve patients' survival after curative operations for cancer, either of the rectum or rectosigmoid junction, other surgeons have adopted a more aggressive approach, extending exeresis to the peri-aortocaval and pelvic nodes, and to the possible liver metastases as well. On the basis of our experience (374 cases from 1972 to March 1989) and a critical review of the literature, indications, techniques, and results of curative operations for both rectal and recto-sigmoid junction cancer are examined. The role of extended abdomino-pelvic lymphadenectomy is also discussed. The Authors believe that in the absence of a reliable evaluation of the potential of these tumors, an aggressive approach is required. Local excision is reserved to very selected cases, which should undergo an intensive follow-up in order to detect recurrences at a very early stage.

[Evaluation of the efficacy of image-guided drainage in the treatment of abdominal fluid collections]. / Valutazione dell'efficacia del drenaggio "imaging guidato" nel trattamento delle raccolte addominali.

In this paper the Authors report their experience in the diagnosis and management of abdominal fluid collections either primary or secondary to surgery. Sixty-eight patients with abdominal fluid collections were considered: in 28 cases an imaging guided percutaneous drainage was performed, while in 40 cases patients were treated with medical or surgical therapy. The Authors describe the different techniques, the approaches and the types of catheter used on the basis of the localization of the collections. The results show the efficacy of drainage procedures in 89% of the patients treated, without any major complication. Some considerations comparing patients treated with percutaneous drainage and patients who underwent different therapy as well as a review of the international literature are also reported. In conclusion the Authors affirm that percutaneous imaging guided drainage is the treatment of choice for abdominal fluid collections anatomically accessible, for the high effectiveness, good tolerability, low cost and minimal incidence of major complications.

[The complications of diagnostic colonoscopy]. / Le complicanze della colonscopia diagnostica.

Major complications of diagnostic colonoscopy based on a series of 17.583 procedures performed from 1980 throughout 1991 are reported. No higher risk of colon perforation was registered either performing total or partial colonoscopy, for the site of perforation was in most cases the sigmoid colon.

[Low-malignancy duodenal leiomyosarcoma]. / Il leiomiosarcoma duodenale a bassa malignità.

The authors report a case of duodenal leiomyosarcoma presenting a low degree of histological malignancy. The main anatomoclinical features of the neoplasm are summarized. The authors conclude indicating not aggressive surgical therapy as adequate in such cases. However, a prolonged post-operative follow-up is always necessary, in order to detect recurrences as early as possible.

[Endoscopic insertion of a prosthesis in the palliative treatment of tumors of the head of the pancreas]. / L'apposizione di protesi per via endoscopica nel trattamento palliativo dei tumori della testa del pancreas.

The Authors report their experience of biliary endoscopic endoprosthesis placement in 42 patients for palliative treatment of carcinoma of the pancreatic head. The morbidity, the mortality and the duration of hospitalization are considerably less than with surgical biliodigestive anastomosis. The mean survival is almost the same in both cases.

[Our experience in the recurrence of rectal cancer operated with radical intention in light of a case load treated in a homogeneous manner]. / La nostra esperienza delle recidive di cancri rettali operati con intento radicale alla luce dei risultati di una casistica trattata in maniera omogenea.

A reappraisal of the results obtained after potentially curative resection for rectal cancer compared with "historical" results is reported. An increase of the overall survival rates was registered as well as a corresponding lowering of the pelvic recurrences: 4.54% in the group of patients with a-two-year follow up. As for relapse surgery, however, reviewing the series from January 1991 to December 1994, the results are still poor because relapses were not resectable in 85.7% of the cases.

[Sarcoidosis and clear cell carcinoma of the kidney: the sixth case?]. / Sarcoidosi e carcinoma renale a cellule chiare: il sesto caso clinico?

The Authors report a very rare case of clear cell renal cancer associated with sarcoidosis, incidentally discovered in a 39 year-old man, admitted for a not correlated pathology (multiple left rib fractures due to automobile crash). Problems related to a proper assessment of sarcoidosis are discussed as well as potential arising of a neoplasm during the entire follow-up period: for that, it must always be complete and accurate.

