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Background and Objectives: A variety of neurologic disorders have been reported as presentations or complications of coronavirus disease 2019 (COVID-19) infection. The objective of this study was to determine their incidence dynamics and long-term functional outcome., Methods: The Neuro-COVID Italy study was a multicenter, observational, cohort study with ambispective recruitment and prospective follow-up. Consecutive hospitalized patients presenting new neurologic disorders associated with COVID-19 infection (neuro-COVID), independently from respiratory severity, were systematically screened and actively recruited by neurology specialists in 38 centers in Italy and the Republic of San Marino. The primary outcomes were incidence of neuro-COVID cases during the first 70 weeks of the pandemic (March 2020-June 2021) and long-term functional outcome at 6 months, categorized as full recovery, mild symptoms, disabling symptoms, or death., Results: Among 52,759 hospitalized patients with COVID-19, 1,865 patients presenting 2,881 new neurologic disorders associated with COVID-19 infection (neuro-COVID) were recruited. The incidence of neuro-COVID cases significantly declined over time, comparing the first 3 pandemic waves (8.4%, 95% CI 7.9-8.9; 5.0%, 95% CI 4.7-5.3; 3.3%, 95% CI 3.0-3.6, respectively; p = 0.027). The most frequent neurologic disorders were acute encephalopathy (25.2%), hyposmia-hypogeusia (20.2%), acute ischemic stroke (18.4%), and cognitive impairment (13.7%). The onset of neurologic disorders was more common in the prodromic phase (44.3%) or during the acute respiratory illness (40.9%), except for cognitive impairment whose onset prevailed during recovery (48.4%). A good functional outcome was achieved by most patients with neuro-COVID (64.6%) during follow-up (median 6.7 months), and the proportion of good outcome increased throughout the study period ( r = 0.29, 95% CI 0.05-0.50; p = 0.019). Mild residual symptoms were frequently reported (28.1%) while disabling symptoms were common only in stroke survivors (47.6%)., Discussion: Incidence of COVID-associated neurologic disorders decreased during the prevaccination phase of the pandemic. Long-term functional outcome was favorable in most neuro-COVID disorders, although mild symptoms commonly lasted more than 6 months after infection., (Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the American Academy of Neurology.)

We apply the technique of convex integration to obtain non-uniqueness and existence results for power-law fluids, in dimension d ≥ 3 . For the power index q below the compactness threshold, i.e. q ∈ ( 1 , 2 d d + 2 ) , we show ill-posedness of Leray-Hopf solutions. For a wider class of indices q ∈ ( 1 , 3 d + 2 d + 2 ) we show ill-posedness of distributional (non-Leray-Hopf) solutions, extending the seminal paper of Buckmaster & Vicol [10]. In this wider class we also construct non-unique solutions for every datum in L 2 ., (© The Author(s) 2021.)

We construct a large class of examples of non-uniqueness for the linear transport equation and the transport-diffusion equation with divergence-free vector fields in Sobolev spaces W 1 , p .

Background: Prepubertal gynecomastia is an extremely rare condition usually requiring surgical treatment, especially in case of class III gynecomastia. This study presents cases treated with a new surgical treatment., Methods: From 2010 at our institution, gynecomastia is treated surgically using a modified technique of periareolar incision. Aesthetic results and possible complications of this technique are reported., Results: Five patients were treated at the authors' unit for class III gynecomastia between January 2010 and December 2011. All patients were properly treated without the need of further surgery for skin resection. One patient developed seroma, treated with suction; one patient showed hematoma, treated with hot packs for 3 weeks. All patients and their parents were satisfied of the aesthetic results obtained. All patients resumed sport activities 4 weeks after surgery. It was not possible to observe intraoperative complications., Conclusion: The technique used meets safety and efficacy standards for the treatment of this type of pediatric gynecomastia. It also offers the best possible aesthetic results with minimum complications which can be treated without the need of further surgery.

