[Extranodal non-Hodgkin's lymphomas. Review and our experience]. / I linfomi non-Hodgkin extranodali. Review e nostra esperienza.

The authors report their experience concerning 12 cases of extranodal lymphoma (6 gastric, 1 duodenal, 2 ileal, 1 rectal, 1 splenic, 1 mammary). Extranodal lymphomas are increasing because of the high number of patients with AIDS and new extra-European immigration. Surgery is important not only for diagnosis, but above all for therapy. The great majority of extranodal lymphomas is diffuse rather nodular. Diffuse histiocytic type is the most commun pathologic feature. Prognosis of gastroenteric lymphomas is better than adenocarcinomas of gastrointestinal tract. The surgical techniques are the same as those used for the others tumors, and combined-modality therapy appears superior to local therapy alone for patients with extranodal disease characterized by unfavorable histology, site or stage. The classification is that of Ann Arbor, but for many authors the TNM system was an useful predictor of survival in patients treated with surgery.

[Schwannoma of the ultimate ileal loop. Case report and review of the literature]. / Schwannoma dell'ultima ansa ileale. Case report e review della letteratura.

The paper reports a rare case of malignant ileal schwannoma. A review of the most recent literature confirms the diagnostic and therapeutic procedures used by the authors. Minimal resection or necessary resection in relation to the site and local situation are the only real therapy apart from palliative surgery. It is vital to identify any possible polycentric manifestation since schwannoma is often associated with Recklinghausen's disease. Radiotherapy and chemotherapy are completely ineffective. Responses were obtained in around 30% of cases in the most common trials; the gastrointestinal localization also appears to be even less responsive. The most active drugs are decarbazine, doxorubicin and ifosfamide, associated with CIVADIC or MAID polychemotherapy protocols. It is often difficult to diagnose malignancy; the overall survival rate (taking grading into account) is 7-10% after 10 years and 50% after 5 years for those forms with the lowest degree of malignancy. Antoni classified schwannoma into: type A with a solid component, and type B with a microcystic component. Treatment and prognosis are identical.

Our operative technique for inguinal hernia.

The most commonly used methods of hernia repair are either Bassini repair or modifications of Bassini repair in fact each sutures, with different methods, the three anatomical coats (transversalis fascia, transversus abdominis and internal oblique muscles, external oblique muscle aponeuroses). Here we propose a different operative technique that sutures only two aponeurotic coats (transversalis fascia and over external oblique muscle aponeuroses). The second sutured coat supports the posterior wall of the inguinal canal. Between 1984 and 1989 we operated about 1100 patients with this method and the recurrence rate is in accordance with the incidence of the other usual types of hernia repair.

[Breast carcinoma in the elderly patient: which treatment?]. / Carcinoma mammario nell'anziano: quale trattamento?

We here describe our experience of the treatment of "breast cancer" in the elderly. The results in this group of patients (37 over 75 years) are like the younger group if: the local control is done; hormonotherapy is prescribed; chemotherapy is done even in the 70-80-year-old group. If a radical mastectomy isn't impossible in the patients over 80, even a simple mastectomy is safe. In this patients a conservative local treatment of the breast is not mandatory. Our over-75-year-old patients have no psychological problem related to mastectomy. They often don't accept obligatory radiotherapy after the conservative treatment of breast cancer, and moreover the breast cancer in the elderly is usual smaller, fibrotic and bigger than 3 cm. Lymph nodal status isn't important for overall survival, but only for the eventual chemotherapeutic treatment, so in patients over 80 year-old simple mastectomy is sufficient because we don't use chemotherapy for the general conditions of the same. The local control of axillary lymph nodes is obtained with radiotherapy if necessary. Screening for breast cancer must also include 70-75-year-old patients. Why is the breast cancer in elderly like the others patients? Some authors have seen that the immuno-reaction around the cancer in elderly is less than the same reaction observed in younger patients. So in the elderly there is a smaller production of "growth factors" important for the growth of the tumor and of "angiogenesis factor", fundamental for the initial growth of the cancer.(ABSTRACT TRUNCATED AT 250 WORDS)

[Choleperitoneum following Kehr's T-tube removal: conservative treatment with culdocentesis associated with sphincterotomy and endoscopic drainage of the bile ducts]. / Coleperitoneo conseguente a rimozione di tubo a T di Kehr: trattamento conservativo a mezzo di culdocentesi associata a sfinterotomia e drenaggio perendoscopico della via biliare.

The Authors present a case of bile peritonitis due to a biliary fistula developed after T tube removal from the common bile duct. Highlighting poor clinical manifestations they report an alternative conservative treatment, by drainage of the bile leakage with culdocenthesis and successive endoscopic spincterotomy and transpapillary drainage.