[Sentinel-node biopsy for breast cancer: our experience]. / Studio del linfonodo sentinella nel carcinoma della mammella: nostra esperienza.

The method of sentinel lymphnode is a new procedure, suitable for the cases of early diagnosed breast cancers: identifying the first lymphatic station of the cancer, it can avoid the axillary lymphadenectomy in those women with primitive invasive and unifocal neoplasis of not more than 1.5 cm in diameter and without lymphnodal invasion. So it is reduced the frequency of postoperative troubles (sensitive and motor diseases, lymphedema). In our study, we have researched and identified, using radioactive isotopes, the sentinel lymphnode in 20 women suffering from subclinic breast cancer. We have obtained a percentage of 5% of false negatives. The optimal level of identification of the sentinel lymphnode and the good level of predictivity about the axillary lymphatic status, that we have obtained, represent a further confirmation of the surety and validity of this method.

[Bleeding gastric lymphoma: report of two cases]. / Linfoma gastrico sanguinante: descrizione di due casi clinici.

We report two cases of bleeding gastric lymphoma. The stomach is the most common site of primary extranodal Non-Hodgkins Lymphomas. The best treatment for primary gastric lymphoma has not yet been defined. For many years the treatment of choice has been the gastric resection. Helicobacter pylori (H. pylori) has been associated with many gastric pathologies, including gastric lymphoma. Eradication of H. pylori is now considered essential for the treatment of this pathology, and usually consists of antibiotic therapy, combined with acid suppression by a proton pump inhibitor. This simple treatment in patients with low grade histology and tumor confined to the stomach can often obviate the need for surgical intervention. Surgery is a necessary treatment, independently of the grading and the staging of lymphoma, in the bleeding complication as the cases we showed.

[Surgical treatment of varicocele in day-surgery: our experience]. / Il trattamento chirurgico del varicocele in day-surgery: nostra esperienza.

Varicocele has been recognized as a treatable cause of male infertility. Recently, new techniques have been described for varicocele repair, including microsurgery, embolization and laparoscopy. The aim of this study is to evaluate the results of a group of patients who underwent subinguinal varicocelectomy using local anaesthesia in Day Surgery, after a careful ultrasonographic study to evaluate the degree and the quality of the reflux in the spermatic vein. The study shows that outpatient subinguinal varicocelectomy is a safe and reliable procedure. This approach is performed in local anaesthesia, has minimal morbidity and recurrences and, in our experience, has led an improvement in the quality of seminal fluid.

[Surgical treatment of mucosal hemorrhoidal prolapse using a circular stapler]. / Trattamento della malattia emorroidaria con suturatrice meccanica circolare.

We present a retrospective clinical study concerning our personal experience with the circular stapler in the treatment of hemorrhoids; the aim of this study was to evaluate the results of this surgical procedure, in terms of operative time, postoperative pain and rate of both short and long-term complications. Twenty-seven patients with grade 3 or 4 hemorrhoids, from January 1999 to June 2001, were included in the study. The main technical details of this procedure, requiring only a short learning period, are described and both short-term complications (such as severe postoperative pain, bleeding, urinary and fecal retention) and long-term ones (such as persistent or recurrent haemorrhoidal prolapse, anal stenosis) are analyzed. The reported results show that, in the presence of appropriate local anatomic conditions, this procedure is able to reduce the operative time, is almost painless and is characterized by low rate of complications.

Hernia of the posterior lamina of the rectus abdominis muscle sheath: report of a case.

A case of hernia of the posterior lamina of the rectus abdominis muscle sheath in a 30 years old female, six months pregnant, is reported. The symptomatology was almost exclusively characterized by a persistent abdominal pain, located in the right costal margin at the intersection with the right adsternal line and aggravated by changes in position and by increases of intra-abdominal pressure. No bulge or specific hernial defect was clinically appreciable. The key to diagnosis, in this case, was an echography of soft tissues performed in the area where the pain was greater: with the patient in orthostatic position, it was possible to demonstrate a defect in the posterior sheath of the rectus abdominis muscle, that, increasing the intra-abdominal pressure, let pass preperitoneal fat between sheath and muscle. Both the predisposing (anatomic and clinical) factors and the provocateurs ones, probably involved in the genesis of this peculiar case, are discussed.

[The surgical treatment of liver metastases from colorectal carcinoma: our experience]. / Il trattamento chirurgico delle metastasi epatiche da carcinoma colo-rettale: nostra esperienza.

