[Abdominal aortic aneurysm and rectal cancer: what surgical strategy?]. / Aneurisma dell'aorta addominale e cancro del retto: quale strategia operatoria?

The incidence of abdominal aortic aneurysm and colorectal cancer association is 0.5-1%. This concomitance of two potentially lethal diseases creates a decision making problem regarding priority of treatment. The Authors report a case in which colorectal cancer and abdominal aortic aneurysm were present. This patient first underwent surgery for colorectal cancer, then for aortic aneurysm. Moreover, the Authors review the Literature and discuss their decisional principles about treatment priorities.

[Anomalies of the inferior vena cava: observations on the anterior approach to the vertebral column]. / Anomalie della vena cava inferiore: osservazioni nell'approccio anteriore alla colonna vertebrale.

The inferior vena cava is formed through a complex process of embryogenesis from the sixth to the tenth week of gestation. Improper completion of the process of embryogenesis may result in four anatomic anomalies: 1) duplication of the inferior vena cava; 2) left-sided inferior vena cava; 3) retroartic left renal vein and 4) circumaortic left renal vein. The Authors report the cases of two patients in which duplication of the inferior vena cava and retroartic left renal vein were respectively observed. The importance to avoid injuries and subsequent bleeding from these anomalous structures during surgical operations is stressed. Moreover, a correct preoperative diagnosis may reduce these complications.

[Anterior approaches to the spinal column: considerations of the surgical technic]. / Vie di accesso anteriori alla colonna vertebrale: considerazioni di tecnica chirurgica.

The anterior approach to the vertebral column is indicated in the tumors or traumas of the vertebral body with prevalent anterior expression. This method allows to control easily all the structures in front of the rachis. Furthermore, the current reconstructive techniques require the exposure of a long tract of the vertebral column. The Authors report their experience with the anterior approach in 22 patients (9 males, 13 females) affected by different pathologies: 10 primary tumors divided as follows: 4 sacral chordomas, 1 L1 chordoma, 2 sacral neurinomas, 1 L5 malignant melanotic schwannoma, 1 D9 osteoblastoma, 1 D6 intraspinal cavernoma, and 1 D3 myeloma; 4 metastatic tumors (2 D10, 1 L4 and 1 L5); 5 fractures of the vertebral body (1 L1, 1 L1-L2, 2 L4 and 1 L5); 2 echinococcal cysts respectively arising from the D11 body, the sacrum and ilium. The Authors overall performed 8 thoracotomies, 6 for dorsal location; in 1 case of L1-L2 fracture a thoracophrenolaparotomy was performed; in 7 cases involving the L3-L5 segment an abdominal anterolateral extraperitoneal approach was followed; finally in 6 cases a transperitoneal laparotomy to approach the sacrum and ilium was performed.

[The osseous location of echinococcal cysts: comments on a clinical case]. / La localizzazione ossea della cisti da echinococco: considerazioni su un caso clinico.

Primary bone location of hydatid disease is extremely rare. The clinical case herein reported represents a primitive bone location of echinococcus in the ileal and sacral area. The aspecific symptoms did not allow for a preoperative diagnosis. The latter was possible only after a CT scan performed for other reasons. The patient underwent a CT scan and MIR which showed a diffuse involvement of the ilium and sacrum along with the presence of two cysts (anterior and posterior). Surgery was performed through an anterolateral extraperitoneal and posterior access in the gluteal region. Asportation "en bloc" of the cysts was not possible. Therefore, they were opened, aspirated and washed with hypertonic solution (33% NaCl). Following surgery Albendazole was prescribed to the patient. At 22 days from surgery, a CT scan confirmed the disappearance of the cysts along with the presence of bone lesions.

[Digestive reconstruction using mechanical staplers after total gastrectomy]. / La ricostruzione digestiva con suturatrici meccaniche dopo G.T.

From 1980 up to nowadays, after total gastrectomy for gastric cancer, the intestinal continuity was assured by oesophago-jejunostomy and oesophago-duodenoplasty using stapling devices. Two patients died for causes not related to the technique, and other two patients developed a stenosis of the oesophago-jejunostomy, which was easily managed by endoscopic dilatation. In one patient a partial dehiscence of the oesophago-jejuno-anastomosis was treated by total parenteral nutrition. The Authors have systematically adopted mechanical sutures after total gastrectomy. However, possible intraoperative accidents and complications should not be underestimated, although most of them may be due to the operator's inexperience or stapler misuse.