[Medullary thyroid carcinoma]. / Il carcinoma midollare della tiroide.

The authors report a case of medullary carcinoma of the thyroid diagnosed at the 2nd Surgery Clinic of IRCCS Policlinico "San Matteo" in Pavia in a series of 600 cases of thyroid pathology. Having emphasised the rarity of this pathology, the authors report the characteristic pathological aspects. They also outline the clinical signs leading to suspected diagnosis, illustrate the diagnostic techniques used to achieve an early diagnosis and underline the importance of the tumour markers CT and CEA. They identify radical surgery, total thyroidectomy with MND lymphadenectomy, as the therapy of choice, followed by accurate and careful monitoring with a view to ensuring an early diagnosis of renewed disease or recidivation.

[Malignant fibrous histiocytoma of the breast. A clinical case]. / Istiocitoma fibroso maligno della mammella. Contributo clinico.

The authors report a personal, observed case of relapsing malignant fibrous histiocytoma of the breast. After recalling the anatomopathologic aspects and the clinical characteristics of the affection, the authors dwell upon the utility of correct diagnosis and point to the right therapeutic way consisting of a radical surgical treatment.

[Primary osteogenic sarcoma of the breast. Clinical contribution]. / Sarcoma osteogenico primitivo della mammella. Contributo clinico.

A case of primary osteogenic sarcoma of the breast is reported. All its clinical, radiological, gross and histological characteristics are analyzed, nevertheless the diagnosis is difficult. The authors dwell upon the utility of fine-needle aspiration and upon the importance of histologic and immunohistochemical studies. After emphasizing the difficulty both in an adequate local control and of metastasis, the authors point to the right therapeutic ways, still debated for the rarity of the tumor, which precludes every prospective trial.

[Solitary fibrous mesothelioma of the peritoneum. Considerations of a clinical case in our observation]. / Il mesotelioma fibroso solitario del peritoneo. Considerazioni su un caso clinico giunto alla nostra osservazione.

The authors report a case of so-called solitary fibrous peritoneal mesothelioma which was successfully operated on. Their case is compared with the few cases reported in the literature. Analysis of findings shows the fibrous peritoneal mesothelioma to be a solitary well defined tumor, generally of considerable size at the time of the diagnosis, very similar to the fibrous metothelioma of the pleura. It is believed to originate in the sub-mesothelial connective tissue. Surgery provides a definitive cure.

[Intestinal occlusion caused by actinic ileitis]. / L'occlusione intestinale da ileite attinica.

During the 5-year period from 1988 to 1992, 6 patients underwent operation for radiation-induced small bowel obstruction at the General Surgery II, IRCCS Policlinico S. Matteo of Pavia. Based on this experience and reports in the literature, physiopathology, pathologic findings, and operative technics are discussed.

[Acute pseudo-obstruction of the colon (clinical cases)]. / La pseudo-ostruzione acuta del colon (contributo casistico).

The Authors report 4 cases of Ogilvie's syndrome come to their observation during the last 5 years by the clinical surgery II of the I.R.C.C.S. Polyclinic "San Matteo" of Pavia. Remembering the infrequency of the affection and the controversial etiopathogenesis theories, the Authors study the clinical picture and the diagnostic problems, pointing out how some researches, especially radiological and endoscopical, permit to obtain a therapeutic solution of the syndrome. They underline the colonic perforation risk, certainly overestimated, and they show the therapeutic, medical or surgical, orientations, according to the evolution of the illness, the anatomic situations and the general conditions of the patient.

[A case of primary carcinoma of the duodenum with subampullar localization]. / Su un caso di carcinoma primitivo del duodeno a localizzazione sottoampollare.

The authors illustrate a case of previous duodenal adenocarcinoma with subvaterian localization and, after revising the literature and some general remarks, they explain their practice. They come to the conclusion that in some well selected cases, duodenal segmental resection can be correctly applied. They remember that the most important factor of the improvement of the prognosis is early diagnosis: it is indispensable for radical exerectical therapy.

[A rare case of massive digestive hemorrhage. Carcinoid of the small intestine]. / Un raro caso di emorragia digestiva massiva. Il carcinoide del piccolo intestino.

The authors reports a case of massive digestive hemorrhage produce by a carcinoid of the small intestine. Having reviewed the most frequent causes of primary hemorrhage of the mesenteric small intestine, attention is focused on the difficulties o making an etiological and topographical diagnosis, in spite of using the most advanced instrumental research methods. The paper concludes that explorative laparotomy is the sole method for making a precise diagnosis and performing appropriate surgical treatment.

[A rare cause of intestinal occlusion: Morgagni-Larrey hernia]. / Causa rara di occlusione intestinale: l'ernia di Morgagni-Larrey.

