[Intestinal perforation by ingested foreign bodies in the digestive tract: an insidious pathology always of interest. Our experience]. / La complicanza perforativa da ingestione di corpi estranei alimentari: una patologia insidiosa sempre attuale. Nostra esperienza.

The authors want to present five cases (from May 1999 to May 2009) of acute abdomen from perforation of the foreign body introduced with food. They highlight how the accidental ingestion is very common but the perforation is rare. The preoperative diagnosis, in these cases, is always very difficult and the radiological examinations are not always able to resolve the diagnostic doubt with other acute intestinal diseases that are responsible of perforation. Then, the surgery procedure is, necessarily, the only possible diagnostic and therapeutic means. The mortality and the morbidity remain still high first of all for the delay in the diagnosis and the advanced age of patients.

[Multiple primitive lipoma of the transverse mesocolon: a rare disease]. / Lipoma primitivo multiplo del mesocolon: una patologia rara.

The Authors describe a case of multiple lipomatosis of the mesocolon and, after a careful review of the literature, they examine particular findings and discuss diagnostic difficulties, anatomopathological features and treatment. Intraabdominal lipoma is very rare and presents difficulties in diagnosis, both for aspecific symptoms and for the unusual site which does not allow early identification. As it is a tumor which arises from primitive and totipotent mesenchymal cells, radical surgery is the only therapeutic option. The correct diagnosis depends on histological testing which can differentiate the lesion from other mesenchymal tumors.

[The capillary hemangioma of the stomach: an unusual cause of haemorrhage. Case report]. / L'emangioma capillare dello stomaco: una rara fonte di sanguinamento. Caso clinico.

Gastric haemorrhages are common clinical emergencies which often directly involve the surgeon in diagnosis and treatment; among these, rare vascular neoplasms deserve particular attention. The Authors report a rare case of benign vascular tumour of the stomach, a capillary angioma. After a literature review they highlight the importance of specific exams to reveal these small neoformations which, generally, show up clinically with acute bleeding, which may be severe, and which may not be discovered if the clinical evaluation is not very detailed. The surgical excision supported by a frozen sections is the most effective treatment.

[Combined diagnosis in breast carcinoma: preoperative role of mammoscintigraphy with Tc99m-sestamibi. Our Experience]. / Diagnostica integrata nel carcinoma della mammella: il ruolo prechirurgico della mammoscintigrafia con Tc 99m-sestamibi. Nostra esperienza.

The Authors, taking recent literature on tumoral pathology breast studies in to consideration, studied a group of patients with a node or a suspect adenous zone by clinical and instrumental examination with mammoscintigraphy. 22 patients were selected by clinical examination, mammography and ultrasonography. A mammoscintigraphy (Tc 99m Sestamibi) was performed before the surgical operation. The histologic examination revealed 14 cases of breast cancer; 12 of these (86%) resulted positive after scintigraphy, while 2 were false negative. In this study, the scintigraphic exam and its diagnostic accuracy were analyzed, both in relation to anatomical structure of the mammary gland (thick breast, fibrocystic mastopathy, postsurgical scars, etc.) and also in relation to characteristics of the suspected node, the nature of which was not possible to determine from other exams carried out. In conclusion, after comparison between our experience and those reported in literature, we conclude that because of its high specificity and sensibility the mammoscintigraphy exam assumes an important comparative index in obtaining elements for an additional evaluation when other instrumental examinations are dubious.

[Myogenic stromal tumors of the stomach: personal experience]. / I tumori stromali dello stomaco di derivazione muscolare: esperienza personale.

