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[corrected] The aims of this study were to evaluate the incidence of overwhelming postsplenectomy infection (OPSI), the usefulness of vaccination in preventing OPSI, and whether affected patients had received the current best practice preventive measures.The patients, observed from June 1991 to May 2005, were reviewed retrospectively. Gender, age, causes of splenectomy, vaccinations and complications were studied.225 patients (178 males, 47 females) underwent splenectomy, and of these, 79 patients (35.1%) were considered for the present study. Seven patients (8.8%) were informed about the risks of infection and received pneumococcal polysaccharide vaccine after splenectomy. Sixty-eight patients (86.7%) receive influenza vaccine every year. One of the patients that did not receive immunoprophylaxis had OPSI (incidence 1.26%) 1 year after splenectomy.Vaccination seems to prevent OPSI. Because of low incidence of OPSI, however, prospective randomised studies in patients without risk factors are needed to evaluate the usefulness of immunoprophylaxis.

Desmoid-type fibromatosis (DTF) is a "locally aggressive, but not metastasizing" proliferation of soft tissues that is difficult to diagnose pre-operatively. Surgical en bloc resection of abdominal DTF can be difficult or an overtreatment. The diagnosis is therefore crucial for the decision making to minimize unnecessary morbidity.A 33-year old female patient with an incidental intra-operative diagnosis of a 20 cm mesenteric mass involving the duodenum, jejunum, ileum and right colon underwent extended resection for a DTF. A review of the literature, limited only to mesenteric localization of DTF, was performed for the diagnosis, treatment and outcome.Twentyfive cases of DTF have been analyzed. Pre-operative diagnosis was suspected in 20% but 95,2% of all the patients underwent resection without pre-operative diagnosis. In two cases, intra-operative, frozen section diagnosis was unsuccessfully attempted. Complications were reported in 12%, recurrence in 4%, and mortality in 0% of the patients.Pre-operative diagnosis of mesenteric DTF is challenging in most cases, but it can avoid unnecessary extended surgery. Efforts should be made to achieve a correct pre-operative diagnosis based on more reliable imaging and pathological features, to help in decision making.In accordo con la “World Health Organization”, il tumore desmoide viene definito come una “proliferazione di tipo clonale dei fibroblasti che origina dai tessuti molli posti più in profondità e che risulta essere caratterizzata da una crescita infiltrante con la tendenza a dare delle recidive locali ma con l’incapacità di metastatizzare”. Noi riportiamo il caso di una giovane donna di 33 anni che presentava una sintomatologia aspecifica, con la presenza di una massa palpabile in sede addominale. La prima diagnosi, eseguita in altra Unità Operativa con US, evidenziava una neoformazione classificata come Leiomioma uterino. Il reperto intraoperatorio durante intervento di isterectomia evidenziava, invece, una neoformazione a partenza dal mesentere. L’esecuzione di due esami bioptici estemporanei non ha portato a nessuna diagnosi di certezza. Veniva quindi eseguita una resezione “en bloc”, allargata con criteri oncologici, della massa, comprendendo digiuno, ileo e colon destro. La diagnosi istologica definitiva è stata poi di Tumore Desmoide. La revisione della letteratura condotta con 25 casi di tumore desmoide del mesentere, ha confermato definitivamente come la diagnosi è molto difficile e quasi mai disponibile prima o durante l’intervento chirurgico. Appare quindi chiaro che la prima scelta di trattamento di questa neoplasia rimane quella chirurgica con margini di resezione R0, pur esistendo la possibilità di un trattamento conservativo farmacologico o radioterapico. Il trattamento del Tumore Desmoide rimane comunque difficile e richiede esperienza ed collaborazione interdisciplinare.