[Appendiceal oxyuriasis: a case report and review of the literature]. / A proposito di ossiuriasi appendicolare: presentazione di un caso e revisione della letteratura.

The authors describe a case of appendicular oxyuriasis and then go on to review the international literature on this condition. Nothing in the case report provides the surgeon with useful pointers which may help him distinguish between appendicular oxyuriasis and common appendicitis. This is in line with all the existing literature which yields no elements capable of suggesting an accurate preoperative diagnosis. Only anamnestic evidence of previous oxyuriasis can help the clinician in this direction. It should be noted, however, that there are no significant differences in postoperative morbidity between "common" acute appendicitis and appendicitis due to oxyuriasis, when the parasitosis is adequately treated.

[Unusual cause of upper digestive hemorrhage: gastric lipoma. Report of a case]. / Una causa rara di emorragia digestiva alta: il lipoma gastrico. Descrizione di un caso.

Lipomas are benign tumors that are common in other sites but rare in the stomach. They are usually submucosal and, when symptomatic, are most often accompanied by gastrointestinal bleeding from ulceration of gastric mucosa overlying the mass or by symptoms of obstruction. A 55-year-old male with epigastric abdominal pain and upper gastrointestinal hemorrhage due to a gastric lipoma is presented; endoscopic and x-ray examinations revealed a submucosal tumor on the posterior wall of the gastric corpus, with ulceration in the mucosa covering it. Biopsies of the mass were nondiagnostic. The patient underwent a complete submucosal excision: the intraoperative histologic study established the diagnosis of gastric lipoma. The post operative period was uneventful. A review of the clinical, diagnostic and therapeutic aspects of this rare disease is reported.

[Iatrogenic false aneurysm of the ulnar artery. A clinical case and review of the literature]. / Pseudoaneurisma iatrogeno dell'arteria ulnare. Caso clinico e revisione della letteratura.

Nowadays false aneurysms have become an important part of the workload of a vascular surgeon as a result of the increasing number of iatrogenic arterial trauma occurring during diagnostic and therapeutic procedures requiring puncture or exposure of blood vessels. A case of a false aneurysm in the ulnar artery caused by a simple syringe needle during an intravenous cannulation is reported. The clinical symptoms and details of the diagnostic procedure based upon color-Doppler and angiography are examined. The vascular operation consisted in proximal and distal arterial control, resection of the aneurysm and end-to-end anastomosis. After surgical treatment the patient experienced an excellent anatomic and functional recovery.

Concomitant preoperative radiochemotherapy in operable locally advanced rectal cancer.

PURPOSE: The aim of this study was to examine the effectiveness of a combination of preoperative radiotherapy and chemotherapy for operable locally advanced rectal cancer (Stages II and III). METHODS: Chemotherapy and radiotherapy are started jointly on day one of the therapy. 5-Fluorouracil is given in a dosage of 1000 mg/m2/day as a continuous 24-hour infusion for 4 days. Mitomycin C is given as a bolus intravenous at a dosage of 10 mg/m2 the first day. The radiation therapy is given to a total dosage of 37.8 Gy. Surgery is generally performed four to five weeks following completion of the radiation therapy. From March 1990 to April 1993, 34 patients with histologically documented adenocarcinoma of the rectum have been treated. Twenty-one lesions were located in the lower third of the rectum. Twenty-nine neoplasms were judged by initial clinical staging as Stage III. RESULTS: Patients compliance to the treatment have been 97 percent. Toxicity of treatment has been low (15 percent). Tumor sizes decreased 50 percent or more in about 80 percent of patients. Distance of the tumor from the anal canal increased in all but seven cases. Twenty-two anterior resections have been performed. The morbidity rate has been 24 percent. No postoperative mortality has been reported. Histologic examination of surgical specimens after integrated treatment showed in 10 cases a tumor confined to the rectal wall (T2), in 3 patients only a residual tumor limited to submucosa (T1), and in 5 (15 percent) patients no evidence of neoplastic cells (T0). CONCLUSIONS: We conclude that preoperative radiochemotherapy was generally well tolerated; in all cases we had a reduction of tumor sizes, surgery presented no technical difficulties, and there was the effect of stage reduction.

