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Considering ileocolic resection as a surgical standard for the treatment of ileocecal valve Crohn's disease, we propose a limited resection of the terminal ileum and ileocecal valve with ileocecal anastomosis.Three patiens between 20 and 37 years of age, diagnosed with Crohn's disease unresponsive to medical therapy, who have stenoses or fissures confined to the terminal ileum and ileocecal valve, seen during instrumental investigations.The proposed procedure allowed us to perform a minimal resection and reconstruction of a new ileocecal valve. Once the symptoms have resolved, at endoscopic follow ups, at 6 and 12 months after surgery, there were no changes in the mucosa of the ileocecal neo-anastomosis.Since Crohn's disease is a systemic disease with a chronic relapsing course complicated by a high rate of post-surgical relapses, it is essential to limit the extension of resections to the macroscopically involved tissues and reduce the anastomotic surfaces. The proposed surgical procedure allows to preserve the caecum and the colon with an optimal postoperative course.We believe that, with specific clinical and endoscopic conditions, the treatment we illustrated can be proposed to other patients as an alternative to the standard VL ileocolic resection.Crohn's Disease, Ileocaecal Valve, Ileocaecal Anastomosis.La malattia di Crohn (MC) è, insieme alla Rettocolite ulcerosa, una malattia infiammatoria cronica dell’intestino (MICI) ad eziopatogenesi multifattoriale. Si distinguono tre profili di malattia associati o meno alla localizzazione a livello perianale non stricturing/non penetrating, stricturing, penetrating. Il quadro clinico e l’evoluzione della patologia sono strettamente correlati al fenotipo. Il trattamento medico, nella maggioranza dei casi, rappresenta il primo step nella gestione del paziente; esso si compone di un ampio ventaglio di scelta tra farmaci anti-infiammatori, cortisonici, immunomodulatori e terapia biologica; la scelta del tipo di farmaco da impiegare viene fatta in funzione del quadro clinico ed anatomopatologico. Il ricorso all’intervento chirurgico è invece indispensabile in presenza di complicanze responsabili di fenomeni occlusivi, perforativi o ascessuali e in caso di fallimento della terapia medica. Tuttavia, in casi selezionati e documentati in letteratura, la terapia chirurgica rappresenta una scelta migliore come primo approccio terapeutico al paziente. Giungono alla nostra attenzione tre pazienti tra i 20 e i 40 anni con diagnosi di Malattia di Crohn non responsiva a trattamento farmacologico. Alle indagini strumentali si individuano stenosi o fissurazioni in corrispondenza dell’ileo terminale e della valvola ileocecale. Le anse a monte delle stenosi appaiono dilatate; alla colonscopia, la mucosa del cieco risulta indenne da malattia o solo lievemente infiammata. L’intervento chirurgico standard per questo tipo di patologia consiste in una resezione ileocolica eseguita in laparoscopia. Dopo una attenta valutazione multispecialistica, accompagnata anche da una revisione della letteratura, si decide di sottoporre i pazienti ad una procedura mininvasiva videolaparoscopica consistente nella resezione dell’ileo terminale stenotico/fistolizzato, asportazione della valvola ileocecale e successivo confezionamento di anastomosi volta a ricreare la valvola rimossa. La tipologia di intervento proposto ci ha consentito di ricreare la valvola effettuando un’anastomosi ileo-cecale e al tempo stesso di risparmiare quanto più intestino possibile considerando l’andamento cronico recidivante proprio della MC. Nel periodo post-operatorio non sono state riscontrate complicanze ed ai controlli endoscopici, a 6 e a 12 mesi dall’intervento, non sono presenti alterazioni della mucosa in corrispondenza dell’anastomosi ileocecale. Riteniamo che, in specifiche condizioni cliniche ed endoscopiche, il trattamento da noi illustrato possa essere proposto ad altri pazienti in alternativa alla resezione ileocolica standard eseguita in VL.

Although stapled anastomoses have been widely evaluated in the context of the elective surgery, few reports compared manual with stapled anastomoses in patients undergoing emergency surgery. The aim of this study is to compare the outcome of hand-sewn end-to-end anastomoses with stapled side-to-side and stapled end-to-side anastomoses in patients undergoing small bowel resection for acute mesenteric ischemia secondary to intestinal obstruction.From January 2015 to June 2021 all the hemodynamically stable patients undergoing emergency surgery with small bowel resection for intestinal obstruction were enrolled in this study. According to surgical technique in performing anastomosis, the patients were divided into three groups: group 1: hand-sewn end-to-end anastomosis, group 2: stapled end-to-side anastomosis, and group 3: stapled side-to-side anastomosis.Although the anastomosis failure rate was higher in group 3, it was not significantly different between the three groups (P = 0.78: chi-square test). Likewise, no significant differences in the median hospital stay were found between the patients' groups (P = 0.87: Kruskal-Wallis test). The median operating time was similar in patients undergoing stapled anastomoses and was significantly higher in patients undergoing hand-sewn anastomoses (P = 0.0009: Kruskal-Wallis test).In patients undergoing emergency small bowel resection for complicated intestinal obstruction, a similar outcome in terms of dehiscence rate and hospital stay can be achieved performing stapled or hand-sewn anastomoses, even if restoring the intestinal continuity with stapled technique is associated with lower operating time.

