[Surgical treatment of parathyroid hyperplasia]. / Il trattamento chirurgico dell'iperplasia delle paratiroidi.

BACKGROUND: To review a series of 11 patients affected by hyperplasia of parathyroid glands and to discuss diagnostic and therapeutic tools. METHODS: A series of 11 patients out of 44 (= 25%) with primary hyperparathyroidism has been retrospectively reviewed. They underwent surgery in I surgical Department of OORR of Bergamo. All 11 patients were submitted to ultrasound and computed tomography examination before surgery, without any localisation of hyperplastic or adenomatous tissue. An exploring cervicotomy was performed with subtotal parathyroidectomy after the anatomopathological result of hyperplasia. RESULTS: No adverse effects related to surgery were observed. All patients could be considered as cured with a median follow-up of 36 months. CONCLUSIONS: Among hyperparathyroidism, hyperplasia is an underhand form and even if the laboratory diagnosis is simple, the imaging techniques cannot always localise the pathologic tissue. Personal experience shows the role of subtotal parathyroidectomy (removal of 3 parathyroid glands and a half of the last one) confirmed by the absence of adverse effects or relapse with a median follow-up of 36 months.

[Epidemiological behavior of perforated peptic ulcer before and after the introduction of the antisecretory drug therapy. Our experience]. / Il comportamento epidemiologico dell'ulcera peptica perforata prima e dopo l'introduzione della terapia medica antisecretiva.

The diagnostic iter and treatment of peptic ulcer have evolved considerably over the past 20 years. The capillary spread of endoscopy has permitted secure and precise diagnoses to be made, in terms of both the site and size of the anatomic lesion, on the one hand, and on the other, the introduction of antisecretory drugs has led to the resolution of the majority of ulcers, so much so that the ulcer is no longer managed using strictly surgical methods but is now treated medically and only emergency cases, such as perforations, undergo surgery. Complications, such as digestive hemorrhage, penetration and stenosis, may lead to the need for surgery. In particular, perforation seems to be the only complication which has not been significantly influenced by the introduction of antisecretory therapy, the point that its status as a "complication" has been questioned leading to the suspicion of its nosological autonomy. The authors review the series of ulcer patients admitted to hospital during the period 1968 to 1991, paying special attention to the correlation with the use of antisecretory drugs which were introduced during the period 1978-1981, the trend of ulcer complications over the entire period, the duration of symptoms and the epidemiology of peptic and perforated ulcers.

[The diagnostic and therapeutic problems of endocrine tumors of the digestive system: our experience]. / Problematiche di diagnosi e terapia dei tumori endocrini dell'apparato digerente: la nostra esperienza.

The authors experience in the surgical treatment of endocrine tumours of the digestive tract is reported. Particularly, they emphasize that in spite of the several syndromes associated with these neoplasms, diagnostic and therapeutic concepts herein analyzed are similar.

[The surgical therapy of morbid obesity: our experience]. / Terapia chirurgica della grande obesità: la nostra esperienza.

The authors report their experience of two years in the surgical management of morbid obesity. The efficacy of the biliopancreatic diversion, method created by Nicola Scopinaro, is underlined. Sixteen patients affected by morbid obesity were treated with this method. Results obtained are comparable to those reported in literature; therefore the authors have been induced to continue in this direction.

[Surgical treatment of pheochromocytoma: our experience]. / Terapia chirurgica del feocromocitoma: la nostra esperienza.

The Authors report their experience of pheochromocytoma surgical treatment based on four recent cases one of which with extra-adrenal location. Newest and more refined diagnostic techniques as well as modern pathophysiologic data allow an early detection of the disease. Furthermore, the availability of proper medico-surgical therapeutic modalities assures less risks and better results.

[Leiomyoblastoma of the small intestine]. / Il leiomioblastoma del tenue.

A case of leiomyoblastoma in the small intestine is illustrated. The patient underwent first and iliac resection and then, 36 months later, a removal of multiple hepatic metastasis. The authors recall as the benign appearance of a leiomyoblastoma sometimes in only apparent, so that it's quite difficult predicting its evolution. Not any histological method can give express an available valuation about the neoplasm malignant potency.

[Leiomyosarcoma of the stomach: contribution to case reports]. / Il leiomiosarcoma gastrico: contributo alla casistica.

The authors illustrate two cases of gastric leiomyosarcoma (LMS) by themselves observed and they point out the anatomicopathologic and clinical appearances. Hemorrhagic sequels, presence of abdominal massa, canalization troubles often are the symptoms revealing a neoplasm, which therapy is a surgical exeresis composed by electric attitudes.

[Hepatic adenoma and oral contraceptives: personal case]. / Adenoma epatico e contraccettivi orali: osservazione personale.

PIP: A 38-year-old Italian patient complained of dyspeptic disturbances and a feeling of postprandial swelling or weight. She had been taking oral contraceptives (OCs) for about 6 years. Ultrasound showed a small rotund formation in the liver. Surgery began and a tumor about the size of a tangerine was found and removed. After the surgery OC use was discontinued and she returned home totally healed on the 14th day after the surgery. The hypothesis on the association between benign liver tumors and OCs 1st appeared in 1973; later on, this was confirmed as a fact by the numerous cases reported. Hepatic adenoma, while rare in children, men, and women after menopause, is not a rare finding in fertile women who utilize OCs. Although there is a definite tie between the use of OCs and hepatic adenoma, the risk involved is minimal. Out of 35 million women using OCs, only 2000 experienced this side effect and in many of those who were affected the tumor regressed upon discontinuation of the contraceptive. The adenoma itself appears as a neoformation, for the most part round, of variable volume from the size of a nut to that of a grapefruit or larger. Also in about 10% of the cases it turns out to be plurifocal. The most frequent complications are hemoperitoneum and intratumoral hemorrhage due to necrosis of the newly formed tissue, and in 8% of these cases they can lead to death. These complications can come on quite unexpectedly and surgery is usually indicated. In surgery the echo-scanner is used to determine if the tumor is plurifocal. Surgery consists of exeresis of the tumor with resection on the healthy hepatic parenchyma. In cases of hepatic bleeding, simple suturing of the liver is usually suggested. If the tumor is large it is best to utilize a segmentary hepatic resection or in rare cases a lobectomy. After surgery OC discontinuation is necessary and assures a definite recovery.^ieng

[Right hypogastric artery steal syndrome caused by a traumatic aneurysm of the gluteal artery with consequent ischemic necrosis of the foot]. / Sindrome da furto dell'arteria ipogastrica di destra da aneurisma traumatico dell'arteria glutea con conseguente necrosi ischemica del piede.

A case of aneurysm of the right gluteal artery with ischaemia of the lower limb due to a recent hypogastric steal syndrome is reported. Attention is drawn to the unusual nature of this finding and its aetiopathogenesis is discussed. Reference is made to the clinical and therapeutic aspects of the case, and the soundness of surgical procedure, which brought about a cure.

[Diffuse entero-mesenteric lipomatosis]. / La lipomatosi entero-mesenterica diffusa

Successful surgical management of an unusual case of diffuse lipomatosis is reported. The clinical and radiological pictures are described and the essential points to be taken into consideration in differential diagnosis are illustrated.