Immediate and delayed two-stage post-mastectomy breast reconstruction with implants. Our experience of general surgeons.

BACKGROUND: Breast reconstruction after a mastectomy, today is considered the best choice to improve the quality of life for the patient. The aim of the procedure is to consider the aesthetic results obtained and the various involvements, comparing them with those already reported in literature. METHODS. There is no certain data of the number of breast reconstructions performed in Italy in the few years. In 1999, in Veneto, reconstruction surgery after total breast removal, represented only 16% of the operations. In our surgery Division, from 1996 to 2000, there were breast reconstructions performed, either immediately or delayed on 87 patients out of 118 after mastectomy. 73.7% none over the age of 60 (range 27-60). The breast removal technique used is the Madden, while, for the reconstruction we have put into effect the submuscle prosthetic implant; 63 patients were subject to follow-up treatment during the period of 10 to 36 months. RESULTS: Seventy-eight percent of the women have judged the final aesthetic results the same or better than expected. Based on reconstruction with prosthesis, is the preferred procedure, even with serious complications which do not always influence the final results. This preference is because of the reduced operation time and the psychological and physical benefits due to immediate restoral of the mammary volume and shape. CONCLUSIONS: Some problems (Garavaglia Law) have slowed down the diffusion in Italy of this type of treatment which is now receiving more and more request and approval by the women affected with breast cancer.

[Cavernous hemangioma of the mediastinum]. / Emangioma cavernoso del mediastino.

The authors present a rare case of cavernous hemangioma of the mediastinum. After a critical review of existing literature on the subject, they discuss the symptoms of this vascular malformation with special emphasis on the difficulties of differential diagnosis versus other space-occupying lesions of the mediastinum. They further discuss the characteristic histopathologic features of cavernous hemangioma, and state that ablative surgery is the only possible therapeutic measure.

[Cytological studies in diagnosis of cancer of the esophagus]. / Indagine citologica nella diagnostica del cancro dell'esofago.

The importance of exfoliative cytology in the diagnosis of cancer of the oesophagus is stressed. The examination uses a straightforward, economical technique and, in association with traditional investigations, offers diagnostic positivity of close to 100%. The interest in exfoliative oesophageal cytology does not derive solely from its confirmation of clinically certain oesophageal cancer, but from the fact that it offers early diagnosis outside of dysphagic symptomatology. Its field of use is thus extended and it proves to be a complementary but indubitably useful technique for diseases of the oesophago-gastric tract, particularly in those presenting high cancerization risk. Its use is therefore recommended for the screening of oesophageal cancer.

[Castleman's benign lymphoma]. / Il linfoma benigno di Castleman.

The Authors, when presenting a personal case of CBL, make a critical revision of the literature, summing up the evolution of knowledge of this morbid picture. They analyse and discuss the aetiological theories suggested by other Authors on the basis of clinical and anatomopathological criteria. Lastly they evidence the difficulty of diagnosis both for the clinical physician and for the anatomopathologist, since there are numerous pathological pictures which may simulate CBL in the symptoms when present, the x-ray aspects and even the anatomohistological examination.

[The prognosis in patients with esophageal cancer: statistical study in relation to age, histotype, tumor stage, and immunological reactivity]. / La prognosi nei pazienti affetti da cancro esofageo: studio statistico in relazione ad eta, istotipo, stadio tumorale, reattivita immunitaria.

This paper analyses the prognostic factors in cancer of the oesophagus in relation to site, histological type, age, and the patient's immunitary reactivity evaluated histologically in the lymphonodes and the tumoral tissue itself, and the invasion or otherwise of the loco-regional lymphonodes. The survival curves are calculated by the actuarial method. In particular, it was seen that patients with absence of peritumoral lymphocytic infiltrate and depletion of the loco-regional lymphonodes present a survival curve stopping at the second year after the operation, whereas reactive patients survive beyond that date in 29% of cases. It may therefore be asserted that the presence of lymphocytic infiltrate in the tumour and of lymphonodal reactivity are a pointer to an attitude of defence of the organism, and the importance of the study of these factors as prognostic criterion in patients subjected to resection of the oesophageal tumour clearly emerges.

[13 cases of double neoplastic localizations, 1 involving the esophagus]. / Considerazioni su 13 casi di doppia localizzazione neoplastica di cui una interessante l'esofago.

During the course of nine years 494 patients suffering from oesophageal cancer have come under our observation, including 13 cases characterised by the phenomenon of double neoplastic localisation. In some cases, in view of the histological identity of the two neoplasias, remote endocanicular colonisation may be presumed, while in other cases the rise of the tumour "disease" may be correlated with the action of carcinogenetic agents on sites of lesser resistance in organisms whose immunitary defences have been decreased in relation to neoblastogenesis. This is supported by the increase in the incidence of malignant neoplasias in patients subjected to immuno-suppressive treatment.