Resected squamous cell carcinoma of the lung infiltrating thoracic aorta: the endoprosthetic option--case report.

The introduction of endo-aortic prosthesis as protection of the vascular wall from selective adjuvant radiotherapy on microscopically aortic residual disease following left upper lobectomy for squamous carcinoma of the lung is suggested by the authors.

[Extended total gastrectomy: indications in the 3rd millennium]. / Gastrectomia totale allargata: quali indicazioni nel terzo millennio.

BACKGROUND: Total extended gastrectomy (TEG) is indicated in the treatment of gastric cancer for necessity or to achieve an oncologic radicality. By this surgical treatment the stomach and other organs or a part of them involved by primitive tumor are removed. METHODS: The authors report a study about 15 patients, out of 116 cases of gastric cancer, operated by TEG between 1990-1998. The middle-age of this patients was 63 years (range 45-76) and their general conditions were good in 9 cases and not-good in 6. The postoperative total parenteral nutrition (TPN) was carried out in all the patients, while preoperatively only in the most compromised patients. The surgical treatments were: 2 TG (total gastrectomy)+splenecomy; 3 TG+splenectomy+pancreatic resection; 4 TG+splenectomy+pancreatic resection+distal esophageal resection; 1 TG+distal esophageal resection; 2 TG+atypic hepatic resection; 1 TG+ atypic hepatic resection+duodenum resection; 2 TG+large intestine resection. While 10 patients were operated on to obtain radicality, 5 patients had a palliative treatment. RESULTS: There was not perioperative mortality, but we have observed: one dehiscence of the duodenal stump and one pancreatic fistula treated with conservative therapy; one left subfrenic abscess treated with surgical therapy. The survival has been higher in the patients treated with radicality. On the basis of these cases, the authors consider: 1) the possibility to obtain radicality by TEG; 2) the gastric localizations more often associated to extravisceral neoplastic localization; 3) the role of extensive lymph node resection (III and IV level) to obtain oncological radicality or neoplastic reduction. CONCLUSIONS. On the basis of their personal experience and related literature, the authors conclude that TEG is indicated to: 1) obtain a better lymphadenectomy; 2) obtain an oncologic radicality; 3) reduce the neoplastic mass in order to facilitate adjuvant therapy; 4) avoid or treat neoplastic complications; 5) improve the quality of life.

Transudative right pleural effusion due to compression of the brachiocephalic vein caused by an intrathoracic goitre.

The case presented in this report is of a female patient who suffered recurrent transudative right pleural effusions, due to a giant benign intrathoracic goitre. The latter caused compression of the brachiocephalic vein, which is a very rare cause of pleural fluid accumulation. Magnetic resonance imaging played a crucial diagnostic role.

[Meigs' syndrome: its clinical picture and treatment]. / Sindrome di Meigs: inquadramento clinico e trattamento.

Meigs' syndrome is a rare clinical entity characterised with ovarian benign tumour, ascites and hydrothorax. Between January '94-September '98 we observed three patients with: ovarian neoformation, light (1 patient), moderate (2 patients) monolateral pleural effusion, moderate (2 patients) and considerable (1 patient) ascites. In all patients the preoperative evaluation (sero-haematologic routine, Ca 125 and other oncologic markers, chest X-ray, abdominal and pelvic ultrasonography, total-body Tc, cytological analysis of pleural and abdominal effusion) was suggestive for malignancy but not confirmed it. So an explorative laparotomy with histological extemporary analysis was performed. The results were: 1 fibrothecomas, 1 fibroma, 1 ovarian inflammation with cystic luteinization areas and fibromatosis uterine. All three patients had a good postoperative course. The symptomatology and the effusions disappeared 7-10 days after operation. The first two cases were diagnosed as classic Meigs' syndrome, the third one, instead, as a pseudo-Meigs's syndrome. In conclusion the A.A., according to literature and their experiences, underline: 1) an ovarian mass with pleural and abdominal effusion not always represents an advanced malignancy; 2) even if elevated Ca 125 value is usually associated to a ovarian malignancy, there are some benign lesions in which we observed elevated level of this marker 3) the removal of the ovarian mass is the only resolutive treatment for these patients.

[Rare primary localization of echinococcus cysts. Presentation of 2 cases and review of the literature]. / Le cisti da echinococco primitive a localizzazione rara. Presentazione di due casi e revisione della letteratura.

Hydatidosis is a parasitic disease. It's generally localized in the liver and in the lung even if any other organ can be potentially affected. From 92 to 98 our group observed two cases of rare primitive localisation of echinococcosis (one mediastinal and one retroperitoneal cyst). The patients performed serologic and instrumental exams to establish the right therapeutic strategy. Both of them were operated (it was carried out a pericystectomy with open cyst in one of them and an exeresis of the right adrenal gland including hydatid cyst in the other one). A patient underwent to Albendazole prophylaxis. During the follow-up the patients performed echography, CT and MRI. Considering the literature's data and their experience the authors emphasize: 1. The diagnosis of rare primitive localization of hydatidosis is very difficult. 2. The diagnostic iter requires a correct relationship between the laboratory and imaging data. 3. Only the exclusion of other localizations of the cyst (liver, lung or other organs) give us the possibility to diagnose a rare primitive localization of hydatidosis. 4. The treatment of hydatidosis is specifically surgical. 5. The surgeon can use several different approaches in relationship to the place and the anatomopathologic characters of the cyst.