Inguinal hernia formation is a common event in patients with Ehlers-Danlos syndrome. Minimally invasive surgical technique for inguinal hernia repair is the same used in patients without EDS but it is related to more intraoperative and postoperative complications.Inour study, we present a case of inguinal hernia in a EDS patient successfully treated with a robotic transabdominal preperitoneal procedure (TAPP procedure).We decided to perform a robotic TAPP with the DaVinci Xi® platform (Intuitive Surgical, Sunnyvale, USA) under general anaesthesia. A robotic docking was performed and three arms were positioned in the abdomen. Total operative timing was 45 mins.During the robotic procedure no intraoperative complications were recorded and no drains were applied. The postoperative period was uneventful and the patient was discharged in the first postoperative day.Inguinal hernia occurs more frequently in patients with EDS, mainly men. Many surgeons believe that EDS may have a negative effect on the clinical outcome of hernioplasty because of postoperative complication and recurrence rates. Our strategy has been robotic technology to facilitate the surgical approach.Robotic technology is feasible and associated with a shorted recovery and better cosmetic results. The endowrist movement of the robotic arms allows wide instrument articulation in a confined space, bypassing the limitis of laparoscopic instruments. In this way, it is possible to realize an accurate dissection of important elements, to reduce operative timing and intraoperative and postoperative complications.Ehlers-Danlos syndrome, Inguinal hernia, TAPP.

Gastric cancer represents the fourth most common form of cancer and the second most common cause of death in the world. It is also one of the most common cancers leading to mortality in Italy. Therefore, this study aimed to determine the survival rate of patients with advanced gastric cancer and its affecting factors in our experience at AOU Federico II.26 patients with late-stage T4N2M0 and T4N2M1 gastric cancer that were diagnosed and registered during 2008 to 2018 in Federico II Surgical department, were studied. All patients were followed to the end of 2019. Kaplan-Meier method was used to draw survival curves and to determine the effective factors on the survival rate of surveyed patients. Moreover, Log-rank test was used to evaluate whether or not survival curves for different patients, related to residual tumor, are statistically equivalent (p0.05).The mean age of the study population was 49±29, and most of them were males (57,8% (15 patients). After diagnosis, the survival rates for 1, 2, 3 and 4 years, were 26,9%, 11,5 %, 3,8%, 19,2 %; 11,5% of patients with residual tumors survived 6 months respectively. Overall average survival was of 20.61 sd 17.52 months with a median of 12. No statistical difference was detected in terms of survival among M0 and M1 sub-groups.Based on the findings of the present study, T4 gastric cancer has a poor prognosis. Survival rate was decreased over time after diagnosis. Tumoral stage at the time of diagnosis is the most important factor affecting the survival of surveyed patients. This shows that there is a crucial need to diagnose the gastric cancer in early stages.Advanced gastric cancer, Surgical techniques, Therapy.Il cancro gastrico (CG) è la quarta causa principale di morte per cancro in tutto il mondo, anche se negli ultimi decenni è stato osservato un calo della sua incidenza e del tasso di mortalità. I casi di tumore avanzato sono difficilmente gestibili in elezione per la presenza di complicanze che impongono spesso un trattamento in urgenza. Lo studio si propone di esaminare 26 casi di cancro gastrico avanzato, trattati tra il 2008 e il 2018 presso il dipartimento di chirurgia generale “Federico II” e sottoposti a follow up fino alla fine del 2019. Le curve di sopravvivenza sono state costruite usando il metodo di Kaplan-Meier. Inoltre il test di Log-rank è stato utilizzato per valutare se le relative curve di sopravvivenza per pazienti con residuo tumorale e non, fossero statisticamente equivalenti. Si è registrata una sopravvivenza media di circa 20.61 sd 17.52 mesi con una mediana di 12. Non sono state evidenziate differenze significative tra pazienti M0 ed M1, in termini di sopravvivenza. Pertanto, alla luce dei dati raccolti, si evidenzia come la diagnosi precoce di tumore gastrico, rappresenti uno dei principali fattori per migliorare la prognosi e la sopravvivenza dei pazienti.