Background: Barrett's esophagus (BE) is one of the complications of gastroesophageal reflux disease (GERD) and a premalignant condition. It consists of a process of replacement of the squamous epithelium of the esophagus by intestinal columnar epithelium containing goblet cells, known as specialized intestinal metaplasia with goblet cells, and several factors have been related to its pathogenesis. The objective of this study was to evaluate an experimental model of duodenogastroesophageal reflux and the effect of ingestion of sodium nitrite solution on the genesis of adenocarcinoma associated with Barrett's esophagus., Materials and Methods: Sixty male Wistar rats were divided into four groups. Twenty were not submitted to surgery and served as controls (10 animals ingesting only water and 10 ingesting water plus a solution of sodium nitrite), while the remaining 40 animals were submitted to side-to-side duodenogastroesophageal anastomosis (20 animals ingesting only water and 20 ingesting water plus the sodium nitrite solution). The Vienna classification for dysplasia and adenocarcinoma was used in the analysis of results., Results: After 42 weeks of observation, Barrett's esophagus was found in 26.3% (5/19) of the animals submitted to surgery that had not ingested nitrites compared to 72.3% (13/18) of the animals in the group submitted to surgery and given nitrites. Six cases of adenocarcinoma (33.3%) were also found in this latter group. Barrett's esophagus was not found in any of the animals that were not submitted to surgery. Categories 2, 3 and 5 of the Vienna classification were only found in the animals submitted to surgery that also received sodium nitrite (66.7%)., Conclusion: The ingestion of sodium nitrite associated with duodenogastroesophageal reflux plays an important role in the genesis of adenocarcinoma associated with Barrett's esophagus.

Extremely elderly patients are being treated with anticoagulant therapy with increasing frequency. We sought to assess the rates of bleeding in such patients and to carefully examine risk factors that might predict this bleeding. This was a prospective cohort study conducted from 1 January 2007 to 29 February 2008 at an anticoagulation clinic in Modena, Italy. Ninety patients, 90 years or older, among 1635 patients with nonvalvular atrial fibrillation were studied; 69 (77%) were women with a median age of 91.71 years (range 90-98). During the enrolment period, all the patients were interviewed during an ambulatory visit and were followed in the outpatient setting. Hemorrhagic, thromboembolic and fatal events over 1 year of follow-up were monitored. Six (7%) patients discontinued vitamin K antagonists (three due to bleeding, two due to noncompliance, two due to physician recommendation). Twenty-one (23%) patients died, and 35 (39%) were admitted to hospital. One patient had an intracranial hemorrhage [1%, 95% confidence interval (CI) 0.27-6.0], two patients had a major extracranial hemorrhage (2%, 95% CI 0.7-8.0). One patient had an ischemic stroke (1%, 95% CI 0.27-6.0), two patients had embolic arterial ischemia (2%, 95% CI 0.7-8.0). All the events occurred when the international normalized ratio was outside the target range, or after oral anticoagulation had been stopped. In our study of extremely elderly anticoagulated patients, we found low rates of bleeding and thromboembolism. These findings support the use of oral anticoagulants in such patients.

Venous thromboembolism (VTE) is a common complication among hospitalized patients. Pharmacological thromboprophylaxis has emerged as the cornerstone for VTE prevention. As trials on thromboprophylaxis in medical patients have proven the efficacy of both low-molecular-weight heparins (LMWHs) and unfractionated heparin (UFH), all acutely medical ill patients should be considered for pharmacological thromboprophylaxis. Unlike in the surgical setting where the risk of associated VTE attributable to surgery is well recognized, and where widespread use of pharmacological thromboprophylaxis and early mobilization has resulted in significant reductions in the risk of VTE, appropriate VTE prophylaxis is under-used in medical patients. Many reasons for this under-use have been identified, including low perceived risk of VTE in medical patients, absence of optimal tools for risk assessment, heterogeneity of patients and their diseases, and fear of bleeding complications. A consistent group among hospitalized medical patients is composed of elderly patients with impaired renal function, a condition potentially associated with bleeding. How these patients should be managed is discussed in this review. Particular attention is devoted to LMWHs and fondaparinux and to measures to improve the safety and the efficacy of their use.