[Role of ultrasonography in the control of patients receiving perioperative total parenteral nutrition]. / Ruolo dell'ecografia nel controllo di pazienti sottoposti a nutrizione parenterale totale perioperatoria.

BACKGROUND: On the basis of personal experience and literature, this study has been carried out in order to clarify the impact of ultrasonography on the diagnosis and prevention of hepatobiliary complications Total Parenteral Nutrition (TPN)-related. METHODS: Between April 1995-April 1997 in the Department of General Surgery-University of Catanzaro, 18 adult patients submitted to major thoracic or abdominal surgery, underwent to TPN for perioperative time (range: 9-55 days). In these patients ultrasonography was performed at pre-established days in pre- and postoperative time in order to diagnose precociously the possibility of hepatobiliary complications. RESULTS: Ultrasonography showed: 3 cases of hepatic steatosis, 5 cases of steatosis and gallbladder biliary sludge, 2 cases of gallbladder biliary sludge alone, 1 case of gallbladder biliary sludge with microlithiasis, 1 case of acute acalculous cholecystitis. The other 6 patients presented only little laboratory tests alterations, but normal ultrasonographic findings. CONCLUSIONS: Therefore it is underlined the importance of systematic ultrasonographic follow-up of patients on TPN as a non invasive method in the early diagnosis of hepatobiliary complications TPN-related. The good compliance of the patients to this instrumental investigation and the not excessive increase of their management's costs are also underlined.

[Routine broncho-myo-plasty after pneumonectomy]. / Bronco-mio-plastica di principio dopo pneumonectomia.

Bronchopleural fistula is certainly the most important and specific complication following total pneumonectomy. In order to reduce this risk a systematic protection of bronchial suture by means of muscular flap transposition is suggested. The authors report 15 cases of total pneumonectomy for lung cancer at different localization. In all the patients a bronchomuscular plasty was used to protect the bronchial suture. The anterolateral body of latissimus dorsi, when it was possible, was preferred for the following reasons: 1) it makes the suture of the main bronchus greatly resistant; 2) it makes easier the obliteration of the pleural cavity; 3) its transposition is rapid and easy. In only one case a diaphragmatic flap was transposed together with its vascular and nervous system giving rise to a phrenic paralysis. Although few cases are reported, the results are successful and encourage the application of this procedure in future.

Tracheal rupture secondary to orotracheal intubation.

A case of tracheal rupture due to orotracheal intubation performed for anaesthesiological procedures is described. It is very likely that this rare complication was favoured by some anatomical factors, which were responsible for a difficult intubation. Tracheal rupture was diagnosed by endoscopy and treated by a decompressive tracheostomy.

[Recurrent biliary calculi]. / La calcolosi biliare plurirecidiva.

The Authors report two cases of recurrent bile duct stones and discuss about the diagnosis and treatment of this infrequent disease. Although diagnostic and management procedures are similar to those commonly used in all types of biliary stones, therapeutical options may be different in relation to the different clinical pictures. The Authors strongly suggest that bilioenteric anastomosis and endoscopic sphincterotomy are the best procedures to assure a correct and definitive treatment of recurrent biliary stones. However, the adoption of different diagnostic and therapeutic approaches, rather than univocal schemes, is recommended.

[Meigs' syndrome. A case report]. / Sindrome di Meigs. Descrizione di un caso.

The authors report on a case of Meigs' syndrome in a patient admitted with vomiting, abdominal pain, peritoneal and right pleural effusion, increased serum levels of CA 125. Surgical excision was successful.

[Rational and mini-invasive approach to the therapy in varicose syndrome: the C.H.I.V.A. treatment]. / Approccio razionale e mininvasivo alla terapia della sindrome varicosa: la cura C.H.I.V.A.

The principles of the C.H.I.V.A. (Ambulatory conservative and haemodynamic therapy of venous insufficiency) procedure are reported. According to the Authors a careful haemodynamic evaluation of the venous system strictly correlates to the clinical and functional results. In their experience, in fact, results showed no variceal recurrence and a very low rate of complications. Therefore, the C.H.I.V.A. procedure is recommended for most of the patients with lower limb varices.

[Carcinoma of the gastroesophageal junction. General principles of surgical therapy]. / Il carcinoma del giunto gastro-esofageo. Principi generali di terapia chirurgica.

On the basis of histo-pathological examinations of postoperative samples following gastrectomy for adenocarcinomas of the esophageal gastric junction, the usefulness of the abdominal approach for this kind of surgical treatment is questioned. Assessment is expressed with other authors about the need for an anatomo-surgical classification of the cardial region, and the need to standardise the different surgical approaches in relation to exeresis location and extent as well as for reconstructive procedures is stressed.

[The use of Mersilene mesh in the treatment of giant laparoceles]. / L'impiego della rete di Mersilene nel trattamento dei grandi laparoceli.

The paper reports on experience with the use of Mersilene mesh in 6 patients with giant laparoceles. Besides being physiologically compatible, Mersilene mesh is recommended when traditional techniques fail. The Rives technique was used, placing the prostheses between the posterior sheath and the rectus muscle; in one case it was inserted under the peritoneum. A good local and general preparation for the operation is recommended. Even though the introduction of prosthetic materials into the body is not always non-injurious, the use of Mersilene mesh is advised because of its easy positioning and the low incidence of complications.