[The endoscopic treatment of postoperative stenoses of the upper digestive tract]. / Trattamento endoscopico delle stenosi post-operatorie del tratto digestivo superiore.

The authors compare their experience in dilatation of postoperative benign esophageal strictures. A total of 60 patients (37 males, 23 females: mean age 52), all with severe dysphagia, from January 1985 to September 1995, underwent endoscopic dilatation: 32 of these with Savary dilators and 28 with balloon dilators. Dilatation was effective in 93% in both groups. Two severe complications were recorded (1 heart attack and 1 perforation) in the group that underwent endoscopic dilatation with Savary dilators. During endoscopic management, pain recurred in 43% and 87% of cases after balloon or Savary dilatations, respectively. The authors believe balloon dilators are more effective, better tolerated and with less complications than Savary dilators. They reserve the management with Savary dilators to the extremely severe esophageal strictures.

[The Bochdalek hernia in the adult: case report and review of the literature]. / L'ernia di Bochdalek nell'adulto: caso clinico e revisione della letteratura.

The Bochdalek hernia, the most common diaphragmatic hernia, except the hiatus hernia, is located on the posterolateral side of this muscle. This pathology is generally diagnosed in children; in fact only 105 such cases occurring in adults have been described in the literature. In these cases, surgical intervention is made necessary by the severity of potential complications. The Author's attention was drawn to a woman of 60 years of age, affected by pituitary nanism, who suffered from a left hand Bochdalek hernia. The symptomatology, characterised by abdominal pains and constipation had been presented for about one year. The computerised tomography confirmed the hernia of abdominal viscera in the thorax cavity. The intervention was conduced via the abdomen: the hernia were reduced, the hernial hole were closed with a double strata and the muscular plane reinforced with a synthetic prosthesis (dual mesh). The postoperative process was regular and the patient dismissed on 11th postoperative day.

[Report on surgical strategy in reoperation of esophageal achalasia]. / Cenni di strategia operatoria nei reinterventi per acalasia esofagea.

Surgical therapy for achalasia of the esophagus gives good results in only 80-90% of cases. Several reasons could be responsible for this 10-20% failure; the most frequent causes are inadequate cardiomyotomy and reflux esophagitis. We report our experience and our procedure in the management of recurrent achalasia. The most important controversies are also discussed.

[Colorectal cancer in the young adult: comments on a sample of 33 patients operated on with the goal to cure]. / Il cancro del colon-retto nell'adulto giovane: considerazioni su un campione di 33 pazienti operati con intento curativo.

A retrospective study of the overall cases operated for colorectal cancer is reported. Subgroups of patients comparable for staging and grading, over 45 years of age and younger than 45 years, radically operated from January 1984 to June 1989, were analyzed in order to evaluate survival and prognosis in younger subjects. A favourable trend in relation to three-year prognosis was registered in younger patients (73% vs. 65%).

[Indications and limitations of endoscopic sclerosis in esophageal varices: our current approach]. / Indicazioni e limiti della sclerosi endoscopica delle varici esofagee: i nostri attuali orientamenti.

From January 1987 to December 1993, 171 patients affected by portal hypertension with bleeding complications underwent endoscopic variceal sclerotherapy. Results show that this technique is particularly effective for the hemostasis, therefore in high generic or specific risk patients is becoming a good alternative to traditional surgery.

[Sialomucins in the follow-up of patients surgically treated for colorectal cancer: preliminary results of a prospective study]. / Le sialomucine nel follow up dei pazienti operati per cancro colo-rettale: risultati preliminari di uno studio prospettico.

Preliminary results of a prospective study on sialomucin content found either at resection margins of colo-rectal cancer after curative surgery or in endoscopic biopsy specimens of colonic mucosa in thirteen patients selected for the follow up are reported. Though not statistically significant because of the small number of cases enrolled, preliminary data indicate that clinical application of differential mucin staining in colo-rectal neoplasms is potentially useful to predict subgroups of patients at risk for local recurrence as well as metachronous colo-rectal cancers.