[Clear cell renal carcinoma metastatic to the thyroid. A case report]. / Metastasi tiroidea di carcinoma renale a cellule chiare. Caso clinico.

A case of clear cell renal carcinoma metastatic to the thyroid 5 years after surgical removal of the primary tumor is presented. The differential diagnosis related to cyto-histologic findings, the uncommon occurrence and the unpredictable behaviour of clear cell renal carcinoma are discussed.

[Bilateral thrombosis of a femoral pseudoaneurysm]. / Trombosi bilaterale di pseudoaneurisma femorale.

One case has been described of acute thrombosis of bilateral femoral anastomotic pseudoaneurysm. The clinical finding of bilateral acute ischemia of the lower limbs required urgent surgical treatment. The operative technique consisted of excision of anastomotic aneurysms and replacement by a new segment of prosthesis with an end-to-end anastomosis to the deep femoral artery. Pathogenesis of the pseudoaneurysms at the femoral anastomosis generally recognized numerous factors such as mechanical, graft or suture defects, hypertension, wound complications. Recognition of femoral anastomotic aneurysms is usually simple, when a pulsative mass is noted. In such a case (reported) of thrombosis of bilateral femoral pseudoaneurysms, preoperative diagnosis was more difficult. Anastomotic aneurysms of little size that occur later after original intervention require observation by echography and angiodinography. When rapid enlargement arises, urgent surgical treatment is required, before rupture or thrombosis. The surgical intervention consists of excision of the anastomotic aneurysm and replacement by a new segment of prosthesis between the prosthesis and the common or deep femoral artery. If the reconstruction at the level of femoral artery is not possible, the anastomosis is performed more distally, at the level of popliteal artery. The results are affected by the degree of urgency of surgery, with significant difference in favour of the patients Who underwent elective procedures.

[Aneurysm of the iliac artery]. / Aneurismi dell'arteria iliaca.

The authors consider isolated iliac artery aneurysms. While the incidence of isolated iliac lesion is, as literature reports, quite low, it rises up to 20% when associated with aortic lesions. The clinical findings are often characterized by effects of compression on the intrapelvic structures, by neurological symptoms and decreased venous flow. Diagnosis is based on ecography, CT and angiography for the definition of side and extension of the aneurysmatic lesion. From the technical point of view, the surgical approach is based on the dimensions of aneurysm and its mono- or bilateral extension. The most common approach in case of bilateral aneurysms or aorto-iliac lesions is transperitoneal, while it's limited to extraperitoneal way, when isolated iliac lesion. If the aneurysm involves the hypogastric artery, mostly when bilateral, the risk of bowel ischemic complications becomes more significative.

[Emergency surgery in patients over eighty]. / L'urgenza chirurgica nell'ultraottantenne.

The authors describe a series of 139 over-eighty patients (M = 53, F = 86), who underwent emergency surgery between 1-1-1987 and 30-6-1993. They consider diagnosis, copathology, type of surgical procedures, postoperative complications and final results. In this series they study 73 large bowel obstruction and 48 peritonitis. They notice important copathologies in 78% of patients, in particular cardiovascular diseases. They performed 74 mayor surgical procedures with 48% of postoperative complications and exitus in 24% of cases, due overall to exacerbation of coexisting diseases. The authors underline the direct between mortality rate and number of copathologies, and analyze the basic rules to follow in surgical indications and during the postoperative period.

[Perforated colonic diverticulitis. Surgical technique]. / Le perforazioni diverticolitiche del colon. Tattica chirurgica.

Emergency surgery is required for performed colonic diverticulitis. Surgical indications are not uniform in literature. In the experience of the authors the operations have been performed in the case of peritonitis subsequent to the perforation or in the case of failure of the conservative treatment. Twenty-four patients underwent surgical intervention because of diffuse (17 cases) or localized peritonitis (7 cases). Exitus were related to cardiovascular complications in patients over seventy. Postoperative results are related to the age, the general conditions of the patient and to the intraoperative finding, of localized or generalized peritonitis. Operations may be divided into two groups: conservative procedures or primary resections. In the first one it is possible to suture the colonic wall without resection; in the second one the intraoperative finding or the extensive necrotic lesions indicates colonic resection or exteriorization. The surgical treatment adopted is correlated both to the age and cardiorespiratory conditions and to the other associated diseases.

[Colorectal pathology: an analysis and comparison between patients of different ages]. / Patologia colo-rettale: analisi e confronti tra pazienti di diversa età.

The increasing incidence of large bowel diseases observed in the last years is age-related. The authors have analyzed 366 patients who underwent surgery for colorectal pathology, divided in two groups (> or < 65 years) considering sex, diagnosis, type of clinical presentation, incidence and type of associated pathology, and post-operative complications. The analysis of the series revealed that type of clinical presentation, surgical patterns, post-operative infections were the same in the two groups, as reported in the literature. The substantial differences were only due to the different incidence of colo-rectal pathology, associated pathology and cardiovascular complications, factors that become characteristic of the elderly patients.

[Prognostic value of postoperative determination of CEA in carcinoma of the large intestine]. / Valore prognostico del dosaggio postoperatorio del C.E.A. nel carcinoma del grosso intestino.

The C.E.A. level was routinely determined in the follow up of 133 patients who underwent surgery because of colorectal cancer. Preoperative levels of C.E.A. appear to be related to Dukes staging of the disease. Postoperative values of the marker were higher than normal in 36 patients, 91% of whom had recurrences; normal postoperative values were observed in 90 patients and only 21% of these eventually showed recurrences.