The recent Sars-CoV2 pandemic has dramatically slowed patients' access to our clinic for vascular pathology when the contagion curve peaked. The need to restore the assistance activity has led us to adopt new individual prophylaxis and hygiene measures.Doctors and staff must wear dedicated clothes. Mask and gloves are mandatory for patients. A visit is scheduled every 60 minutes to allow the sanitation of the rooms. The day before the visit patients are contacted by telephone for the Covid-19 risk triage. In the presence of symptoms the visit is postponed. In the presence of other risk factors a IgG/IgM Rapid Test for Covid-19 is performed on admission to the clinic. In the presence of fever, if an extraordinary rapid test cannot be performed, the visit must be postponed. Rapid test positive patients cannot be visited: they are placed in solitary confinement at their home waiting for a nasopharyngeal swab for Covid-19. When the rapid test is positive, immediate room sanitation also occurs. The rooms dedicated to the outpatient clinic as well as medical and not medical instruments are disinfected.The one adopted can be a useful management model for any type of care activity in order to guarantee the safety of patients and all the staff.COVID-19, Management, vascular, Outpatient clinic.La recente pandemia da SARS-CoV2 ha complicato l’accesso dei pazienti presso il nostro Ambulatorio di Patologia Vascolare, specialmente durante i giorni in cui la curva di contagio raggiungeva il picco. La necessità di fornire un’adeguata attività assistenziale ci ha spinti ad adottare una serie di misure igieniche e di profilassi che riteniamo possano essere d’esempio nella gestione di qualsiasi tipo di ambulatorio durante un pandemia. I medici ed il personale devono indossare abiti dedicati e dispositivi di protezione individuali. Mascherina chirurgica e guanti sono obbligatori anche per i pazienti. All’ingresso viene misurata la temperatura a tutti i soggetti che accedono presso la struttura. Sono previsti percorsi differenti. Vi è una zona-filtro con la sala d’attesa ed altre stanze, ed una via specifica che conduce agli ambulatori. Sono disposti numerosi erogatori di gel idro-alcolico per la disinfezione delle mani. Una visita è programmata ogni 60 minuti per consentire la sanificazione degli ambienti. Il giorno prima della visita i pazienti vengono contattati telefonicamente per la valutazione del rischio Covid-19. Esiste una scheda di triage dedicata. In presenza di sintomi la visita viene rimandata. Se esistono altri fattori di rischio viene eseguito un test rapido IgG/IgM per Covid-19 al momento dell’accesso. In presenza di febbre, se non è possibile eseguire un test rapido straordinario, la visita deve essere rimandata. I pazienti positivi al test rapido non possono essere visitati: sono posti in isolamento in domiciliare in attesa di un tampone nasofaringeo per Covid-19. Quando il test rapido è positivo avviene la sanificazione immediata delle stanze in cui è sostato il paziente. Gli ambienti dedicati all’ambulatorio e gli strumenti vengono disinfettati tra una visita e l’altra. L’adozione rigorosa di tutte queste misure riteniamo sia la chiave per garantire un’adeguata assistenza sanitaria evitando che i pazienti ed il personale siano esposti al rischio di contagio.

To summarize and compare the most recent data from the literature to clarify the management of male breast cancer.A review article.Diagnosis and Treatment of Male Breast Cancer have been derivative for years. Nowadays MBC is a nosological entity in its own right with biological, molecular and clinical features that require a multidisciplinary approach and the involvement of specific skills. Multimodal treatment involves surgery, radiotherapy and chemotherapy. It is evident that the outcome of the MBC is worse than the female one. MBC is often diagnosed in advanced stages. Screening programs in the male population need to be strengthened to obtain an earlier diagnosis. It is necessary to know even more in depth the endocrine-metabolic and behavioral risk factors related to the neoplasm. Finally in the coming years it is reasonable to expect an improvement in multigenic tests: the sensitivity of these methods could predict the risk of recurrence even more precisely. This could lead to substantial changes in the choice and duration of treatment with results that could be surprising.Male breast cancer, Management, Review, Update.Le strategie di diagnosi e trattamento del carcinoma mammario maschile sono derivative da anni: in assenza di studi di controllo randomizzati si applicavano le evidenze scientifiche ricavate sulla popolazione femminile. In particolare il comportamento biologico del tumore della mammella maschile veniva paragonato alla controparte femminile dell’eta postmenopausale. Negli ultimi venti anni questa convinzione e stata progressivamente accantonata. Oggi la neoplasia mammaria del sesso maschile è considerata un’entità nosologica a sé stante, con caratteristiche biologiche, molecolari e cliniche che richiedono un approccio multidisciplinare e il coinvolgimento di competenze specifiche. Il trattamento multimodale prevede terapia chirurgica, radioterapica e chemioterapica proprio come avviene per il carcinoma mammario femminile, con la differenza che nel maschio la diagnosi avviene quasi sempre ad uno stadio più avanzato. L’assenza di un programma di screening paragonabile a quello esistente per le donne rivela delle sostanziali differenze prognostiche tra i due sessi. Pertanto il nostro studio si propone di raccogliere e confrontare tra loro i dati più recenti della letteratura al fine di facilitare la gestione dei pazienti con carcinoma mammario maschile.

