[Appendiceal "mucocele": apropos of 2 cases]. / II "mucocele" appendicolare: a proposito di due casi.

Two patients affected by appendiceal mucocele underwent emergency operation in our Department. Clinical findings and surgical management of the disease are discussed as well as controversy regarding the pathologic classification of the disease. The term "mucocele" is not referred to an exact histopathologic lesion: it describes the gross enlargement of the appendix, due to the accumulation of mucus in the dilated lumen. Currently such lesions are classified as nonneoplastic or as retention appendiceal cysts or as mucous-secreting tumours; the benign forms are cured by appendectomy, the malignant ones often require right colectomy for technical reasons. Pseudomyxoma peritonei significantly decreases survival of patients suffering from mucinous cystadenocarcinoma, but it does not affect survival in case of mucinous cystadenoma.

[Giant pedunculated leiomyoma of the fundus uteri]. / Leiomioma gigante peduncolato del fondo dell'utero.

The Authors report an uncommon giant leiomyoma of the uterus observed in a young woman after a prolonged and misknown course. The peculiar features of these large neoplasms as well as the diagnostic methods and the difficulties of the surgical treatment are discussed. The patient underwent successful surgical removal of the tumour with preservation of uterus and ovaries, and is still in good health after a two year follow up.

[Total thyroidectomy in the treatment of multinodular toxic goiter]. / La tiroidectomia totale nel trattamento del gozzo tossico multinodulare.

The Authors report their experience in the management of 201 patients with multinodular toxic goiter (MTG): 122 (60.7%) underwent subtotal thyroidectomy (STT), while 79 (39.3%) underwent total thyroidectomy (TT). Through a retrospective study the patients were stratified into two groups according to the type of operation (TT or STT). Overall, neither operative mortality nor recurrent nerve damage were encountered. Permanent hypocalcemia was observed in 7 patients (5.7%) who underwent STT and in 6 patients (7.5%) who underwent TT (p=N.S.), while transitory hypocalcemia was observed in 12 cases (9.8%) in group I and 11 cases (13.9%) in group II (p=N.S.). All patients were followed every 4 months for the first year and every 6 months thereafter. Average and median follow-up period were, respectively, 72 and 74 months. The Authors conclude that total thyroidectomy is the surgical treatment of choice in multinodular toxic goiter (MTG). A thorough anatomical-surgical evaluation is essential in order to prevent the complications characteristic of this type of surgery (inferior laryngeal nerve injury and hypoparathyroidism).

[Lateral cysts and fistulas of the neck. Diagnosis and treatment]. / Cisti e fistole laterali del collo. Diagnosi e trattamento.

Lateral neck cysts and fistulae are considered to be a well-defined clinical entity which needs a precise knowledge of the development of the branchial system to have an appropriate and subsequent successful treatment. According to the recent classification cysts of I and II type and fistulae of I, II and III type can be recognized. In the former ultrasonography and Computerized Tomography represent the most appropriate diagnostic tools, while in the latter fistulography is preferred. An elective surgical excision seem to be resolutive in the majority of cases: on the contrary emergency surgery is related to a certain relapse of this pathology. 45 cases of branchial pathology are reported; diagnostic and therapeutic choices are then discussed.

[Hürthle cell tumors: personal experience]. / Tumori a cellule di Hürthle: esperienza personale.

Hürthle cell tumors of the thyroid gland are uncommon lesions (3% of all well differentiated tumors). Histological diagnosis is often difficult: according to recent criteria only those tumors with almost 75% of oxyphil cells are well recognized as Hürthle cell neoplasms. Extracapsular and blood-vessels invasion, capsular penetration, DNA patterns and tumoral necrosis are indicative for malignancy. The Authors report their experience in the management of 46 patients who underwent thyroid surgery for Hürthle cell neoplasms. Histological findings, surgical approach and post-operative follow up are discussed.

[Primary lymphoma of the rectum: diagnosis and treatment]. / Il linfoma primitivo del retto: diagnosi e trattamento.

The authors report a rare case of primary rectal lymphoma non Hodgkin in a young non HIV infected man. Preoperative diagnostic problems, the standards for classification and staging and the proper treatment are briefly discussed. The importance of an accurate histological and immunohistochemical study on preoperative multiple biopsies for a correct diagnosis, staging and treatment, are emphasised in this report.

[Palliative treatments in inoperable pancreatic tumors. Technics compared]. / I trattamenti palliativi nei tumori del pancreas inoperabili. Tecniche a confronto.

The authors experience of palliative treatment of advanced pancreatic cancer is reported. 32 patients underwent palliative surgical procedures of biliary decompression (20 choledochoduodenostomy and 12 cholecystoenteric bypass). In 26 patients a gastroenteric anastomosis was also performed. 8 patients underwent non surgical procedure because of their very poor conditions or short term survival. The authors point out the advantages offered by surgical treatment. Nevertheless a careful selection of patients submitted to this procedure is recommended.

[Role of surgery in the treatment of primary gastric lymphoma]. / Il ruolo della chirurgia nel trattamento del linfoma gastrico primitivo.

Recently the role of surgery in the LGP treatment is reviewed. 30 cases of LGP are reported; GT was in 9 cases performed, GST in 21 cases. All the patients were included in a therapeutical protocol as chemo and/or radio-therapy as adjuvant treatment. Two patients treated with GT died; the medial survival ranged was 30.5 months for the patients in stadium Ie, 52 months for the patients in stadium IIe and 15 months for the patients in stadium IV. The central role of surgery for treatment of this lesion is underlined; finally the role of adjuvant therapy is emphasized in the improvement of long-term survival.