Authors report a case of Morgagni-Larrey obstructed hernia recently observed. After remembering pathogenetic hypothesis and pathological findings, they discuss clinical patterns, diagnostic tools and differential diagnosis. Authors suggest to consider surgical repair as a choice treatment, also for asymptomatic patients.

Primary Hodgkin's disease of the thyroid: report of a case and a review of the literature.

A case of primary and exclusive Hodgkin's disease of the thyroid gland in a 29-year-old woman and a review of the literature are described. Diagnosis with fine-needle aspiration biopsy (FNAB) was performed before surgery. The patient underwent subtotal thyroidectomy, followed by a radiotherapy dose of 46 Gy. Post-operative histological examination confirmed the cytological diagnosis without evidence of thyroiditis or lymphadenopathy. Five months after thyroidectomy, surgical staging confirmed the exclusive localization of the disease in the thyroid. The patient is followed up on an out-patient basis and is still in good health, 24 months after treatment.

[Traumatic lesions of the spleen. Analysis of 35 cases]. / Le lesioni traumatiche della milza. Analisi di 35 casi.

A retrospective review of all the traumatic splenic ruptures from 1974 to 1988 was performed. Thirty-five patients were treated with splenectomy: 24 were males and 11 women. Teenagers and young adults were the most affected age groups. The mechanisms of injuries were: road accidents (78.8%), falls (12.1%), aggression, autoaggression and iatrogenic mishap (3%). Eighty per cent of the patients had associated injuries. Authors suggest a decisional algorithm to precise preoperative diagnosis and to treat the patients correctly. Mortality was 11.4% and primarily due to associated injuries.

[Primary malignant tumors of the small intestine. A clinical report]. / I tumori maligni primitivi del piccolo intestino. Contributo clinico.

The clinical records and pathologic patterns of all the cases of primary small bowel malignancies, treated in the last 15 years, were reviewed. There were 12 patients: 8 men and 4 women ranged from 41 to 86 years old. Carcinoma was the most common (82%) followed by carcinoid and lymphoma (9%). The distribution of the malignancies showed preponderance in the proximal jejunum and duodenum. Multiple primary malignancies were found in 17% of enteric cancers. The most common presentation was pain (75%) followed by weight loss (58%), palpable mass, anemia and gastrointestinal bleeding (25%), obstruction (17%). Barium studies of the duodenum and of the small bowel, duodenal endoscopy were the most useful diagnostic tools but a correct preoperative diagnosis was made in only 42% of the patients. Curative resection was attempted in 67% of the cases. The prognosis is poor.

[A modification of the Sweet-Allen simple reconstruction technique after total gastrectomy]. / Modifica della tecnica di ricostruzione "semplice", dopo gastrectomia totale, sec. Sweet-Allen.

The Authors report their personal modification of Sweet-Allen's esophago-jejunal reconstruction after total gastrectomy. In their opinion, it enables to combine the advantages of the omega-shaped loop (easier and faster surgical technique, reduced postoperative morbidity) with those typical of the Roux-en-Y loop, that is complete elimination of biliary reflux, leading to better long term functional outcome and quality of life for the totally gastrectomized patient.

[Morgagni-Larrey hernia (author's transl)]. / L'ernia di Morgagni-Larrey.

The authors describe minutely Morgagni-Larrey hernia, that is the least frequent of the spontaneous herniae of diaphragm, but it seems that it has a real superior incidence that in past time. They sop, particularly, to sketch the different stages of diagphragmatic embryogenesis that, in its complexity, induces to morphogenetic mistakes of variable relief. These mistakes have always their role in the pathodenic mechanism of considerate disease. In the end, they report a case which happened to their observation and that seems to resume the paradigmatic data of Morgagni-Larrey hernia, for its etiopathogenic, anatomo-pathologic and symptomatologic characteristics.

[Total hematic histamine in gastrectomized patients]. / L'istamina ematica totale in pazienti gastroresecati.

The Authors estimated the blood histamine in 15 patients after gastric-resection and found a significant decrease in all the cases with respect either to basal valus or to normal subjects. The autors suppose it is due to a lower presence of istidin-decarbojlase, owing to removal of gastric tissue where such enzime is placed.

[Enterovesical fistula (author's transl)]. / Le fistole entero-vescicali.

The authors get a starting point from describing a case with undecided etio-pathogenesis, to focalize the entero-vesical fistulas that represent the most frequent variety of entero-urinary fistulas. Particularly they stop a little on manifold aspects of etio-pathogenetic and classificative order, refer anamnestic, clinical, instrumental and radiological data which allow to get an undoubted diagnosis, emphasize the high rates of complete recoveries in relation to the timely application of adequate surgery.