Myogenic gastric tumours are a rare pathology and present difficulties in terms of nosographic classification, which in most cases can be overcome thanks to improvements in imaging and immunohistochemical techniques. Over the period 1995-1999 we observed 5 patients with aspecific dyspeptic symptoms and occasional epigastric pain, suffering from non-epithelial gastric tumours, associated, in one case, with a carcinoma of the stomach. Histological examination of endoscopic biopsies was inconclusive for a definite histopathological diagnosis, while intraoperative biopsies showed the myogenic origin and the absence of morphostructural abnormalities. In the light of these data, we performed three wedge resections, one distal gastric resection and, in the patient with advanced gastric cancer, a D3 total gastrectomy. Histological examination, immunohistochemistry and cytofluorometry enabled us to diagnose stromal tumours with a low risk of malignancy in all cases. At follow-up after 9-54 months all patients are still alive and free of disease. Though the preoperative diagnosis of stromal tumours is possible with endosonography and CT, only histology, immunohistochemistry and cytofluorometry enable us to define the condition nosographically and establish a prognosis with sufficient accuracy to allow correct surgical treatment. A prolonged follow-up is always necessary to identify eventual relapses and/or metastases, which are particularly frequent in the borderline group or in cases with a high risk of malignancy.

[The Allgrove syndrome]. / La sindrome di Allgrove.

Allgrove syndrome, rare autosomal recessive pathology, characterized by adrenocortical insufficiency, achalasia and alacrimia, rises usually in pediatric age, while its observation in adults is very rare. A clinical case appeared in an adult, observed by the Authors, is the reason to evaluate the etiopathogenetic mechanisms of this syndrome, with particular attention about potential role of genetic abnormalities and about others factors, again not well known.

[Idiopathic varicocele. Diagnosis and follow-up with CW-Doppler and Echo-Color-Doppler: our experience]. / Varicocele idiopatico. Diagnostica e follow-up con Doppler-CW ed Eco-Color-Doppler: nostra esperienza.

The Authors outline their experience on routine use of Doppler velocimetry in pre- and post-operation studies on patients affected with idiopathic varicocele. This instrumental study, characterized by non-invasive techniques and repeatability, if correctly carried out, allows both accurate identification of anatomical alterations which are at the bottom of varicocele and correct indications for surgical treatment. Moreover the Authors confirm the importance of spermatic veins ligature following the Ivanissevich method in the treatment of male infertility.

[Clinical and etiopathogenetic evaluation of a rare cause of spontaneous pneumoperitoneum and volvulus of the ileum: pneumatosis cystoides intestinalis. Report of a case]. / Valutazioni cliniche ed etiopatogenetiche su una rara causa di pneumoperitoneo spontaneo e volvolo dell'ileo: la pneumatosi cistica intestinale. A proposito di un caso.

A case of pneumatosis cystoides intestinalis with pneumoperitoneum and volvulus complications is reported. After careful examination of the literature, etiopathogenic, pathophysiological and clinical features of the disease are analyzed by the Authors, also in the light of recent findings. Major diagnostic and therapeutic implications are discussed regarding possible complications requiring a different therapeutic approach. PCI, a lesion which can be benign, primary or secondary in many conditions, may be characterized by the presence of spontaneous pneumoperitoneum which only requires a careful, but not aggressive therapy, unlike other complications such as volvulus or intestinal occlusion which, instead, require timely surgical action. The Authors describing the therapy adopted, highlight the positive role of the enteral nutrition (NE) and oxygen therapy in the clinical course of the disease.

[A case of appendiceal mucocele associated with adenocarcinoma of the left colon]. / Su di un caso di mucocele appendicolare associato ad adenocarcinoma del colon sinistro.

The Authors report an unusual case of appendiceal mucocele associated with a large bowel carcinoma occasionally observed in the course of examinations for the first pathology. Due to the rareness of the association of the two affections, the clinical problems and pathogenetic theories are reviewed, also analysing the histological differences of the various mucoceles which need a different surgical approach. They conclude stating that the preoperative diagnosis of appendiceal mucocele, is easier today than in the past, thanks to the routine use of ultrasonography and tomography through which it is possible to reveal concomitant pathologies often clinically silent.

Diagnostic possibilities and clinical indications of policlonal labeled Ig in the bowel inflammatory disease.

