Unexpected histopathologic result of a wide surgical excision of a bleeding lesion of the skin: a case of Merkel cell carcinoma of the leg.

BACKGROUND: Merkel cell Carcinoma is a very rare primary cutaneous tumor that often looks like an innocuous and asymptomatic nodule or plaque of the skin, but with a very fast growing. It is also called neuroendocrine carcinoma of the skin or trabecular cancer. The main treatment is based on a local excision followed by radiotherapy or chemotherapy. The most common site of presentation of this lesion is head and neck (40-60%.) and it often occur in older men with immunological system dysfunction like HIV patients, cancer, severe infections and immunosuppression for transplantation. METHODS: The authors report a case of a bleeding Merkel Cell Carcinoma of the right leg in a 83 years old man with HCV infection, chronic kidney disease and diabetes mellitus type 2 that required local excision. RESULTS: Lesion was entirely removed and then patient was sent to oncologists. After two months from surgical excision, healing process is regular and without complications. CONCLUSIONS: This type of tumor can be misdiagnosed and, if bleeding, it can represent a serious surgical emergency.

[Hemorrhoidectomy with stapler vs. traditional hemorrhoidectomy: comparative outcome of 2 groups of patients]. / Emorroidectomia con stapler VS. emorroidectomia tradizionale: risultati comparativi tra due gruppi di pazienti.

Authors compare the results of two groups of patients, with III and IV degree haemorrhoids. The first group (48 patients) were treated with traditional surgery, open or closed. The second group (42 patients) treated with stapling haemorrhoidectomy. The groups were compared in order to determine if a true advantage exists regarding post-operative pain and functional recovery. Authors conclude that stapler haemorrhoidectomy, is somehow better in reducing the pain and offers a quick functional recovery. But the technique must be adopted in selected patients with mucosal prolapse, when the haemorrhoidal plexus is below the dentate line. In those cases, with inveterate mucosal prolapse, and thickened external fibrous tissue, or an irreducible prolapse of the external haemorrhoidal plexus, the choice must be carefully evaluated.

[Laparoscopic appendectomy and laparotomy appendectomy: comparison of methods]. / Appendicectomia laparoscopica ed appendicectomia laparotomica: metodiche a confronto.

The study compares the real advantages of laparoscopic appendicectomy using only a transumbilical trocar, with laparotomic appendicectomy in the management of acute and/or chronic pain in the lower right abdominal quadrant. From May 1997 to April 2000, 88 patients were treated: 27 (group I) with the laparoscopic approach, and 61 (group II) with laparotomy. We compared operating times, incidence of complications, hospital stay and cosmetic result. We also reviewed the literature on this subject over the past ten years. Average operating time was 45 minutes in group I and 30 minutes in group II; complications consisted in 2 cases of omphalitis in the laparoscopic group and 3 infections of the wound and 2 cases of lipolysis of the abdominal wall in the laparotomic group. The average hospital stay was 3.2 days in the laparoscopic group against 4.7 days in the laparotomic group. Resumption of work and sport occurred after 10 to 20 days and 15 to 45 days in groups I and II, respectively. The total cost was lower in the laparoscopic group. The laparoscopic approach appears to be an effective technique for the management of acute and chronic appendicitis, as it allows both treatment of the pathology and diagnosis and treatment of other unknown pathologies, with exploration of the abdominal cavity. In addition, it guarantees a good cosmetic result, a short hospital stay with a low incidence of complications and an advantageous cost/benefit ratio.

Totally Implantable Central Venous Access: 15 years' experience in a single unit.

The use of Totally Implantable Central Venous Access Systems (T.I.C.V.A.S.) has become an essential aid for those patients requiring extended intravenous infusion treatments or complete parenteral nutrition, and for whom the peripheral venous system may be or may become inadequate for infusions. This paper describes fifteen years of experience in the use of totally implantable systems. It examines the application methods as well as the different systems, complications, patient satisfaction, quality of life, and cost/benefit ratio. We examined 261 patients observed during a period of approximately 15 years. A surgical team carried out the operations for these patients in an operating room under the strictest asepsis conditions. The Port-a-Cath central venous access systems were used in 221 cases (84.6%) and the Pas-Port peripheral venous access systems were used in 40 cases (15.3%). We observed no particular differences between the different types of systems implanted. The total rate of complications was 11.7%, 0.7% of which were positioning complications, 4.2% stability complications, and 6.1% management complications. There were 2 cases (0.76%) of defective performance of the implanted system. We found patient satisfaction with the method average in 19.85% of the cases, good in 70.23% and excellent in 11.9%. Quality of life improved because of reduced total hospitalization time and more convenient treatment management. Regarding the cost/benefit ratio we also found that the benefits outnumbered costs. In connection with the cost of the system the possibility of home management leads to a marked decrease in hospitalization expenditure. Today these systems should be considered as being essential in the correct management of the patient requiring medium-to-long-term infusion treatment. On the whole these treatments are well accepted by the patient and the possibility of home or day hospital management allows a marked reduction in hospitalization, which affects both social life and costs. The incidence of complications was found to be relatively low considering that most of them are the result of poor management of the system by the paramedical personnel or by the relatives of the patients. In this sense, better education in the management of the system would further optimize results. (The Journal of Vascular Access 2001; 2: 161-167).

[Secondary bacterial peritonitis: a diagnostic and therapeutic update]. / La peritonite batterica secondaria: attualità diagnostica e terapeutica.

In spite of the availability of new powerful antibiotics, intraabdominal sepsis still has a high mortality rate (20-50%). With regards to postoperative peritonitis, the referred high mortality rate is due to a late recognition and a consequently late treatment. The causes for late diagnosis are: uncertain clinical picture; misuse of analgesic drugs; reluctance of the surgeon to accept a failure. Moreover, many operated patients are under treatment with antibiotics: their misuse, particularly broad spectrum ones, is responsible for the selection of resistant bacteria. Age is another very significant prognostic factor: mortality rate is constantly higher in elderly subjects than in younger ones. Malnutrition, immunodepression, origin and location of sepsis, concomitant diseases, immunosuppressive treatments, delayed diagnosis, all can significantly affect clinical outcome. Probably the most important and less assessable factor is represented by the surgeon himself with his experience and technical accuracy: any mistake may worse patient's prognosis. Recently, many Authors have stressed the pathogenic relevance of the intestinal mucosa as a barrier, which may influence the clinical course.