Total thyroidectomy in Basedow-Graves' disease treatment: our experience.

In the present study the authors, after a short historical description of the Basedow-Graves' disease, describe their case-study gathered over the last five years. They mention the most widely accepted hypothesis regarding disease's etiology, strongly linked to autoimmune disorders, and the role that some viral agents (Coksackie B and HTLV-II) may have in initiating autoantibody production and T cells activation in genetically predisposed individuals. Basic and clinical aspects of the diagnosis and disease treatment, highlighting the use of thyroidectomy, are addressed. They conclude that total thyroidectomy represents today the treatment of choice, which, after appropriate preparation to reach the euthyroidism condition, can ensure a successful cure.

Unilateral synchronous breast tumors. Rare association of myofibroblastoma and osteosarcoma.

The authors describe the case of a patient with two particularly rare contiguous tumors, myofibroblastoma and osteosarcoma, in the same breast. Rare does not mean untreatable, and the chance of recovery is no less than with more common tumors. However, rare tumors do present a significant problem for pathologists due to diagnostic difficulties, and so an exact prognosis is not always possible.

Indications for and limits of conservative surgery in breast cancer.

Improvements in diagnostic techniques and, above all, breast cancer screening campaigns - essential for early diagnosis - have enabled the objectives of conservative surgery to be pursued: disease control, no or low incidence of recurrences and an excellent esthetic result. However, to reach these objectives, it is essential to ensure a careful evaluation of the medical history of every patient, a detailed clinical examination and the correct interpretation of imaging. Particular attention should be paid to all factors influencing the choice of treatment and/or possible local recurrence: age, site, tumor volume, genetic predisposition, pregnancy, previous radiotherapy, pathological features, and surgical margins. The decision to undertake conservative treatment thus requires a multidisciplinary approach involving pathologists, surgeons and oncological radiologists, as well, of course, as the patient herself.

Pancreatic pseudocyst: case report and short literature review.

We report a case of pancreatic pseudocyst secondary to acute necrotizing pancreatitis treated with open cystogastrostomy. Following a literature review, we stress the enormous benefits offered by modern diagnostic techniques, and especially imaging techniques, for the diagnosis and monitoring of this disease. Treatment should be delayed for at least six weeks, following which the drainage by open surgery offers the best results and lowest morbidity and mortality, followed by laparoscopy and endoscopy, indicated in particular cases and in patients where open surgery is contraindicated.

Liver trauma. Diagnosis and treatment.

The authors summarize the essential steps in liver surgery. Modern imaging techniques are of great help in establishing a circumstantiated diagnosis of post-traumatic lesions of the intra-abdominal parenchymatous organs, and especially the liver. Such diagnosis must always be based on the AAST (American Association for the Surgery of Trauma) classification, essential for a correct approach. Each therapeutic choice must be based on a careful clinical evaluation to establish whether emergency exploration of the abdomen or simple patient monitoring is indicated. Organ injuries and consequent hemoperitoneum must be found and quantified. In any case, diagnosis and treatment must only begin once all measures have been taken to ensure the maintenance of vital functions and the normalization of the main blood chemistry parameters.

Ectopic parotid: case report.

A recent case led the authors to re-examine the clinical characteristics of the cervical ectopia of the major salivary glands. These glands develop in the embryo between the sixth and seventh week, starting with the formation of endodermal invaginations of the branchial section of the floor of the primitive mouth. These cell cords, initially solid, proliferate in the underlying mesenchyme, starting from the opening of the future excretory duct, and subsequently branch and canalize. During embryogenesis, the endodermal invaginations become closely interconnected with the adjacent lymphatic tissue. It is thus possible for lymphoid tissue to migrate into the parotid or the other major salivary glands, or conversely, for salivary tissue to become included in the cervical lymph nodes. Very rarely, ectopic salivary gland tissue can also be found in other unusual locations, including the neck region, as a result of a developmental abnormality of the branchial apparatus. The base of the neck is the most common location, while ectopia of the mid third of the neck is quite rare. The authors discuss the clinical details and diagnostic procedure leading to preoperative diagnosis. This congenital anomaly can, albeit rarely, degenerate into cancer, and surgical excision is thus imperative.

Mucocele of the appendix. Two case reports.

The authors present two cases of mucocele of the appendix and discuss them in relation to the literature and the clinical features of this disease. They clarify the definition of mucocele as an intraluminal accumulation of mucus in the appendix, and concentrate on the observable pathological processes, agreeing on the higher frequency of mucinous cystadenoma and the possibility that mucocele can develop into peritoneal pseudomyxoma or degenerate into cystadenocarcinoma. They also note that most diagnoses are made intra-operatively during appendectomy, and that, in cases suspected preoperatively, thorough investigation with imaging techniques is very important in order to plan the best treatment.

