Pneumothorax in the Emergency Room: personal caseload.

The aim of this study was to collect information on the incidence, pathophysiology, treatment and mortality of pneumothorax in the Emergency Room. Pneumothorax is classified as spontaneous (primary, secondary or catamenial) or traumatic (iatrogenic or secondary to a blunt or penetrating chest injury). Between January 2007 and December 2009, 102 patients with pneumothorax were seen in our Emergency Room. Their records were examined and their data collected retrospectively. The type and side of the pneumothorax and age, sex, incidence and mortality were analyzed. The cases, involving 93 males and 9 females, broke down as follows: 68 spontaneous (66.7%), 33 traumatic (32.3%) and one iatrogenic (0.98%). The mean age was 47.3 (range 12-99); the incidence was 0.10%. There were no deaths due to pneumothorax in the Emergency Room. Traumatic pneumothorax was associated with blunt chest trauma, pleural effusion, hemothorax, cranial trauma, fractured collarbone, upper and lower limb fracture, pelvic fracture, vertebral and spinal trauma, sternum fracture and abdominal trauma. Pneumothorax is a common clinical problem. A multidisciplinary approach is essential to reduce the risk of morbidity and mortality. The incidence of pneumothorax in the Emergency Room was similar to that reported in the literature, while mortality data cannot be compared due to the lack of published studies.

[Biliary lesions after laparoscopic cholecystectomy]. / Lesioni biliari dopo colecistectomia laparoscopica.

Laparoscopic cholecystectomy is the suitable treatment for symptomatic cholelithiasis, even if the incidence of biliary lesions following this procedure may be up to threefold higher than that of open cholecystectomy. We report our experience concerning the incidence, aetiopathogenesis, diagnosis and treatment of complications in a homogeneous group of laparoscopic cholecystectomies. In a total of 492 laparoscopic cholecystectomies only three bile duct lesions were observed (0.6%); they were classified according to Bismuth and re-assessed according to Strasberg. They consisted in two biliary leakages and one bile duct stricture. All patients were evaluated by full blood test, ultrasonography and endoscopic retrograde cholangiopancreatography. Endoscopic treatment was successful in the two patients with biliary leakage, while the patient with a stricture required surgical therapy. In conclusion, we suggest that a correct knowledge of the aetiopathogenesis together with a multidisciplinary approach to the diagnosis appear to be the best method for the detection, complete classification and most suitable treatment of symptomatic cholelithiasis.

[Radioimmuno-guided surgery (RIGS) in breast disease]. / La chirurgia radioimmunoguidata (RIGS) in patologia mammaria.

Radioimmunoguided surgery is a new technology capable of detecting minimal neoplastic lesions using radiocolloids. We used this technique in two fields: to detect sentinel lymph nodes in breast cancer and to remove non-palpable breast lesions. Radioimmunoguided surgery was employed in 135 women; in 32 for sentinel lymph nodes and in 103 for radioguided occult lesion localization using a radioactive tracer (Technetium Tc99m) injected subdermally for sentinel nodes, or near to the non-palpable lesions under US guidance. In our experience these two applications of radioimmunoguided surgery are useful and accurate for determining the nature of lesions and for providing definitive treatment in a single surgical intervention.

Simple versus double jejunal pouch for reconstruction after total gastrectomy.

BACKGROUND: Even though many types of reconstruction after total gastrectomy have been proposed to reduce postgastrectomy syndromes, choosing a method that would further improve the quality of life and nutrition of the gastrectomized patient is controversial. Hunt-Lawrence single pouch reconstruction seems to obtain better results compared with the more common Roux-en-Y technique, but both of these reconstructive approaches are associated with some reduction in food intake and some problems in achievement of ideal body weight. METHODS: In this prospective, randomized trial, after total gastrectomy 18 patients had reconstruction according to the Hunt-Lawrence or single pouch technique (SP group), whereas for 23 patients, the technique was modified with construction of a second pouch in the distal portion of the jejunal loop (DP group). Patients in the two groups were compared at 12 months after surgery for problems in gastrointestinal function, quality of life, improvement in body weight and nutritional parameters, serum albumin, hemoglobin level, and serum protein. RESULTS: The DP group demonstrated fewer symptom problems, better weight maintenance, and better laboratory values when compared with patients undergoing standard single jejunal pouch reconstruction. CONCLUSIONS: Reconstruction with use of a double pouch as a gastric substitute leads to better outcome assessments than with a single pouch reconstruction. Our double pouch technique has demonstrated significant improvement in quality of life and nutritional recovery in terms of functional results as well as patient satisfaction.

