[Laparoscopic appendectomy. Retrospective analysis of our experience compared with the literature]. / Appendicectomia laparoscopica. Analisi retrospettiva della nostra esperienza in rapporto alla letteratura.

BACKGROUND: The benefits of laparoscopic appendectomy (LA) remain controversial. This study reports a critical examination of our experience in a peripheral hospital. METHODS: A total of 128 appendectomies have been performed since January 1996, of which 63 (49%) were laparoscopic. The patients included 52 (82.5%) females and 11 (17.5%) males with a mean age of 20.8 years (range 11-46). Emergency surgery was required in 6 cases (9.5%) and was elective in 57 (90.5%). Appendectomy was performed during another operation in 3 cases (laparoscopic cholecystectomy). RESULTS: Mortality was nil. Morbidity was 1.7% (1 case). The index of conversion was 0%. Only one major complication occurred. This took the form of perforation of an ileal loop following accidental lesion during adhesiolysis. The intraoperative diagnosis was not confirmed in 12 (19%) cases: 9 ovarian cysts, 1 terminal ilieitis and 2 cases of acute salpingitis. In 10 cases (15%) surgery was associated with adhesiolysis, and in 6 cases (9.3%) the appendix was retrocecal. Mean operating time was 42 min (range 18-105 min). The mean hospitalisation was 3.3 days. CONCLUSIONS: The authors emphasise the numerous advantages of laparoscopic techniques in their experience, including excellent cosmetic results, reduced PO pain, rapid functional recovery, lower incidence of adhesion, wound infection and laparocele, and more cost-effective when mechanical staplers are not used. Owing to the ability to explore the entire abdominal cavity, the main advantage of this technique consisted in a correct differential diagnostic balance, especially in young women of child-bearing age, between appendectomy and pathologies of the uterus and adnexa.

[Laparoscopic cholecystectomy. Our experience]. / Colecistectomia laparoscopica. Nostra esperienza.

BACKGROUND: The many advantages and extreme versatility made laparoscopic cholecystectomy (L.C.) the gold standard for symptomatic cholelithiasis. The aim of this research is a retrospective analysis of personal experience with laparoscopic cholecystectomy in a peripheral hospital compared with the literature on the subject. METHODS: Since June 1982, a total of 989 L.C. have been performed. The patients were: 691 (68.6%) women and 298 (29.4%) men with a mean age of 56 years (range 17-84). The indications were: 791 symptomatic cholelithiasis, 142 chronic cholecystitis, 45 empyema-hydrops and 11 adenomyomatosis. RESULTS: No postoperative death have been observed and the conversion rate was of 24 cases (2.3%). The main complications were 3 cases of injury of the biliary tract and 2 cases of postoperative bleeding (1 from cystic artery and 1 from the umbilical wound). Minor complications observed were 12 cases (1.2%) of infections of the umbilical wound and 3 cases of umbilical hernia (0.3%). The elevation of stasis index was observed in 3 cases which solved spontaneously. The length of stay was 2 days in 957 cases (97%), 8 days in 24 cases and 4-5 days in 8 (0.7%). CONCLUSIONS: No major trochar's lesions occurred, contrary to the percentages quoted in the literature (0.02%-0.9%). The selective use of the open technique and of the multiuse conic section trocar in the "closed" technique is suggested. The 3 cases of bile duct lesions did not occur during the training period, contrary to what quoted in the literature. In personal opinion, a careful surgical technique with a good Calot's triangle preparation, is necessary to prevent these inconveniences. Parietal complications (umbilical wound infections and laparocele) even if lesser than in the laparotomy technique, can be reduced by using the endobag and suturing the abdominal fascia of the 10 mm trocars. Moreover, the use of a systematic subhepatic drainage during the first 24 postoperative hours is suggested, since it can be useful to reveal possible bleeding.

[Gastric carcinoma. Our experience]. / Il carcinoma gastrico. Nostra esperienza.

This study analysed 66 cases of gastric cancer from 1985 to 1992. Twenty-seven patients (41%) has been treated with anti-H2 drug, either medical care or Jerkily "a la demande": 12 patients have been treated several years. Of the 66 patients: 52 (89%) were operated on while the other 16 received medical treatment because of the extension disease and their precarious condition. Long-term 35 (67%) patients (of the 52 operated) died four years later, independently of the stage and PKT of the first and the second level. The 27 patients treated with anti-H2 drug showed the most undifferentiated grading and 88% belong to the third and the fourth stage; moreover 81% underwent first diagnostic endoscopy notwithstanding a clinical and surgical history of gastric ulcer. Is it possible, therefore, that anti-H2 drug delay the diagnosis.

[Anorectal lesions in Crohn's disease. Our experience]. / Lesioni ano-rettali nel Crohn. Nostra esperienza.

Nine years experience of anorectal surgery for Crohn-related lesion have been analysed. The series regards only 14 cases with pathology including ragade, abscesses and anocutaneous and retrovaginal fistulas. Treatment was as conservative as possible except for cases in which fistulizations led to sepsis as a result of which some adjustments had to be made and proctectomies in incontinence.

[Carcinoma of the palate. Clinical cases]. / Il carcinoma del palato. Contributo casistico.

The paper reports a series of 29 patients treated for advanced neoplasias of the palate at the Oncology Institute in Turin. The study confirms the proportional deterioration of the survival rate in correlation with the advanced stage of the carcinoma. The majority of deaths due to insufficient control occur during the second year following treatment but, after this period, the survival rate tends to stabilise around 40%.

[Our experience on intestinal infarct. 21 cases]. / Nostra esperienza in tema di infarto intestinale. Ventuno casi.