[Identification and preservation of the parathyroid glands in thyroidectomy using methylene blue]. / La identificazione e conservazione delle ghiandole paratiroidi in corso di tiroidectomia mediante l'uso del blu di metilene.

The risk to the parathyroids in thyroid surgery is widely known. Postoperative parathyroid insufficiency occurs because of accidental devascularization of one or several glands, or infarction due to manipulation, or resection within the thyroid lobe. The prevention of this complication requires a careful surgical technique which limits any injury of the parathyroids. A simple, safe and cheap method to improve the identification of these glands is the preoperative intravenous infusion of methylene blue, that results in a distinct staining of the parathyroids. The authors describe their experience with this useful procedure which helps to reduce the incidence of hypoparathyroidism after total and near total thyroidectomy.

[The treatment of recurrent inguinal hernias by using Marlex mesh preperitoneally]. / Il trattamento delle ernie inguinali recidive mediante l'uso delle reti di Marlex per via preperitoneale.

Several techniques are utilized in the treatment of inguinal hernia: each type of repair offers advantages, but a variable number of recurrences occurs regardless of the hernioplasty technique used. Treatment of hernial recurrence is a troublesome goal for surgeons. Nowadays, the use of prosthetic materials with a posterior surgical approach simplifies and resolves most of the problems encountered in the past. The authors report their experience with the use of Marlex mesh for hernia repair through a preperitoneal approach pointing out the advantages of such prosthetic material and of the surgical access as well. Finally, the importance of patients selection is stressed.

[Drainage in surgery on the thyroid]. / Il drenaggio nella chirurgia della tiroide.

The authors report their experience of 534 thyroid operations and underline the importance of neck drainage in this type of surgery. Drainage positioning is very important for the prevention and immediate indication of hemorrhaging complications. Some correct indications, like large goiters, hyperthyroidism, reoperation and the lack of vascular ligature, are considered and discussed.

[Carcinoma of the splenic flexure]. / Il carcinoma della flessura splenica.

The Authors report their experience in the management of 25 cancers of the splenic flexure corresponding to 4.8% of large bowel cancers overall observed. Twelve patients underwent elective surgery consisting in a left hemicolectomy, which in 1 of the 12 cases required an associated distal splenopancreatectomy. Operative mortality was null, whereas morbidity involved 1 case of anastomotic dehiscence. Thirteen patients presenting with complete obstruction underwent emergency surgery: a two-stage resection with primary colostomy was performed in 5 cases, a sub-total colectomy with one-stage ileo-rectal anastomosis or ileo-sigmoid anastomosis was performed in 8 cases. In this last group of 8 patients mortality rate was 12.5% (1 pt.) and diarrhoea was the most important sequela. On this regard the Authors point out the opportunity to perform an ileo-sigmoidostomy, which reduces the incidence of such complication.

[Parathyroid cysts]. / Le cisti paratiroidee.

The Authors review the world literature on parathyroid cysts and report a case of this uncommon disease. The importance of an early pre-operative diagnosis by ultrasound, blood calcium level and parathyroid hormone assay with fine needle aspiration biopsy is pointed out. According to several surgeons, only the functioning parathyroid cysts require operation; needle aspiration may be appropriate therapy for the nonfunctioning ones.

[Respiratory complications in compressive goiters]. / Complicanze respiratorie nei gozzi compressivi.

Authors' experience in respiratory complications of compressive goiter is reviewed. Three cases with typical symptoms, relative therapy and outcome are reported. Appearance of respiratory distress should urge to avoid delay in elective surgery performing. In case of acute respiratory failure, immediate emergency tracheostomy is mandatory, subsequently followed by elective intervention. In case of malignancy, if radical surgery is not possible, tracheostomy is the short and medium-term palliative surgical treatment of choice.

[Diverticulosis of the small intestine. Observations on a complicated case]. / La diverticolosi dell'intestino tenue. Osservazioni su di un caso complicato.

Small bowel diverticula, particularly the jejunal ones, are a rare disease with a poor and vague symptomatology. Sometimes detected by change under X-ray examinations or at surgery, they do not need any surgical treatment: only clinical and X-ray controls are required. Prophylactic resection of symptomatic low jejunal diverticula is controversial: patient's age and status will affect the indication to surgical treatment. Jejunal diverticulosis may generate serious, though not dramatic, symptoms: intestinal obstruction, inflammatory complications, haemorrhage, perforation of the diverticula are the most frequent emergencies which require an immediate surgical procedure. A clinical case is here reported.

[Varicose veins of the lower limbs caused by incompetence of the saphenous-femoral ostium: standard or complete stripping?]. / Le varici degli arti inferiori da incompetenza dell'ostio safeno-femorale: stripping corto o completo?

The Authors report their experience of 256 stripping operations performed during the last 3 years for varicose veins of the lower extremities. Preoperative Doppler examination was used to detect reverse flow in the saphenous veins. Removal of the entire saphenous trunk was performed in 158 limbs with segmental or total reverse flow; in the remaining 98 cases with reflux only in the proximal tract of the saphenous vein a selective stripping operation and, five weeks later, phlebectomy of remaining varicosities were performed. The results were assessed by follow-up examination from 6 months to 3 years. When there is a specified indication, the selective stripping operation appears to be an excellent and aesthetic solution with a very low incidence of saphenous nerve's injuries. Useful advice to obtain the best results with the traditional stripping operation are also pointed out.

Papillary-cystic tumour of the pancreas. Case report.

A papillary-cystic pancreatic tumour was excised in a 19-year-old girl, who was apparently free from recurrence 20 months later. Despite morphologic indications of malignancy, the prognosis after surgical removal of this uncommon tumour is good. Its origin probably is the epithelial cells of the small pancreatic ducts. The case is described and the literature is reviewed.