Laparoscopic adjustable gastric band complications like oesophageal dilatation, intractable nausea and vomiting, band migration, late slippages, and port problems with a cumulative rate of 19.2%. Rarely, LAGB complications may be related to the connection tube system and in this case the clinical presentation and the effects of the problem can generate difficulties in diagnosis.A 47 years old woman who had a LAGB placed 2 years before the symptoms was admitted in our centre with nausea, vomit, leukocytosis and distended abdomen with a generalized tenderness. Computed tomography images showed an anomalous course of banding tube and a contemporary compression of a small bowel tract secondary to the traction exerted by an adipose tissue band attracted by the tube.A laparoscopic exploration of the abdominal cavity showed a tight loop of LAGB tubing causing a small bowel obstruction with an ischemic damage, so surgeons provided to LAGB removal and a 50 cm ileum resection CONCLUSIONS: Small bowel obstruction resulting from LAGB tubing is an uncommon complication which was reported in few cases. Although bariatric surgery currently represents the best treatment option for morbid obesity and its related- diseases, peri- and post-operative complications have always to be taken into account.Adjustable gastric band complications, Bariatric surgery, Bowel obstruction, CT scan, LAGB tube.Al giorno d’oggi, il bendaggio gastrico regolabile laparoscopico (LAGB) sta assistendo ad un progressivo declino nella maggior parte dei centri di chirurgia bariatrica; questo è principalmente dovuto ai suoi scarsi risultati, nel follow-up a lungo termine, in termini di riduzione dell’Indice di massa corporea (IMC) e all’ampio spettro delle sue complicanze. Quello che viene presentato è un raro caso di complicanza da LAGB correlata al suo tubo di collegamento con il port di regolazione esterno; nel dettaglio, il decorso anomalo del catetere del dispositivo ha determinato una compressione di un’ansa digiunale per trazione esercitata da una banda di tessuto adiposo attratta dal catetere stesso. La presentazione clinica e gli effetti delle complicanze legate al bendaggio gastrico possono generare difficoltà nella diagnosi e nel trattamento; per tali motivi risulta fondamentale, quando le condizioni cliniche lo permettano e la diagnosi non sia chiara, richiedere l’intervento di uno specialista in chirurgia bariatrica.

Sentinel lymph node biopsy (SLNB) is a minimally invasive technique to stage the axillary lymph node status. The burden of nodal metastasis is of great concern, as the clinical relevance and therapeutic implications of pN1mi and pN0(i+) in the sentinel lymph node (SLN) remain a matter of debate.We examined the pathological features of 901 patients above the age of 65 presenting with clinical T1-T2 N0M0 breast tumours (3 cm), detecting tumours related to llary non-sentinel node (NSN) metastases when the SLN was minimally involved.A total of 270 patients underwent complete axillary lymph node dissection (cALND) after their SLNB specimen tested positive for macrometastasis, micrometastasis and isolated tumour cells (ITCs). Seventy-six patients were diagnosed with micrometastatic disease pN1mi (27.5%), whilst ITCs (pN0i+) were detected in seven patients (2.5%). NSNs were found to be involved in two patients (2.6%) with micrometastases at the SLN. No further metastatic disease was detected in NSNs when the SLN contained ITCs. At a median follow-up period of 5.8 years, no axillary recurrence was observed among pN1mi and pN0(i+) patients. Lobular histotype, multicentricity and lymphovascular invasion were found to be associated with NSN involvement.The results from our case series are supported by IBCSG 23-01 level 1 evidence, which demonstrated a local recurrence rate of 1% in 'minimally involved not-surgical treated axilla'.Based on current evidence, we spare well-informed and consenting patients from further axillary surgery when the SLN is minimally involved in early breast cancer within an agreed protocol, whilst scheduling adjuvant treatment based on the patients' primary tumour characteristics.

Aging is one of the major risk factors for varicose veins. The same is for Knee and Hip Osteoarthritis. Most of the patients undergoing to Hip (THA) or Knee (TKA) arthroplasty are over sixteen. Varicose veins, excluding thrombophilia, are the most significant risk factors for VTE after THA and TKA. This study investigates on the usefulness of prophylactic treatment of GSV insufficiency in elderly patients undergoing to orthopedic surgery. A retrospective study enrolling 44 over-sixty five patients, undergoing to TKA or THA. 24 patients underwent to traditional surgery and 20 to EVLA. The presence of evident varicosities and/or a saphenic reflux lasting > 500 ms has been considered as operability criterion. Both in surgery and EVLA group has been performed the ablation of visible varicosities and only saphenic refluxing traits. Results: 1 case of symptomatic DVT was recorded after arthroplasty. A statistically significant difference (p = 0.006) of recovery time between surgery and EVLA groups has been detected. There is not a statistically significant difference in long-term recurrence rate between surgery and EVLA. Conclusions: It is useful to program GSV surgery, before treat hip or knee. This study showed a 50% decrease in the incidence of postoperative DVT.