Conservative surgery for early cancer of the distal rectum.

From 1967 through 1988, 36 patients underwent local excision of a distal rectal cancer as an initial operative procedure with curative intent. A diagnostic, preoperative protocol was performed to assess the histologic grade of the tumor, the depth of penetration in the rectal wall, and the presence of positive lymph nodes or distant metastases. All patients had a transanal local excision performed under general anesthesia. If preoperative criteria were not confirmed by histopathologic specimen examination, a major operation was advised. To increase the chance of local control, external adjuvant radiotherapy was used in T2 cancers. Postoperative mortality was 0 percent. The postoperative complication rate was 9.3 percent. The observed local recurrence rate was 3 percent, and the rectal cancer-specific death rate was 6 percent. We compared these results with those obtained in 70 concomitant patients operated on by us employing a traditional resection for Dukes' A rectal cancer. There are no statistically significant differences between groups. In light of our findings, a policy of curative local excision is justified in accurately selected cases of distal rectal cancer.

[The prognostic role of anatomo-pathological factors in colorectal cancer: an univariate analysis]. / Ruolo prognostico dei fattori anatomo-patologici nel cancro del colon-retto: analisi univariata.

An univariate analysis of pathologic data of 987 patients with primary colorectal carcinoma treated over a period of 22 years was performed. Six variables such as tumor site, histologic type, depth of invasion, nodal involvement, distant metastases, histologic grade and tumor stage were tested for their prognostic value. 5-year survival rate was investigated. Patients with tumors in the left colon and rectum have shown a better prognosis than patients with tumors in the right colon (53-51% vs. 38% p = 0.0007). As regard histologic type non significant differences between mucinous and non-mucinous carcinoma was observed (44% vs 48% respectively p = 0.4). The depth of tumor invasion was an important prognostic factor; according to tumor infiltration patients can be divided in four groups (T1, T2, T3, T4) with 5-year survival rates of 80%, 74%, 39% and 16% respectively (p = 0.0000). Highly significant decrements in survival occurred when lymph node metastases were demonstrable (20% vs. 67% p = 0.0000). Prognosis was still strongly related to histologic grade, with significant difference in survival rates between G1 and G2-G3 tumors (71% vs. 48%-42% p = 0.0000). Finally prognosis was closely related to the stage of spread at the time of diagnosis.

Surgical approach and sandwich radiotherapy for resectable rectal cancer: advantages and problems.

One hundred and twelve patients with locally advanced adenocarcinoma of the rectum have been treated with a protocol of adjuvant radiotherapy from 1981 to 1989. Radiotherapy was administered with a "sandwich" method at a dosage of 2700 cGy preoperatively and of 1800 cGy post-operatively. Only patients in stages B and C have been considered for results. Postoperative morbidity has been 16% and postoperative mortality 2.7%. Local failure was seen in 20% of patients without significant differences by stage, location, grading and operative technique. Distant metastases were seen in 31% of patients. Five-year actuarial survival was 49% and respectively 58% in stage B and 38% in stage C (P less than 0.01). Compared with a series of historical controls treated with surgery alone, the local recurrence rate was 20% vs. 26%, the distant metastases rate was 31% vs. 38% and the five-year actuarial survival rate was 49% vs. 36% (P greater than 0.01).

[Hartmann's procedure in emergency surgery of the colorectum]. / L'intervento di Hartmann nella chirurgia d'urgenza del colon-retto.

The authors report their experience with Hartmann procedure. 28 patients were treated: 21 males and 7 females. The mean age was 58 years. Perforative diverticulitis was the commonest indication (14 patients), followed by carcinoma (11 patients). Miscellaneous causes accounted for 3 patients. This procedure was primarily performed as an emergency operation (71%). One patient died post-operatively (3.5%); post-operative morbidity was 10.7%. A second operation was not planned if the first operation had been performed for palliation of metastatic or locally advanced cancer (7 patients). Restoration of colonic continuity was achieved successfully in 14 patients with no mortality and morbidity. According to their experience, authors believe Hartmann procedure to be the most suitable operation facing a left colon emergency. It is usually easy to perform and well tolerated by poor risk patients.