Unilateral synchronous breast tumors. Rare association of myofibroblastoma and osteosarcoma.

The authors describe the case of a patient with two particularly rare contiguous tumors, myofibroblastoma and osteosarcoma, in the same breast. Rare does not mean untreatable, and the chance of recovery is no less than with more common tumors. However, rare tumors do present a significant problem for pathologists due to diagnostic difficulties, and so an exact prognosis is not always possible.

Indications for and limits of conservative surgery in breast cancer.

Improvements in diagnostic techniques and, above all, breast cancer screening campaigns - essential for early diagnosis - have enabled the objectives of conservative surgery to be pursued: disease control, no or low incidence of recurrences and an excellent esthetic result. However, to reach these objectives, it is essential to ensure a careful evaluation of the medical history of every patient, a detailed clinical examination and the correct interpretation of imaging. Particular attention should be paid to all factors influencing the choice of treatment and/or possible local recurrence: age, site, tumor volume, genetic predisposition, pregnancy, previous radiotherapy, pathological features, and surgical margins. The decision to undertake conservative treatment thus requires a multidisciplinary approach involving pathologists, surgeons and oncological radiologists, as well, of course, as the patient herself.

[Etiopathogenetic and clinical considerations of corpus luteum cysts]. / Considerazioni etiopatogenetiche e cliniche sulle cisti luteiniche del corpo luteo.

The Authors report a case of hemoperitoneum after breaking of luteal cyst of corpus luteum and stress the main characteristics of this pathology. Ovarian cysts are frequently observed in the annexa; they are distinguished in folliculis cysts, luteal cysts, luteal cysts of corpus luteum. Their evolution, influenzed so both by endocrine factors so many from plogistic stimulation, pass through three essential moments: - obliteration for quick cicatrization of the stigma Graafian follicle; - hematic pouring and central softening; - increase of intracavitary fluid that stops with constitution of the fibrous tissue. In the second phase of the menstrual cycle, functional-anatomic changes occur that cause the formation of gravidic corpus luteum or menstrual corpus luteum. The luteal cysts of corpus luteum represent the result of the cystic evolution of the corpus luteum. These cysts are characterized by an intense endocrine activity and can frequently produce a surplus of steroids, particulary of progesterone. They can cause bleeding, often of slight entity but also severe that; these represent a frequent and dangerous complication, especially in women subjected to anticoagulant treatment with warfarin. This drug can determine a raise of intracystic pressure with consequent breaking of the capsule and hemoperitoneum for which is necessary emergency operation like in the case here described.

[A complication in biliary surgery: the biloma]. / Una complicanza degli interventi sulle vie biliari: il biloma.

Authors stress that complications in laparotomic and laparoscopic extrahepatic biliary surgery aren't exceptional. Lesions could be due to section or to stenosis of biliary duct. We can distinguish: intraoperative lesions, which consist in a intraperitoneal bile groan that needs an immediate treatment; lesions that could be found in postoperative period and in any case many days after surgery. Among this complications there is biloma, i.e. a localized uncapsulated extraductal bile collection. Authors refer about their experience and describe clinical findings of this complication. They conclude affirming how biloma treatment doesn't require always resurgery or CT scan drain. Main biliary tract endoscopic decompression could be often useful.

[Our experience in inguinal hernia recurrences treatment]. / Il trattamento delle ernie inguinali recidive: nostra esperienza.

Reporting their personal experience, the authors focus on characteristics and causes of recurrence, either after traditional surgery or with tension-free technique. They describe difficulties and advantages in open interventions and laparoscopic ones. Facing a relapse it's convenient to assume an "eclectic" behaviour, thinking both of general and specific single patient anatomo-pathologic features.

[Acute neoplastic colic obstructions: therapy and postoperative complications. Our experience]. / Le occlusioni acute neoplastiche del colon: terapia e risoluzione di complicanze postoperatorie. Nostra esperienza.