BACKGROUND/AIMS: Ulcerative colitis (UC) and Crohn's disease (CD) represent the more common forms of idiopathic inflammatory bowel disease. They have a peculiar course, which is characterized by exacerbation and submissions, and a symptomatology that changes in relation to severity and extension of the lesions. The aim of this study is to establish the diagnostic usefulness of 99m Tc human policlonal immunoglobulin (HIG) imaging in patients with inflammatory bowel disease (IBD). METHODOLOGY: During the period between September 1995 and September 1997 we submitted a group of 32 patients affected by UC (n = 22) and CD (n = 10), to Human Immunoglobulin labeled with Technetium 99m (99m Tc-HIG) scintigraphy. The diagnosis of IBD was obtained in all cases by endoscopy with biopsy. RESULTS: Scintigraphic examination with labeled HIG showed an abnormal intestinal fixation (ileal or colic) of the marked immunoglobulins in 17 patients (77.2%) affected by UC and in 8 patients (80%) affected by CD. In 5 (22.7%) and 2 (20%) patients, respectively, the scintigraphic examination revealed a normal distribution of the immunoglobulins without appreciable focal accumulation. Among the patients with a negative scintigraphic examination, only one presented an endoscopic and histologic report that documented UC in an active stage. The histologic and endoscopic findings observed in all cases of CD were similar to that of HIG scintigraphy in 7 of the 8 scintigraphic-positive cases and in 1 of the 2 scintigraphic-negative patients. CONCLUSIONS: The authors, on the basis of their results, suggest that this diagnostic strategy may have a significant role in the diagnostic protocol and in the follow-up of chronic inflammatory bowel disease.

[Authors' experience with the role of preoperative ultrasonography in the study of benign lesions of the gallbladder]. / La nostra esperienza sul ruolo dell'esame ecografico preoperatorio nello studio delle lesioni parietali benigne della colecisti.

The benign parietal lesions of the gallbladder are diseases that, as known, found their pathogenetic moment on hyperplasia of constituent tissues of the gallbladder wall and comprises the controversial chapter of "cholecystosis". The Authors, to contribute to their better clinical and pathogenetic staging, report their experience on 25 cases. They debate on the usefulness of ultrasonography, surely a diagnostic progress for these formations, which are small structures more or less echogenic and that they develop in the gallbladder; the echographic imaging, for its sharpening, has substituted the cholecystographic procedure. The aim of present study is to analyse the results obtained by using echography as diagnostic preoperative procedure of "cholecystosis". The ultrasonography supplies the surgeon an indication to prophylactic surgical treatment as single, effective procedure in preventing the gallbladder carcinoma.

[Primary gastrointestinal localization of N-H lymphoma: authors' experience]. / Le localizzazioni gastrointestinali primitive del linfoma N-H: nostra esperienza.

Primary non-Hodgkin lymphoma of the alimentary tract is a rare pathological entity with few peculiar clinical aspects, therefore characterized by problems of differential diagnosis with other neoplastic and inflammatory diseases. The Authors report on some cases of primary gastrointestinal N-H lymphoma observed in their experience and discuss about the most significant clinical and pathological data. They conclude that currently surgical treatment is the first fundamental step of a multidisciplinary therapeutic program, which may allow an improvement of the prognosis.

Palliative endoscopic treatment of malignant esophagorespiratory fistula: case report.

The authors report on a case of esophagorespiratory fistula due to squamous carcinoma of the esophagus treated on an emergency basis by endoscopic insertion of an Atkinson prosthesis following dilation of the malignant stenosis with Savary dilators. The authors suggest the endoscopic insertion of a prosthesis as the first approach in the emergency treatment of a malignant esophagorespiratory fistula because of the easiness of the technique, and its low morbidity and mortality rates; furthermore, this procedure relieves digestive and respiratory symptoms rapidly and reduces hospital stay while providing the patient with a better quality of remaining life.