[Post-mastectomy breast reconstruction: esthetic-psychological rebalance]. / Ricostruzione mammaria postmastectomia riequilibrio estetico-psicologico.

Patient motivation and desire are the main indications for restoring the breast. Breast reconstruction can alleviate the sense of deformity that may develop after mastectomy or conservative treatment.

Endolaparoscopic rendezvous treatment: a satisfying therapeutic choice for cholecystocholedocolithiasis.

BACKGROUND: There are many different strategies for the treatment of the main bile duct lithiasis. When lithiasis of the biliary tract is suspected at a preoperative stage, we can treat patients with sequential treatment: endoscopic netrograde cholangiopancreatography followed by laparoscopic cholecystectomy. If common bile duct-lithiasis is recognized at an intraoperative stage, many options for treatment exist, one of which is intraoperative retrograde endoscopic sphincterotomy (ES) (laparoendorendezvous). METHODS: We report our experience using the aforementioned technique with 58 patients affected by cholelithiasis and complex Common bile duct disease who underwent laparoscopic cholecystectomy and intraoperative ES consecutively from March 1996 to May 2000. Of the 58 patients, 43 were affected by cholecystocholedocolithiasis: 12 by previously described lithiasis plus stenosant papillitis, 2 also by a pancreas head cancer, and 1 by cancer of the papilla. RESULTS: The combined technique was performed in 86% of the cases. Six patients required conversion to open surgery. In two other patients, laparoscopic choledocotomy was performed with positioning of a Kehr-tube for an ampulla-impacted lithiasis. CONCLUSIONS: Intraoperative ES offers a valid approach to the treatment of cholecystocholedocolithiasis in one session. Furthermore, it represents a valid alternative to transcholedocical laparoscopic treatment of cholelithiasis and complex common bite duct pathology.

Digestive hemorrhages of obscure origin.

BACKGROUND: The diagnosis of digestive bleeding in some cases can require a diagnostic laparotomy when other methods have been ineffective. Video-laparoscopy can provide such cases with a certain diagnosis and the possibility of performing a simultaneous surgical treatment. METHODS: Our experience using video-laparoscopic to treat digestive hemorrhages of obscure origin involved 16 patients. The examined patients presented with the following diseases: Meckel's diverticulum (8 cases), gastric leiomyoma (1 case), small bowel leiomyoma (4 cases), jejunum leiomyosarcoma (1 case), small bowel melanoma (1 case), and Peutz-Jeghers syndrome (1 case). RESULTS: In all these patients the laparoscopic approach allowed us to identify the origin and site of the hemorrhages, and subsequently to treat the identified lesions. In one patient, an intraperitoneal resection of the diverticulum was performed using Endo-Gia (TM30NIF; Tyco Auto-Suture). In the remaining cases, a minilaparatomy was performed for resection of the disordered loop. CONCLUSIONS: Video-laparoscopy is very useful for avoiding explorative laparatomies on patients affected by digestive hemorrhages of obscure origin. In these cases, the video-laparoscopic approach allows full and meticulous explorations of the small bowel to be performed, and seems to be useful for diagnosis through direct observation of the lesions. Moreover, if necessary, video-laparoscopy can be used for the effective treatment of the diseases.

[Madelung's disease. Clinical case and review of the literature]. / Malattia di Madelung. Caso clinico e revisione della letteratura.

Symmetrical benign lipomatosis (Madelung's disease) is extremely rare. Approximately 200 cases have been reported in the literature. SLB is a syndrome characterized by the occurrence of symmetric lipomas of the neck. No clear etiology has been recognized while a frequent association with systemic metabolic abnormalities has been described. The only effective therapy is the palliative surgical removal of the fatty tissue by lipectomy or liposuction. Experience with surgically treated patients shows the tendency of this disease to recur.

[Hydatid cysts of the right lobe of the liver treated with total pericystectomy using a transparenchymal approach]. / Cisti idatidee del lobo destro del fegato trattate con pericistectomie totali per via transparenchimale.

The Authors report on 2 cases of hydatid cyst of the right hepatic lobe. A transparenchymal approach with total pericystectomy was the treatment of choice.

[Laparoscopic adrenalectomy: technical knowledge in lateral position]. / Adrenectomia laparoscopica: note di tecnica con posizione laterale.

Laparoscopic approach to adrenal glands present to the patient the advantages of a lower invasivity respect to anterior or posterior thoracoabdominal access. Thanks to the minor pain occurring after the operation, the rapid gain and canalization, the brief hospitalization and the better aesthetic result. This method is to prefer to the others.

[Splenic localization of an echinococcal cyst]. / Localizzazione splenica della cisti da echinococco.

The finding of echinococcal cyst in the spleen is an extremely uncommon event occurring in Literature in 4% of the cases, setting, for frequency, after the liver and the lungs. The symptomatology is not very evident, being characterized by fever, left upper quadrant fullness or discomfort due to splenomegaly, which is demonstrable with physical examination and US. Splenectomy is the best surgical choice in the treatment of echinococcal cyst while conservative surgery should be reserved as an alternative in very selected cases.

[Primary cysts of the spleen: a case report]. / Cisti primarie della milza: descrizione di un caso clinico.

The cystic pathology of the spleen is comparatively infrequent and the origin is parasitic, hydatid. The parasitic cysts are the 65% of the total and the cysts secondary at trauma are the 28%. The real or primary cysts of the spleen are only the 75 of the case record. Analyze, in this work, the etiology and the clinic of these formations and show the personal experience about a clinical case arrived at our observation with negative anamnesis for trauma and with aspecific symptomatology like dyspepsia. We think that this notification is useful because the cystic primary formations of the spleen are very rare.