The aim of this prospective cohort study was to determine the incidence of dalteparin bioaccumulation (measured using anti-Xa levels), and bleeding during thromboprophylaxis in elderly patients with renal failure who were admitted to hospital with an acute medical illness. Patients who met the criteria for being at high thromboembolic risk received dalteparin 5,000 IU subcutaneously once daily while the other patients (low risk) received 2,500 IU daily. Thromboprophylaxis was administered for at least 6 days. Anti-Xa activity was determined before the first dalteparin dose and again on day 6, 4 hours after the administration of the dalteparin dose. Bleeding was assessed daily. Compression ultrasonography was performed to identify any deep vein thromboses. There was no evidence of bioaccumulation on day 6 of therapy, irrespective of renal function. No episodes of major bleeding or venous thromboembolism occurred. Larger, randomized studies are warranted to confirm the safety of dalteparin in this patient population.

Background: Metronidazole is first-line therapy for C. difficile-associated diarrhea primarily because of its low cost relative to vancomycin. Currently, it is unknown which patients will fail metronidazole therapy. Our goal was to prospectively evaluate risk factors for metronidazole failure., Study: Included patients had symptomatic C. difficile-associated diarrhea, either mild or severe. Once enrolled, detailed baseline data were gathered. All interviews were performed daily while the patient was in the hospital for up to 14 days. If discharged prior to 14 days, the patient received a follow-up phone call on day 5 and day 14. Enrolled patients were given a daily stool survey to complete., Results: We enrolled 27 patients with C. difficile-associated diarrhea. All patients (10 of 10) who had their offending antibiotic(s) discontinued had symptomatic resolution of diarrhea by day 14 of metronidazole treatment. Conversely, 59% (10 of 17) of patients who remained on antibiotics during treatment had symptomatic resolution by day 14 (P=0.02). The risk ratio for treatment failure was 2.0 (95% confidence interval, 1.29-3.10) in patients who remained on antibiotics. In our treatment group, there would be one additional metronidazole treatment success for every 2.4 patients who discontinued antibiotics., Conclusion: Patients who remain on antibiotics while undergoing treatment of C. difficile-associated diarrhea have a high likelihood of treatment failure with metronidazole.

Objectives: Clostridium difficile is the most common cause of infectious nosocomial diarrhea and can be found in up to 30% of asymptomatic hospitalized patients. Our primary aim was to compare the clinical characteristics of hospitalized patients who received antibiotics and developed C. difficile-associated diarrhea (CDAD) with those of hospitalized patients who received antibiotics and did not develop the disease., Design: Case-control study comprising inpatients at a single institution., Patients: Case-patients were defined as patients who had diarrhea and tested positive for C. difficile. Control-patients (matched 4:1 to case-patients) were defined as patients who received antibiotics for at least 5 days and did not develop CDAD., Results: On univariate analysis, nine variables were associated with CDAD. Only three of the variables, need for intensive care, length of stay, and macrolide antibiotic use, were found to be significant (P < .05) on logistic regression analysis. The odds ratios for status as a CDAD case were 3.68 (CI95, 1.44 to 9.40) for stay in the intensive care unit and 1.03 (CI95, 1.02 to 1.05) for each day of hospital stay. Receipt of macrolide antibiotics reduced risk significantly; the odds ratio was 0.23 (CI95, 0.19 to 0.87)., Conclusions: We identified need for intensive care and length of stay as important risk factors for the development of CDAD. We also identified macrolide antibiotic use as protective against its development. Patients receiving intensive care may represent a population to study for targeted prophylaxis.

A mammographic screening program was started in 1999 in the Province of Verona and was offered to women aged 50-69. The purpose of this study was to analyse and compare our data, particularly the type of surgery and histotype, with the literature data where no screening program was implemented. During the first three years of the screening, 113 patients underwent surgical treatment in our Institute. The histology of the mammary lesions was benign neoplasia in 28 (24.7%) and breast cancer in 85 (75.3%) patients. Seventy-three women (85.9%) with malignant neoplasms were submitted to conservative treatment. Mastectomy was performed in 12 (14.1%) patients, 8 of whom with immediate breast reconstruction. Patients coming from screening programs benefit in a high percentage of cases from conservative treatment, which, together with the reduced aggressiveness of the cancers, permits alternative treatments for the axillary lymph nodes and a reduction in adjuvant chemotherapy.

