[Spigelian hernia: 3 case reports]. / Ernia di Spigelio. Descrizione di tre casi clinici.

Spigelian hernia is an uncommon hernia of the abdominal wall, often not easily diagnosed. Three cases of Spigelian hernia are reported. In the first patient it was an incidental discovery, in the second one hernia was complicated by strangulation of the small bowel, in the third patient hernia was symptomatic without complications. In all the patients, in their previous clinical history, an operation for hernia or other abdominal pathologies was observed. These patients were treated surgically, using direct reconstruction of the abdominal wall in two cases, while a non-absorbable mesh was positioned in the preperitoneal space in the third patient. The anatomopathological and clinical features of Spigelian hernia are described and the problems in diagnosis discussed; in addition, the importance of surgical cure in incidental hernia is underlined.

[Myxoid liposarcoma of the retroperitoneum. Presentation of a clinical case]. / Liposarcoma mixoide del retroperitoneo. Presentazione di un caso clinico.

Of all the soft tissue sarcomas, those localised in the retroperitoneum represent a particular challenge to the surgeon. Diagnosis is often late, when the tumour has already reached considerable proportions, creating particular problems for its removal. Liposarcomas are the most common histological form of retroperitoneal tumour. The authors report the case of a patient with retroperitoneal myxoid liposarcoma and use their analysis as the starting point for a review of the literature focused on the diagnosis and treatment of retroperitoneal tumours. They underline that modern imaging techniques (Eco, CT, NMR) are essential during the preoperative stage for a complete and detailed study of the neoplasm, as well as during follow-up. With regard to treatment, surgery is still the most effective approach in cases where this is feasible. The current trend towards aggressive surgery is backed by the improved results in terms of survival. An improved prognosis for patients with retroperitoneal tumours is linked to an early diagnosis and the development of more efficacious complementary therapies.

[Subarachnoid hemorrhage and systemic arterial pressure. Physiopathology and perioperative management]. / Emorragia subaracnoidea e pressione arteriosa sistemica. Fisiopatologia e gestione perioperatoria.

A correct assessment of arterial pressure state during subarachnoid haemorrhage (SAH) is one of most critical issue in neurologic intensive care and in neuroanesthesia. It is important to evaluate two different clinical conditions during SAH: before and after aneurysmal clipping or embolization. Before clipping it is mandatory to evaluate a possibility of rebleeding and so it is important to maintain systolic pressure at lower level. Otherwise after clipping it can be useful to maintain systolic pressure at higher level to prevent vasospasm and related ischemia. In this review the Authors examine the pathophysiology of SAH and SAH complications as rebleeding, vasospasm and ischemia. According to international data, they propose pressure parameters appropriated for SAH according to timing of treatment so as to prevent and treat SAH complications.

[Hepatic incidentaloma. A case report of cholangiocarcinoma]. / Incidentaloma epatico. Osservazione di un caso di colangiocarcinoma.

The finding of incidentalomas is becoming increasingly frequent during the course of routine diagnostic tests. At the hepatic level, the preclinical diagnosis of primary tumours has enabled a growing number of patients to undergo surgery with reduced operating trauma and greater oncological radicality. The authors report a case of cholangiocarcinoma whose pre-clinical diagnosis enabled its resection in spite of the patient's advanced age.

[Mucinous cystadenocarcinoma (malignant mucocele) of the cecal appendix]. / Cistoadenocarcinoma mucinoso (mucocele maligno) dell'appendice cecale.

Mucinous cystadenocarcinoma of the cecal appendix is a very rare malignant neoplasia. The majority of these tumours are discovered during surgery performed for other pathologies or as a chance finding in the histological analysis of surgically removed inflamed appendix. There is no characteristic symptomatology of this neoplasia which requires oncologically correct surgery, such as right hemicolectomy. The authors report a case study o peritoneal recidivation of a mucinous cystadenocarcinoma of the appendix.

[Primary gastric lymphoma. Survey of 5-years surgical cases]. / Linfomi gastrici primitivi. Revisione di 5 anni di casistica operatoria.

The incidence of gastric lymphoma, unlike that of carcinoma, is increased in these last years. In spite of all that, until today, there isn't codified therapeutic trend. There are many reasons: different patterns of histological classification, the importance of the different adjuvant therapies. Personal experience in ten case of primitive gastric lymphoma over a total of 63 operations of gastric neoplasms in five years (1989-1993) is presented. The analysis of personal results and a review of the literature suggest guideline (surgery, chemotherapy) according to the study of the disease, underlining that in every case the most important therapeutic approach.

[Fibrous hamartoma of the urachus. Report of a case complicated by strangulation of the stalk]. / L'amartoma fibroso dell'uraco. Documentazione di un caso clinico complicato da strozzamento del peduncolo.

Of the anomalies affecting the urachus, fibrous hamartoma is an extremely rare pathology. In particular, in adults it is very unusual for this pathology to assume clinical relevance, producing symptoms typical of acute abdomen. Diagnosis is only confirmed by histological examination and it is impossible to diagnose prior to surgery; hamartoma of the urachus shows no peculiar characteristics during radiological and ultrasonographic imaging to allow its precise diagnosis and is usually interpreted as ovarian cysts or another mobile abdominal neoformation in the peritoneal cavity. The case reported here, which is documented by photographic images, contributes to the scarce bibliography on this topic.

[Total intravenous anesthesia in neurosurgery. Our clinical experience]. / Anestesia endovenosa totale in neurochirurgia. Nostra esperienza clinica.

BACKGROUND: The quality of a "neuroanesthetic" technique is the result of its pharmacokinetics, of its effect on intracerebral homeostasis and metabolism, of its antinociceptive and neuroprotective features. Aim of this study is to test the effectiveness of TIVA as the technique of choice in neurosurgical patients throughout a retrospective analysis of 1982 patients scheduled for brain tumors, neurovascular surgery and spine lesions. METHODS: 1982 patients (1023 F, 959 M), ASA I-IV, aging 15-80 yrs scheduled for neurosurgery were studied. Hemodynamic and electrophysiological parameters were monitored carefully. Time of recovery was evaluated although this parameter is influenced by perioperative clinical status and by area and kind of brain damage. RESULTS: A good hemodynamic stability was observed. Recovery time was quick, related with brain damage and time of surgery. Incidence of postoperative nausea, vomiting and seizures was very low. Two cases of awareness were noted. CONCLUSIONS: 1982 neurosurgical operations were carried out in TIVA without major complications and side effects: the authors are therefore sure that TIVA can be considered the anesthetic technique "of choice" in neurosurgical patients.

Early percutaneous endoscopic gastrostomy (PEG). A safe and effective enteral feeding technique in neurologic intensive care unit.

Enteral feeding by percutaneous gastrostomy is recommended as the "best choice" in NICU patients. It allows us to obtain early gut activation and to prevent physiopathologic events leading to multiorgan failure syndrome. In this retrospective study the Authors describe their experience related to 76 patients admitted in NICU between January 1992 and April 1994. In these patients percutaneous gastrostomy was easily and safety performed at the bedside with early enteral nutrition and drug administration and a related low incidence of infections complicating central and peripheral vein catheterization. Moreover the authors underline the avoidance of nasogstric tube and its side effects and a good compliance of patients and nurses that seems to be a real advantage of this technique. The authors suggest their 13 guidelines to improve management of enteral nutrition by gastrostomy and to avoid its short-comings.