Authors report their experience about neoplastic large bowel obstructions and present two cases of anastomotic leakage resolution by means of transtomy wash-out. They observe that the most important problem in this surgery is anastomotic leakage which, if small, can be solved in a non operative way. According with literature, they also point out anastomotic leakage is commonly due to the impossibility of a correct preparation of colon to operation in emergency. They conclude it is possible, in case of little leakages, to perform trans-stomy wash out which permits a good toilette and sterilization of the colon.

Nosocomial infections in colo-rectal surgery of the old patient.

Every surgical act, especially in geriatric age, can be a relevant moment in the onset of nosocomial infections. This has a peculiar aspect in patient who undergo colo-rectal surgery, both in election and especially in emergency, in which the simple opening of intestines always involves a minimal contamination. In order to reduce the incidence of infections, and therefore the septic complications of this surgery, it is necessary to pay attention to the preparation of the surgical equipe, of the operating room, of the surgical instruments and, in election, to the careful preparation of the patient through a careful evaluation of the possible bio-umoral alterations, in order to correct them. The results of our experience allow us to say that the prevention of post-operatory sepsis find its main moment in the careful evaluation and eventual correction of the nutritional status, in the stimulation of the immune system, in the antibiotic prophylaxis both parenteral and topical, and, last but not least, in a correct surgical technique. All this is particularly important for patients affected by colo-rectal neoplastic and inflammatory diseases, for which the intestinal bacteria, more virulent in weak and fragile patients, often represent the source of contamination that can start a sepsis and then assume an important part in determining the final result of surgery.

[Etiopathogenic hypothesis on carcinoma of the gallbladder: our study]. / Un'ipotesi eziopatogenetica in tema di carcinoma della colecisti: il nostro studio.

The authors are interested in determining causes of gallbladder cancer (GBC). By this intention, they theorize a correlation between genetic modifications (which are responsible of malignant transformation of biliary epithelium) and some intestinal infections. From 1999 to 2004 they observed 15 GBC and all 15 gallbladder have been analyzed histologically and from microbiological aspect; by these means from 1999 till 2004 they have studied also 30 persons with colelithiasis. The authors noticed that bile of both groups contained, in three cases in the first and in 8 cases in the second, a germ named Escherichia Coli which normally lives in intestine, while in 10 operated gallbladders of the first group and 12 of the second there was a positive for k-ras. They are studying to confirm their theories.

[Treatment of skin neoplasms with polidocanol infiltrations. Our experience]. / Trattamento delle neoplasie cutanee con infiltrazioni di polidocanolo. Nostra esperienza.

The authors try to explain the importance of day surgery today. They report their 5 years experience in treatment of face and neck skin neoplasms by injections of a sclerosant product as hydropolyethoxydodecan, in case of a difficult good esthetic result with surgery or other therapies because of patients general conditions, such as diabetic ones, or because of their viral nature. Then they affirm to have treated 350 benign and malign tumors with this method. All subjects presented a complete resolution of disease in few weeks and none between them controlled has actually complications or recruitment of neoplasm. They conclude by saying that this result is probably due to local ischemic reaction caused by the substance used.

[A case of intestinal obstructions caused by a gossypiboma]. / Su un caso di occlusione intestinale da garzoma.

The Authors explain a case of intestinal obstruction due to a gossypiboma. They stress the great importance of the prevention in surgical operations (count of surgical towels, exploration of the surgical site) and the role of the differential diagnosis.

[Merkel cell tumor: a case report and literature review]. / Tumore a cellule di Merkel: presentazione di un caso clinico e revisione della letteratura.

Merkel cell tumor (MCT) is extremely rare, being discovered so far about 400 cases in literature. It is classified among neuroendocrine tumors. We report a case of MCT in the subclavicular region in a 93 years old woman. We confirm the efficacy of radiotherapy associated with octreotide, which these tumours express specific receptors for.