[Retroperitoneal sarcomas: our experience]. / Tumori dei tessuti molli a localizzazione retroperitoneale: la nostra esperienza clinica.

BACKGROUND: Retroperitoneal soft tissues sarcomas (STS) are relatively uncommon and constitute a difficult management problem. Although surgical resection is often difficult or impossible, current chemotherapy is not effective and radiation is limited by toxicity to adjacent structures. Thus, complete surgical resection remains the most effective modality for selected primary and recurrent disease. PATIENTS AND METHODS: Fifteen patients with retroperitoneal STS were admitted and treated between January 1990 and January 2003, and prospectively followed. Nine patients underwent complete surgical resection of 8 malignant and 1 benign tumor. Two patients underwent incomplete surgical resection of 1 malignant and 1 benign tumor. Patient, tumor, and treatment variables were analyzed for disease-specific and disease-free survival. RESULTS: The patients with unresectable disease, incomplete resection, and high-grade tumors presented significantly reduced survival time. In this study, stage at presentation, high histologic grade, unresectable primary tumor, and positive gross margin are strongly associated with the tumor mortality rate. CONCLUSIONS: Patients approached with curative intent should undergo aggressive attempts at complete surgical resection. Incomplete resection should be undertaken only for symptoms relief. Because death often occurs as a result of local progression in retroperitoneal liposarcomas, it is possible that incomplete resection may be beneficial in this histologic type. Complete surgical resection is the most effective modality for the treatment of retroperitoneal sarcomas.

[Papillary microcarcinoma of the thyroid. Clinical implications and therapeutic strategy]. / Il microcarcinoma papillare della tiroide. Implicazioni cliniche e strategia terapeutica.

The Authors examine their experience about clinical implications and therapeutic strategies on Papillary MicroCarcinoma (PMC) of the thyroid gland. Clinical charts of 412 patients, who underwent thyroid surgery, were analyzed. The Authors stress "incidental diagnosis", benign associated lesions and frequency of population presentation; they conclude that the total thyroidectomy is the procedure of choice with oncology validity.

[Therapeutic strategies in differentiated cancer of the thyroid: total thyroidectomy]. / Strategie terapeutiche nel cancro differenziato della tiroide: la tiroidectomia totale di principio.

Differentiated thyroid cancer is peculiar for its prognosis often excellent. The Authors report their experience about 78 patients affected with differentiated thyroid carcinoma, operated between 1976-1999 at the Institute of Surgical Pathology and Surgical Clinic of Cagliari University. 70 (89.7%) patients underwent total thyroidectomy, 6 (7.5%) subtotal thyroidectomy and 2 (2.5%) thyroid lobectomy. In 11 patients total thyroidectomy was performed in two times within 60 days after initial lobectomy. Tumor was found in 2 (18%) of 11 of the reoperations. Lymphadenectomy was performed only in presence of cervical lymph nodal metastases. Following 70 total thyroidectomy the incidence of recurrent nerve palsy was 4.2% and permanent hypoparathyroidism 11.4%. 79% patients received adjuvant postoperative radioiodine therapy to ablate residual functioning tissue or distant suspected metastases. After a mean follow up period of 5.8 years, recurrences developed in 10.2%. Any local recurrences, 5 (6.4%) cervical nodal recurrences, 3 (3.8%) distant metastases were encountered. Two (2.5%) of the three patients with recurrence distant metastases died from thyroid carcinoma. The Authors identify total thyroidectomy as the minimal procedure. Surgical management of the cervical nodes is recommended only in the presence of metastatic lymph-nodes. Post surgical ablation with I131 of microscopic remnants optimize detection and treatment of the recurrence and distant metastases.

[Neonatal choledocholithiasis: a case report]. / Coledocolitiasi neonatale: descrizione di un caso.

Cholelithiasis as cause of jaundice in newborn is rare. Usually is associated with known predisposing factors as hemolysis, congenital anomalies of biliary tree, total parenteral nutrition, prolonged fasting. However there are recent signals in literature about idiopathic neonatal cholelithiasis, that seems to be more common than previously suspected. We describe a case of idiopathic neonatal choledochal lithiasis with spontaneous resolution in few days from jaundice beginning. The importance of ultrasonographic investigation for diagnosis and follow-up is confirmed. However, because it is often a self limiting phenomenon, an aggressive approach is not warranted in the asymptomatic infant.

[Ovarian cysts in the differential diagnosis of acute and recurrent abdominal pains]. / Le cisti ovariche nella diagnosi differenziale dei dolori addominali acuti e ricorrenti.

The authors review the differential diagnosis in the acute and recurrent abdominal pain and the classification of ovarian cysts in prepuberal girls. They report the description of three cases of ovarian cysts in prepuberal girls and the role of ultrasonography in their diagnosis in a paediatric department.

Juvenile Huntington's disease.

A rare case of juvenile Huntington's disease manifesting since the age of seven years is reported. The inheritance was typically autosomal dominant as three other members on the paternal side died of similar disease. A definite family history can becrucial in the diagnosis of juvenile Huntington's disease.

[Relevance and therapeutic implications of dysplasia in the follow-up of ulcerative rectocolitis]. / Significato ed implicazioni terapeutiche della displasia nel controllo della rettocolite ulcerosa.

Long standing ulcerative colitis (UC) is a condition capable of malignant transformation. Even if the rate of occurrence of carcinoma differs considerably among the various series, there is general agreement that it can be detectable in advance through the finding of glandular dysplasia. The Authors examine such a problem in a series of 27 patients submitted to clinical and endoscopic follow-up from 1984 to 1989. During this study a total of 237 rectosigmoidoscopies, 83 colonoscopies and 71 histologic exams were performed. At the outset mild or moderate dysplasia was found in 5 cases (18%). However, in the follow-up no evidence of dysplasia was detectable in 4 of the 5 cases. In the remaining case dysplasia was present only in one control. It was not found in the subsequent two histologic examinations. In our limited experience the incidence of dysplasia was not significant enough to require a prophylactic proctocolectomy. Instead a frequent and thorough endoscopic follow-up is recommended.