Conservative therapies for patients affected by Peripheral Arterial Occlusive Disease (PAOD) aim first to correct the risk factors and to slow down the disease progression. Among these, exercise has positive effects on blood flow, muscle metabolism and well demonstrated systemic effects. These include reduction of chronic inflammation markers, improvement of walking mechanics and heart function. Controlled physical training increases the ability to perform the daily activities improving life expectancy of these patients. The aim of this study is to evaluate the effects and the effectiveness of physical training performed in thermal water compared to traditional treadmill walking exercise.98 patients affected by IIb stage PAOD, according to Leriche-Fontaine classification, were enrolled. Patients were randomized into two groups: the first arm carried out an intensive training program under medical supervision (group A); the second one carried out a rehabilitative exercise associated with crenotherapy (group B). The following parameters were detected: Ankle-Brachial pressure index (ABI), actual claudication distance (ACD), maximum walking distance (MWD), flow mediated dilatation (FMD) and the intima-media thickness (IMT). All patients underwent Doppler echocardiography and complete biochemical assay.In both groups, there was a statistically significant improvement of lipidaemia compared to baseline. When compared with each other, the two groups did not show statistically significant differences. There were no significant differences between the two groups regarding echocardiographic findings. Vascular reactivity study showed a statistically significant improvement of FMD after 3 months of exercise in both groups. In crenotherapy group (B) FMD values were significantly higher than the treadmill ones (A). In both groups a statistically significant improvement in ACD was observed CONCLUSIONS: Our experience shows that crenotherapy has similar effects compared to traditional physical training in the treatment of PAOD, being equally well tolerated and safe; it gives an advantage over conventional physical training in terms of ACD and MWD improvement, although not statistically significant, and it is extremely welcome to patients compared to traditional physical training.Arterioscleroses, Intermittent Claudicatio, Peripheral Arterial Diseasen, Physical Exercise, Rehabilitation.Le terapie conservative per i pazienti affetti da Arteriopatia Obliterante Periferica mirano, a correggere I fattori di rischio e a rallentare la progressione della storia naturale della malattia. Tra queste, l’esercizio fisico ha effetti positive sul flusso sanguigno, il metabolismo muscolare ed altri ben dimostrati meccanismi sistemici che includono la riduzione dei markers di infiammazione cronica, il miglioramento della meccanica del cammino e la funzione cardiaca. L’esercizio fisico controllato incrementa l’abilità di svolgere le comuni attività quotidiane, migliorando l’aspettativa di vita di questi pazienti. Lo scopo di questo studio è valutare gli effetti e l’efficacia dell’esercizio fisico eseguito in acqua termale confrontato con l’esercizio tradizionale eseguito su tapis roulant. Sono stati arruolati 98 pazienti affetti da Arteriopatia Obliterante Periferica allo stadio IIb della classificazione di Leriche-Fontaine. Dopo la randomizzazione, i pazienti sono stati divisi in due gruppi: il primo braccio ha eseguito un programma di allenamento intensive sotto supervisione medica (gruppo A); il secondo ha eseguito un allenamento riabilitativo associate a crenoterapia (gruppo B). Sono stati rilevati i seguenti parametri: Indice Caviglia/Braccio (ABI), Actual Claudication Distance (ACD), Maximum Walking Distance (MWD), Flow-Mediated Dilation (FMD) e lo Spessore Medio- Intimale (IMT). Tutti i pazienti sono stati sottoposti ad un Ecografia Color Doppler Cardiaca e un completo assessment biochimico ematico. In entrambi i gruppi, esiste un miglioramento statisticamente significativo della lipidemia in confronto al tempo 0. Quando confrontati tra di loro, i due gruppi non dimostrano differenze statisticamente significative. Non esistono differenze statisticamente significative tra i due gruppi per quanto riguarda i reperti ecocardiografici. Lo studio di reattività vascolare ha dimostrato un miglioramento statisticamente significativo del FMD dopo 3 mesi di allenamento. Nel gruppo B i valori sono significativamente più alti rispetto a quelli ottenuti nel gruppo A. In entrambi i gruppi sono stati osservati incrementi statisticamente significativi dell’ACD. La nostra esperienza ha dimostrato che la crenoterapia associate all’esercizio fisico ha effetti simili comparati al tradizionale allenamento riabilitativo nei pazienti affetti da Arteriopatia Obliterante Periferica, essendo egualmente ben tollerato e sicuro; la crenoterapia conferisce all’esercizio fisico un vantaggio rispetto all’esercizio tradizionale in termini di miglioramento dell’ACD e dell’MWD, sebbene non statisticamente significativo; inoltre è meglio accettato e tollerato dai pazienti rispetto all’esercizio tradizionale.

The intraoperative staging of the pancreatic cancer is important to make a proper treatment. For this reason the intraoperative echography is playing an important role in the right treatment choice. The intraoperative echography, that can be performed with an open or laparoscopic probe, is used to confirm the preoperative diagnosis and assess the pancreatic cancer resecability. The intraoperative echography (IOUS) or laparoscopic intraoperative echography (LIOUS) are useful to identify the patients with a non resecable cancer and perform a faster neoadjuvant treatment. The LIOUS can also avoid an useless laparotomy. The aim of this study is to assess, both in our experience and in the cited literature, the concordance rate between the pancreatic cancer preoperative staging, performed with TC and MRI (when it is available), and intraoperative staging, performed with intraoperative laparotomic or laparoscopic echography. Material and methods We have analyzed the treatment management of 34 patients, who were candidate to major surgery for suspected pancreatic head cancer and who underwent to intraoperative LIOUS or IOUS staging from 2001 to 2012. Results LIOUS and IOUS have allowed to detect cases in which preoperative diagnosis, proved by CT and MRI, was not agreeing with intraoperative diagnosis (22 patients on 34, 64% discordance rate), avoiding the execution of a demolitive and uneseful surgery in order to guarantee the surveillance and life's quality of patients. Conclusion We suggest to perform in every patients undergone to pancreatic surgery an intraoperative ultrasound exam, to detect unresecable and unpredicted lesions.

