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The authors present three cases of symptomatic, large, benign, nonparasitic hepatic cysts. The diagnosis was determined by US and CT scan, the latter enabling differential diagnosis with neoplastic or hydatid cysts. All patients were treated with open hepatic resection. In 2 cases, laparoscopy was performed to enable complete diagnosis. The authors used LigaSure™ (Covidien, USA) instrument, avoiding bleeding complications and reducing surgery time. Histological examination confirmed the diagnosis of benign cysts. CT follow-up at 6 months and 1 year demonstrated the efficacy of the surgery, with no recurrences.

The adrenal myelolipoma is a relatively rare benign tumour of adipose cell and bone marrow elements, non functioning and asymptomatic. Giant and bilateral adrenal myelolipoma is quite rare. The Authors report a case of bilateral adrenal myelolipoma, a giant one (> 15 cm) on the left side and a small one (> 4 cm) on the right with constant pain in a 57-year-old man, shown by computerized tomography. The hormonal blood tests were normal. Surgical excision was performed for large left symptomatic mass, by open laparotomy, and biopsy for right minor adrenal lesion. Histology confirmed diagnosis of myelolipoma for both masses. Follow-up to 6-12 months did'nt show any change of the right myelolipoma. The authors agree with the need to remove the giant adrenal myelolipoma, because the lesion > 10 cm have a high risk of cancer and hemorrhagic complication, while for small myelolipoma (< 6 cm) 6-12 months follow-up is the appropriate choice.

The authors report on their experience with two cases of Krukenberg's tumour treated at Chioggia Hospital in patients admitted for pelvic tumours. The clinical manifestation of Krukenberg's tumour is mainly related to the presence of the pelvic mass even in advanced forms of gastrointestinal cancers. The authors stress the importance of an adequate follow-up of premenopausal patients with a previous gastrectomy for adenocarcinoma because the incidence of ovarian metastases is quite frequent and influences the prognosis. The Authors do not consider a bilateral preventive ovariectomy associated with gastrectomy as advisable in premenopausal patients, because the studies to date are inadequate for the purposes of drawing conclusions regarding the benefit of these procedures. They consider a more valid policy to be a thorough follow-up in women with a previous gastrectomy for adenocarcinoma because the priority must be accorded to diagnosing secondary lesions so as to be able to perform an ovariectomy which may improve the prognosis. With this in mind it is important to assess Ca 19.9 and perform radiological procedures, such as CT and MRI. The prognosis may be distinctly unfavourable as in one of the cases reported by the Authors involving a very rare form of secondary lesion of the bone marrow and consequent medullary aplasia, with the onset of severe haemorrhages in several areas leading to the patient's death. They consider that surgical treatment should be preceded by a diagnostic laparoscopy. When there are other concomitant negative prognostic factors such as neoplastic ascites and perineal carcinosis, ovariectomy will prove ineffective from the prognostic point of view.

Aim: The aim of this paper is to review and assess the selective principles for a radical treatment of gastric carcinoma with respect to resection type as well as the role of lymphadenectomy., Methods: From 1994 to 1999, we operated 222 patients affected by gastric adenocarcinoma at the 1st Surgical Clinic Institute in Padua. Out of the whole group, 138 patients (62.1%) underwent radical surgical treatment (75 patients with total gastrectomy, extended in 30 cases, and 63 patients by means of gastric resection)., Results: The overall survival rate at a median follow-up of 4 years was 58% for the patients treated with total gastrectomy, and 77% in case of distal gastric resection; 97% of patients with early gastric cancer are alive at a median follow-up of 3 years., Conclusion: Whenever it is feasible, subtotal gastrectomy could ensure a radical treatment of gastric carcinoma with low morbidity and mortality rate. The survival rate of such patients was 77%. Prognosis of early gastric cancer is excellent. Patients with IV stage tumors surgically treated had a poor outcome, and they should be susceptible of a multidisciplinary palliative approach.

Recent series reported increasing incidence of esophageal and cardial cancers with prognosis still severe in spite of surgical progress. The late diagnosis reduces the chance of radical surgery; on the other hand about 80-90% of patients develop local or distant recurrence. Therefore the treatment of esophageal and cardial cancer is often palliative: surgical resection is reserved only to selected cases. Endoscopic palliation was the treatment of choice in a total of 265 patients 174 of which received laser therapy and 91 prosthesis intubation. The results it good in about 80% of cases.

