In-clinic secondary tracheoesophageal puncture and voice prosthesis placement in laryngectomees.

Secondary tracheoesophageal puncture (TEP) with voice prosthesis placement represents one of the possibility to restore vocal function after total laryngectomy. However, some patients have comorbidities that contraindicate general anesthesia. In our department, an in-clinic TEP procedure for retrograde voice prosthesis placement was developed. It allows the immediate placement of the prosthesis and the avoidance of the use of dilators. We described our technique with advantages and pitfalls. The Provox Vega Puncture Set was used. Our technique for in-clinic secondary TEP without general anesthesia or target controlled infusion was a safe and effective procedure. It allows the use of the traditional TEP set, with possibility of voice prosthesis placement after previous TEP closure.

[Gastrointestinal stromal tumors. A case of small intestine stromal tumor (SIST) with an uncertain biological aspect]. / Gastrointestinal stromal tumors. Un caso di neoplasia stromale dell'intestino tenue (SIST) dal comportamento biologico incerto.

Tumors of the small intestine are relatively rare. The diagnosis is difficult to establish because the symptoms are vague and non-specific. Although the small intestine constitutes 75% of the length and over 90% of the mucosal surface area of the gastrointestinal tract, only 1 to 2% of gastrointestinal malignancies occur in this segment. Metastases are usually present at the time of diagnosis. The outcome of these patients can be improved if the possibility of a malignant small bowel tumor is considered in all cases of unexplained abdominal pain or gastrointestinal bleeding, especially in younger age. Malignant tumors occur with increasing frequency in distal small bowel with a preponderance of malignant lesions in the ileum compared with the jejunum and the duodenum. Adenocarcinoma is the most common tumor of the primary malignant small bowel tumors, followed by carcinoid, lymphoma and leiomyosarcoma. Mesenchymal tumors of the gastrointestinal tract, traditionally regarded as smooth muscle tumors, have demonstrated different cellular differentiations based on immunohistochemical and ultrastructural features. Therefore the terms leiomyoma and leiomyosarcoma have been replaced by a more encompassing term, gastrointestinal stromal tumor (GIST). The majority of GISTs occurs in the stomach; stromal tumors involving the small intestine (SISTs) are far less common but seem to have greater malignant potential. The clinical a case of a small intestinal stromal tumor (SIST), localised in the jejunum and characterised by an uncertain histological aspect, is presented and a review of the literature is made.

[Diagnosis, treatment and prognosis of gastric stump cancer]. / Diagnosi, trattamento e prognosi del cancro del moncone gastrico.

The authors report 10 cases of gastric stump cancer undergoing operation in the Surgical Department of S. Croce Hospital in Moncalieri between 1978 and 1993, 9 men and 1 woman aged approximate by 67 years. The first operation was a Billroth II with reconstruction according to Polya or Kroenlein. The disease-free period was on average thirty years. In 5 cases the operation was palliative (GEA+Braun) for cancer at fourth stage, in 3 cases radical for cancer in early stage, in 2 cases total gastrectomy+Y for one cancer in early stage and one cancer at II stage TNM. The actuarial survival after 5 years is 50% and this result is satisfactory thanks to four cases of early stump cancer. From our experience, though of only 10 patients, we can deduce that total gastrectomy or degastroresection, in early stage have the same index of survival.

[Gallbladder carcinoma. Our experience]. / Il carcinoma della colecisti. La nostra esperienza.

Carcinoma of the gallbladder is the most frequent neoplasm of the biliary tract. During the period between 1 January 1979 and 31 December 1991 a total of 1016 operations for cholecystectomy were performed by our Division of Surgery and 27 cases of gallbladder carcinoma were diagnosed. The symptoms were generally similar to those of benign hepatobiliary disorders. The diagnostic tests carried out did not allow a preoperative diagnosis of gallbladder carcinoma to be made. In the majority of cases diagnosis was a surprise following the histological analysis of the operated part. The prime therapy for these lesions is surgery. Since it is not possible to make an early diagnosis of this type of neoplasm, which in the majority of cases has a fatal prognosis, the authors consider that the finding of inveterate calculosis, large calculi and echographic thickening of the gallbladder wall represent indications for surgery even in the absence of major symptoms.

[Personal experience in treating bilateral inguinal hernias]. / La nostra esperienza nel trattamento delle ernie inguinali bilaterali.

The treatment of bilateral inguinal hernias is an operation which has a high failure rate. This operation is influenced by a number of factors, above all the strain on aponeuroses and muscle fibres during reconstructive plastic surgery. In addition, metabolic factors, the advanced age and in particular surgical infections should also be taken into account. Over the course of past years synthetic prostheses have been introduced for hernia treatment (tantalum, nylon, steel, ivalon); currently, polypropylene, dacron and goretex are used. Placement may be intraperitoneal, preperitoneal and prefascial. The authors report their experience from December 1989 to December 1991 in relation to 70 patients undergoing surgery for bilateral inguinal hernias. The following results were obtained: a low percentage of complications, reduction of costs and no recidivation to date. These results enable the authors to affirm that the use of synthetic mesh for the treatment of bilateral inguinal hernias is the most appropriate method of choice.

[Palliative treatment of esophageal carcinoma. Personal surgical experience]. / Il trattamento palliativo del carcinoma esofageo. Nostra esperienza chirurgica.

Malignant tumours of the oesophagus cannot always be handled radically; in personal clinical experience, only a third of patients suffering from oesophageal carcinoma have been subjected to radical oesophagectomy. The purpose of palliative treatment is to suppress dysphagia and restore possibly natural, adequate feeding. As for techniques, intraluminal catheterization by the combined endoscopic and gastrotomic route has been personally preferred to surgical bypass and gastrostomy whose palliative value should be confined to cases in which no other technique can be used. Good results have been obtained with catheterization and patients have been able to feed themselves naturally without noting the ineluctability of their disease.