Three cases of primary hydatidosis of the gluteus muscle: our experience in clinical, diagnostic and treatment aspects.

Three cases of primary hydatidosis of the gluteus muscle treated in our department during the last 10 years are described. The first was initially misinterpreted as perineal or sciatic hernia. The diagnosis was set in the operating room. In the second case we included in our differential diagnosis the possibility of parasitic involvement at unusual sites. The diagnosis was confirmed by ultrasonography followed by computed tomography (CT) scans in order to rule out liver and pulmonary involvement. The last patient was initially operated elsewhere but finally came to us to treat his complications. At years following surgery there was no evidence of recurrence in any of the patients, but the last one still suffers from recurrent fasciitis and sciatica.

Clinical role of HER-2/neu expression in colorectal cancer.

PURPOSE: To evaluate the HER-2/neu expression and its relationship with clinicopathological parameters and prognosis in colorectal cancer patients. METHODS: A total of 51 colorectal cancer patients who underwent resection with curative intent from January 2005 to March 2006 were included in this study. Patients were regularly followed up and survival data were obtained as of as April 2011. HER-2/neu protein expression was evaluated from tissue samples from the primary tumor using a semiquantitative standardized immunohistochemical staining kit. Staining intensity was scored as faint (1+), weak to moderate (2+) and moderate to strong (3+). RESULTS: Forty-nine (96.1%) patients showed 1+ staining, 2 (3.9%) 2+, while no case was strongly positive (3+) for HER-2/neu. No apparent association was noted between HER-2/neu expression and patients' age, gender, tumor location, tumor grade, stage and survival. CONCLUSION: Moderate (2+) overexpression of HER-2/neu was detected in a small proportion of colorectal cancer patients. Considering the low rate of HER-2/neu overexpression in colorectal cancer, studies with larger sample sizes using standardized tests are essential to understanding the biologic role of HER-2/neu in this disease.

Jejunojejunal lipoma causing intussusception.

Jejunojejunal intussusception and jejunojejunal lipomas are both very rare clinical entities. The present case report describes this event in an adult patient with severe episodes of hematochezia and colicky upper abdominal pain. The diagnosis was not made preoperatively, as none of the endoscopic findings were pathognomonic and, furthermore, CT scans could not rule out malignancy. Exploratory laparotomy was mandatory and at surgery a jejunojejunal intussusception secondary to a lipoma was found. Segmental resection and primary reanastomosis were performed in the presence of evidence of bowel ischemia.

The role of sonography in the diagnosis of cystic lesions of the breast.

INTRODUCTION: Breast sonography is appropriate in the initial assessment of a women younger than 30 years with a palpable lump and in the adjunctive evaluation of mammographic masses, and palpable abnormalities not seen mammographically. MATERIAL AND METHODS: A total of 269 patients underwent breast examination with ultrasound due to the presence of bilateral or unilateral palpable lesions. Women under 40 years old were submitted to US examination only while patients older than 40 years underwent US breast assessment and conventional mammography. RESULTS: Mammography had an accurancy of 57.3% and confirmed diagnosis in 113 out of 197 patients; in 57 patients (28.4%) it identified the lesion but could not determine the diagnosis. False-positive results for malignancy were detected in 23 patients (11.7%) and there were no false-negative results. Ultrasound assessment had an accuracy in diagnosis reaching 87.3%, 172 cases out of 196. (87.3% vs 57.3% p < 0.05); false-positive results were identified in 17 cases (8.6%). CONCLUSION: Sonography demonstrates a better diagnostic significance than mammography in the early detection of cystic breast carcinoma.

Gastrointestinal stromal tumors of the rectum: report of five cases.

We report on five patients (three males and two females), with a median age of 66.2 years (range, 58-73 years) who were admitted in our department from April 1998 until January 2004 with the diagnosis of rectal gastrointestinal stromal tumor (GIST). Their main symptoms were rectal bleeding, constipation and abdominal discomfort. Two patients were treated by an abdominoperineal resection of the rectum. One patient received palliative surgical treatment and adjuvant therapy with imatinib for metastatic disease. Another patient presented with complete rectal prolapse, and was treated with Delorme's procedure. The subsequent pathological examination of the resected specimen showed positive resection margins and was given adjuvant therapy with imatinib. Finally, one case was considered inoperable. However, after nine months of treatment with imatinib, the magnetic resonance imaging (MRI) scan revealed a significant reduction in the tumor size, and the patient was treated with abdominoperineal excision of the rectum. All cases have been proved to be immunohistochemically positive for the CD117 and the CD34 stain. During the follow-up period (mean duration 3.7 years), one patient died of progressive disease while the other four had no sign of recurrence.

Primary hydatidosis of the gluteus muscles: report of three cases.

