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The debate on truth telling is at the core of contemporary biomedical ethics. Differences in truth telling arise from the delicate interplay between autonomy and beneficence in medicine, under the influence of cultural variables. Recently, a trend toward evolution of truth-telling practices has been noticed in countries previously known for non-disclosure. Italy is among them. This article analyzes in detail the different factors that have been influential in the Italian context, focusing on cancer patients. Medical profession, public discourse, medical deontology and legislators played an important role in Italy's shift toward the western autonomy predicament. A review of the scanty published data on informed consent and truth telling in Italy, however, consistently shows that partial or non-disclosure are still present. This seems to represent a general trend in nations traditionally centered on family and community values. The article explores these issues to achieve a better understanding of the specific Italian cultural context, while avoiding common stereotyping. The subject treated contributes to the growing debate on cultural diversity in medicine and in oncology.

Leptin is a hormone which controls fat metabolism. Leptin plasma levels and adipose tissue mRNA expression were measured in cancer patients. Plasma levels were correlated with TNM staging, cachexia parameters, tumour markers and hormones. Breast and colorectal cancer patients showed blood plasma levels of insulin, TNF-alpha and tumour markers higher than controls. Breast cancer patients, but not colorectal cancer patients, had plasma levels and adipose tissue expression of leptin significantly higher than controls associated with elevated values of estrogen- and progesterone-receptors. These data suggest the possible use of leptin as a clinical marker.

The authors report their experience of 610 cases of laparoscopic cholecystectomy (VLC) and focus attention on the specific complications of this operation, in other words those not linked to the access phase (pneumoperitoneum and introduction of the trocars). The total percentage of complications reported was 1.3%. The most frequent complication was hemorrhage (0.6%), a finding which is in line with international literature. It is emphasised that complications almost always occur postoperatively, sometimes after the early discharge of patients and for this reason they may be more severe. The importance of an accurate dissection of the cholecystic ileum is underlined as being the only real guarantee against lesions to the common bile duct. In overall terms, however, after appropriate training and under the guidance of an expert surgeon, VLC may be considered as the new "gold standard" for treatment of cholelithiasis.

A total of 135 spontaneous pneumothorax (PNX) episodes, occurring in a sample of 100 patients, are examined with a mean follow-up of 4 years. Aim of this retrospective analysis is to evaluate the influence of different therapeutic approaches on relapse rate. The evaluated treatment options are: respiratory physiotherapy, thoracentesis, prolonged drainage, surgery such as bullectomy or "frottage". By mean of correlation index, a decreased incidence of relapse is shown for surgery--with no relapse--followed by prolonged drainage and then by thoracentesis, and by respiratory physiotherapy.

The authors focus on a physiopathologic manifestation, most often misdiagnosed, which present as a "lipomatous-like mass in the supraclavicular fossa". This is generally at the origin of sophisticated radiologic tests and, not infrequently of useless biopsies. The paper analyzes the different reasons leading, alone or in combination, to the phenomenon by which the mediastinal fat is pushed toward regions where no limits anatomic structures exist, such as the supraclavicular fossa. Knowledge of the above causes, together with a careful physical examination plus a standard postero-anterior-X-ray can easily lead to a correct diagnosis of "pseudotumor of the supraclavicular fossa", avoiding costly and needless diagnostic and therapeutic interventions.

Two-hundred and fifteen number of patients are presented, who underwent surgical procedures with the support of autologous blood transfusions. The latter have many advantages over traditional allogenic transfusions, such as diminished risk of infections, absence of blood compatibility problems and deep venous thrombosis prophylaxis, through a preoperative controlled state of hemodilution. We have opted for a pre-operative technique, with harvest of blood, obtained before surgery, at quantity of 350 ml each 4 to 5 days. No early, nor late complications occurred, nor any postoperative hemoglobin or hematocrit decrease. The above data, together with a relevant reduction of cost per blood unit, to encourage a wide use of autologous blood transfusion, whenever feasible.

A case of adenocarcinoma of Meckel's diverticulum is reported. Small bowel neoplasias are the least frequent in the gastrointestinal tract and localization to the diverticulum is extremely rare. Among histological types, adenocarcinoma accounts for the minority of cases. Early diagnosis is difficult because of lack of specificity of signs and symptoms, except in advanced stages. Small bowel resection with lymphadenectomy is the recommended therapeutic approach. Although, in reported case it could not be performed, because of the diffuse intraabdominal metastasis at diagnosis. This and similar cases would open the discussion about a possible indication for prophylactic resection of Meckel's diverticulum. No definitive conclusion can be drawn at present since no follow-up study is available on the natural history of diverticula which have been observed during abdominal surgery and have not been resected.

Central venous catheterisation via the supraclavicular and subclavicular route was performed in 61 and 44 cases respectively at the department's intensive therapy unit. A statistical assessment was made of the modalities of application, complications, time of indwelling, and reasons for removal. A large number of more serious complications (pneumothorax, haemothorax, arterial puncture) were noted with the supraclavicular technique, whereas subclavian catheterisation permitted longer residence times and was rarely responsible for serious disturbances, even though there were more instances of poor positioning. A preference is expressed for the second method. Mention is also made of employment of the internal jugular in recent cases, though these are not yet sufficiently numerous to enable any conclusions to be drawn.

A case history is reported of a spontaneous, nontraumatic, hemoperitoneum in an eleven year old girl. The onset, the accompanying symptoms and the clinical course, mimicked those of acute appendicitis. However the etiology was found to be the spontaneous rupture of a cavernous hemangioma of the omentum. Only one other similar case has been reported in the literature.