[Breast carcinoma in pregnancy: a clinical case]. / Carcinoma della mammella in gravidanza: caso clinico.

Breast cancer is a rare, but frequently hidden pathology. A woman, 36 years old, during the early months of pregnancy found a little tumor in her right breast. A fine needle biopsy was negative for cancer. Despite this, the tumor rose and two months after delivery (the patient breast-fed her daughter for a month), she had pain in the right axillary region and the tumors involved all superior dials of the right breast. A Madden mastectomy was performed. The histopathological report was: ductal invasive breast cancer 3 of 19 lymph nodes involved, stage IIIA, TNM pT3N2M0, ER -, PgR +--. Chemotherapeutic regimens were: at first ADM 75 mg/m2 for 5 cycles, and after CMF 1-8 for 6 cycles. After six months the woman had a cutaneous recurrence in the scar of mastectomy, treated with surgery and RT. Thirteen months after, she had lung MTS and then brain MTS. The patient died thirty months after the mastectomy. The surgeons have to discover the women high-risk for the breast cancer before and during the pregnancy. Excisional biopsy is the diagnostic procedure of choice for breast lump during pregnancy. When a breast cancer develops during a pregnancy, the surgeon has to operate immediately the tumors. Chemotherapeutic regimens should be delayed until the second o third trimester or after delivery.

[Biliary tract carcinoma. Case report]. / Il carcinoma della via biliare principale. Contributo clinico.

Carcinoma of the main biliary way is a condition that often leads to a fatal outcome owing to the rapid growth and late onset of the symptoms. The importance of a correct, timely diagnosis is stressed, with reference to a clinical case in which even CT scanning did not confirm either the presence of the neoformation or the dilation of the intra and extrahepatic bile ways. The usefulness of humoral markers for the diagnosis of the disease in its preclinical phase in the interests of surgical treatment that is as radical as possible is underlined.

[Pseudomyxoma peritonei with appendiceal and ovarian mucinous cystadenoma. A case report. Correlations with synchronous or metachronous colorectal carcinomas]. / Pseudomixoma peritonei con cistoadenoma mucinoso appendicolare ed ovarico. Contributo clinico. Rapporti con i carcinomi colo-rettali sincroni o metacroni.

Mucocele is a rare pathology which is difficult to diagnose prior to surgery. The clinical symptoms are aspecific. Diagnosis is generally made at the time of surgery. Explorative laparoscopy is not advised owing to the possibility of encouraging metastatic diffusion. Surgery associated with ex tempore freezer tests must be carried out with the greatest caution to avoid rupture of organs and the spread of mucin. Appendectomy and removal of the adnexa is recommended in benign forms, with or without omentectomy. Omentectomy is necessary together with hystero-adnexectomy and right hemicolectomy in malignant forms, as well as lymph node cleaning and removal of all mucin in pseudomyxoma peritonei.

Giant esophageal polyp: a rare and benign neoplasm.

Giant esophageal polyp is a very rare neoplasm, usually benign but often demanding both for diagnostic and/or therapeutical procedures and for dramatic symptomatologic onset in the patient (regurgitation and asphyxia). The authors present a brief clinical report of a patient with a 20 cm.-long esophageal polyp removed by left lateral cervicotomy and esophagotomy for 8 cm. below the upper esophageal sphincter (histologic examinations showed a pedicled polypoid fibrolipoma with a remarkable presence of myxoid and vascular components). The authors also describe diagnostic and therapeutic methods to manage this rare disease and they gave a brief review of recent literature.

[Primary lymphoma of the small intestine. A clinical case report and review of the literature]. / Il linfoma primitivo dell'intestino tenue. Descrizione di un caso clinico e revisione della letteratura.

The authors present a case of small bowel primitive lymphoma found in a 66-years-old female. After having briefly reviewed the literature they direct their attention to the clinical-instrumental diagnostic difficulties of this neoplasm which is often discovered only when it has already invaded various organs. Therefore surgical therapy is not always radical. This fact in addition to the fatally rapid postoperative course led the authors to discuss the problems involved in a correct treatment of this pathology.

[Ileal and axillary metastasis of primary unknown site melanoma. Clinical case]. / Metastasi ileale ed ascellare da melanoma primitivo a sede ignota. Caso clinico.