Introduction The breast and salivary gland tissue share embryologic and thus pathological similarities. Acinic cell carcinoma (ACC) is a typical tumor in salivary glands, but rarely arises in breast too. We reviewed 38 cases of mammary ACC reported in literature and our case, the first ACC born within a fibroadenoma. Materials and methods Data were collected by a research for the key words acinic cell carcinoma breast on Pubmed in March 2014, including a case treated in our department. All reviewed cases were compared for clinical approach and histological pattern. Results To date 23 articles presenting cases of ACC of the breast are reported in literature. We included in our review 38 cases previously described and one new case. The histological pattern was predominantly solid with a microglandular structure. All the tumor cells were cytologically characterized by monotonous round cells with a finely granular, weakly eosinophilic, or clearly vacuolated cytoplasm. The most of the cells were intensely stained with anti-lysozime, anti-amylase, anti-α1-chimotripsin, anti-EMA and anti-S100 protein antisera. Immunohistochemistry was also performed to point out: estrogen receptor (ER), progesterone receptor (PR), androgen receptors (AR), human epidermal growth factor receptor 2 overexpression (HER2/neu), E-cadherin (E-cad), cytokeratin-7 (CK7), gross cystic disease fluid protein 15 (GCDFP15), smooth muscle actin (SMA). Conclusion ACC of the breast is a rare tumor, showing similarities with the salivary gland counterpart, above all in terms of good prognosis, and differences from the ordinary invasive breast carcinoma. Further investigations are needed to elucidate the true histogenesis and the correct treatment.

This paper aims to compare EVLA to traditional surgery, by evaluating the incidence of recurrences.We performed a meta-analysis to challenge both surgical and LASER treatment, using, as clinical outcome, the presence or the absence of reflux. A systematic review of literature about the treatment of varicose veins was performed, searching in the following databases: PUBMED-MEDLINE, Cochrane Library. Search terms considered were: stripping, HL/S, surgery, LASER, EVL*, varicose vein, GSV, saphenous vein. Only RCTs based at least on sixmonths follow-up were considered eligible in the study. Methodological quality of the included studies was evaluated using Cochrane Collaboration Bias Risk Assessment Tool. Effects of the dichotomous variables taken in consideration were evaluated using pooled risk-ratios with 95% C.I. Articles were evaluated initially from abstracts; eligible papers were fulltext examined.We have considered 2 groups, A and B. A Group: 756 legs treated with conventional surgical procedure; B Group: 755 legs treated with EVLA technique. A Group showed 175 post-procedure recurrences, while B showed 97 recurrences. The average O.R. was 1.72; minimum O.R. was of .497 while the maximum was of 8.064.The obtained OR average value is 1.72 with a 95% C.I. of 0.94-3.12, which includes the value 1, contrary to the criteria for rejection of the null hypothesis. For this reason there is not a statistically significant difference between the results obtained by the two techniques.The endovascular laser ablation (EVLA) does not prove to be superior in terms of recurrence, to the surgical technique. However, it remains a viable treatment option in patients with impaired great saphenous vein, reducing postoperative pain and hospital stay.Laser therapy, Meta-analysis, Saphenous vein, Surgery, Venous insufficiency.Questo lavoro si propone di confrontare la tecnica ablativa della vena safena interna con Laser Endovascolare alla chirurgia tradizionale, valutando l’incidenza di recidive.È stata eseguita una meta-analisi per confrontare la validità della tecnica endovascolare Laser con il trattamento chirurgico, utilizzando, come risultato clinico, la presenza o l’assenza di reflusso. È stata effettuata una revisione sistematica della letteratura sul trattamento delle vene varicose, con ricerca nei seguenti database: PUBMED-MEDLINE, Cochrane. I termini di ricerca considerati sono stati: stripping, HL / S, surgery, laser, EVL*, varicose vein*, GSV, saphenous vein. Sono stati considerati ammissibili nello studio Trials Randomizzati e Controllati (RCT) basati almeno su sei mesi di followup. La qualità metodologica degli studi inclusi è stata valutata utilizzando il Cochrane Collaboration Bias Risk Assessment Tool. Gli effetti delle variabili dicotomiche prese in considerazione sono state valutate calcolando il rischio relativo con un intervallo di confidenza al 95% .Gli articoli sono stati valutati inizialmente dagli abstracts; i documenti idonei sono stati esaminati full-text.Abbiamo considerato due gruppi, A e B. Gruppo A: 756 arti trattati con intervento chirurgico convenzionale; Gruppo B: 755 arti trattati con la tecnica EVLA. Il gruppo A ha mostrato 175 recidive postprocedura, mentre B ha mostrato 97 recidive. L’ODDS Ratio (O.R.) medio è 1,72; O.R. minimo è di 0,497, mentre il massimo è stato di 8,064.Il valore OR medio ottenuto è di 1,72 con un Indice di Confidenza al 95% di 0,94-3,12, che comprende il valore 1, contrariamente ai criteri di rifiuto dell’ipotesi nulla. Per questo motivo non vi è una differenza statisticamente significativa tra i risultati ottenuti con le due tecniche.L’ablazione endovascolare laser (EVLA) non dimostra di essere superiore, in termini di recidive, alla tecnica chirurgica. Tuttavia resta una valida opzione terapeutica nei pazienti con insufficienza della safena interna, riducendo la sintomatologia dolorosa postoperatoria e i tempi di degenza.

