Extralobar pulmonary sequestration showing high CA 19-19 levels.

We report a case of 40 year-old woman with left thoracic pain who was diagnosed as having a cystic mass located posteriorly at the basis of the left pleural cavity. The preoperative serum CA 19-9 level was increased (2 900 IU/mL). Further investigations did not find neoplastic lesions in the gastrointestinal tract. The intraoperative finding of an anomalous systemic arterial supply to the mass suggested the diagnosis of extralobar sequestration, confirmed at the histopathological examination. The association between pulmonary sequestration and increased tumor markers levels is overlooked in western literature, but it is often reported by many Japanese authors. This case report would underline the practical usefulness for preoperative diagnosis of pulmonary sequestration, when the CT-scan does not demonstrated an anomalous systemic vessel. The common embryogenic origin of both respiratory and digestive apparatus can explain the increased levels of tumor markers such as CA 19-9 and carcinoembryonic antigen in bronchogenic cyst, intestinal duplication and pulmonary sequestration.

[Littoral hemangioma of the spleen]. / Emantioma littorale della milza.

The authors report a rare case of littoral hemangioma of the spleen (LHS) accompanied by a revision of the literature on the argument. A male 65-year-old patient was referred to their attention with suspected ultrasonographic diagnosis of lymphoma with a splenic localisation. The complete CT diagnosis led to suspected splenic angioma. During surgery, anatomopathological analysis of the biopsy revealed LHS. The pathological anatomy showed lesions ranging in size from small foci to large nodules which almost completely replaced the splenic parenchyma. These areas were made up of vascular canals or axes that imitate splenic sinuses and have irregular lumen, often appearing as papillary projections and cyst-like spaces; they are bordered by high (cylindrical) endothelial cells that project into the vascular lumen and reveal hemophagocytosis; there is very little mitotic activity. The patient was discharged 7 days after surgery. The authors underline the extreme rarity of this neoplasm and the virtual absence of symptoms, although some cases report signs of hypersplenism, including platelet deficiency and anemia. The diagnostic iter must take care to exclude other pathologies affecting the spleen, including lymphoma, metastases and primary malignant splenic tumours. Lastly, a differential diagnosis must be made with the malignant variant, littoral hemangiosarcoma of the spleen.

Ligand binding to the (1 --> 3)-beta-D-glucan receptor stimulates NFkappaB activation, but not apoptosis in U937 cells.

Recent data suggest that sepsis stimulates macrophage apoptosis (Ao) with subsequent induction of macrophage dysfunction. Nuclear factor-kappaB (NFkappaB) activation has been linked to Ao in either a pro- or antiapoptotic role. Glucans are biological response modifiers which exert antisepsis activity. This investigation examined the effect of (1-3)-beta-D-glucan receptor binding by a high affinity ligand on Ao and NFkappaB activation in U937 cells in the presence or absence of LPS. A high affinity glucan ligand (IC50 = 23 nM) activated NFkappaB, but did not induce Ao or significantly alter LPS induced U937 Ao. These data indicate that: i) modulation of the macrophage (1-3)-beta-D-glucan receptor stimulates NFkappaB; ii) does not induce Ao or significantly diminish LPS induced Ao and iii) activation of the U937 FAS receptor does not alter the relative Ao responses in glucan and LPS treated cells.

[An unusual association: Jaffe-Linchtenstein syndrome, arcuate ligament syndrome and hepatic adenoma]. / Una insolita associazione: sindrome di Jaffè-Linchtenstein, sindrome del legamento arcuato e adenoma epatico.

A case of a woman affected by an unusual association of rare diseases, is presented. The patient was referred to our department for acute anaemia. Preoperative investigations revealed that the patient was affected by fibrous polyostotic dysplasia, so called Jaffè-Lichtenstein syndrome. The presence of skin brown spot and endocrine disorders requiring pill administration, allows to classify the patient as carrier of Albright syndrome. Moreover, the angiography pointed out a celiac trunc stenosis (Dunbar syndrome). The long-standing administration of the pill could be the cause of bleeding adenoma. The patient underwent hepatic resection. We did not treat the Dunbar syndrome because of poor symptoms. From literature, we review some opinions on the fibrous dysplasia of the bone.

[Peptic ulcer: changing indications for gastric resection during the last 15 years]. / Ulcera peptica: cambiamento di indicazione alla resezione gastrica negli ultimi 15 anni.

In this study the authors want to underline the changing strategies for peptic ulcer disease. Considering the experience of two Surgery Departments in Piedmont, the G. Bosco Hospital of Turin and the S. Croce Hospital of Moncalieri, in the last 15 years, they observed a notable reduction of gastric resections owing to new drugs such as H2-antagonist and omeprazole in peptic ulcer therapy. The authors report, therefore, recent suggestions to gastric resection in the cases of complicated ulcer or not. Today pyloric stenosis due to chronic ulcer no longer operated and perforated ulcer is resected only when there is a great gastric hole, or a relapse perforation or a bleeding together to perforation. On the contrary hemorrhagic ulcer is operated when the bleeding is either notable, or relapse, or continuous, or untransfusible.

