Management of true splenic artery aneurysms. Two case reports and review of the literature.

Few series of splenic artery aneurysms (SAA) have been reported, but today asymptomatic SAA are detected with increasing frequency. Their importance lies from their potentially fatal consequences as life-threatening hemorrhage. SAA management still remains controversial as reported in this review. Our 2 patients treated with resection of the aneurysms, both located in the middle third of the splenic artery. Some authors demonstrated that when splenic artery has been ligated (or embolized) and the patients remain anatomically splenic, they may not retain any splenic function. Laparoscopic SAA ligation repair appears to be optimal and useful for aneurysms protruding from the pancreas and it is gaining interest because clinical recovery is rapid with a poor morbidity and economic and cosmetic advantages. Transcatheter embolization too offers a temporary control in urgency to stop hemorrhage and go back at later date to make much better elective operation. Endovascular interventions as percutaneous embolization has recently gained popularity: it offers a safe alternative or adjunctive therapy to traditional surgery. We hope in the future instrumentation will likely improve so that this procedure can be done percutaneously by development of prosthetic devices in the 21th century.

Raltitrexed plus oxaliplatin as first-line chemotherapy in metastatic colorectal carcinoma: a multicentric phase II trial.

For advanced colorectal carcinoma, two new drugs, raltitrexed (TOM) and oxaliplatin (L-OHP), have recently shown interesting results. Preclinical and clinical studies suggest that this combination, because of its favorable toxicity profile, high response rate and convenient schedule of administration, can be administered successfully in this disease. In our phase II study, 37 non pre-treated patients with metastatic colorectal carcinoma were treated with TOM (3 mg/m(2)) and L-OHP (130 mg/m(2)) every 3 weeks. In total, 222 cycles were administered; all patients received at least 2 cycles (median 6, range 2-8). There were two complete and 14 partial responses for an overall response rate of 43% (95% CI 27-69%). The median time to response was 2.5 months (range 2-4) and the median duration was 10.3 months (range 5-18). Twelve of the 23 (52%) patients with symptomatic colorectal cancer were classified as clinical benefit responders for at least 4 weeks during the study period. Treatment was well tolerated, and both acute, essentially hematologic, and cumulative hepatic and neurologic toxicities were manageable and reversible. Response rate and toxic effects observed during this study warrant additional studies comparing this TOM-L-OHP regimen with CPT-11 and/or capacitebine-containing regimens in metastatic colorectal carcinoma.

[An angiogenesis study of Dukes' B colonic tumors]. / Studio sull'angiogenesi nei tumori colici Dukes' B.

PURPOSE: To evaluate the angiogenesis in Dukes' B colon cancer. PATIENTS AND METHODS: In 60 patients (age, 39-75 years), the microvessel density and the relationship between the angiogenesis and other histologic features were retrospectively evaluated. In an ongoing prospective study, 25 patients have been enrolled to determine the possible therapeutic implications of VEGF quantitative analysis. RESULTS: The retrospective portion of this study confirms the prognostic value of the angiogenesis in terms of recurrences and survival. At present, no conclusions can be drawn from the prospective portion of the study.

[Adenocarcinoma of the duodenal bulb. A clinical case report]. / Adenocarcinoma del bulbo duodenale. Presentazione di un caso clinico.

A rare case of adenocarcinoma of the duodenal bulb, arising from adenoma and submitted to Whipple's procedure is presented. A diagnostic delay of about 3 months, according to literature is observed. This delay is generally due to the low incidence of the illness, aspecific symptoms and frequent endoscopic and radiologic false negative, most of all in lesions of the third and fourth duodenal portions. Diagnostic tools for these duodenal tumors are endoscopy and upper gastrointestinal barium studies (UGI). CT is useful to determine preoperatively the stage of the illness and can occasionally show the primary duodenal lesion, as in this case. Surgical approach is still controversial, except in lesions of the second duodenal portion, where Whipple operation is the procedure of choice, if the tumor is resectable, of course. In the other duodenal portions some authors suggest segmental duodenal resections instead of Whipple's procedure.

[Jejunal mucosectomy as a preliminary technique of pancreatico-jejunal anastomosis]. / La mucosectomia digiunale come momento preliminare dell'anastomosi pancreatico-digiunale.

The Authors describe mucosectomy as a preliminary technique to pancreatico-jejunal anastomosis. The removal of the last few centimeters of the jejunal mucosa enhances the perfect adhesion of the loop to the pancreatic parenchyma. Results seem to confirm theory: in our experience, "telescopic" technique associated with mucosectomy and somatostatin administration prevented so far anastomotic leakages.

[Personal experience in the area of colorectal anastomoses without protective colostomy]. / Esperienza personale nel campo delle anastomosi colo-rettali senza colostomia di protezione.

The Authors report their past 3-year-experience in colorectal anastomosis without protective colostomy. General results in terms of complications and mortality rates are similar if not even better than those referred by the international Literature.

[Bowen's disease of the anus]. / Maladie de Bowen anale.

Bowen's disease of the anus and the perineum is undoubtedly a rare pathology. This is demonstrated by the fact that, while described by M. Bowen in 1912, only 112 cases have been reported in 1979. The differential diagnosis is more difficult than that of Bowen-like papulosis and Queyrat's erythroplasia. Ano-perineal Bowen's disease is, or may be, in a large number of cases, seen concomitantly with a primary ano-rectal or vaginal carcinoma, even if they were diagnosed after Bowen's disease.

Anorectal continence and bladder function. Effects of major sacral resection.

The effect of sacral resection up to S-2 has been investigated in two patients with "chordomas," surgical division of the spinal roots was unilateral and bilateral, respectively. Anal manometry, electromyography of the sphincters, and the ascertaining of tactile, thermic, and painful stimuli perception in the perineum and anal canal were executed to determine the effects of denervation on anorectal continence. Vesical function was tested by vesical manometry. Results differ strongly between the two patients: the first, with unilateral loss of S-2, has perfect anorectal continence. The second, with bilateral loss of S-2, is incontinent and unable to discriminate rectal contents. It is sufficient to retain only one S-2 root for the maintenance of physiologic continence, including distinction between different types of bowel contents (gaseous or solid) passing through the anal canal. The same is true concerning bladder function.

[Indications for mechanical anastomoses]. / Indications des anastomoses mécaniques.

The author critically reviews indications, advantages and disadvantages of EEA staplers in colo-rectal surgery, basing on literature and personal experience. According with the overwhelming majority of scholars, the authors states that the applications of the EEA stapler represent a remarkable advance in the specific field making operations easier and safer.