Background/aims: Endoscopic variceal banding ligation (EVL), first described by Stiegmann in 1988, is now an accepted alternative to sclerotherapy (EVS) for esophageal varices with previous bleeding. However, results are conflicting in terms of complications, eradication, recurrence, rebleeding and mortality rate. We aimed to compare EVL with EVS in a prospective randomized trial in patients with previous esophageal bleeding proved by endoscopy. End points were rebleeding rate and death during a short (eradication period) or long-term follow-up (> 1 year)., Methodology: One hundred patients (50 EVL, 50 EVS) were enrolled. Eradication rate, number of treatments needed to achieve eradication, recurrence of varices, rebleeding and complications were recorded and analyzed., Results: No differences were observed between the two groups regarding age, sex and Child class. One patient dropped out in the EVL group and 6 in the EVS group. Eradication was obtained in 44 (88%) with EVL and 41 (82%) with EVS with a mean of 3.41 and 5.29 treatments (p<0.001), respectively. Rebleeding occurred during eradication in 6 patients (12%) in the EVL group and 21 (42%) in the EVS group (p=0.001); after eradication, 7 patients (14%) rebled in the EVL group and 4 (8%) in the EVS group (not significant). Non-variceal bleeding was observed in 5 patients (2 EVL and 3 EVS) during follow-up. Two patients in the EVL group died after variceal rebleeding; 3 died of gastric bleeding; and, 15 from non-hemorrhagic events (8 EVL and 7 EVS). In the EVL group 14 patients had recurrent varices and 7 rebled; in the EVS group 11 recurred, with rebleeding in 5. Major complications were fewer in the EVL group (1 stenosis, 4 chronic ulcers) compared to 18 patients in the EVS group (9 stenosis and 9 chronic ulcers) (p<0.005)., Conclusions: EVL might be preferable to EVS for faster reduction and obliteration of varices, with a lower rate of complications and rebleeding before eradication. No differences were observed in recurrence.

One hundred ninety-six patients with gastric adenocarcinoma underwent surgical resection at the Istituto di 1a Clinica Chirurgica di Padova from 1983 through 1997. Sixty-six patients (66%) underwent total gastrectomy and 53 patients (36.2%) subtotal distal gastrectomy macroscopically curative (H0, P0, S0-2, R0), in all the cases associated to incomplete D2-D3 loco-regional lymphadenectomy. Postoperative morbidity was zero after partial gastrectomy and 3% after total gastrectomy. Five-year survival, analyzed retrospectively, after total gastrectomy was 75% for stage I and II (56% in presence of lymph nodes metastases and 94% in absence) and 15% for stage III and IV; it was instead 65% for stage I and II (57 in presence of lymph nodes metastases and 73% in absence) and 50% for stage III and IV after partial gastrectomy. In a prospective study 5-year actuarial survival was 61% after total standard gastrectomy, 76% in the extended forms and 91% after partial gastrectomy, overall 5-year survival in stage I and II was 70%.

Extended resections do play a definite role in the surgical approach to advanced gastric malignancy. Local extension of distant spread of the tumor is no longer to be considered as a contraindication to aggressive surgery based on the evidence that even for palliation, extensive operations, when feasible, have proved to be beneficial in preventing complications related to the natural history of the disease. Over a nine-year period 105 patients with gastric cancer were surgically treated. Out of the 88 patients undergoing tumor excision, 53 were submitted to total gastrectomy (there were 35 males and 18 females, mean age 63 years). This procedure was considered potentially curative in 37 cases and palliative in 16. In 8 of the patients treated with palliation. An extensive procedure, including splenectomy in 7 cases (1 of which with concomitant distal pancreatic resection) and a colonic resection in 1 case, was undertaken. Alimentary continuity following total gastrectomy was restored by jejunal interposition (Mouchet-type reconstruction) in 3 cases, Roux-en-Y esophagojejunostomy in 7 and simple: end-to-side esophagojejunostomy (Sweet and Allen-type) in 6. No postoperative complications have occurred and mean survival time was 8 months with a maximum of 20 months in a patient with a good nutritional status and quality of life (Karnofsky index 78%) who developed no complications related to tumor recurrence.(ABSTRACT TRUNCATED AT 250 WORDS)