Five years experience in the field of acute intestinal ischaemia, a total of 21 cases, is examined and it is concluded, in agreement with the literature, that most patients undergo simple laparotomy (70%) because diagnosis is made late or there is an operative surprise. In the event of diagnostic suspicion leading to operation in the early hours, therapeutic successes quoad vitam leave a short intestine syndrome with metabolic complications that are hard to manage. The possibility of large-scale employment of diagnostic tools such as selective arteriography that makes early diagnosis possible is therefore necessary.

[The surgical treatment of carcinoma of the lip. A report on cases]. / Il trattamento chirurgico del carcinoma del labbro. Contributo casistico.

The authors study a group of 108 patients treated for lip carcinoma by surgery alone or associated with radiotherapy and/or chemotherapy. They point out that the stage at the moment of the first treatment influences the prognosis and they confirm the survival after surgical therapy around 60% at 5 years.

[Benign lesions of the salivary glands of the lip. Apropos of 3 cases]. / Lesioni benigne delle ghiandole salivari delle labbra. A proposito di tre casi.

The paper reports data concerning three cases of benign salivary gland lesion of the lip in order to contribute to the number of case studies given the reduced frequency of this pathology. Patients underwent surgical exeresis of the lesions and no relapse was observed during follow-up.

[Malignant neoplasm of the parotid gland. A caseload contribution]. / Neoplasie maligne della ghiandola parotide. Contributo casistico.

Data from a retrospective study conducted on 20 patients with parotid malignancies are reported. Males were more often affected than females and adult-elderly than the young. A large percentage of the cases were histologically undifferentiated. Eleven total parotidectomies were performed. A further 9 patients only required surgical biopsies for the purpose of histological confirmation. Two of the twenty patients are still alive over 10 years after diagnosis of the tumour.

[Primary lymphoma of the parotid gland. Considerations on 2 cases]. / Linfomi primitivi della ghiandola parotide. Considerazioni su 2 casi.

Data are reported on 2 cases of primary non-Hodgkin lymphomas of the parotid gland considered interesting in view of the rarity of such tumours. The patients were treated surgically and are currently alive and well over 10 years later.

[Preoperative determination of CEA and GICA in gastric neoplasms]. / Il dosaggio preoperatorio del CEA e del GICA nelle neoplasie gastriche.

Data are presented on a series of 39 stomach cancer patients subjected to preoperative assays of blood CEA and GICA. High levels of both markers were found in the advanced (stage III and IV) cases. The use of both markers together improved the sensitivity of the test but only to 30%. Nevertheless preoperative CEA and GICA assays are recommended because of the information they provide about tumor stage.

[Several cases of benign neoplasms of the parotid gland (excluding pleiomorphic adenomas)]. / Considerazioni su alcuni casi di neoplasie benigne della parotide (esclusi gli adenomi pleiomorfi).

A series of 7 patients (4 males, 3 females) suffering from benign, non-pleiomorphous neoplasia of the parotid observed in the period 1963-1983 is reported. The most commonly adopted surgery was extracapsular enucleo-resection. No post-operative complications were observed. No recurrences were encountered during follow-up.

[Pleomorphic adenoma of the parotid gland. Cases contribution]. / L'adenoma pleiomorfo della parotide. Contributo casistico.

Data relating to a series of 23 pleiomorphous adenomas of the parotid (19 primary forms and 4 previously operated recurrences) are reported. The ages most affected are the 4th, 5th and 6th decades with a higher incidence of females. The most commonly adopted surgery was extracapsular enucleoresection of the tumour (17 cases) followed by superficial parotidectomy (4 cases) and total parotidectomy (2 cases). No significant post-operative complications were observed. Anesthetic results were excellent. No recurrences were observed during follow-up.

Hormonal and surgical treatment of endometrial adenocarcinoma: actuarial survival.

We studied the survival period in two groups of patients with endometrial adenocarcinoma treated at the Chair B Institute of Gynecology and Obstetrics. The first series includes 30 of the 52 patients treated from 1976 to 1979. The second series includes 81 patients treated from 1980 to 1986. Lymph nodal positivity was present in 5 cases out of 30 patients belonging to Group I: all the interested lymph nodes were in the pelvic areas. Lymph nodal metastases were, instead, present in 10 cases as regard patients of Group II. Pelvic lymph nodes were involved in all the cases; in 5 of them also the paraaortic nodes were involved.

Two cases of clinical Ib stage cervix carcinoma with exclusive metastases to presacral lymph-nodes.

There is regular progression of metastases through different stations of pelvic lymph nodes as far as para-aortic lymph-nodes in 81.1% of the cases examined of cervix carcinoma. In this paper we report two cases of squamous carcinoma of the cervix with metastases limited to one presacral lymph node, while other pelvic and para-aortic lymph nodes were free. These cases are two examples of irregularity of invasion of metastases from cervix carcinoma. It is extremely rare that presacral station is single and first invaded without extension of lower lymph nodal level. Our technique of pre-sacral lamina excision in connection with the inferior bridge of para-aortic and para-caval connective tissue during para-aortic lymphadenectomy is confirmed. The fatal outcome of the first patient's case is related to such risk factors lymph nodes metastases, deep infiltration of the cervix and involvement of lower section of the uterus. The second patient was free of disease within four months from surgery.

The correlation between estrogen and progesterone receptors and some clinical and pathological features in human breast cancer.

The correlation between estrogen (ER) and progesterone (PgR) receptor status and some clinical and pathological features was evaluated in a series of 680 breast carcinomas. ER status was significantly related to age, menopause, histological grade and vascular invasion. No relationship was found with tumor size, lymph node involvement, histotype and multicentricity. PgR status was significantly related to vascular invasion only. Despite the relationship between ER and favorable pathological features, ER-positive patients did not show a longer disease-free interval after surgery when no systemic adjuvant therapy was administered. ER status is thus of little prognostic value.