[Spontaneous and postoperative bile peritonitis. Surgical technique]. / Il coleperitoneo spontaneo e postoperatorio. Strategia chirurgica.

BACKGROUND: Bile peritonitis has a diversified aetiology that can present in clinical pictures of variable gravity depending on whether the bile is uncontaminated or activated by other secretions (intestinal, pancreatic) or actually infected. The consequent treatment is therefore eclectic. In our opinion, however, the therapeutic strategy proves effective if modulated on the basis of certain priority elements that should be carefully considered. The type of treatment adopted in relation to immediate and long-term results has been evaluated. METHODS: The investigation was carried out retrospectively on the series of bile peritonitis treated at the Surgical Clinic of the University of Modena from 1980 to 1998. 45 cases of bile peritonitis are reported of which: 32 postoperative, 2 post-traumatic, 2 following transparietohepatic injection, 7 during acute necrotic cholecystitis, 2 following spontaneous perforation of the biliary tree. As regards the type of treatment, in 13 cases (well-drained postoperative forms) a conservative solution was adopted; in another 13 cases (9 septic and 4 with mixed bile supply) surgery was resorted to again, in the remainder transparietohepatic drainage was carried out in association almost always with the application of a transpapillary endoprosthesis. RESULTS: Morbility was 26.6% (12 cases); 4 patients (8.8%) were reoperated for late complications with mortality of 50%. Total mortality was 20% (9 patients). CONCLUSIONS: Treatment of bile peritonitis may be eclectic but the complex forms benefit from early surgical or parasurgical treatment for a definitive resolution of this feared complication.

[Primary lymphoma of the breast. Three cases of non-Hodgkin lymphoma]. / Il linfoma primitivo della mammella. A proposito di 3 casi di linfoma non-Hodgkin.

Primary and sole breast lymphoma is a very rare disease. With the review of our series of 616 cases operated on for breast cancer, only 3 cases (0.48%) of primary breast non-Hodgkin lymphoma (LNH) have been observed. The authors outline the problems concerning diagnosis and therapy of this rare disease: pathological and immunohistochemical aspects are discussed. They stress the importance of staging in order to plan a correct multidisciplinary approach.

[Our experience in the surgical treatment of early breast cancer. Results of a prospective study of 204 cases]. / La nostra esperienza nel trattamento chirurgico del carcinoma mammario iniziale. Risultati di uno studio prospettico su 204 casi.

The authors report the results of a prospective study on 204 patients (1980-1993) affected by early infiltrating breast cancer (size pounds 2 cm) as a part of a surgical series of 608 cases. 53 cases who underwent QUART (25.9%) and 151 cases (74.1%) who underwent mastectomy modified according to Patey have been collected. 10 years actuarial survival has been respectively 79% after extensive surgery and 78% after conservative treatment. Local recurrences have been observed in 9 cases after meticulous follow-up (median 74.8 months, range 12-178): 3 (5.66%) patients after QUART and 6 (3.97%) after mastectomy; furthermore 1 patients after a conservative treatment (1.88%) has developed a second tumor at the same side probably dependent on the presence in the primary tumor of an extensive intraductal component. No correlations between histological features, grading, positive nodes, receptor status and local recurrences have been found. Only the age of patients looks significantly correlated with frequency of recurrences: 44.45% of local recurrences have been observed in patients less than 45 years old. Local recurrences after QUART have obliged, in all cases, to a radical mastectomy. Furthermore, frequency of distant metastases has been considered: after QUART percentage is lower (9.43%) than after radical mastectomy (13.9%). This consideration looks correlated with the longer follow-up of the later group. A multidisciplinary approach is advised but the most important role is played by surgery. In conclusion it is outlined that conservative surgery is addressed to selection and consenting patients.

[Natural history of breast cancer: lobular carcinoma versus ductal carcinoma in our experience]. / A proposito della storia naturale del cancro della mammella: carcinoma lobulare versus carcinoma duttale nella nostra esperienza.

Aim of the study is to evaluate the biology, the clinical evolution and the prognosis of lobular carcinoma of the breast. We retrospectively evaluated the patients treated in our institution during the last 13 years. 117 patients with lobular carcinoma of the breast and 117 patients, randomized out of 397 patients with 'classical' pattern of ductal carcinoma were compared. Age distribution, type of surgery, tumor size, TNM stage, axillary lymph node involvement, multifocality, multiple breast cancers, local and distant recurrences, overall survival and disease-free survival have been evaluated. There was not a significant difference in tumor size, lymph node involvement, stage distribution, estrogens and progesterone receptors status, local and distant recurrences. The only significant differences were found in multifocality and multiple breast cancers. The said difference does not seem to modify the overall survival and the disease-free survival that are the same in the two groups. Our research shows that tumor size and axillary lymph node status are the only elements that have to be considered in the choice of the surgical treatment and prognosis. It seems that the difference in distant metastatic pattern between lobular and ductal carcinoma is the distinctive feature in the follow-up of these patients.

[Complications of gastroesophageal reflux: considerations on a non-selected case series]. / Le complicanze del reflusso gastro-esofageo: considerazioni su una casistica non selezionata.

According to the experience of the authors on a non-selected case report, pharmacologic progresses in the therapy of various aspects of peptic disease permit an ease management also of gastro-esophageal reflux disease. Moreover, endoscopy is the very modern pivot of conservative treatment of more severe complications as strictures are, through repetitive and progressive instrumental dilatations. The surgical treatment of the most severe and intractable eveniences must be chosen for only a low percentage number of patients, after a careful functional analysis of the single case. Very important is the endoscopic and histologic control of Barrett esophagus and severe dysplasia.