[Penile metastasis of bladder cancer]. / Metastasi peniena da cancro della vescica.

The Authors mark a case of penile metastasis in a man 70 years old suffering from bladder cancer. They emphasize the rarity of this manifestation. They discuss about symptomatology, diagnosis and pathogenesis even today debated. They mark therapeutical indications about the short expectation of life, that these patients have from appearance of the metastases.

[Use of a double-J endoprosthesis in the treatment of tuberculous stenosis of the pelvic ureter: clinical case]. / Utilizzazione di endo-protesi "doppio J" nel trattamento di stenosi tubercolari dell'uretere pelvico: caso clinico.

The Authors illustrate a case of tubercular stricture of the pelvic ureter, successfully treated, with the insertion of endo-ureteral prosthesis (double J) and with anti-mycobacterial therapy. They underline the increasing of incidence of the urinary t.b.c. (compared with the pulmonary) particularly at ureteral level. They confirm the efficiency of the ureteral catheterisation as therapy of the strictures, especially in the initial stages of the disease. They explain that this treatment can have only a temporary effect but can give time for a successive restoring surgical therapy.

Diaphragmatic hernias due to blunt thoracoabdominal trauma.

This nineteen-year retrospective review was designed to evaluate diaphragmatic hernias due to blunt thoracoabdominal trauma in a series of 50 patients. Motor-vehicle accidents were the most frequent cause. The diagnosis was made immediately after injury in 34 patients (acute hernias), but delayed from two months to 30 years in 16 (chronic hernias). Two patients, with multiple associated injuries, died soon after admission and diagnosis was made at necropsy. The nature of injury, the physical findings and the plain chest roentgenograms suggested a traumatic diaphragmatic hernia in most of the remaining acutely injured patients. All patients with chronic hernias had suggestive or suspicious abnormalities on chest roentgenograms; however, appropriate upper gastrointestinal tract and barium enema studies were of utmost importance for the correct diagnosis. Reduction of herniated viscera and repair of diaphragmatic defect were generally accomplished through a laparotomy in acute hernias, whereas thoracotomy was the preferred approach in delayed instances. There were four postoperative deaths, three with severe multiple associated injuries and one with respiratory failure.

[Retrosternal gastric bypass in the palliative treatment of advanced carcinoma of the thoracic esophagus]. / Il bypass gastrico retrosternale nel trattamento palliativo del carcinoma avanzato dell'esofago toracico.

Palliative substernal gastric bypass was performed in 20 patients with far-advanced, obstructing carcinoma of the thoracic esophagus between the years 1978 and 1982. In 18 patients the thoracic esophagus was bypassed using the stomach brought to the neck by substernal route for anastomosis to the proximal end of the divided cervical esophagus. The thoracic esophagus was completely excluded in 10 patients; the tumor-bearing segment of the esophagus excluded formed a small and asymptomatic mucocele with time. The Kirschner-Ong technique with the additional step of Roux-en-Y jejunal anastomosis to the intra-abdominal esophagus was used to provide drainage of esophageal secretions in 8 patients with tracheoesophageal invasion or impingement, for fear of imminent esophagorespiratory fistula; in three of these patients a radiation therapy was subsequently administered. In two patients an isoperistaltic gastric tube formed from the greater curvature and brought to the neck substernally was used for esophageal bypass. Anastomotic leakage occurred in 3 patients (15%). The thirty day operative mortality was 10 per cent (2/20) and the mean survival time was 10 months. The palliation afforded was excellent in all survivors with restoration of the ability to swallow a normal diet until the time of death. The authors believe that a simple one-stage bypass of the esophagus using the stomach substernally is an effective alternative to esophageal intubation, prolonged radiation therapy or colon bypass in achieving palliation with an acceptable morbidity and mortality in a high risk patient group.

[Bilateral splanchnicectomy according to the Dubois method in pain caused by chronic pancreatitis and by inoperable neoplasms of the pancreas]. / La splancnicectomia bilaterale second Dubois nelle algie da pancreatite cronica e da neoplasie inoperabili del pancreas.

The authors report a personal series of 12 p. undergoing splanchnicectomy through Dubois' transhiatal approach because of abdominal pain of pancreatic origin. They underline this technique produces immediately a total, lasting pain relief, improving quality of life of these patients.

