[Splenic artero-venous fistula and portal hypertension. A case report with review of the literature]. / Ipertensione portale secondaria a fistola artero-venosa splenica. Descrizione di un caso clinico e revisione della letteratura.

Splenic artero-venous fistula (SAVF) is a rare but potentially curable cause of pre-hepatic portal hypertension. About 100 cases have been reported in the world medical literature. The Authors report a case of 46-year-old man with a splenic artery aneurysm and a large SAVF treated by surgical resection of splenic vessels and splenectomy. The literature about SAVF is reviewed to recognize etiology, anatomical location, main symptoms at presentation, diagnostic findings and management of this rare syndrome.

Penetrating trauma to the scrotum and the corpora cavernosa caused by gunshot.

The authors describe a case of gunshot wound of the male genitalia by two low-velocity bullets. The first bullet caused a lesion of the right testicle and came out of the right hemiscrotum; the second one had penetrated the left gluteal region with no exit wound. The penile ultrasound confirmed the presence of the bullet at the root of the right corpus cavernosum. The patient underwent exploratory surgery, drainage of the voluminous bilateral scrotal hematoma, and suture of a laceration of the right-testicle cranial portion. Due to the absence of active bleeding, voluminous hematoma and serious injuries in the corpus cavernosum, no surgical removal of the bullet in the right corpus cavernosum was required. The patient regained a normal sexual function 1 month after the operation.

[Retrograde ejaculation]. / L'eiaculazione retrograda.

Antegrade ejaculation requires intact anatomy and innervation of the bladder neck. Retrograde ejaculation is an uncommon cause of infertility and can be defined as the escape of seminal fluid from the posterior urethra into the bladder. This pathological condition can result from disturbances at the bladder neck due to anatomical lesions, neuropathic disorders or pharmacological influences. Also congenital and idiophatic causes have been described. The diagnosis may be confirmed by findings sperm in post-coital specimens of urine. Pharmacological manipulation, electro-ejaculation and vibro-ejaculation can be utilized to recovery ejaculation. When anterograde ejaculation in this patients cannot be restored artificial insemination using sperm recovered from the antegrade post-coital urine is indicated. The aim of this paper is to evaluate the data of literature on aetiology and therapy of retrograde ejaculation.

Four years experience of primary intra-arterial chemotherapy (PIAC) for locally advanced and recurrent breast cancer.

AIMS: To find a means of achieving operability very quickly without the additional discomfort of prolonging systemic chemotherapy. To improve the patient's quality of life by obtaining quick tumor reduction and decreasing systemic toxicity. MATERIALS AND METHODS: From January 1991 to January 1995, 13 patients with locally advanced breast cancer (LABC) and 8 patients with recurrent breast cancer (RBC), were treated by transfemoral Seldinger technique, with the catheter tip placed into the subclavian artery at the basis of the internal mammary artery. The patients received 5-fluorouracil (5FU) 1000 mg, epirubicin (EPI) 30 mg/m2, mitomycin (MMC) 7 mg/m2 over an infusion for 30 minutes. The cycle was repeated every two weeks for three times. RESULTS: The overall response rate was 62%. Stage IIIb and RBC patients had a response rate of 100% and 25% respectively. In respondent patients a measurable response was seen after the first cycle. Ten patients were radically operated. After a media follow-up of 21 months, the overall survival is 52% at 48 months (68% at 48 months and 65% at 34 months for stage IIIb and RBC patients respectively). CONCLUSIONS: PIAC is feasible and effective. In LABC patients it reaches 100% of response rate. Systemic toxicity was absent and the local one was mild. The interval between the starting of PIAC and operation is short. There was an optimal compliance of the patients.

[Resection surgery in malignant neoplasms of the exocrine pancreas: our experience, 1987-1994]. / La chirurgia resettiva nelle neoplasie maligne del pancreas esocrino: nostra esperienza 1987-1994.

From 1987 to 1994, 24 patients underwent resection for pancreatic cancer; they represented 24% of all patients observed in that period. Surgical procedures were a pancreatoduodenectomy (PD) in 20 cases, a distal pancreatectomy in 4 cases, a palliative intervention in 61 cases, an exploratory laparotomy in 13 cases and a video laparoscopy in 2 cases. Adjuvant treatments were given in addition to resection in 20 patients. In the 20 patients undergoing PD, mortality was 20% and morbidity 20%. There was no mortality and no morbidity in distal pancreatectomy. The 1-year survival in pancreatoduodenectomy was 50% and 0% for distal pancreatectomy. Pancreatic resection, radical and palliative, whenever technically possible, represents the treatment of choice for pancreatic cancer.

[Treatment and prevention of postmastectomy lymphedema (our experience)]. / Il trattamento e la prevenzione del linfedema postmastectomia (nostra esperienza).

The authors consider the incidence of arm lymphedema after mastectomy. Considering the temporary results which come from surgical practices, either from excision operations or lymphovenous anastomosis, they stress out the importance of the prevention measures and of the physiotherapeutic treatment. This is essential to keep lasting as long as possible the results of the operation when it is necessary because of serious functional deficit. Two cases of Thompson's operation are shown.

[Clinical trial with a new anti-epileptic: barbexaclone]. / Ensaio clínico com um novo anti-epiléptico (barbexaclone).

A new anti-epileptic agent (barbexaclone) was tried in 48 patients suffering from epilepsy and presenting a total of 67 types of crises. All the patients were considered "bad cases" because either by the intensity of the epileptic manifestations or by their refractoriness to the usual medications. The results, similar to others already published, could be considered as good for grand mal epilepsy both for those convulsions occurring during either the sleeping or waking hours and suggest further observations in focal crises. Though not considered as a first line medication in petit mal seizuras the drug gave excellent results when used as an adjuvant in the supression of absences and the annulation of convulsant effects of some drugs used in petit mal. No toxic reactions were noted, and the side effects, which were never very intense, tended to disappear in the majority of cases with continued use of the drug.