[Etiopathogenetic and clinical considerations of corpus luteum cysts]. / Considerazioni etiopatogenetiche e cliniche sulle cisti luteiniche del corpo luteo.

The Authors report a case of hemoperitoneum after breaking of luteal cyst of corpus luteum and stress the main characteristics of this pathology. Ovarian cysts are frequently observed in the annexa; they are distinguished in folliculis cysts, luteal cysts, luteal cysts of corpus luteum. Their evolution, influenzed so both by endocrine factors so many from plogistic stimulation, pass through three essential moments: - obliteration for quick cicatrization of the stigma Graafian follicle; - hematic pouring and central softening; - increase of intracavitary fluid that stops with constitution of the fibrous tissue. In the second phase of the menstrual cycle, functional-anatomic changes occur that cause the formation of gravidic corpus luteum or menstrual corpus luteum. The luteal cysts of corpus luteum represent the result of the cystic evolution of the corpus luteum. These cysts are characterized by an intense endocrine activity and can frequently produce a surplus of steroids, particulary of progesterone. They can cause bleeding, often of slight entity but also severe that; these represent a frequent and dangerous complication, especially in women subjected to anticoagulant treatment with warfarin. This drug can determine a raise of intracystic pressure with consequent breaking of the capsule and hemoperitoneum for which is necessary emergency operation like in the case here described.

[A complication in biliary surgery: the biloma]. / Una complicanza degli interventi sulle vie biliari: il biloma.

Authors stress that complications in laparotomic and laparoscopic extrahepatic biliary surgery aren't exceptional. Lesions could be due to section or to stenosis of biliary duct. We can distinguish: intraoperative lesions, which consist in a intraperitoneal bile groan that needs an immediate treatment; lesions that could be found in postoperative period and in any case many days after surgery. Among this complications there is biloma, i.e. a localized uncapsulated extraductal bile collection. Authors refer about their experience and describe clinical findings of this complication. They conclude affirming how biloma treatment doesn't require always resurgery or CT scan drain. Main biliary tract endoscopic decompression could be often useful.

[Our experience in inguinal hernia recurrences treatment]. / Il trattamento delle ernie inguinali recidive: nostra esperienza.

Reporting their personal experience, the authors focus on characteristics and causes of recurrence, either after traditional surgery or with tension-free technique. They describe difficulties and advantages in open interventions and laparoscopic ones. Facing a relapse it's convenient to assume an "eclectic" behaviour, thinking both of general and specific single patient anatomo-pathologic features.

[Acute neoplastic colic obstructions: therapy and postoperative complications. Our experience]. / Le occlusioni acute neoplastiche del colon: terapia e risoluzione di complicanze postoperatorie. Nostra esperienza.

Authors report their experience about neoplastic large bowel obstructions and present two cases of anastomotic leakage resolution by means of transtomy wash-out. They observe that the most important problem in this surgery is anastomotic leakage which, if small, can be solved in a non operative way. According with literature, they also point out anastomotic leakage is commonly due to the impossibility of a correct preparation of colon to operation in emergency. They conclude it is possible, in case of little leakages, to perform trans-stomy wash out which permits a good toilette and sterilization of the colon.

Giant mucinous cystadenoma in a young patient. A case report.

The Authors describe the clinical case of a seventeen-year-old girl who presented with abdominalgia, fever, nausea and vomiting. During surgery it proved necessary to remove not only the appendix but also a voluminous mucinous cystadenoma of the ovary. The authors take this observation as a starting point for a description of the pathophysiological and clinical findings of these neoplasms.

[Hepatic hydatidosis: old and actual therapeutic strategies]. / L'idatidosi epatica: pregresse e attuali strategie terapeutiche.

The authors, reporting on their experience, confirm as the incidence of the hepatic hydatidosis and the complications related to this pathology today are very meaningful. They specify that the objectives to be pursued are: elimination of the parasite, prevention or treatment of the complications, prevention of the development of a new infestation. They dwell therefore upon the various techniques, both conservative and radical, that marked the history of the hepatic hydatidosis surgery, and they conclude affirming that the procedures of eradication of the parasite and the pericystectomy, in particular in laparotomic way, also represents the ideal treatment in consideration of the a little encouraging results of the medical therapy.

[Closed trauma of the spleen. Indications to surgical treatment]. / I traumi chiusi della milza. Indicazioni al trattamento chirurgico.