[Treatment of esophagotracheal and esophagobronchial fistulas secondary to carcinoma of the esophagus]. / Il trattamento delle fistole esofago-tracheali ed esofago-bronchiali secondarie a carcinoma dell'esofago.

An experience with 16 patients with respiratory tract fistula (RTF) related to carcinoma of the esophagus is presented. The malignant fistula was present at the time of initial presentation and/or before any therapeutic intervention in 11 patients, and developed either during or following a course of radiation therapy in 5 patients. Bronchoscopy examination in 8 patients prior to RTF development showed tracheobronchial invasion or impingement in all. The patients were divided in five groups according to the treatment received. One patient received no specific therapy although was fed via nasogastric tube. Three patients had a feeding gastrostomy. Four patients underwent insertion of a Celestin tube. Three patients were submitted to esophageal exclusion with combinations of cervical esophagostomy, feeding gastrostomy and ligation or complete division of the gastroesophageal junction; drainage of the excluded esophagus was provided by a red rubber catheter. Five patients received by-pass operation: four had Kirschner-Ong operation with gastric by-pass placed substernally and distal esophagus anastomosed to a Roux-en-Y jejunal loop; in one patient an isoperistaltic gastric tube brought to the neck substernally was used for esophageal by-pass. These patients had, by far, the best palliative results with complete relief of their respiratory tract symptoms and restoration of the ability to eat and drink. Substernal gastric by-pass of the RTF is therefore advocated if the general conditions of the patient are improved with the institution of parenteral hyperalimentation and antibiotic therapy.

[Current role of surgery in the treatment of pulmonary metastasis]. / Il ruolo attuale della chirurgia nel trattamento delle metastasi polmonari.

During the period between november 1964 and december 1982, 48 patients were operated upon for metastatic lesions of lung from previous or actual carcinomas and sarcomas elsewhere in the body. The most frequent sites of origin of the primary malignancy were colon, testis and breast. The usual approach was through a thoracotomy; bilateral lung metastases were removed with one-stage procedure through a median sternotomy in two patients. The operative mortality was 2%. Overall five-year survival was 26%, which was not influenced by tumor histology, disease-free interval, or extent of pulmonary excision. In view of these findings, conservative pulmonary resection of metastatic lesions is advocated, regardless of the tumor histology or the disease-free interval, when the following criteria are adhered to: primary site controlled or controllable; no extrapulmonary metastases demonstrable; good operative risk; no other effective means of treatment available.

[Long-term results of the surgical treatment of ileo-colonic Crohn disease]. / Risultati a distanza del trattamento chirurgico della malattia di Crohn ileo-colica.

18 patients with Crohn's disease primarily treated with excisional surgery were studied. The crude recurrence and reoperation rate were analyzed. The influence of sex, age and length of history prior to operation was in this respect also studied.

[Results of the treatment of carcinoma of the thoracic esophagus with one-stage resection and esophagogastrostomy]. / I risultati del trattamento del carcinoma dell'esofago toracico mediante resezione ed esofagogastrostomia in un tempo.

Between november 1964 and december 1982, 102 patients were operated upon for the treatment of carcinoma thoracic esophagus. The philosophic objectives were to restore promptly the ability to swallow and to achieve a worthwhile survival period. To fulfill these requirements wide excision of the growth and immediate esophagogastrostomy were performed through a combined abdominal and right thoracic approach. In higher thoracic growths the Authors added a cervical phase. The resectability rate was 74% and the overall hospital mortality rate was 19,6%. Anastomotic leaks occurred in 10 patients (9,8%) with fatal outcome in 6. Pre- and postoperative care (particularly hyperalimentation and intensive respiratory therapy) and use of mechanical devices reduced the operative mortality rate to 8,1% between 1976 and 1982 without deaths in the last 16 patients. Very satisfactory palliation was achieved in 80% of the patients who survived the standard esophagogastrectomy. These patients enjoyed uncomplicated oral alimentation for the remainder of their lives. Despite there has been considerable improvement in operability and resectability rates and in survival of resection as compared to past years, long term results of treatment of carcinoma of the esophagus continue to remain disappointingly low. Overall survival rate at 5 years was 10,2% in this report. The stage of the disease influenced significantly survival: curative as opposed to palliative resections demonstrated a marked difference in 5-year survival (28,2% vs 2,8%). Long-term survival of patients with carcinoma of the esophagus will probably not improve until early diagnosis is possible. Therefore esophagogastrectomy should be the treatment of choice until other forms of therapy prove superior to it both in terms of palliation and long-term survival rate.