BACKGROUND: Hydatid disease caused by the tapeworm Echinococcus granulosus is a worldwide problem especially in sheep and cattle raising countries. AIMS: Muscle involvement is most commonly encountered as recurrence of previously treated disease or concurrently with primary lesions of the liver or lung. Furthermore, the rarity of muscle hydatidosis has unique implications in diagnosis and management. METHODS: We report on three cases of primary echinococcus of the gluteus muscles presented in our clinic during a 10-year period. RESULTS: We have administered albendazole for one cycle of 28 days in two of our patients based on the size and appearance of the cyst. All patients underwent total pericystectomy without cyst rupture. We have not found any recurrences after minimum follow up of 12 months. CONCLUSIONS: Muscle echinococciasis respond well to surgical intervention. Complete and intact removal of the cyst in primary muscular hydatidosis should be considered curative.

A prospective comparison of ampullectomy with pancreaticoduodenectomy for the treatment of periampullary cancer.

Local surgical treatment of periampullary neoplasms seems attractive in the context of the reduced morbidity and mortality than the more radical treatment options. The aim of our study was to compare local excision (LE) of the ampulla with standard pancreaticoduodenectomy (PD) for the treatment of periampullary cancer in terms of overall survival. Inclusion criteria were primary tumor < or = 2 cm with no evidence of lymph node involvement or distant metastasis on abdominal computed tomography (CT). Between January 2000 and January 2004, 23 patients were enrolled onto this study (9 in the LE group and 14 in the standard PD group). The two groups were homogeneous with respect to age and gender as well as the size and origin of the primary neoplasm. There was no correlation of the survival with age, gender, presence of lymph node metastasis, size of the primary tumor, type of surgery or histologic grade (x(2), p >0.05). However, the origin of the tumor had major impact on survival, with pancreatic tumors having the worst prognosis. Hospital stay was significantly reduced in the LE treated patients. Our results showed that LE for periampullary tumors is a viable option and is well suited for medically unfit patients or those who refuse more radical treatment options.

Intact germinal layer of liver hydatid cysts removed after administration of albendazole.

BACKGROUND: Hydatid disease is a common health problem especially in Mediterranean and sheep-farming countries, caused by infection with the metacestode stage of the tapeworm Echinococcus. The liver is the most frequent primary site of Echinococcus granulosus infection in humans. Surgery remains the main treatment modality for cystic hepatic hydatid disease, with complete resection of the germinal layer being of major importance for recurrence. Perioperative administration of albendazole has been reported to improve surgical outcome but the results are controversial. We report here our observations on the usefulness of preoperative chemotherapy in surgical outcome in terms of morbidity and recurrence. METHODS: Five patients with complex liver hydatid cysts received 28 days of albendazole prior to partial cystectomy. Radiological examinations with computed tomography and ultrasound and surgical outcome were used to assess the efficacy of the regimen. RESULTS: Three patients underwent a complete removal of the germinal layer of the cyst and there were no cases of biliary fistula in these patients. There were no relapses in any of the patients at 12 months' follow-up. CONCLUSIONS: Preoperative use of medical therapy consisting of albendazole facilitates complete resection of the germinal layer by detaching it from the laminar layer, thus reducing not only the recurrence rates but also the postoperative complications, especially bilious fistulas.

Parecoxib vs. lornoxicam in the treatment of postoperative pain after laparoscopic cholecystectomy: a prospective randomized placebo-controlled trial.

BACKGROUND AND OBJECTIVE: Non-steroidal anti-inflammatory drugs are considered as an effective treatment of postoperative pain after laparoscopic cholecystectomy. COX-2 inhibitors are newer drugs having less adverse effects. Data supporting their efficacy postoperatively in comparison to older non-steroidal anti-inflammatory drugs are scarce. Our study is a prospective, randomized, double-blinded, placebo-controlled trial comparing the efficacy of lornoxicam vs. parecoxib for the management of pain after laparoscopic cholecystectomy. MATERIALS AND METHODS: We enrolled 76 patients, ASA I and II, scheduled for elective laparoscopic cholecystectomy. The patients were randomized to receive before induction parecoxib 40 mg i.v., lornoxicam 8 mg i.v. or placebo. Pain at rest and on movement was assessed using a visual analogue scale at 0, 6, 12 h postoperatively. Total meperidine consumption and adverse effects were also recorded. RESULTS: At 12 h, visual analogue scale scores at rest and on movement were significantly lower with parecoxib and lornoxicam compared with control ( P = 0.047). The percentage of patients needing meperidine and the average dose of meperidine administered was significantly lower with parecoxib and lornoxicam compared with control (P < 0.001 and P = 0.018). There was no difference between parecoxib and lornoxicam. One patient receiving lornoxicam vomited. CONCLUSIONS: Parecoxib 40 mg i.v. and lornoxicam 8 mg i.v. were equianalgesic and both were more efficacious than placebo for the management of pain after laparoscopic cholecystectomy.

Squamous cell carcinoma arising in a mature cystic teratoma of the ovary with synchronous invasive lobular breast cancer: case report.

