Colonic lipomas. Three surgical techniques for three different clinical cases.

Colonic lipomas larger than 2 cm in diameter are likely to be symptomatic. In some cases a complication is the first clinical sign. Massive lower intestinal bleeding or obstruction, acute bleeding, prolapse or perforation or, rarely, acute intussusception with intestinal obstruction require urgent surgery. Diagnosis is often made following colonoscopy, which can also have a therapeutic role. Imaging procedures such as CT has a secondary role. Patients with small asymptomatic colonic lipomas need regular follow up. For larger (diameter > 2 cm) and/or symptomatic lipomas, resection should be considered, although the choice between endoscopic or surgical resection remains controversial. We believe that even lipomas > 2 cm can safely be removed by endoscopic resection. If surgery is indicated, we consider laparoscopy to be the ideal approach in all patients for whom minimally invasive surgery is not contraindicated.

Intracellular and cell-free (infectious) HIV-1 in rectal mucosa.

The intestinal mucosa contains most of the total lymphocyte pool and plays an important role in viral transmission, but only slight attention has been given to the immunological and virological aspects of human immunodeficiency virus-1 (HIV-1) infection at this site. In this study, before initiating or changing antiretroviral therapy, paired blood samples and rectal biopsies (RB) were obtained from 26 consecutive HIV-infected subjects. HIV-1 isolation and biological characterization, DNA, and HIV-1 RNA titration were assessed, as were in vitro tumor necrosis factor-alpha (TNF-alpha) and interleukin-beta (IL-1beta) spontaneous production. The rate of HIV-1 isolation from peripheral blood mononuclear cells (PBMCs) and RBs was 75% and 58%, respectively. All RB-derived isolates were nonsyncytium inducing (NSI), independent of the phenotype of blood-derived isolates. Proviral DNA and detectable HIV-1 RNA levels were measured in 100% and 77% of RBs, respectively. A statistical correlation was observed between HIV-1 DNA and HIV-1 RNA levels in rectal mucosa (P = 0.0075), whereas no correlation was found between these levels in blood samples (P > 0.05). Antiretroviral treatment did not seem to influence HIV-1 detection in RBs. Higher levels of in vitro proinflammmatory cytokine production were found in the RBs of most infected patients when compared with healthy controls. Therefore, the rectal mucosa is an important HIV-1 reservoir that demonstrates a discordant viral evolution with respect to blood. Both the virus type and the mucosa pathway of immunoactive substances might have important implications for therapeutic decision-making and monitoring and could influence the bidirectional transmission of HIV-1 in mucosal surfaces.

An unusual association of intracranial aneurysms and oesophageal duplication in a case of Klippel-Trenaunay syndrome.

The Klippel-Trenaunay syndrome (KTS) is a congenital disorder resulting from a mesodermal abnormality, characterised by cutaneous capillary haemangiomas, hypertrophy of bone and soft tissues and varicose veins. The presence of intracranial aneurysms has rarely been described, while oesophageal duplication has not been reported previously. We describe a patient with the KTS with both there additional abnormalities, which could be explained by a postulated mosaic gene abnormality.

Análisis de hemocultivos positivos en el Laboratorio de Microbiología del Instituto Oncológico Nacional: "Dr. Juan Tanca Marengo" ION-SOLCA desde may. 1996.- may. 1997 / Analysis of positive hemocultivos in the Laboratory Microbiology of the Institute Oncológico Nacional \"Dr Juan Tanca Marengo\" ION-SOLCA from may. 1996, -may 1997

Cambios dramáticos en los métodos de obtención de hemocultivos en la práctica clínica han ocurrido recientemente, debido a factores como el número aumentado de pacientes con riesgo de infección, identificación de patógenos nuevos en el torrente circulatorio, uso diseminado de catéteres intravasculares, y un merjoramiento universal en la habikidad y eficacia de recuperar e ydentificar microorganismos en sangre. En nuestro hospital no existe datos sobre las bacterias más frecuentemente aisladas, motivo por el cual se realizó está revisión retrospectiva, encontrándose que las bacterias más comúnmente aisladas son Pseudomonas, Acinetobacter y Enterobecter. Sin embargo un número elevado de cultivos sangíneos fueron positivos para Candida alvicans.

[Current indications for esophageal transection with gastric devascularization in the treatment of hemorrhaging esophageal varices]. / Le attuali indicazioni alla transezione esofagea con devascolarizzazione gastrica nel trattamento delle varici esofagee sanguinanti.

When endoscopic sclerotherapy fails or after recurrence, a surgical approach is necessary. Oesophageal transection is a rational and effective option, because, compared to the shunt, it does not change hepatic haemodynamics, it has lower operative mortality, particularly in emergency, and it does not complicate the surgical technique of a subsequent liver transplant. The authors report their own experience of 12 patients undergoing oesophageal transection out of a total 148 treated with endoscopic sclerotherapy for bleeding oesophageal varices, over a 5 year period. 4 patients were operated in emergency and 8 after haemorrhagic recurrence, 5 because of advanced hepatopathy and 3, young and Child A, because they were potential candidates for a liver transplant. Operative mortality has been nil, morbidity about 40% and the mean postoperative stay 15.4 days (range 10-21). In a mean follow up of 30 months haemorrhagic recurrence was 16.6% (2 cases); 2 patients died respectively 26 and 40 months after surgery.

[Thyroid carcinoma. Criteria for the selection of surgical treatment]. / I carcinomi della tiroide. Criteri di scelta del trattamento chirurgico.

Surgery is still today the first choice treatment in the thyroid neoplasm. The authors examined 37 patients with thyroid cancer out of 389 thyroidal operation performed in the period 1982-85 at the Institute of Surgical Pathology II and Surgical Clinic of University of Bari. The pro-operation screening was scintigraphy, US study and needle biopsy. In 23 case, with positive cytology examination and/or clinical malignancy the performed operation was total extracapsular thyroidectomy. Other nine patients underwent lobectomy and in 2 cases the operation chosen was sub-total strumectomy completed by thyroidectomy after histologically proved malignancy. The laterocervical lymphadenectomy was done only in the case of nodes involvement. Operative mortality was 0 and post-operative stay was about 6 days. The extracapsular total thyroidectomy is the first choice operation for cancer. Nevertheless recently some Authors proposed less destructive operation in the small differentiated type cancers with good results.