Differences in AgNOR quantity between colorectal cancer and corresponding metastases: are they useful for prognostic purposes?

In order to evaluate the relationship between primary colorectal adenocarcinomas and their metastases with regard to AgNOR proteins expression, we have performed a morphometric analysis of AgNOR silver precipitates (AgNORs) in advanced colorectal carcinomas (stage III-IV) as well as in corresponding lymph node and distant metastases. Surgical specimens studied consisted of 64 primary tumours, 56 lymph node and 43 hepatic or omental metastases; for each formalin-fixed paraffin-embedded specimen, silver staining according Ploton et al. (1986) was performed and the AgNOR area (NORA) relative to primary site, lymph node and/or distant metastases was calculated. A significant difference (P < 0.001) among the non-neoplastic colonic control mucosae and primary or metastatic neoplastic lesions was found, but no statistically significant differences were encountered among the categories of primary colorectal carcinomas and their lymph node or distant metastases. Moreover, on the basis of NORA data case per case, three groups of patients were selected. In particular, in the group 1 NORA values of metastases were higher than those of the corresponding primary carcinomas, while in the group 2, NORA values of metastases were lower than those of the corresponding primary neoplasms; no differences of NORA values were encountered in group 3. The cumulative patient survival estimated by the Kaplan-Meier method showed a worse prognosis for patients belonging to group 1, where higher AgNOR values, not only in primary carcinomas but also in lymph node and distant metastases, were found.

[Nipple discharge: indications for surgery]. / La mammella secernente: indicazioni alla chirurgia.

Nipple discharges are related to physiological events or due to benign lesions of the breast. Sometimes they can express mammary cancers. The authors report their experience of the diagnosis and treatment of 1241 patients with secreting breast. They underline the importance of a correct diagnostic protocol to select cases needing surgical treatment.

[Acquired phimosis due to lichen sclerosus et atrophicus]. / La fimosi acquisita da lichen sclero-atrofico.

From January 1986 to December 1991, 6 cases of acquired phimosis secondary to balanitis xerotica obliterans were observed. The authors report their experience in the diagnosis and treatment of this disease. Five patients were treated with plastic of the foreskin, one was circumcised and treated with local instillation of corticoids. The authors conclude that the histological study of the specimen is very important to demonstrate the nature of the lesion.

[The use of fibrin glue in the surgery of breast carcinoma]. / L'impiego della colla di fibrina nella chirurgia del carcinoma della mammella.

Twenty-four patients operated on for breast carcinoma with associated axillary node dissection were randomly assigned to two protocols. In the first group fibrin glue was applied intraoperatively, in the second group no complementary treatment was accomplished. The aim of the study was to evaluate the effect of fibrin glue in reducing postoperative axillary sero-lymphatic secretion. In the fibrin glue group a significant reduction of postoperative axillary secretion was observed.

[Palliative treatment in neoplastic jaundice. Personal experience]. / Il trattamento palliativo dell'ittero neoplastico. Esperienza personale.

The palliative treatment of biliary duct neoplastic obstruction represents a problem of great importance and frequently can't leave out of consideration patients clinical conditions and phase of neoplastic disease. Authors, in this article refers their experience on palliative treatment of neoplastic jaundice and indications for surgical or endoscopic treatment. Their experience shows that surgical palliation must be performed in patients with preoperative instrumental investigations without "surgical risk", this vouches for a better quality of life than endoscopic procedure performed with diffuse neoplastic disease and in patients with surgical risk.

[Treatment and prognosis of metachronous bilateral carcinoma of the breast]. / Trattamento e prognosi del carcinoma bilaterale metacrono della mammella.

In this study the incidence, the treatment and the survival of 7 patients with bilateral metachronous breast cancer have been evaluated. From this experience, the value of careful follow-up of mastectomized patients in order reach an early diagnosis of bilateral breast cancer is stressed.