Papillomatosis is a relatively common (22%) benign microscopic lesion in the breast and rarely seen in women less than 30 years old. It is a papillary proliferation of the ductal epithelium which ...partly fills up smaller ducts and to degree distends them. The histological classification of this entity is controversial because similar or identical lesions have been classified using different terms such as epitheliosis and epithelial hyperplasia, and interpretation of published series has been difficult due to imprecise definition of this term. Clinical, radiological and histological patterns of this entity are often sufficient to raise concern as to possible malignancy. Moderate or florid hyperplasia without atypia is considered to carry slight (1,5-2 times) increase in risk of later developing cancer, while in the atypical hyperplasia the risk is four to five times that of the general population. The authors describe a case of papillonlatosis recentely observed in a 67 years old female patient and, confirmed the importance to establish an accurate preoperative diagnosis. It is important that the surgeon works with the pathologist to produce clear descriptive report of epithelial changes from normal through hyperplasia to atypias in order to establish a precise surgical indication.
Although the surgical treatment of acute and complicated diverticulitis has been refined over the years, discussion is still ongoing about whether a single or two stage procedure (Hartmann's ...procedure) should be performed in patients with peritonitis from perforation of a colonic diverticulum. A retrospective review was completed for patients undergoing surgery for acute complicated diverticulitis from 1980 to 1997. All patients were categorized according to Hinchey classification. Of the 186 patients treated, emergency operation was performed in 52 (28 per cent; group I) and an elective operation in 134 (72 per cent; group II). All patients had a resection of the involved colon and anastomosis was performed using CEEA staplers. In the group I, 50 patients underwent resection with immediate reconstruction with or without colostomy and two an Hartmann's procedure. Among the group II, primary anastomosis with or without proximal diversion was performed in 132 patients; two patients underwent an Hartmann's procedure. Post-operative mortality was of 5.76% in the group I and 2.9% in the group II. Nine anastomotic leaks occurred in the group I and 18 in the group II. Comparing these results with the recent literature, we have concluded that primary resection is virtually always possible in acute and complicated diverticulitis. Primary anastomosis with or without colostomy, in expert hands, is a safe procedure for patients in stage I of Hinchey's classification or II, but should be considered on an individual basis in presence of peritonitis. In case of fecal peritonitis, persistent hypotension, ascites, severe immune compromise and extreme malnutrition the Hartmann procedure represent the procedure of choice.
The Authors suggest a training programme for surgeons in post graduates courses. With this object in view, the inguinal hernia repair by Lichtenstein has been chosen as the most suitable one. The ...training course has been divided into theoretic lessons and surgical practice in the operating theatre, carried out in stages as assistant and then as operating surgeon. The good standard achieved, together with the clinical results obtained, demonstrates the effectiveness of the teaching method.
Neurinomas of the brachial plexus: case report Forte, A; Gallinaro, L S; Bertagni, A ...
European review for medical and pharmacological sciences,
1999 Jan-Feb, Letnik:
3, Številka:
1
Journal Article
Recenzirano
Neurinomas, also referred to as neurilemmomas and schwannomas, are rare benign tumours of the peripheral nerves, a low proportion of which arise from the brachial plexus. Authors report a case of an ...ancient schwannoma arising from the brachial plexus. The tumour, usually asymptomatic, may cause sensory radicular symptoms, or rarely motor deficits in the involved arm. Enucleation of the tumour from the nerve without damage to any of the fascicles is the correct treatment.
Neurinomas, also referred to as neurilemmomas and schwannomas, are rare benign tumours of the peripheral nerves. A small percentage of these lesions arise from the brachial plexus. The Authors report ...two cases of schwannoma arising from the brachial plexus. Such lesions, usually asymptomatic, may cause sensitivity alterations or, less frequently, motor deficits in the involved arm. Tumour enucleation, avoiding damage to any of the nervous fascicles, is the treatment of choice.
Bronchogenic carcinoma is one of the tumors with the statistically most markedly rising incidence, at least in western countries. For many years both the resectability and the long-term results have ...remained invariable due to the serious delay with which the disease is usually diagnosed. In addition, the success of treatment appears to be closely correlated with disease stage; in particular lymph node involvement has a major influence on the long-term survival following adequate treatment. As a consequence, a strong conviction has established itself in recent years, that radical removal of all mediastinal lymph node stations ipsilateral to the operated lung represents not only a necessary staging procedure, but also a useful measure to improve the prognosis of these patients. However, the real utility of radical lymphadenectomy is questioned by a number of groups: on the one hand the supporters of lymph node "sampling", inasmuch as the usefulness of radical lymphadenectomy has not been demonstrated by randomized clinical trials; on the other hand those workers, in particular from Japan, who on the basis of observations of the lymphatic flow in the mediastinum stress the necessity to extend lymph node clearance to the nodal station contralateral to the tumor. The current opinion is changing under the influence of recent developments, for instance the possible use of the sentinel technique also in lung cancer, and the possibility of "reasonable" or targeted lymphadenectomies, planned in relation to the lobar location of individual tumor. Whichever of these approaches is chosen--and this choice is still a matter of debate--many agree about the importance of neoadjuvant treatment not only to render patients eligible for surgery but also to improve the prognosis for patients at the most advanced stages of the disease.
The authors report their experience in "minimally invasive" treatment of benign biliary lesions. More than 80% of them occur after injury to the bile ducts during cholecystectomy. The clinical ...experience reported in this work concerns three patients managed with a coordinated--percutaneous and endoscopic--approach. In all patients an ERCP with biliary sphincterectomy has been performed at first, followed by percutaneous biliary drainage with external-internal catheters. All drainage catheters have been removed after one year. No patient has evidence of recurrence after a mean follow up of 18 months. Only in a patient a recurrent cholangitis treated with antibiotic therapy has been observed. This preliminary study suggests that the "rendez-vous" technique may be useful for the initial management of biliary strictures in most patients. This association improves the success rate and can avoid surgery. The role of surgery is reserved to few selected cases and particularly to lesions which are detected at the time of the operation.
The Authors analyse the main problems concerning malignant tumours of the small intestine. They report a case of jejunal adenocarcinoma recently observed. They emphasise the importance of surgery, ...both diagnostic and therapeutic, even in advanced stages, for the treatment of this neoplasm.
The authors report their experience in ambulatory treatment of cicatrizial phimosis in outpatients, by using local anaesthesia with eutectic cream of lidocaine and prilocaine. This preliminary study ...shows that preparation seems to be effective and well tolerated. To the aim of getting a good analgesic result the most important aspects are a careful application of the cream all over the concerned area and an occlusive bandage for 60-90 minutes at least.
Seat-belt injuries to the supra-aortic trunks Illuminati, G; Caliò, F G; Bertagni, A ...
European review for medical and pharmacological sciences,
1997 Jul-Aug, Letnik:
1, Številka:
4
Journal Article
Recenzirano
Five seat-belt related injuries to the supra-aortic and cervical vessels occurring in four patients are reported. All patients but one were symptomatic, none presented with stroke, and in one case ...arterial lesion was revealed by delayed onset of symptoms. Outcome of surgical treatment was overall good. Systematic search of such injuries and surgical repair of those without major neurological signs might be advisable.