Background and aim Up till now, only one study providing practically complete information on acute pancreatitis in Italy has been published. The aim of this prospective study was to evaluate the clinical characteristics, in terms of diagnostic assessment and outcome, of a large series of patients affected by acute pancreatitis in Italy. Materials and methods The study involved 56 Italian centres, homogeneously distributed throughout the entire national territory. Each participating centre was furnished with an ad hoc software including 530 items along with subsequent collection, tabulation and quality control of the data. Results One thousand five hundred and forty case report forms of patients affected by acute pancreatitis were collected but 367 of them (24%) were subsequently eliminated from the final analysis. Therefore, 1173 patients (581 females and 592 males) were recruited. Mean age of patients was 62.0 ± 18.2 years (95% confidence interval, 60.9–63.0). On the basis of Atlanta classification, 1006 patients (85.8%) were defined as mild and 167 (14.2%) as severe pancreatitis. Biliary forms represented the most frequent aetiological category (813 cases, 69.3%) while alcoholic forms only 6.6% (77 cases); the remaining aetiologies accounted for 7.1% (83 cases) while 200 cases (17.1%) remained without a definite aetiological factor. Complete recovery was achieved in 1016 patients (86.6%) whereas morphological sequelae were found in 121 patients (10.3%) and mortality in 36 patients (3.1%; 0.4% in mild and 19.2% in severe acute pancreatitis). Ultrasonography was largely utilised as a first line diagnostic tool in all patients, with valuable visualisation of the pancreas in 85% of patients. Computer tomography scan was also widely used, with 66.7% of exams in mild and 33.3% in severe pancreatitis. Patients affected by biliary pancreatitis presented more severe (p = 0.004) and necrotizing forms (p = 0.021). Mortality was significantly related (p Conclusions Association of creatinine serum level over 2 mg/dl with an abnormal chest X-ray showed a high significant correlation with a more severe outcome in terms of morphological sequalae and mortality (p = 0.0001). Acute pancreatitis in Italy more commonly presents biliary aetiology and favourable outcome with low rate of complications and mortality. From a cost-effectiveness standpoint, diagnostic approach to this disease needs to be better standardised.

Research of a starting point to debate about the possibility of identifying a unique sign of previous DVT.A retrospective study involving 202 outpatients with venous insufficiency of the lower limbs (CEAP classes C 4/6), classified according to the affected venous district. Patients positive for deep vein thrombosis (DVT) were subjected to Compression Ultra Sound test (CUS test) with measurement of the wall thickness at the point of formation of the thrombus and at fixed points of common femoral and popliteal veins used also in the patients with negative history of DVT RESULTS: Among total group, only 19 patients (9.40%) had an history of DVT. No one of them had a superficial incontinence. The measurement of wall thickness in positive DVT history patients (group A) resulted in an average value of 1.10 mm (s.d=0.06), while the average value obtained in negative DVT history (group B) was 0.55 mm (s.d.= 0.20). However, in 13 patients wall thickness was1mm (mean: 1.04 mm). The difference between the averages of group A and B was statistically significant (p0.05).In all positive DVT history patients and in 13 ones with negative history we found an increase in wall thickness, with a value1 mm. Can the wall thickening more than 1 mm be considered an indicator of previous DVT? Can it be considered a "marker" for thrombophilia status?The usefulness of a sign of previous DVT (even if asymptomatic), detected during a routine Doppler ultrasound check of lower limbs, could be a warning bell to investigate thrombophilia status.Chronic Venous Insufficiency, Duplex ultrasound, Hypercoagulability, Post-thrombotic Syndrome, Venous Thromboembolism.Lo scopo di questo studio è quello di fornire un punto di partenza per discutere circa la possibilità di individuare un segno ultrasonografico suggestivo di pregressa Trombosi Venosa Profonda (TVP). Abbiamo effettuato uno studio retrospettivo che coinvolge 202 pazienti ambulatoriali con insufficienza venosa degli arti inferiori (CEAP classi C 4/6), classificati in base al distretto venoso interessato. I pazienti positivi per TVP sono stati sottoposti ad un CUS test con misurazione dello spessore della parete nel punto interessato dal trombo e in punti specifici della vena femorale comune e della vena poplitea; tali punti sono stati utilizzati anche nei pazienti con anamnesi negativa per TVP Dell’intera popolazione esaminata, solo 19 pazienti (9,40%) presentavano in anamnesi un episodio di TVP, e nessuno di essi aveva una incontinenza del circolo superficiale. La misurazione dello spessore parietale, a 1 cm di distanza prossimalmente (in senso emodinamico) all’ostio safeno-femorale e a 1 cm distalmente allo sbocco delle vene gemellari sulla vena poplitea, nei pazienti con anamnesi positiva (gruppo A) ha dato come risultato un valore medio di 1,10 mm (sd = 0,06), mentre il valore medio delle misurazioni eseguite nei medesimi punti ottenuto nei pazienti senza anamnesi di TVP (gruppo B) è stato pari a 0,55 mm (sd = 0.20). Tuttavia, in 13 pazienti con anamnesi negativa il valore medio dello spessore della parete è stato1mm (media: 1,04 millimetri). La differenza tra le medie del gruppo A e B è statisticamente significativa (p0.05). La differenza tra la media dei valori misurati nel gruppo A e il sottogruppo della popolazione B con spessore parietale1mm non è statisticamente significativa. È lecito supporre che i pazienti del sottogruppo B avessero sofferto una trombosi venosa profonda asintomatica. Per questo motivo, la nostra ipotesi è che l’ispessimento parietale oltre 1 mm potrebbe essere considerato un indicatore di pregressa TVP. In linea con quanto supposto si potrebbe anche valutare di considerare l’ispessimento parietale “marker” per un maggior rischio di trombosi venosa profonda.

