[Legislative, medicolegal and economic aspects of day hospitals]. / Aspetti legislativo, medicolegale ed economico del Day Hospital.

After a short historical review and having dwelled on the nomenclature and legislative framework, the authors describe the medicolegal implications of the day hospital. They describe international experience within the various disciplines, with reference to economic aspects in terms of costs and the increased efficacy of these structures, the quality of service and government policies, in particular in industrialised countries. The authors conclude that day hospitals present considerable advantages both in economic terms and for patients. However, the organisation of the system needs to be improved and, where possible, procedures standardised. Bearing in mind the importance of costs to modern medicine, it is impossible not to take economic aspects into account, while also improving the quality of relations between doctors, patients and the health system.

Neck hibernoma: case report and literature review.

The case history of a 23 year old man with a large hibernoma of the cervical region is reported. Th tumour showed all the clinical and pathologic characteristic of these rare benign neoplasms. A review of the most recent literature supports the Authors' conclusion that local excision is curative.

Successfully managed genital necrotizing fasciitis with multiple debilitating diseases. A case report.

Genital necrotizing fasciitis is a rapidly progressive bacterial infection of soft tissues with a reported average mortality of about 36%; associated debilitating diseases increase the mortality rate. The Authors report a case of successful management, due to an aggressive medical and surgical therapy, despite the presence of multiple debilitating diseases and an advanced necrosis.

[The chance finding of gallbladder carcinoma during cholecystectomy for long-term symptomatic lithiasis. A clinical case]. / Riscontro occasionale di carcinoma colecistico durante colecistectomia per litiasi sintomatica di lunga durata. Caso clinico.

The case of a patient who underwent conventional cholecystectomy for gallbladder adenocarcinoma is reported. Gallbladder carcinoma is rare, but since laparoscopic cholecystectomy has quickly emerged as a popular alternative to open cholecystectomy an increasing number of gallbladder carcinomas are discovered. Most of the time it is detected as an incidental tumor, the patient being with no or few symptoms and often the lesion too far advanced for any type of curative surgery. The most important questions related to the therapy are focused and a partial review of the literature is made.

Surgical management of thrombosed popliteal artery aneurysm: two case reports.

Popliteal artery aneurysm is not a rare event and is the most common type of peripheral arterial aneurysm. The Authors report on their experience with two cases. One patient had a giant popliteal aneurysm and was treated with a dacron patch, while the other had a smaller one and was treated with an inverse saphenous vein bypass. The Authors stress the importance of a thorough study of the patients in order to rule out aneurysmal disease in other sites. They conclude that early surgical intervention is the only effective therapeutic tool to avoid serious complications.

[Breast reconstruction: a possible balance between oncological therapy, reconstructive methods and the patients]. / La ricostruzione mammaria: un equilibrio possibile fra terapia oncologica, metodiche ricostruttive e paziente.

BACKGROUND: Based on their experience of oncological surgery and wishing to respond to the patients' reconstructive requirements, the authors analyse the damage caused by medical therapy (chemo-hormone therapy and radiotherapy) in terms of reconstructive techniques; they aim to establish whether the tissues used in reconstruction interfere with the diagnosis and treatment of recidivations and to identify the best reconstructive strategy in relation to "timing"; lastly, they examine the possibility of realising a cosmetically improved breast. METHODS: A 2-year retrospective study was made during which 3 patients underwent immediate reconstruction using expanders (including 2 with bilateral reconstruction) and 1 patient underwent postradiotherapy differed reconstruction; all patients were followed up for a maximum of 4 years. The following surgical methods were used to improve cosmetic results: 1) conservation of the pectoralis minor which was turned sideways to create the muscular pocket; 2) costal and sternal disinsertion of the pectoralis major; 3) the implant was covered with the muscular pocket in the upper quadrants and with subcutaneous tissue in the lower quadrants; 4) realisation of a mammary groove; 5) immediate mastopexy of the surviving breast. All patients underwent intraoperative and postoperative polychemotherapy. RESULTS: At present (January 1997) none of the patients treated shows signs of locoregional recidivation or general metastases. Complications were observed in the form of subacute infection of the prosthetic flap exposing the expander and infection of the suture material used to reshape the breast in contralateral mastopexy in the patient undergoing reconstruction after radiotherapy. When evaluating the cosmetic results, scar diastasis varied in all patients. Smoothing of the scars, slight implant distortion observed echographically, grade 2 contraction of the periprosthetic capsule were assessed using Baker's scale and all patients were found to be grade I or II. In the light of these results and their personal experience, the authors then analyse, with reference to the literature, the effect of radiotherapy on reconstruction using tissular expansion, the effect of chemotherapy on reconstruction using expansion or autologous implants; the combined effect of radio and chemotherapy on reconstruction using autologous implants or tissues. Timing and the difficulty of diagnosis locoregional recidivation are also discussed. CONCLUSIONS: The authors fully agree with the need to carry out immediate reconstruction, when indicated (above all in bilateral reconstruction) using implants since it is simpler. Chemotherapy does not interfere with the expansion process whereas, if it is deemed necessary to use radiotherapy, it is certainly better to undertake reconstruction using autologous tissues. For special reconstruction methods (replacement of the expander, differed reconstruction with expander), greater use should be made of the day hospital, or better still office surgery.

[Local recurrence after gastrectomy for cancer. Presentation of 2 clinical cases]. / La recidiva locale dopo gastrectomia per cancro. Presentazione di due casi clinici.

The Authors report two cases with local recurrence after partial gastrectomy for advanced gastric carcinoma. The Authors suggest that chemo and/or radiotherapy associated with surgical treatment can improve the prognosis in some patients with recurrence. Response to chemotherapy and time elapsing before recurrence appears may select this group of patients.

[2 cases of biliary ileus]. / Su due casi di ileo biliare.

Successful enterotomy and the removal of large calculi blocked in the small intestine in two cases of biliary ileus are reported. The aetiopathogenesis, clinical picture and treatment of this form are also described. In the first case, the calculus was discovered about 1 metre from the Treitz fascia, in the second, about 1 1/2 metres from the ileocaecal valve.