The Authors mention the historical evolution that led to consider the splenectomy as the ideal operation in patients with post-traumatic lesions of the spleen. They linger then on the actual knowledges about the physiopathology of this organ that determined a substantial change of mind to a conservative treatment, when possible. By reporting their experience of the last decade, they weigh up how every therapeutic choice must be consequent to an accurate clinical evaluation that suggests the surgical abdomen exploration in urgency or, on the contrary, the monitoring of the patient. They linger particularly on the validity of the investigation and quantization of organ lesions and of the subsequent hemoperitoneum. The Authors end affirming that an accurate diagnostic evaluation and the subsequent therapy must take place in a specialized Trauma Center that ensures intensive monitoring and, if necessary, a timely operation in these patients.

[Spontaneous splenic rupture in a patient with cytomegalovirus infection]. / Rottura spontanea di milza in presenza di infezione citomegalica. Descrizione di un caso clinico.

The Authors report a case of spontaneous splenic rupture in a patient with Cytomegalovirus infection, stress the main characteristics of this infection and describe the mechanism that, during the viral infection, causes morphological and functional alterations of the spleen. The hypersplenism secondary to hyperfunctioning, the formation of immunocomplexes with secondary infarction, mainly of the white pulp, and the disseminated intravascular coagulation are responsible, as in the observed case, of the rupture of splenic capsula. The Authors conclude that the wide diffusion of Cytomegalovirus infection needs the knowledge of all the pathologic signs of this infection to make a timely diagnosis and treatment.

[Etiopathogenic hypothesis on carcinoma of the gallbladder: our study]. / Un'ipotesi eziopatogenetica in tema di carcinoma della colecisti: il nostro studio.

The authors are interested in determining causes of gallbladder cancer (GBC). By this intention, they theorize a correlation between genetic modifications (which are responsible of malignant transformation of biliary epithelium) and some intestinal infections. From 1999 to 2004 they observed 15 GBC and all 15 gallbladder have been analyzed histologically and from microbiological aspect; by these means from 1999 till 2004 they have studied also 30 persons with colelithiasis. The authors noticed that bile of both groups contained, in three cases in the first and in 8 cases in the second, a germ named Escherichia Coli which normally lives in intestine, while in 10 operated gallbladders of the first group and 12 of the second there was a positive for k-ras. They are studying to confirm their theories.

[Stomach GIST]. / I gist dello stomaco.

Gastric stromal tumors give diagnostic and therapeutic problems, especially with regard to histopathologic identification and biological behavior. These tumors are very rare in all case reports. These ones are the most frequent of all alimentary tract. They are often incidentally found; because of their potential transformation, they have to be treated by respecting oncologic eradication standards and observing prognostic criteria based on a correct histopathologic evaluation (neoplasm localization and dimension, its structure, presence of cytological atypisms, mitotic index, ploidia, surgical resection). Then there has to be a good follow-up program.

Nosocomial infections in colo-rectal surgery of the old patient.

Every surgical act, especially in geriatric age, can be a relevant moment in the onset of nosocomial infections. This has a peculiar aspect in patient who undergo colo-rectal surgery, both in election and especially in emergency, in which the simple opening of intestines always involves a minimal contamination. In order to reduce the incidence of infections, and therefore the septic complications of this surgery, it is necessary to pay attention to the preparation of the surgical equipe, of the operating room, of the surgical instruments and, in election, to the careful preparation of the patient through a careful evaluation of the possible bio-umoral alterations, in order to correct them. The results of our experience allow us to say that the prevention of post-operatory sepsis find its main moment in the careful evaluation and eventual correction of the nutritional status, in the stimulation of the immune system, in the antibiotic prophylaxis both parenteral and topical, and, last but not least, in a correct surgical technique. All this is particularly important for patients affected by colo-rectal neoplastic and inflammatory diseases, for which the intestinal bacteria, more virulent in weak and fragile patients, often represent the source of contamination that can start a sepsis and then assume an important part in determining the final result of surgery.

[Ileum-colon junction benign obstructions]. / Le occlusioni benigne della giunzione ileo-colica.

The Authors discuss on anatomical and functional characteristics of ileum-colon junction, physiological narrowing in alimentary tract and often involved in benign obstruction. They report their series and analyze all inflammatory or not inflammatory diseases potentially involved, by describing them shortly and giving some information about their clinical features and imaging. The treatment of this obstruction will be done as soon as possible, before wall lesions force to make a larger resection.

[Acute pancreatitis: our experience in the light of natural history]. / Pancreatite acuta: nostra esperienza alla luce della sua storia naturale.

The Authors enumerate main steps of acute pancreatitis natural history. Then they discuss their last five years case-report. After having stated that clinical presentation depends on anatomo-pathological conditions, they consider aetiological causes and morphopathogenetic moments involved in the onset and development of this disease. They conclude stating how only proper diagnosis and treatment can prevent its potential evolution in multiorgan failure.