The tuberous breast syndrome.

The tuberous breast syndrome is the result of a complex series of defects with various degrees of expression. However, much confusion has been generated in the literature by the use of often inadequate terminology, which is partly the cause of multiplicity of managements being proposed that mainly aim to correct the major defect and not the entire syndrome. The surgical approach adopted by our group stems from the improvement of classic techniques, consisting essentially of a combination of periareolar mastopexis, additive mastoplasty, and gland base enlargement by cross incision. Our results were fully satisfying both aesthetically and functionally. We achieved a correct shape, resolved ptosys and reduced areolas with no double-fold effect, and attained good symmetry in more complex unilateral cases.

Hepatic growths mimicking adrenal tumors.

BACKGROUND/AIMS: The upper district of the perirenal space is widely open and compliant, especially on the right side. Hepatic growths can, therefore, easily invade the adrenal gland area, mimicking adrenal tumors and vice-versa for adrenal and renal tumors. Data on the nature and exact origin of a mass in this region are important for appropriate preoperative management, surgical approach and prognosis but, sometimes, even modern imaging fails in this design. METHODOLOGY: The records and imaging documentation of 42 patients with a mass exceeding 6 cm in the hepatorenal space, have been retrospectively reviewed and compared with surgical and histological findings. RESULTS: Among the 14 patients with "non-functioning adrenal tumors," the preoperative diagnosis had been accurate in all but 2 cases where the suspected adrenal lesion turned out, intraoperatively, to be liver growths. These 2 cases are discussed in detail. CONCLUSIONS: The distinction between an intrahepatic and extrahepatic mass challenges modern imaging techniques, and even invasive procedures sometimes fail. A deceptive diagnosis may lead to inappropriate preoperative management and surgical procedures.

Surgery in Crohn's disease: when, where and why the recurrences?

One frustrating feature in the surgical management of Crohn's disease is the high recurrence rate which may lead to reoperation. It is common opinion that relapses occur haphazardly both in time and in site, and the causes remain unknown. When does a recurrence really arise after surgery? Is the site of recurrence determined by definite causes? Is there a relapsing factor? Between 1965 and 1995, 177 patients underwent surgery for Crohn's disease. The procedures performed in 145 cases were those popular at the time, while a recent series of 20 selected patients was managed following a new approach based on epiploonplasty. This strategy stems from the strong conviction that Crohn's disease is not a primary bowel disease but the result of stasis and superimposed infection due to a primary hemolymphatic disorder of the mesentery. The five-year recurrence rate was 62% in patients operated on according to standard procedures, while no recurrences were reported in the epiploonplasty group. Among 12 remaining patients with recurrent disease, two cases are reported in detail because they provide evidence in favor of the hemolymphatic theory. This study also maintains that recurrences, viewed with the hemolymphatic disorder in mind, occur immediately after surgery, while the superimposed intestinal inflammatory process and stricturing events may appear clinically at different time intervals during follow-up. The site of recurrences usually corresponds to the mesenteric region subjected to compression. Altered mesenteric microcirculation appears to be the true essence of the disease.

A new approach in the management of Crohn's disease: observations in 20 consecutive cases.

Although the "modern history" of Crohn's disease dates back to 1932, the etiology is still nebulous, the medical treatment inefficient and resective surgery results in a high recurrence rate. Twenty consecutive patients with terminal ileitis underwent ileo-cecal resection and mesenteric-epiploonplasty to enhance collaterals and lymphatic drainage. This approach was advised by experimental observations (the ligation of colonic lymphatic ducts in rabbits), by the intraoperative use of optics to better appreciate the details of the diseased bowel before and after injecting dye and by the angiographic results in one patient. In rabbit experiments, the obliteration of lymphatic drainage led to Crohn's disease-like macroscopic and microscopic patterns, while diffusion of the dye injected in the diseased segment showed altered lymph flow. The angiographic study in one patient confirmed the presence of vascular anomalies. Direct observation through optics revealed large vessels in the serosa with milky contents and the oozing of sticky exudate. In the 8 patients who underwent this procedure over 5 years ago, there were no recurrences. We strongly believe in the vasculo-lymphatic etiology of Crohn's disease and in mesentery-epiploonplasty as the only actual indirect approach to resolve hemolymphatic obstructions.

[Primary gastric lymphoma. Diagnostic and therapeutic considerations on 30 cases]. / Il linfoma gastrico primitivo. Considerazioni diagnostico-terapeutiche su 30 casi.

From 1987 to 1992, 30 cases of Primary Gastric Lymphoma were operated in the Institute of Patologia Speciale Chirurgica of the University of Bologna. Clinical features, diagnostic findings, therapeutic procedures and histologic characteristics are reported. The results are discussed after a brief literature review.

Virilizing adrenocortical tumors in adult women. Report of 10 patients, 2 of whom each had a tumor secreting only testosterone.

BACKGROUND: Virilizing adrenocortical tumors are uncommon in adult women. These lesions generally secrete dehydroepiandrosterone (DHEA) and dehydroepiandrosterone sulfate (DHEAS), but not testosterone, which usually is produced by ovarian tumors. Exceptionally, adrenal growths may give off testosterone and no other assessable androgen. The detection of the site of excess testosterone yield is paramount for proper surgery. The true nature of the growth often is unpredictable, even at the time the pathologist examines the surgical specimen. METHODS: The workup in a virilized adult woman relies on biochemical tests such as 24-hour urinary 17-KS and 17-OHCS levels and plasma corticosteroid levels (testosterone, DHEA, DHEAS, and androstenedione), and on modern imaging studies such as ultrasonography, computed tomography, and digital angiography. RESULTS: Among a series of 190 adrenal tumors collected in the last 30-year period, only 10 virilizing growths (5.3%) were detected. Two cases of virilization mixed with cushingoid features were observed. In two other cases, reported in detail, the tumor secreted testosterone only, without other assessable androgens. Seven of the 10 tumors were malignant. CONCLUSIONS: In cases of tumors secreting testosterone only, high-resolution imaging has contributed significantly in pinpointing the site of the growth, whereas dynamic hormone testing, using selective stimulation or suppression studies, has been misleading. The malignant nature of the growth may be revealed only by the presence of metastases, because pleomorphism and capsular and vascular invasion have been detected histologically in clinically benign tumors. The prognosis for large tumors usually is dismal.

[Hydatid cysts of the ovary. Description of a case]. / Le cisti di echinococco dell'ovario. Descrizione di un caso.

Hydatid cysts of the ovary are rare lesions usually secondary to the rupture of an hepatic cyst. They may remain asymptomatic for long periods of time and may be discovered incidentally or cause irritation or compression symptoms. The history and whole abdomen echography consent diagnosis also based on the detection of the primary lesion. A case of hydatid cyst of the ovary is reported.

[Slowly reabsorbable suture threads in arterial microsurgery]. / Fili di sutura a lento riassorbimento in microchirurgia arteriosa.

Authors present the results of an experimental research to evaluate the effectiveness of a slow resorbable suture (Polyglactyn 910) in arterial microsurgery. Healing of vascular wall, histologically evaluated, showed good reliability, compared to other suture materials.