Aim of the Study: To evaluate the indications for open surgical biopsy of breast lesions resulting in a benign histologic report., Methods: A consecutive series of 754 benign breast biopsies was collected from six Italian centers previously participating in a multicenter study on the benign/malignant biopsy ratio. Histologic diagnosis, diagnostic tests performed, final clinical diagnosis and the indication for surgical biopsy were compared., Results: Fibrocystic alterations represented the most frequent histologic type (43.2%), followed by fibroadenomas (34.5%). Atypical hyperplasia, phyllode tumors and cancer-like lesions (radial scar, sclerosing adenosis) accounted for a minority of cases. The diagnostic approach was different among centers, with mammography, ultrasonography or cytology being underused in some of them. Suspicion of cancer was an indication for surgical biopsy in 66.7% of cases. In the remaining cases the final report was negative or benign, but biopsy was advised for growing lesions (11.3%) or for cosmetic (3%) or psychological reasons (8.2%). In 4% of cases surgical biopsy was presumably advised for the concurrent influence of high-risk conditions such as previous breast cancer (0.7%), family history of breast cancer (2%) or contralateral synchronous breast cancer (1.3%). In 6.8% of the cases biopsy was advised elsewhere for unknown reasons. The indications for biopsy differed among centers, with one center having a low rate of suspicious cases (37%) and a high rate of reported "cosmetic" or "psychological" reasons (47%)., Conclusions: Leaving aside differences in diagnostic approach and aggressiveness, two thirds of all lesions were biopsied in order to exclude cancer. The routine use of a more complete diagnostic protocol and/or alternative methods to obtain a histologic diagnosis (e.g. core biopsy) might substantially reduce the need for open surgical biopsy.

A 67 year old man presented with non-invasive thymoma, associated aplastic anemia and important hypogammaglobulinemia; the postoperative course has been characterized, three months later, by thrombocytopenia (kept under control with steroid therapy) and, two years later, by squamous lung cancer, not susceptible of surgical treatment. The patient died five years after operation because of progression of the lung cancer. Anemia improved only partially after operation; there where no effects on hypogammaglobulinemia. Thymoma has been reported in literature in 50% of patients with aplastic anemia, 7-13% of adult patients with hypogammaglobulinemia is affected by thymoma, in 21% of patients that presented with thymoma other tumors have been discovered through clinical history.

Over the last few years, estrogen receptor determination by means of immunohistochemistry has been extensively used. The aim of this study was to compare this technique with estrogen receptor determination by means of dextran-coated charcoal, and to evaluate whether one of the two methods is more predictive of prognosis. Estrogen receptors were determined by means of both the dextran-coated charcoal method and immunohistochemistry in 405 patients with primary breast cancer; age, pathological tumor size, nodal status, and progesteron receptors by dextran-coated charcoal method were also recorded. The disease-free and overall survival probabilities were estimated using the product-limit method; Cox's proportional hazard model was used to evaluate the prognostic role of estrogen receptors as determined by the two methods. There appears to be a close association between estrogen receptor determination by the two methods (81.5% of concordant results) and their prognostic role was similar, even when the patients were divided into different groups (on the basis of their estrogen receptor status) and adjustments for the effect of other prognostic variables were taken into account. Our study shows that the two methods can be used indifferently to evaluate estrogen receptor status as a prognostic factor in breast cancer patients.

The diagnosis of traumatic hernia of the diaphragm can be obtained at the time of injury or months-years after the trauma. The Authors report a case of traumatic hernia of the diaphragm, diagnosed 3 years after a blunt thoracic trauma in a 47-year-old man. The patient was admitted to the hospital for a pneumothorax caused by perforation of the herniated colon. He underwent colonic resection and reduction of the herniated viscera but unfortunately he died of septic shock on the 40th postoperative day. Pneumothorax is a very rare complication of traumatic diaphragmatic hernia and few cases are reported in literature. The diagnosis in the delayed phase is not easy since the correlation with the trauma is not always clear.