[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.

[Perforated diverticulum of the cecum: conservative therapy or resection?]. / Il diverticolo perforato del cieco: terapia conservativa o resezione?

The diverticulum of the right colon is a rare disease in Western Countries but is very common in Eastern races. The etiology is usually congenital in the lesions limited to the cecum (true diverticulum). The diagnosis is rarely made preoperatively. The most useful help is from CT and US. Because the clinical features suggest an acute appendicitis, in most cases of appendicectomized patients the intervention is made without any other investigations. At laparotomy, when the diverticulum is surely identified, a conservative treatment is recommended (diverticulectomy or invagination). If there are some doubts an ileo-colic resection is more opportune. After recovery it is useful to study the colon with an Rx clisma.

[Carcinoma of the gastric stump. Our experience]. / Il carcinoma del moncone gastrico. Nostra esperienza.

The authors have examined eight patients operated at the Department of Surgery "B" of the G. Bosco Hospital (Torino) from 1980 to 1992 for gastric stump cancer. All patients were male of about 72 years who were subjected to resection: 5 for gastric ulcer and 3 for duodenal ulcer. During the first operation they used the same recanalization technique after gastric resection: the semi-oral distal gastric jejunal anastomosis created by Hofmeister-Finsterer. The second operation was the subtotal gastric resection made on 6 patients, total gastrectomy in 1 case and explorative laparotomy in an inoperable case. The average of free time from disease was 32 years while it is 24 years in literature. The mean survival was 40 months. The 5-year survival was about 33%. The authors conclude that carcinoma of the gastric stump has a worst prognosis then carcinoma in normal stomach. The subtotal resection has the same results as in total gastrectomy.

[Current surgical approach in the treatment of pancreatic pseudocysts]. / Attuale orientamento chirurgico nel trattamento delle pseudocisti pancreatiche.

INTRODUCTION: The paper evaluates the role of surgery in the treatment of pancreatic pseudocysts in the light of current knowledge. The authors underline the important part played by ultrasonography and CT in monitoring the evolution of pseudocysts: ETG on account of its high levels of sensitivity and specificity and CT due to its diagnostic accuracy which is equivalent to almost 100%; these methods allow the surgeon to decide if and when to operate. MATERIALS AND METHODS: A series of operations were carried out by the authors' division in 15 patients suffering from pancreatic pseudocysts. Emphasis is placed on the high percentage of emergency operations, 40%, due to complicated pseudocysts. External drainage was always used in emergency surgery, whereas in elective surgery it was preferred to use cystojejunostomy with a Roux-en-Y loop, followed by cystogastrostomy; cystoduodenostomy was only chosen in one case. The operative mortality rate was 20%. DISCUSSION: In elective surgery the operation which currently gives the best results is cystojejunostomy with a Roux-en-Y loop, but cystogastrostomy should not be overlooked due to the ease with which it is performed. A recent acquisition is the use of needle aspiration and CT- or ETG-guided percutaneous drainage in the treatment of post-necrotic pseudocysts, therefore after 4-8 weeks' maturity, both in a rapid-growth from and in the event of suppuration. Pancreatic resection is indicated for multiple atypical pseudocysts caused by retention, and this also serves to treat the underlying pancreopathy. Duodenocephalopancreatectomy is now considered to be excessive by the majority of authors. In emergency surgery, drainage of the pseudocysts is the method of choice using either a surgical or percutaneous method.

[Biliary ileus. Review of the literature and report of 22 further cases]. / L'ileo biliare. Revisione della letteratura e presentazione di 22 nuovi casi.

A critical review of the world literature of the main authors in the past twenty years (871 cases) and the personal series (1975-1987: 22 cases) shows that biliary ileus is a rare, serious pathology with an emergency surgical indication. The numerical data collected confirm the need for a conservative surgical attitude, limited to the removal of the obstructing cause. Some authors have maintained that it is possible to treat the occlusion and the bilio-digestive fistula and carry out the cholecystectomy contemporaneously. Personally it is considered that the latter possibility can be confined to carefully selected patients who are not too elderly, do not present associated pathologies and for whom the diagnostic opinion is one of preoperative biliary ileus. Cholecystectomy is therefore programmed and this is followed at a later stage by repair of the biliary fistula, the occlusive pathology being corrected immediately so as to eliminate as far as possible the immediate risks of prolonged emergency surgery on the bile ways and digestive tract at the same time.