A wide range of lesions may occurs after accidental or voluntary ingestion of caustic substances including mild epithelial injury to whole thickness necrosis of the involved organs. The type of management varies according to the severity of the damage, medical therapy being indicated in the less severe cases while surgery is required in life threatering lesins or alternatively as elective treatment of trighly desabling sequelae last complications such as. From 1981 to 1989 we observed 20 patients with acute hastro-oesophageal lesions due to ingestion caustic substances 19 of then were successfully treated with medical therapy. Only 1 patient underwent surgery and died of oesophagus cardiac fistula with right atrium perforation (24 days following total gastrectomy). Based on either our own experience and the data reported in the literature we believe that the most adequate management of patients with lesions of the E.G. due to caustic agents tract must include: vital functions control maintenance intensive care treatment of shock endoscopic monitoring of E.G. lesions emergency surgical treatment where needed.

The total gastrectomy, as known can expose to some sequences which form on a pathophysiologic and clinic plain syndrome of "AGASTRIC". The most paradigmatic of these disturbances are the weight loss, the pain, the dyspepsia, the anorexia, can be erroneously interpreted as a recurrence of the neoplasm illness. On the base of these disturbances, there are some pathophysiological alterations associated to the resection. The postprandial distension syndrome, the dumping, the diarrhea, the anemia, can be relieved by an appropriated hygienic-diet therapy. The reflux of biliopancreatic secretion into the esophagus, the disturbances related to the duodenal exclusion, the accelerated transit can be loosed or reduced by a correct technic, while the cloridopeptic deficiency is obviously unresolvable. From 1981 till 1988, 43 patients were submitted to a total gastrectomy for adenocarcinoma (29 M, 14 F), having a middle age of 62 years: 30 with a radical intent (Ro), and 13 palliative. Besides 10 of the Ro group were submitted to a enlarged intervention. The digestive continuity was renewed through an interposition of isoperistaltic jejunal loop according Mouchet-Camey in 23 cases, by use of a dysfunctional loop according Roux en-Y in 5, and by esophagus-jejunal T-L anastomosis such omega, according Horloff in 2 cases. There were registered one decrease for A.R.D.S. All the patients were been followed according the follow-up protocol, for monitoring neoplasm evolution of the illness and the eventual metabolic-functional disturbances. In the periodic postoperative control all the patients with Mouchet-Camey reconstruction had no evidenced dumping syndrome, neither cases of malabsorption of the essential nutritive principles, with constant recover of the weight.(ABSTRACT TRUNCATED AT 250 WORDS)

An appraisal in terms of cost/benefit or follow-up gastrectomy for gastric cancer is made. Between 1981 and 1987, 90 patients underwent surgery (resectability 94%); of the radically treated patients, 32 underwent total gastrectomy (55%) and 26 subtotal resection (44%). In the group of 32 patients receiving palliative treatment, 11 underwent total gastrectomy. Two patients (4.6% died postoperatively of pulmonary complications and hyperosmolar coma during TPN. Instrumental, clinical and laboratory follow-up was performed in 82 patients out of 88 (93%), 6 not being available for outpatient follow-up. Our standard follow-up examination in these patients includes the following studies (chest x-ray, EGD, liver ultrasound, upper abdominal CT scan, cholescintigraphy with HIDA and barium examination of the upper G.I., tract when needed) performed every 6 months for the first 2 years and then annually for the next 5 years. Laboratory tests were performed every 3 months for the first 2 years and then every 12 months in order to monitor both evolution of neoplasia and possible metabolic functional problems. In the group of patients who underwent total radical gastrectomy, no side-effects or dysfunctional problems were observed, and the recovery of body weight was never less than 80% of the weight prior to diagnosis of the disease. Until now, 4 deaths due to neoplasia have occurred, 2 of which following recurrences after total gastrectomy for peritoneal carcinosis and multiple liver metastases, with an average survival time of 21 months.(ABSTRACT TRUNCATED AT 250 WORDS)