The incidence of Cutaneous Melanoma is 4-5% of all the tumors of the skin. This incidence increases several folds in the last years. Metastases of Melanoma involve lungs, skin, soft tissue, liver, bone, brain, but in 20-30% of the patients involve gastrointestinal (GI) tract. In 60-70% of the cases GI metastases involve small bowel, in 15-20% stomach, in 10-20% large bowel, in 5% esophagus. In 8% of the patients the primary cutaneous melanoma is not known. The prognosis of the patients with metastatic melanoma is poor with an average survival of 5 months. One patient male, 51 years old, underwent surgery for metastases from melanoma in the lymph nodes of the right axilla and in the gastrointestinal tract (ileum). An ileo-ileo anastomosis and a lymphoadenectomy of the nodes of the right axilla were performed. After a first chemotherapy with DTIC (800 mg/m2) + a-IFN(3MU three times every week) and another with CDDP (30 mg/m2 day 1-3), DTIC (250 mg/m2 day 1-3) and VDS (2.5 mg/m2 day 1) with no response, the patient was treated with chemo-immunotherapy sec. Bernengo, slightly modified: CDDP 75 mg/m2; IL-2 18 MU (9MU b.d.) day 3-6 and 17-21; a-IFN 5MU three times every week. This therapy had a partial response of short-course (three months) and the patient died 15 months after surgery. The authors hope that immunotherapy and genetic therapy improve the survival of the patients with metastatic melanoma in the next years.

[Low ileorectal anastomosis in the surgery of ulcerative rectocolitis]. / L'ileorettoanastomosi bassa nella chirurgia della rettocolite ulcerosa.

The authors report their experience of 23 patients with ulcerative colitis treated with surgery from 1991 to 1994. At admission 8 patients had a high-grade illness, 10 patients had a middle-grade illness, 5 patients had a toxic megacolon. All the patients were treated with systemic medical management (mesalazine + methylprednisolone) and topical medical management with rectal steroid (methylprednisolone) and rectal mesalazine by enema, and with nutritional support (Total Parenteral Nutrition). The 5 patients with toxic megacolon, after 48 hours of unsuccessful medical management, underwent surgery with deferred urgency; the other 18 patients underwent surgery after one-four months. The authors prefer the ileorectal anastomosis (IRA), since the rectal lesions are more susceptible to topical therapy. A single-stage IRA was performed in 17 patients. A sigmoid resection has been employed in the first stage in the 18th patient with a local development of the disease in the sigma; a following relapse of the lesions required a total colectomy with a low ileorectal anastomosis. A first-stage subtotal colectomy with ileostomy and Hartmann closure of the rectum with low ileorectal anastomosis at a later date was performed in the 5 patients with toxic megacolon. One of these, 18 years old, died after a heart failure. After surgery, as soon as the patients start moving their bowels all of these had again a systemic therapy with mesalazine for a short period and after they had a topical therapy with mesalazine + methylprednisolone by enema, for a long period. The average postoperative period of admission was 16.3 days. The functional results have been encouraging with an average of 1.6 bowel movements daily and an average of 0.4 nocturnal bowel movements. All the patients had a normal anal sphincter function with an acceptable stool frequency. In male patients there no urinary or sexual defects. In one case of these, there was a low grade of dysplasia, revealed by endoscopic biopsy. The authors conclude that today surgical treatment of ulcerative colitis is not well established.

[Peritoneal mesothelioma. A case report]. / Il mesotelioma peritoneale. Caso clinico.

Peritoneal mesothelioma is a rare neoplasm (annual incidence: 1-2 cases per million in the general population) and forms about 10% of all mesotheliomas. The authors report a case of malignant mesothelioma of the peritoneum in a male, 61 years old. After laparotomy the patient was treated with intraperitoneal administration of cisplatin (40 mg/m2 day 1-2-3-29-30-31) and intravenous administration of mitomycin C (10 mg/m2 day 1). The renal toxicity was avoided with the GSH and with prehydration before and after administration of the cisplatin. The bone marrow toxicity was avoided with the subcutaneous administration of G-CSF (300 mg three times each week) and erythropoietin (10.000 U three times a week). After the first cycle, with the reduction of the ascites, the cisplatin was administered intravenously too. After six cycles of chemotherapy (18 months after laparotomy) the patient is alive and he has a performance status of 1 (ECOG/WHO). The chemotherapy with cisplatin and mitomycin C must be preferred to the anthracycline in all the patient with cardiologic involvement. The cisplatin administered by intracavitary route give a quick response with less systemic toxicity. A review of the literature confirms the rarity of this pathology, linked epidemiologically with exposure to asbestos, and the difficulty of the preoperative diagnosis: in fact cytologic assay and ultrasonographic and TC scan always don't permit to discover a mesothelioma. The laparotomy and the laparoscopy are useful in the P.M. for the possibility of the biopsies and the apposition of the catheters for intracavitary therapy. The response of peritoneal mesothelioma to treatment is poor. The median survival after the appearance of the symptom is less than 18 months.

