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Descending necrotizing mediastinitis (DNM) is a primary complication of cervical or odontoiatric infections that can spread to the mediastinum through the anatomic cervical spaces. The delay of the diagnosis or under assessment of the disease, with no adequate draining techniques, results in high mortality up to 20%. We report our experience about 9 clinical cases of DNM observed and surgically treated in our unit from 2000 to 2006; five of these patients were admitted in the last two years. We stress the differences of management of this affection that needs a close cooperation between surgeon, intensive care unit and infectious disease specialist.

A case of 28 years woman with nipple's leiomyoma we report. Only 38 cases are reported in the literature. This neoplasm presents a difficult differential diagnosis with the remaining flogistic and neoplasm breast and nipple disease.

Inflammatory pseudotumor is rare benign lesion ad uncommon is a multiple localization of the liver and spleen. We report a case of inflammatory pseudotumor of the liver associated with an other lesion in the spleen, a 53-years-old ma in which we observed the evolution of clinical picture. Making the diagnosis is often difficult, despite the use of the modern imaging and laboratories techniques, and generally these masses often confuse with others lesions, such as primary or secondary neoplasm, because the clinical presentation and morphological appearance are often unspecific. The medical treatment seems to be more appropriate for patients when it is possible make a correct diagnosis with a biopsy of the lesion. In the other cases, the surgical procedure is the best treatment that must be supported by histologic examination.

In this work thirty patients with symphtomatic not complicated gallbladder disease were studied by ultrasound (US) and by oral-cholecystography, to value the correlation between the results and the surgical judgement of laparoscopic cholecystectomy (LC) difficulty level (by Visual Analogue Scale). Wall thickening and diminished gallbladder function were significantly (P < 0.001) associated with increased technical difficulty of LC. Moreover the US evaluation of Veress's needle insertion seat is helpful. There was no significantly association between LC operative difficulty and volume and other US parameters (P > 0.05). Basing on results and on literature review, US and oral-cholecystography can be considered as predictors of LC operative difficulties and it can be used as a screening.

The Authors report 6 cases of Warthin's tumor of the parotid gland recently observed. In all cases the tumor was intraglandular, single, and no noteworthy disorders or symptoms except for a 2 to 5 cms tumefaction were present. At surgery all lesions appeared well-capsulated and the exeresis followed a cleavage plane easily identifiable which enabled the preservation of the residual glandular tissue as well as the surrounding nervous and vascular structures. All the patients, up to now, are free from relapse.

The authors analyze the most current methods for the treatment of ulcerated breast cancer in the elderly. They describe a peculiar case recently observed, characterized by an ulcerative lesion spreading from the hemiclavicle to the foreaxilla including the axillary cavity, causing a large phlebo-lymphaedema, anaesthesia and paresis of the homoteral upper limb. After an initial treatment with tamoxifen a scapulo-humeral disarticulation and a suture of the cutaneous wide defect were performed using a myo-skin graft which included the deltoid muscle. A radiotherapeutic treatment followed by tamoxifen therapy was carried out. No distant metastases and no local relapses were registered in the one year follow up. The Authors on the basis of their experience and according to the review of the Literature suggest that age itself is not a limiting factor to the therapeutic approach of ulcerated breast cancer.

The aim of this study is to evaluate, after laparoscopic (CL) or open (CO) cholecystectomy, the incidence of pulmonary atelectasis and hypoxaemia which are strictly related to the onset of pulmonary complications. Two groups of 20 consecutive patients affected by symptomatic and not complicated gallstone disease were cholecystectomized either using CO or CL. Hypoxaemia was assessed preoperatively and after operation. Postoperative determination was performed at the 4th, 8th, 12th and 24th hour and then every 12 hours until discharge from hospital. A not informed radiologist evaluated atelectasis through two X-rays, preoperatively and postoperatively at the 3rd day. Atelectasis cases were divided in micro, focal, segmental, lobar and of the entire lung. Statistic analysis was performed using the "t" Student test. No mortality or intraoperative complications occurred. The two groups were similar for age, sex, smoker percentage, obesity, preexisting pulmonary dysfunctions and anaesthesiological risk (ASA). Operative time resulted in longer in CL compared to CO patients although in an insignificant way. PO2 value resulted significatively reduced (P < 0.05) at 4th, 8th, 12th and 24th postoperative hour after CO, while subsequent measurements did not show significant differences. There was no evidence of PO2 significative reduction after CL. After operation atelectasis was found in 11 patients (55%) of CL group (P < 0.05) and in 17 patients (85%) of CO group (P < 0.001). Atelectasis observed in the group of 11 CL patients was represented by 7 micro and 4 focal types, while in the CO group 7 micro, 8 focal and 2 segmental types were found. This study suggests that CL alters the pulmonary function less than CO.

The authors report their laparoscopic access technique. It has to be considered a variation of the classical closed technique, with the introduction of the Veress needle and the first trocar directly at the level of the fascia which is kept in traction by two Kochers.

The F.A.P. is an hereditary disease autosomic dominant, characterized by the growth, from a minimum of 100 to several thousands, of adenoma of the large bowel that degenerate in carcinoma if not intervene surgically. The gene of the F.A.P. has been founded in the chromosome 5, region 5q 21-q22. The incidence is of one case above 6,850-30,000 inhabitants. The F.A.P. characterize it self besides the adenoma, of the large bowel also for the extracolic diseases (adenoma of the small bowel and of the stomach, epidermoid cysts, osteomas, dermoid tumors, congenital hypertrophy of the pigmentary epithelium of the retina). The Authors report their experience concerning a patient with F.A.P.: a man of 40 years old. The patient's genealogic tree was so composed: a brother, a sister and 2 children (a boy of 9 years old and a girl of 6 years old). They have been exposed to the following screening examinations: hemoccult test, rectal exploration, coloscopy and oculist visit). These investigations have given negative results. Because of the youth of the children it has been advised a yearly check-up. At last the Authors underline that each time a patient with F.A.P. is discovered (proband) it is necessary subject the 1 degree grade familiar to the screening above mentioned; because the life expectation in the secondary case (calls-up) discovered.