Multimodal treatment for oesophageal primary cancer. A preliminary study.

OBJECTIVE: This study examines the role of chemoradiotherapy, surgical reconstructive techniques of the esophagus and lymphadenectomy in relation to morbidity and mortality. METHODS. From January 2005 to January 2008 we observed 18 patients with esophagus cancer. Eleven patients manifested a lesion of the middle third, 4 patients had a lesion of the upper third and 3 patients had a lesion of the lower third. Preoperative histological evaluation revealed 3 adenocarcinomas and 15 squamous carcinomas. Four patients with a lesion of the upper third received neoadjuvant chemotherapy RESULTS: In 13 patients reconstruction used stomach and 5 patients underwent reconstruction with the colon. Complications ensued in 3 of the latter: dehiscence of the anastomosis, anastomotic stenosis and chylothorax. Three patients highlighted a moderate malabsorption syndrome. A T3N1M0 patient received postoperative cisplatin/5-fluorouracil and radiation therapy. CONCLUSIONS: The use of the stomach represents the therapeutic gold standard for minimized incidence of complications. Lymphadenectomy allows to establish a precise stage of cancer. Chemoradiotherapy is recommended in case of risk of relapse.

Yersinia enterocolitica intestinal infection with ileum perforation: report of a clinical observation.

Yersinia enterocolitica infection is responsible in human beings for ileocolitis appearing with abdominal pain, diarrhoea and fever. This kind of disease usually heals spontaneously with no remarkable complication. Intestinal perforation is a rare complication of the disease. To date only eleven cases of surgical complications arising from abscess and intestinal perforation due to Yersinia enterocolitica have been reported in literature. In our clinical case the patient, who had previously undergone appendicectomy, required urgent surgery for pelvi-peritonitis due to intestinal perforation on necrotic-ulcerative ileitis with adenomesenteritis from Yersinia enterocolitica. The surgical treatment combined with intestinal resection and targeted antibiotic therapy have proved to be effective.

Giant metastatic small bowel and mesentery localization and pleural metastases secondary to breast cancer. Case report.

The authors present a case of a patient with double metastatic abdominal and thoracic localization coming from breast cancer. Peculiarity of this case concerns both the considerable size of metastatic abdominal mass (11 centimetres of the major axis for a weight of almost half a kilogram) and the swift development of the relapses at distance, even in the presence of an original tumour at first stage. Both abdominal surgical operation of the removal of the mass and diagnostic video assisted thoracoscopy (VAT) are described.

Giant bullous emphysema resection by VATS. Analysis of laser and stapler techniques.

OBJECTIVE: Advances in video-assisted thoracic surgical (VATS) technique led the authors to reconsider the treatment and thoracoscopic management of patients with giant bullous emphysema (GBE). METHODS: From January 1993 to December 2001 we treated 40 patients with unilateral GBE: 24 males and 16 females, mean age 51+/-1 years. Thirty patients presented respiratory insufficiency, seven patients a spontaneous pneumothorax and three patients a bullae infection. Excision was performed by using Nd:YAG laser in five patients (12.5%) and stapling device in 35 patients (87.5%). Among the last 35, in 20 patients a partial pleurectomy stripping up to the 5th intercostal space was associated. In 15 patients this technique was modified through the systematic application of polytetrafluoroethylene (PTFE) to reinforce stitches. RESULTS: We experienced one conversion to open thoracotomy owing to haemorrhaging, in one patient who underwent a partial pleurectomy stripping. In the stapler resection patients, with PTFE application, the mean duration of air leaks, for type 1 bullae of Wakabayashi was 2.2+/-1.8 days and, for type 4, 5.9+/-1.4 days; the mean length of hospital stay was 6.1+/-0.5 days. CONCLUSIONS: The resection in VATS of giant bullous emphysema by stapling device associated to reinforcement in PTFE reduces duration of air leaks and hospitalisation and improves pulmonary function.