Malignant transformation of a mature ovarian cystic teratoma is the most serious complication of this relatively common neoplastic lesion. While any constituent tissue of the teratoma can undergo malignant transformation, squamous cell carcinoma represents approximately 80% of those malignancies. Furthermore, the synchronous occurrence of a second malignancy in that setting is extremely rare. Preoperative diagnosis of malignant transformation within a mature cystic teratoma is extremely difficult and poses a great challenge to current clinical surgical practice. The particularly aggressive behavior of this rare tumor, also poses significant surgical managing dilemmas. We present a case report of a premenopausal woman with an invasive squamous cell carcinoma arising in a mature cystic teratoma and a synchronous invasive lobular carcinoma of the breast.

Lipomatosis of the ileocecal valve leading to episodes of partial small bowel obstruction.

The cases of two female patients with lipomatosis of the ileocecal valve inducing episodes of intestinal obstruction are presented. A barium enema with air contrast was performed in patient 1; patient 2 was operated on to treat ileus. Resection of the fatty tissue from the ileocecal valve was performed at operation, after histologic diagnosis on frozen section. These cases suggest that limited resection removing fatty tissue is effective and preferable to more radical resection.

Combination of serum carcino-embryonic antigen and C-reactive protein--a useful test in preoperative staging of colorectal cancer.

The value of the simultaneous estimation of serum carcino-embryonic antigen (CEA) and C-reactive protein (CRP) concentrations in staging patients with colorectal neoplasias was evaluated. The study included 95 patients with benign or malignant epithelial tumors of colon and rectum. The simultaneous negative values of CEA and CRP were able to exclude stage D tumors with a specificity of 92.6% (P less than 0.001). Simultaneously positive values of CEA and CRP were able to diagnose stage C or D tumors with a specificity of 92.1% (P less than 0.001). It is concluded that the combination of CEA and CRP tests can substantially contribute to the preoperative staging and assessment of the extent of colorectal cancer.

[The treatment of external biliary fistulae by means of lavage and continuous aspiration]. / Il trattamento delle fistole biliari esterne tramite lavaggio ed aspirazione continua.

In 99% of cases external biliary fistulas are caused by liver and biliary tract surgery. The paper describes a new continuous aspiration of the fistula. This method was used to treat 18 patients and full closure of the fistula was achieved in 15 out of 18 patients.

Perforated small bowel diverticulosis. Case report.

Three patients who presented with perforated small bowel diverticulosis were healed by resection of the perforated segment and primary anastomosis. Clinical awareness of this disease may reduce the relatively high mortality reported by most authors.

[Blood endotoxin in acute pancreatitis using limulus amebocyte lysate test (LAL test)]. / Studio sull'endotossinemia nella pancreatite acuta con l'impiego del limulus amebocyte lysate test (LAL test).

Forty-five cases of acute pancreatitis observed during the period 1986-88 were included in this study. Four of the 45 patients were operated during the acute phase and of these, two died. The remaining 41 patients were treated with conservative therapy using the application of a nasogastric tube, analgesics, and the endovenous administration of various solutions and antibiotics. The severity of each attack of pancreatitis was assessed according to Ranson and Agarwal's criteria. In severe cases (more than 3 of Ranson's criteria) the presence of endotoxin in the systemic circulation was shown using the "limulus" method, together with contemporary low levels of C3 complement factor. As is evident from the results of the study, the presence of endotoxinemia and the low level of C3 in acute pancreatitis are related to the high percentage of complications.

Unusual primary locations of hydatid disease. Case report.

Two unusual cases of primary hydatid disease are described. In one of them a retroperitoneal cyst, presenting as a palpable abdominal mass, was strongly adherent to the inferior vena cava and dislocated the right kidney. Partial cystectomy and drainage were performed. The other cyst, of the right ischiorectal fossa, was initially misinterpreted as a perineal of sciatic hernia. It was completely removed. No other site of hydatid disease was found and the patients remain well 3 and 4 years postoperatively.

Thyroglossal duct cyst carcinoma (report of two cases).

Two cases of papillary carcinoma of thyroglossal duct cyst that were treated in our department are presented. Differential diagnosis and pathological features are emphasized. Radical excision of the cyst according to Sistrunk's technique is recommended. The recent literature concerning this subject is reviewed.

Prophylactic cholecystectomy during splenectomy for beta thalassemia homozygous in Greece.

The impact of prophylactic cholecystectomy upon early mortality and morbidity of splenectomy for patients with beta TH H was investigated. The results of our study suggested that it is a safe procedure that is not associated with any increase in operative mortality and postoperative complications. This was true even when beta TH H was complicated by pigment cirrhosis and ascites. In view of increasing longevity of those patients with beta TH H, as well as the increased risk for gallstones even after splenectomy, we recommend the use of prophylactic cholecystectomy as a standard approach for all patients undergoing splenectomy for beta thalassemia homozygous.