[Clinical study of aortic co-involvement in lumbo-aortic lymph node metastasis of testicular carcinoma]. / Studio clinico sul coinvolgimento aortico nelle metastasi linfonodali lombo-aortiche da carcinoma testicolare.

The Authors review the international literature about the frequency of vascular involvement (inferior vena cava and aorta) in the lymph node lumbo-aortic metastases of the testicular neoplasm. They report a case of a patient with an aortic involvement from lymph node metastases of a mixed (seminoma and germ cell) cancer of the left testis. They performed en bloc resection of the bulky metastases including the aorta involved. The literature data as well as the outcome of the operated case show a moderate survival also in patients with advanced disease.

[Clinical study of metastasis of thyroid differentiated carcinoma]. / Studio clinico sulle metastasi da carcinoma differenziato della tiroide.

The Authors report 5 cases of distant metastases of well-differentiated thyroid carcinoma over a number of 114 patients operated for thyroid neoplasm (4.3%). In 101 pts was total thyrodectomy performed, in 13 pts underwent istmo lobectomy. Distant metastases were verified in 3 patients with follicular and in 2 patients with papillary carcinoma. In 2 cases the metastases were in lungs, in 2 cases are the bone, and in one patient in lungs and bones. In 3 patients istmolobectomy had been performed at first operation. All the patients were treated with radioiodine. Three patients were alive after 3, 5 e 10 years from the diagnosis of metastases, 2 of them are presently disease free.

[Experience on the pancreatic function after an episode of acute biliary oedematous pancreatitis]. / Studio sulla possibile alterazione della funzionalità pancreatica dopo un episodio di pancreatite acuta biliare edematosa.

The authors have examinated 35 patients 4 - 5 years after a previous episode of acute oedematous biliary pancreatitis. 20 patients had been cholecystectomized while 15 had not been operated. The patients of the first group didn't show any impairment of the endocrine or exocrine pancreatic function while the patients who were not cholecystectomized in 4 cases on 15 showed an impairment of the exocrine pancreatic function valued with the elastase-1 test in the stools. In 2 patients there was also a slight impairment of the glucose metabolism. The authors suppose that the persistance of a biliary disease can affect the pancreatic function.

[Reoperations in thyroid surgery]. / Reinterventi in chirurgia tiroidea.

The Authors examine etiology, incidence and hazards related to reoperation in thyroid surgery either for benign either for malignant pathology. The Authors present, then, 26 secondary operations performed in the Unit of Surgical Pathology of the Department of Surgical Sciences Chieti University: 15 for benign, 11 for malignant pathology. In the cases of thyroid malignant pathology, in 2 patients (operated in different hospitals) there was a parenchimatous recurrence, in 2 patients a lymphnodal recurrence. In all the patients a total thyroidectomy was performed, in one patient associated with lymphadenectomy. In the patients with lymphadenomatous recurrence a functional laterocervical lymphadenectomy was performed.

[Clinical experience in tumors of the common bile duct]. / Esperienza clinica sui tumori della via biliare comune.

The authors, after a short review of the literature present 6 cases of cancer of the common bile duct. One was localized at the hepatic hilus, three in the middle of the c.b.d., two in the distal choledochus. In each case a c.b.d. resection was performed associated in one case to a minor hepatic resection, in two cases to a Whipple operation.

[Surgical treatment of isolated adrenal metastasis from lung carcinoma]. / Trattamento chirurgico delle metastasi surrenaliche isolate da carcinoma polmonare.

A surgical treatment of patients with lung cancer non-microcitoma and isolated adrenal metastasis has been reported in literature although limited in number and follow up. The Authors report 12 cases of patients operated for lung cancers non-microcitoma and isolated adrenal metastasis. One patients was lost in the follow up, two patients died 3 and 6 months after the adrenalectomy. The other patients are alive after 88, 39, 36, 17, 13 months after the adrenalectomy. Four of these patients are also disease free. Other 4 patients, more recently operated, are alive and disease free after 3, 3, 9 and 9 months after the adrenalectomy. The Authors believe that a surgical treatment is justified in these patients, considering the results of the series reported in literature and also their own results.

[Our experience regarding biologically inactive gastroenteropancreatic neuroendocrine tumors]. / La nostra esperienza in tema di: tumori neuroendocrini gastroenteropancreatici biologicamente inattivi (GEP-BINT).

The Authors present 9 cases of gastro-enteropancreatic neuro-endocrine biologically inactive tumors. In 5 cases the tumor site was appendicular. In 4 patients an appendectomy was performed, in one patient a right hemicolectomy and the patients after a period of 3-9 years are well and disease free. In a patient with a gastric carcinoid and a single hepatic metastasis a total gastrectomy with an hepatic metastasectomy were performed but the patient died 16 months thereafter. In a case localized to the right colon with a single hepatic metastasis a right hemicolectomy was performed with a metastasectomy but the patient died after 12 months. In a case localized to an ileal loop a segmental resection was performed followed by a medical therapy with octreotide and the patient is well and disease free after 3 years. In a case localized to the pancreas with widespread lymphatic metastasis it was performed a simple biliary diversion (coledocho-duodenostomy) followed by medical therapy with octreotide. Surprisingly after 4 years the patient is alive and a TC control shows a decrease of the pancreatic tumor and of the lympho glandular tumefactions.