Data from twelve patients who had hepatic resections for colorectal liver metastases were retrospectively analyzed to determine: 1) whether the use of the ultrasonic surgical dissector and the Argon laser can significantly simplify major hepatic resections and decrease both perioperative blood loss and postoperative morbidity and mortality, and 2) whether an adequate patients selection for surgery can effectively determine an improvement in recurrence rate. We performed 4 bisegmentectomies (2 of V and VI; 2 of VI and VII); 1 trisegmentectomy (V, VI, VII); 2 left lobectomies; 1 right hepatectomy and 4 wedge resections, using both the ultrasonic surgical dissector to fractionate and aspirate the hepatic parenchyma and to clear major vascular and biliary structures and the Argon laser for the coagulation of minor vascular and biliary vessels. The resected metastases averaged 5.5 cm (range: 1.5-7.5); blood transfusion requirements were significantly reduced from previous reports, averaging only 1.25 units (range: 0.3); the average operative time was 238 minutes (110 to 420 minutes). There were no operative deaths, operative morbidity rate was 16.6. The results indicate that the ultrasonic surgical dissector and the Argon laser have made a significant contribution to our marked decrease in the average blood loss and transfusion requirement. The long-term results seems to be improved by an adequate patients selection.

[Phyllodes tumor of the breast: diagnostic and therapeutic problems]. / Tumore fillode della mammella: problematiche diagnostiche e terapeutiche.

Phyllodes tumour (PT) is a rare breast tumor with mixed connective and epithelial components, which usually relapses topically after excision. Five patients with PT took part in the study (4 were positive for benign PT and one was positive for malignant PT at extemporary histological examination). The patients (3) with 3 cm or minus benign lesion had mass excision with a large resection of the surrounding mammary tissue. In the remaining patient with benign neoplasm (8 cm lesion) simple mastectomy was carried out. Finally the patient with malignant PT (5 cm lesion) underwent a simple mastectomy without following chemotherapy or radiotherapy. Follow-up (at 6 and 12 months) consisted of mammography and clinical examination. One out of the 3 patients treated with large resection had a local relapse which was then treated surgically. There was no evidence of relapse at 12 months in the remaining patients with benign tumor. The patient with malignant PT returned to our attention with multiple bone metastases in the thoracic lumbar tract two years later. She received multiple courses of combined radiotherapy and chemotherapy. Local relapses do not appear to affect survival: as a consequence, wide excision should be the primary treatment of benign phyllodes tumors. Total mastectomy has been indicated for malignant phyllodes tumors and for very large tumors.

[Surgical treatment of carcinoma in situ of the breast]. / Trattamento chirurgico del carcinoma in situ della mammella.

After briefly mentioning the incidence of in situ breast carcinoma and the importance of mammography as an instrument of early diagnosis, the Authors inspect their own case notes and discuss indications and problematical characters linked to the various surgical techniques. It is concluded that, in case of a not infiltrating mammary carcinoma, it is possible to entertain an adequate conservative surgical treatment on condition that it is always associated to a modern and effective radiotherapy of the remaining mammary parenchyma and that it is feasible an attentive and extended follow-up; when even only one of these two conditions is not practicable or in the presence of cancer-phobic patients, the alternative of a unilateral or bilateral subcutaneous mastectomy, followed by an immediate reconstruction with an implant, does remain efficacious both on the oncological and esthetic point of view.

[Treatment of primary gastric lymphoma in IE/IIE stages]. / Il trattamento del linfoma gastrico primitivo negli stadi IE/IIE.

The primitive gastric lymphoma constitutes 2-5% of malignant gastric neoplasms. The present treatment of such a pathology is not defined, since it seems that this disease deserves a multidisciplinary approach: surgical, chemotherapical, radiotherapical. The authors by means of this study, intend to estimate the results of the therapeutic treatment employed in 18 patients suffering from primitive gastric lymphoma in the stage IE and IIE. From the results obtained by our study, it emerges that in the lymphomata located in the cavity at the stage IE, there takes place the almost total superimposition of the results, in terms of survival to 5 years, in the patients treated surgically and in those treated by chemotherapy. Therefore, in such cases the chemotherapic treatment can be proposed because it is bloodless, the patient appreciates it more and it seems to be accompanied by a very small number of complications. In the patients with lymphomat located in the antrum at the stage IIE, we have obtained good results in terms of survival joining radiotherapy and chemotherapy to surgery, as reported by Moore. Even taking into account the very small number of cases we have considered, we think the primitive gastric lymphoma at the stage IE must be treated by means of chemotherapy, while that one at the stage IIE requires and integrated treatment.