Aim: Retrospective evaluation of 19 diaphragmatic ruptures due to blunt trauma., Materials and Methods: We collected all patients with thoracic and/or abdominal blunt trauma who were admitted to the department of surgery (Clinica Chirurgica and Chirurgia generale C) from 1970 to 1995. We selected patients with ascertained diaphragmatic rupture., Results: We considered 17 cases of TDR (15 males and 4 females). Mean age was 38 years (range 16-67). Radiologic findings were consistent with TDR in 10 cases out of 17 (58.8%). Right hemidiaphragm was injured in 6 cases (31.6%). 10 patients (52.6%) presented at operation with intrathoracic visceral herniation. 8 patients underwent laparotomy, 7 both laparotomy and thoracotomy, 4 thoracotomy alone. Perioperative mortality was 15.7% (3 patients)., Discussion and Conclusions: The clinical features were complicated by a large number of associated lesions; radiologic diagnosis is comparatively easy if visceral herniation into the thorax is present, repeated radiologic examinations facilitate diagnosis. The surgical access is determined by concomitant associated injuries which may require urgent operation.

Aims and Background: Although they have been decreasing over time due to improved specificity of diagnostic assessment, benign biopsies of the breast are still common. Benign biopsies should be regarded as negative events, due to their economical and psychological cost and their possible negative impact on cosmesis and on further diagnostic evaluation., Methods: Retrospective data on benign/malignant breast biopsies ratio (B/M) were collected in 9 Italian centers for a period of 10-15 years. The time trend of B/M and its association to age or to single centers was evaluated., Results: Overall 31,001 cases were considered. A strong association of B/M to age was evident (average B/M values were 5.0, 1.3, 0.6, and 0.2 for women aged < 40, 40-49, 50-59, and > 59 years). A significant trend of decreasing B/M over time was observed only for one center. Age standardized B/M was significantly different (P < 0.000001) between centers, ranging between 0.34 and 1.69. Multivariate analysis confirmed an independent significant association of age and center to B/M., Conclusions: Marked differences in B/M are evident between centers, which cannot be explained by the confounding effect of age or by any apparent difference in the diagnostic protocol. The observed differences are likely ascribed to individual variations in diagnostic aggressivity. A progressive increase of the predictive value of calls for surgical biopsy may be achieved over time and centers with a high B/M should make every effort to optimize their performance. Acceptable (< 40 = 5, 40-49 = 1.5, 50-59 = 0.75, > 59 = 0.3) and desirable (2.5, 0.75, 0.35, 0.15) age specific reference standards for B/M are proposed.

The authors consider 88 cases of mastectomy and immediate breast reconstruction mainly performed using the skin expander plus prosthesis method or latissimus dorsi myocutaneous flaps. At the same time, 53 patients underwent contralateral mastopexy for symmetry. The mean follow-up was 21 months (range 2-102). Progressive disease was observed in nine cases: one patient presented scar relapse, one axillary relapse, two contralateral tumor, two contralateral tumor and distant metastasis, three distant metastases and one death from distant metastasis. Reconstruction complications were capsular contracture in 12 cases, infection in nine, skin necrosis in two, skin expander breakage in three and implant dislocation in one. The final result was judged good in 54 cases, fair in nine, poor in 11 and unevaluable in 14. In conclusion immediate breast reconstruction does not seem to interfere with the disease or oncological therapy. After analysing separately, and comparing the results and complications of the two main techniques used, latissimus dorsi seems to be the most reliable method in the majority of cases but skin expanders can be a good technique in patients with small and firm breasts and without complicating risk factors.

Objective: To present our experience of 10 patients with extra-adrenal retroperitoneal paragangliomas, and assess prognostic tests., Design: Retrospective study of casenotes., Setting: University hospital, Italy., Subjects: 10 Patients who presented with paragangliomas between 1970 and 1991., Main Outcome Measures: Histological and immunohistochemical results, and outcome., Results: All tumours were completely resected and there was no operative mortality. Of the 8 patients who had no metastases at presentation 3 died of recurrence 3, 5, and 10 years later, respectively; 4 were alive and free of disease 2-7 years after diagnosis. The 2 patients with synchronous bone metastases at presentation died 1 and 4 years later. Immunohistochemical analysis of type I cells (chromogranin A and neurone-specific enolase) showed little correlation with progression of disease, but there was a correlation between the presence of type II cells (S100 protein) and good prognosis., Conclusions: Excision is the treatment of choice for paraganglioma. Immunohistochemical techniques may provide useful information about prognosis, in particular about those patients who are at increased risk of recurrence. Long term follow up is essential, because successful management of recurrence is dependent on early recognition.