[Study of the possibility of an effect of biliary disease on the occurrence of chronic pancreatitis]. / Studio sulla possibilità di una influenza della patologia biliare nell'insorgenza di una pancreatite cronica.

The authors report a series of patients suffering from chronic pancreatitis and underline the high frequency of biliary pathology in these subjects. The authors remind, then a research performed, some years ago, by one of them. In such a research the performing of an anastomosis between the pancreatic duct and the biliary common duct in a series of experimental animals caused an acute pancreatitis or in the surviving animals a chronic pancreatitis. The authors believe that a biliary pathology may be responsible not only of an acute pancreatitis but also of a chronic pancreatitis.

Thyroid paraganglioma: report of a case and review of the literature.

A case of thyroid paraganglioma is reported. Immunohistochemically the tumor showed negativity for thyroglobulin and calcitonin and positivity for chromogranin A and S-100. Protein-positive sustentacular cells were demonstrated. The authors discuss the previous literature on these tumors.

[Our experience with pheochromocytoma]. / La nostra esperienza in tema di feocromocitoma.

The authors report cases of pheocromocytomas operated in the period 1991-1997. 16 of these patients presented a monolateral pheocromocytoma, 1 a bilateral. A patient had a malignant evolution, one patient presented an extrasurrenal para-aortic localization. All the patients were operated by a middle longitudinal laparotomy. There was no mortality, neither significant morbility. In all the patients, who presented pre-operatory arterial hypertension, there was a regression of the symptomatology.

[A case of leiomyosarcoma of Meckel's diverticulum]. / Su di un caso di leiomiosarcoma del diverticolo di Meckel.

The authors report a case of mesenchymal tumor (leiomyosarcoma) arising in a Meckel's diverticulum, with an history of digestive bleeding. Different kinds of Meckel's diverticulum tumors, their symptomatology and diagnostic difficulties are then discussed.

[A case of carcinoma arising on the duodenal stump after gastric resection]. / Su di un caso di carcinoma insorto su moncone duodenale consecutivo a gastro-resezione.

The duodenal cancers are very uncommon and the carcinomas arising on a duodenal stump following a B II gastric resection are a real rarity. The Aa. present a case of a patient with a cancer arisen on a duodenal stump 24 years after a gastric resection. The patient was operated with a Whipple D.C.P.

[A clinical study of chronic actinic enteropathy]. / Studio clinico sulla enteropatia cronica attinica.

Two cases of chronic radiation enteritis are reported. The resection of the intestinal tract was performed in both cases. The literature is then reviewed.

[Clinical study on the treatment of differentiated carcinoma of the thyroid gland]. / Studio clinico sul trattamento del carcinoma differenziato della tiroide.

A study on 88 patients operated for a differentiated thyroid carcinoma (63 papillary and 25 follicular cancer) is reported. In 66 cases a total thyroidectomy was performed (in 16 associated with an ipsilateral lymphadenectomy), in 11 a subtotal thyroidectomy and in 11 a lobar isthmectomy. In the follow-up there were 3 deaths and 4 recurrences. Notwithstanding the limited number of cases, the Authors registered a worse diagnosis for the follicular carcinomas (2 deaths and 2 recurrences on 25) compared to the papillary (1 death and 2 recurrences on 63).

[The surgical treatment of primary hyperparathyroidism: clinical experience]. / Il trattamento chirurgico dell'iperparatiroidismo primitivo: esperienza clinica.

The primitive hyperparathyroidism (PHPT) constitutes still cause of discussion both from the diagnostic point of view and from the therapeutic one although surgical successes are generally reported. Between the most important problems there is the increase of the HPT asymptomatic or oligosymptomatic patients with the decisional difficulties in the timing of the surgical treatment and the difficult framing of the HLP disease associated with MEA and the relating surgical failures. Besides some authors support an unilateral dissection of the neck in patients with adenoma diseases diagnosed before the intervention against the traditional address of a bilateral exploration. Our experience is based on 31 patients subjected to intervention of parathyroidectomy for primitive HPT: 26 carriers of adenomas, of which 1 double, and 5 of diffused hyperplasia. We have effected 25 simple parathyroidectomy for adenoma, 1 resection of three parathyroid glands for double adenoma, 2 subtotal parathyroidectomy (7/8) for diffused hyperplasia. 2 patients had new surgical treatment for persistent hypercalcemia, and they were respectively carriers: 1 of a second ectopic adenoma and 1 of asymmetrical hyperplasia; 2 patients finally, operated in other hospitals had a second exploration and they were affected from MLP. In 26 patients we had very good results, in 2 persistence of hypercalcemia (patients who had a second look) and 3 hypocalcemia.