[Adenocarcinoma of the proximal stomach and cardia: problems of surgical strategy and technics]. / Adenocarcinoma dello stomaco prossimale-cardias: problemi di tattica e tecnica operatoria.

In a total of 142 patients with adenocarcinoma of the proximal third of the stomach and cardia, curative resection was carried out in 88 during the period 1960-1980. The patients were divided in two groups. I group included 32 patients with tumor distal to the esophagogastric junction. In II group (54 patients) the tumor involved the esophagogastric junction (adenocarcinoma of the gastric cardia). In I group, when the proximal border of the cancer was well defined and sufficient length was maintained between the proximal tumor border and esophagogastric junction, the abdominal approach was preferred and the operation performed was generally a total gastrectomy combined with splenectomy and celiac node dissection. Distal pancreatectomy was performed as necessary. In most patients of the II group, the operation was performed using separate abdominal and right-sided thoracic incisions. Two principally types of operation were used: extended total gastrectomy and extended proximal subtotal gastrectomy, depending on degree of gastric wall involvement, combined with extensive esophagectomy, splenectomy and regional nodes dissection in both cases. Distal pancreatectomy was not performed routinely but only as necessary. In this group of patients there was no significant difference in the overall cure rate between the extended total gastrectomy and the extended proximal subtotal gastrectomy. Operative morbidity and mortality rates were also comparable.

[Radioimmunologic analysis of calcitonin and parathyroid hormone in the study of calcium homeostasis in the newborn infant during the first days of life]. / Contributo del dosaggio radioimmunologico della calcitonina e del paratormone nello studio dell'omeostasi calcica nel neonato nei primi giorni di vita.

Measurements of serum calcium on the first, third and sixth day of life and serum Parathyroid hormone (PTH) and Calcitonin (CT) by radioimmunoassay on the first and third day of life have been effected on a group of 31 infants born after 29-42 weeks of gestation and weighing at birthday 1300-3510 g. The mean serum iCT levels on the first day of life (996 +/- 95 pg/ml) were significantly higher than on the third day of life (533 +/- 79 pg/ml; p less than 0,001) and both were upper normal range of method (200 pg/ml). Mean serum iCT values were found negatively correlated both with birthweight (p less than 0,025) and with gestational age (on 1st day p less than 0,02; on 3rd day p less than 0,001) in AGA newborns. No correlation was found between iCT values and serum Calcium values. The mean serum iPTH levels on the first and third day of life were in the normal range (on 1st day 416 +/- 61 pg/ml; on 3 rd day 640 +/- 114 pg/ml) and not correlated neither with serum Calcium and serum iCT levels, nor with birthweight and gestational age of the newborns. It is excluded that any transient hypoparathyroidism can cause early neonatal hypocalcemia and it is confirmed the presence of high levels of serum Calcitonin in term and premature infants.

[Clinical and instrumental study program of nodular diseases of the thyroid]. / Programma di studio clinico-strumentale delle affezioni nodulari della tiroide.

Authors have passed from a combined clinical and radioisotopic analysis to an integrated polyinstrumental approach by adding thermography and above all echography. In order to achieve the purpose Authors have confronted in retrospective a "clinico-radioisotopic group" of 103 cases, from 1965 to 1975, and an "integrated polyinstrumental group" of 53 cases, since 1976. Comparing the "clinico-radioisotopic method" with "polyinstrumental approach" the main results could be summarized as follows: the diagnostic specificity improved in benign lesions from 77% to 96%, however in malignant lesions it remained about the same (63%). Considering these results the Authors have subdivided thyroid nodules, mainly based on echography, in two distinct categories with the following orientation: I. Solitary Thyroid Nodule: a) definitely cystic -- demonstrated by echography; b) "cold" -- by conventional scintygraphy; c) "negative" -- by thermography; d) non uptake of tumor seeking radiopharmaceutical. The control, therapy and surveilance of these cases should be limited to needle aspiration of the cystic cavity followed, of course, by citologic examination. This aspirations is both diagnostic and possibly therapeutic. II. Solitary Thyroid Nodule: a) definite solid -- echography; b) "cold" -- convential scintygraphy; c) "positive" --thermography (possibly "negative"); d) non uptake of tumor seeking radiopharmaceutical. Here the therapeutic orientation is clearly surgical.