27 patients suffering from carcinoid of the lung (18 females and 9 males, middle age 52 years, range 26-68) underwent surgery in our department. The neoplasms were located at the pulmonary hilum in 21 cases. The diagnosis was occasional in 6 cases, cough (51.8%) and recurrent bronchitis (37%) were the most frequent symptoms. No instances of carcinoid syndrome were detected. Preoperative staging ruled out pathologic mediastinal lymph nodes or hematogenous metastases. 26 patients underwent complete excision of the neoplasm (11 lobectomies, 9 pneumonectomies, 4 bilobectomies, 1 segmental resection, 1 bronchial wedge resection). Histologically, 4 cases were categorized as atypical carcinoids. Two patients died within 1 year, one suffering from atypical carcinoid because of disease progression, and an other one (suffering from atypical carcinoid) who underwent only at exploratory thoracotomy followed by chemotherapy. A patient suffering from typical carcinoid died within 1.5 years because of gallbladder carcinoma. From our experience and from the literature review it appears that carcinoids has to be considered as malignant neoplasms and treated according to.

9 patients (8 males 1 female, middle age 24.3 years, range 20-41) affected by primary mediastinal germ cell tumor were surgically treated in our department. They were 4 seminomas, 2 embryonal carcinomas, 1 malignant teratoma and 2 benign teratomas. Three patients were asymptomatic; cough, dyspnea and chest pain were the most frequently observed symptoms. The staging work-up did not show signs of metastatic disease in the malignant types. Benign teratomas underwent complete excision. In one patient suffering from seminoma radiotherapy and chemotherapy caused complete remission of the disease. In the others cases remission of the neoplasm was obtained by resection and adjuvant therapy in 3 cases, by neoadjuvant treatment and excision of the residual mass in 3 cases. Among the patients suffering from seminoma, 2 are dead at 60 months since initial treatment and 2 are alive at 132 and 120 months respectively. Among the patients with malignant nonseminomatous tumours, 2 are alive at 60 and 36 months and 1 patient is dead at 13 months. Two patients with benign teratoma are alive at 189 and 168 months respectively. At present a multimodality treatment including surgery, radiotherapy and cisplatin-based combination chemotherapy, give the most satisfactory results in the treatment of malignant mediastinal germ cell tumours.

Four cases of iatrogenic rupture of the oesophagus are presented. The site of the lesion was in the cervical tract in 1 case and in the thoracic tract in the other 3 cases. Their etiology was pneumatic endoscopic dilatation for achalasia in 2 cases, endoscopic insertion of a Celestin tube for carcinoma of the thoracic tract of the oesophagus in 1 case, and diagnostic endoscopy in the last one. Instrumental findings were relevant in all cases. All patients underwent surgery. In the patients suffering from achalasia, the rupture was repaired by a patch of the gastric fundus. The patient suffering from carcinoma underwent an oesophageal resection, the one with cervical perforation underwent a mediastinal drainage. There were no deaths or considerable post operating complications. In a patient suffering from achalasia gastro-oesophageal reflux was demonstrated after some months following the operation.

Retrospective analysis of 17 cases of phyllodes tumor with a follow-up of almost 1 year revealed no close correlation between histological pattern and clinical course, since local relapse occurs even after histological findings of benign lesion in the primary tumor. Phyllodes and fibroadenoma patterns are often associated in the same patient and extensive surgery is not recommended owing to the fact that recurrences are observed both after subcutaneous mastectomy and after simple resection. We conclude that local control of the disease by wedge resection and strict follow-up may be the most rational approach.