[Aneurysms of the subclavian artery: clinical experience]. / Gli aneurismi dell'arteria succlavia: esperienza clinica.

The aneurysm of the subclavian artery is not common. The authors present three cases of aneurysms of the subclavian artery of which two cases already were in phase of complication for rupture. Two Patients underwent intervention of by-pass with Dacron prosthesis: between common carotid and axillary artery in one and between common carotid and distal head of the subclavian artery in the other. In a Patient with post-traumatic pseudoaneurysm of the subclavian artery was not possible to perform any intervention of direct reconstruction because of the precarious clinical conditions due to the hemorrhage for rupture and we performed only a resection of the aneurysm with binding of the subclavian artery. A Patient died two months after the operation for respiratory failure due to bronchial pneumonia; two Patients are still living, one with a moderate motor deficit of the upper limb. The rupture of the arteriosclerotic aneurysms of the subclavian artery is not frequent, but the gravity of this complication recommends the surgical treatment also in the asymptomatic cases if the clinical conditions of the Patient allow it.

[Acute thrombosis of the infrarenal aorta]. / Trombosi acuta dell'aorta infrarenale.

The Authors report three cases of patients operated for acute thrombotic aortic occlusion. All the three patients were treated with an aortic transabdominal approach, thromboendarteriectomy and aorto-femoral by-pass. In two patients the result was satisfying, one with a late and partial recovery of the motility of the inferior limbs. One patient died for heart failure in eighth postoperative day. The Authors believe that this unsatisfying result was caused by delay in the surgical treatment (almost 30 hours).

Glutathione-related antioxidant defenses in human atherosclerotic plaques.

BACKGROUND: Oxidative stress, resulting from an antioxidant/prooxidant imbalance, seems to be crucial in atherogenesis. Recent evidence has emerged, however, of a surprisingly high content of low-molecular-weight antioxidants in human atherosclerotic plaques, although other antioxidant systems have not been investigated in these lesions. METHODS AND RESULTS: We studied glutathione-related antioxidant defenses (which play a key role in tissue antioxidant protection) in carotid atherosclerotic plaques of 13 patients subjected to endarterectomy and in normal internal mammary arteries of 13 patients undergoing coronary artery bypass surgery. Selenium-dependent glutathione peroxidase activity was undetectable in the plaques of 7 patients; the other 6 patients with plaques showed a mean enzymatic activity approximately 3.5-fold lower than that of mammary arteries. Glutathione reductase activity was also markedly lower in the plaques than in the arteries. Glutathione transferase instead had comparable activity in the two tissues. Remarkably, 5 of the 7 patients with an undetectable selenium-dependent glutathione peroxidase activity but none of the 6 with a detectable one were characterized by multivascular atherosclerotic involvement (3 patients) or stenosis of the contralateral carotid artery (2 patients). CONCLUSIONS: A weak glutathione-related enzymatic antioxidant shield is present in human atherosclerotic lesions. Although the cause of this phenomenon remains to be determined, the present data suggest that a specific antioxidant/prooxidant imbalance operative in the vascular wall may be involved in atherogenic processes in humans.

[Unusual pathology of the spleen]. / Patologie non frequenti della milza.

The Authors report 7 cases of unusual spleen pathology represented by 2 real cysts, 1 pseudocyst, 1 hydatid cyst, 2 abscesses, 1 splenic artery aneurysm. Pathophysiological hypotheses are examined, and clinical and diagnostic considerations are stressed, evaluating particularly anatomo-histologic characteristics and the differential diagnosis through non invasive imaging techniques. All patients were subjected to splenectomy via laparotomy, except for the case of real cyst where an inferior hemisplenectomy was performed. In the case of splenic artery aneurysm, an urgent aneurysmectomy was required together with splenectomy, considering the young age of the patient (29 years old), and the type of aneurysm presenting in a double rupture phase. Reoperation was necessary in only one patient to drain an hematic abscess. After a 9 year follow up all the patients are well.

[Personal experience in the treatment of carcinoma of the head of the pancreas]. / Esperienza personale nel trattamento del carcinoma della testa del pancreas.

The Authors report 195 cases of carcinoma of the head of the pancreas observed in the period 1983-1995. Only 94 (48%) of these patients were operated: in 32 cases an exploratory laparotomy was performed, while in 36 a bilio-digestive bypass, associated in 2 patients with a gastro-jejunal bypass was assured. In 26 patients a resection was performed: in 12 a Whipple procedure, in 6 a total duodenopancreatectomy, in 8 a pylorus preserving procedure (Traverso-Longmire). The mean survival was 2 months after laparotomy, 6 months after bilio-digestive bypass, 20 months after Whipple procedure, 20 months after total duodenopancreatectomy, 23 months after a pylorus preserving procedure (Traverso-Longmire). The Authors believe that the Whipple procedure is the treatment of choice for the carcinoma of the head of the pancreas. Only in cases of suspected multifocality or when there is a severe nodal involvement it is advisable to perform a total duodenopancreatectomy.