[Liposarcoma in the submandibular region. Clinical case]. / Liposarcoma della regione sottomandibolare. Caso clinico.

The authors report a case of liposarcoma in the sub-mandibular region, and they describe the histological species and the way of spreading. They suggest a surgical, non-demolitional therapy, that they carried radical if it is related to a strict follow-up. Anatomical and functional results, after demolishing surgical therapy, are sometimes unacceptable if the real benefits in terms of survival are considered. No supporting therapy has been used because of the presumed insensibility of the neoplasm to the chemo-radiotherapeutic treatments. At 2 years from surgical treatment no local relapses, on distance metastasis have been related.

Photon emission from normal and tumor human tissues.

Photon emission in the visible and near ultraviolet range by samples of human tissue removed during surgery has been measured by means of a low noise photomultiplier coupled to a data acquisition system. The results show that among the 25 analyzed samples the 9 from normal tissues had an emission rate of the order of some tens of photons/cm2 min, while most of the 16 tumor tissue samples had a very much higher rate.

Ovarian varicocele: ultrasonic and phlebographic evaluation.

The aim of this work is to suggest a new diagnostic approach to the "female varicocele syndrome" which utilizes transvaginal ultrasonography. The presence of circular or linear anechogenic structures with a diameter greater than 5 mm, which were found in transverse and oblique sections of the lateral fornices, was indicative of pelvic varices. The vascular nature of these structures was confirmed with the Valsalva's maneuver and in the upright position. The presence of "pelvic varices" was confirmed by retrograde phlebography of the left ovarian vein in 46% of the cases. In such cases the parity was greater than in subjects without "pelvic varices" (chi square = 12.75, p less than 0.001), and the principal symptoms were characterized by pelvic pains and menstrual cycle disorders.

Radiologic anatomy of the genital venous system in female patients with varicocele.

The diagnosis of varicocele in a female patient is difficult clinically. Until recently, only celioscopy and uterine phlebography were helpful. We have developed a new method for diagnosis of the pelvic varicocele using retrograde phlebography of the ovarian and iliac veins. Thirty-three women with pelvic pains and disorders of the menstrual cycle have been studied. In 15 patients, an insufficiency of the left ovarian vein was revealed. In three of the patients, an analogous insufficiency of the right ovarian vein was also recognized, along with chronic bilateral stasis in the pampiniform plexes. An insufficiency of the left iliac vein was present in seven of the patients without ovarian varicocele. The average age of the women without ovarian reflux was lower (22.5 years) than that of women with reflux (36.6 years) (p less than 0.01). In this last group of patients, the number of pregnancies was greater (30 children) than in the group without reflux (two children) (chi-square = 12.75; p less than 0.001). This indicates how parity plays an important role in the determination of the appearance of a varicocele. We conclude that the diagnosis of pelvic varicocele may be made by a new diagnostic method represented by retrograde phlebography of the ovarian and iliac veins. The use of it in patients with chronic pelvic pains and disorders of the menstrual cycle of unknown nature can be done routinely.

[Pathology caused by suture materials in patients with gastric resection. Endoscopic findings]. / La patologia da filo di sutura nel resecato gastrico Rilievi endoscopici.

The authors report the results obtained from an endoscopic study on 131 gastric resected patients, who in 18.3% showed a pathology due to suture thread. The Authors dwell upon the clinical picture shown by these patients, and also consider the cases performed on urgency for hematemesis and/or melaena, and upon the diagnostical role of endoscopy. Moreover, they report the results obtained through the endoscopic therapy, which in 100% of the cases allowed the removal of the suture thread.