Estrogen and progesterone receptor status was reviewed in 405 patients from prior adjuvant breast cancer trials at the University of Verona. Only 233 patients were actually examined with respect to hormone status and outcome. No relationship between hormone receptor status and most of the commonly followed prognostic signs, i.e. tumor size, nodal status, and age, was found. Overall survival was correlated with hormone receptor positivity for patients with more than 4 positive axillary nodes. Disease-free survival was correlated only with PgR positivity, in premenopausal and in T1 groups.

The authors consider their experience in male breast cancer. Making a review of the literature they point out the risk factors and the prognosis of this disease.

The finding of a case of cystadenocarcinoma supplies the opportunity for a reviewing of the literature concerning this rare liver neoplasm. From a diagnostical standpoint, the instrumental tests result non-specific. Only the needle-biopsy of papillary formations set forth through the echography within hepatic formations of cystic type is able to supply diagnoses of cystadenocarcinoma. Yet, the procedure is not exempt from risks. Decisive may be the peroperative histologic testing on fragments of the cyst wall. In consideration of the better prognosis of cystadenocarcinoma in respect of hepatocarcinoma and cholangiocarcinoma, and the risk of relapse, the election surgical treatment should be represented by hepatectomy.

The Authors show three cases of mediastinal seminoma, and discuss the epidemiologic, etiopathogenetic and clinical aspects of such neoplasms; they dwell upon the criteria allowing to define as primitive an extragonadal germinal tumour, and emphasize the importance of the multidisciplinary therapeutical approach in controlling these neoplasms, characterized anyhow in the pure forms by a remarkable sensitiveness to radium; promising looks the use of the tumoral markers (beta-HCG and AFP) for a diagnostical specification, for the choice of the treatment and for the evaluation of its effects.

The authors consider the incidence of arm lymphedema after mastectomy. Considering the temporary results which come from surgical practices, either from excision operations or lymphovenous anastomosis, they stress out the importance of the prevention measures and of the physiotherapeutic treatment. This is essential to keep lasting as long as possible the results of the operation when it is necessary because of serious functional deficit. Two cases of Thompson's operation are shown.

Ten patients (9 males and 1 female; mean age: 44.8 yrs) with bullous lung disease were treated. Frequent patient-history findings were smoking and spontaneous pneumothorax. Nine cases were treated surgically either by bullectomy or atypical resection. In one case, an attempt at endobullous aspiration failed owing to the patient's very poor general condition. Among the postoperative complications in three cases we observed difficult pulmonary re-expansion and infection of the surgical wound with consequent pleural empyema in another.

Taking a case of duodenal schwannoma, that they had observed, as a starting point, on the base of their experience and the data of literature, the authors discuss the epidemiological, of classification and anatomo-pathological aspects of this rare neoplastic form. They particularly outline the clinical aspect, the diagnostic pre-operating iter and the correct and radical surgical behaviour that must be practiced during laparatomy.

A multivaried statistic process, the linear discriminant analysis, applied to VEMS, CV, I.T., FEF 25-75, pH, PaO2, PaCO2, was used by the authors to foresee, in 42 patients suffering from bronchogenous carcinoma, the arising or absence of respiratory complications after operation. With such method, the falsely positive or negative previsions, resulted to be 13 with a total percentage of error as high as 30%. These results suggest that, even when elaborated through the multivaried analysis, the parameters studied do not allow to adequately discriminate the patients who would develop, after operation, bronchopulmonary complications from those who would be exent from them.

The Authors study the pre- and post-operative nutritional treatment of the patients suffering from oesophageal stenosis, principally neoplastic, waiting to undergo the radical operation. Although the compensation of the nutritional situation of these patients through the enteral and parenteral nutrition results difficult to be effected, the results encourage to apply this clinical practice everywhere a demolitive operation, always long, heavy, and burdened by a high morbidity and mortality, is foreseen.

The Authors report a case of gastric metastasis from melanoma of the skin, occurring 6 years after removal of the primary neoplasm. The metastasis, which was characterized by conspicuous alimentary tract haemorrhage, called for emergency surgery consisting in a total gastrectomy with oesophago-jejunal anastomosis according to Roux. The Authors then go on to review the literature on the subject, stressing the frequency of gastrointestinal metastases in skin melanomas with an incidence affecting up to 60% of cases in autopsy series. After examining the main clinical aspects, endoscopic appearances and r-ray findings, the Authors deal at some length with prognosis, pointing out that isolated metastases may constitute a surgical indication in view of the cases of fairly good long-term survival reported in the literature.

The Authors show a case of a 68 year old woman underwent a successful operation for spontaneous stomach heavage. The linear solution of continuity, 5-6 cms long, was sutured on the small gastric curve. The treatment consisted in suturing the lesion and performing a decompressive gastrostomy.

A case of mediastinal Castleman's disease is reported. A 46-year-old male patient presented a mass 9 X 5.5 X 3 cm wide, located in the supero-posterior mediastinum. The mass was removed by right thoracotomy. On histologic examination it was diagnosed as Castleman's disease of hyaline vascular type.

The authors report the results of a 6-8 year follow-up of 42 patients treated by selective proximal vagotomy with pyloroplasty for gastric or duodenal ulcer disease. On the basis of Visick's classification, the patients broke down into the following categories: Cat. 1: 66.6%; Cat. 2: 26.1%; Cat. 3: 2.3%; Cat. 4: 4.7%, with 92.7% belonging to the first two categories. These data are in agreement with other data reported in the literature, and show no significant differences as compared to follow-up one year after surgery.

Starting from the observation of a case of scleroderma with oesophageal location, the Authors study the digestive troubles of such disease, and remark that, in some cases, the treatment with cimetidin can give good results as to symptomatology, in spite of the chronic evolution of the disease.

The Authors face the diagnostic and therapeutical problems involved in the tardy recognition of diaphragmatic breakages. On the basis of two clinical cases observed, they emphasize the relative frequency of this lesion, the variability of the clinical pictures, the limits of the clinical and radiological diagnostics, the utmost seriousness of the complications. They face the problem of the choice of the surgical way of approach and the techniques for repairing the diaphragmatic lacerations.

Thirteen cases of congenital anomalies of the bile passages are described, as observed in the Verona Surgical Clinic during the period 1970-75, out of a total of 908 operations on the biliary passages and hence with a frequency of about 1.6%. They consisted of one case each of agenesis of the gall-bladder, septal gall-bladder, clepsydra gall-bladder, Hartmann's sac, diverticulum of the gall-bladder, outlet of the right hepatic in gall-bladder, outlet of cystic duct in third duodenal portion, accessory cholecystobiliary ducts, three cases of outlet of cystic duct in right hepatic duct, and two cases of common choledocho-wirsunghian canal. After a brief description of the individual types of anomaly, the main data in the relevant literature are considered, with a review of the semeiological and therapeutic aspects of the most frequent anomalies.

The authors review their series of thyroid operations, totaling 383 cases in the last seven years. In that series the incidence of recurrent nerve lesions leading to permanent sequels was 1.07% (all treated without surgical preparation of the nerve); an additional 0.53% of the patients developed transient paralysis of the recurrent nerve--of which the authors discuss the possible etiology. The authors conclude by stating the need for careful recognition of the recurrent nerve in all surgical procedures involving the thyroid gland, except some enucleo-resections; they confirm the importance of branches of the inferior thyroid artery and the inferior horn of the thyroid cartilage as reference points.

The frequency of benign mammary disease and the need to differentiate between benign and malignant tumors without the indiscriminate use of instrumental examinations and biopsies have prompted the Cooperative Interdisciplinary Group on Mammary Neoplasms to adopt the diagnostic protocol and propose a number of therapeutic indications. Though involving a progressive reduction in biopsies, the use of the protocol has not led to failure to recognize carcinomas, the number of identified malignancies being maintained within the anticipated limits.

Acute tracheal compression caused by mediastinal masses is a rare event. Dyspnea is the most frequent symptom and the treatment of choice is intubation followed by surgical operation. Four cases of acute tracheal compression due to retrosternal goiter are described. All of them underwent emergency surgical treatment. Clinical findings and problems of surgical technique are discussed.

The Authors show 10 cases of traumatic disruption of diaphragm, subsequent to close or open trauma, all subjected to urgency operation. They discuss the problems concerning diagnosis and surgical tactics, and point out the frequency of visceral and osseous associated lesions and their importance in conditioning prognosis.