Presentation of a case of carotid stenosis in an elderly patient with multiple co-morbidities, and its management.Pre-operative management of an elderly patient affected by carotid artery stenosis with cardiac, metabolic and renal comorbidities and a recent history of buccal squamous carcinoma.Pre-operative anestesiologic assessment showed an increased risk for the presence of heart failure, cardiogenic pulmonary hypertension, mild/moderate stage renal disease.The frail elderly represents a real challenge for the surgeon, because in choosing treatment other options must be taken into account both in view of local disease and of various systemic comorbidities.Lo stroke è la terza causa di morte nel mondo occidentale dopo l’infarto del miocardio ed il cancro, con il 10-12% di tutti i decessi; l’eziologia ischemica riveste un ruolo preponderante (il 25% è su base embolica), per cui la stenosi aterosclerotica carotidea rappresenta un fattore di rischio. Lo studio NASCET ha provato l’utilità della chirurgia nel trattamento di tale patologia, tuttavia sotto precisi criteri di selezione. Il seguente caso riguarda un paziente affetto da stenosi carotidea che, pur rientrando nei criteri emodinamici di operabilità (percentuale e velocità di flusso), in considerazione delle comorbidità presenti alla diagnosi, non è stato possibile sottoporre a intervento di Trombo-Endo-Arteriectomia (TEA). Il paziente che si era affidato a noi si presentava completamente asintomatico e ciò è stato confermato anche dalla TC cerebrale cui è stato sottoposto dopo la diagnosi di stenosi. Considerando che la neoplasia del paziente, al momento della diagnosi, era al III stadio e che tale staging consente un tasso di sopravvivenza a 5 anni inferiore al 50% e che la TEA non è esente dal rischio di re-stenosi, si è ritenuto che tale procedura non poteva migliorare la prognosi del paziente. L’alternativa presa in considerazione, quindi, è stata l’angioplastica con stent. Tuttavia, se si valuta la non trascurabile possibilità di una recidiva locale della neoplasia, non si può escludere l’utilità di un ulteriore ciclo di radioterapia, con il rischio che questa possa determinare una stenosi in-stent, essendo, la neoplasia omolaterale alla stenosi da trattare. Per questi motivi è stata adottata una terapia conservativa con doppia antiaggregazione (Clopidogrel + Acido Acetil Salicilico). A 8 mesi, il paziente non ha sviluppato accidenti neuro-vascolari.

The minimally invasive approach to parathyroid glands represents an important field of application of radioguided surgery. As always happens, in all cases pertaining to hyper-specialized skills, scientific production has long been the prerogative of a few Authors, but the ever increasing technological diffusion, combined with excellent results often achieved, increases the interest in this technique. This is particularly true in the era of minimally invasive surgery. The Authors realize a review of the existing literature to allow an overall view of current knowledge on this particular topic and to guide future research.

Introduction Recent reports have demonstrated improvement in the 5-years serviva with resecate ductal adenocarcinoma. The aim of study is to determinate the factor influencing long-term survival after DCP. Materials and methods We have critically reviewed a group of 85 patients how were admitted to our department with diagnosis of ductal adenocarcinoma of the head of pancreas between January 1974 and January 1998. Results Patients were stratified according to stage using TNM classification; in stage I 31 patients with 5 T1aN0M0 disease, 11 patients with T1bN0M0 and 15 patients T2N0M0 disease. By contrast, in stage III 54 patients with 48 patients T2N1M0 and 6 patients with T3N1M0. Tumour size was recorded for 72 patients with a median of 3.8 cm. The R1 dissection was performed in 67 patients. The R2 resection was performed in 18 patients. In our series we verified and analysed the histopathologic features of 5 patients with 15-years survival (5.8%). The features regard age, male or female, tumours size, stage and positive lymph node resection. Discussion We found a specifically subset of patients where the combination of prognostic factors, in particular, negative surgical margins R0, tumour size ≤30 mm and the absence of lymph node metastasis independently reduced the mortality indicating that earlier tumour detection and histologically curative resection are important factors contributing to long term survival and healing of ductal adenocarcinoma of the head of the pancreas.

Introduction The annular pancreas is a congenital anomaly in which pancreatic tissue partially or completely surrounds the second portion of the duodenum. Its often located above of papilla of Vater (85%), rarely below (15%). This pancreatic tissue is often easily dissociable to the duodenum but there is same cases where it the tissue is into the muscolaris wall of the duodenum. Material and methods We describe three case of annular pancreas hospitalized in our facility between January 2004 and January 2009. There were 2 male 65 and 69 years old respectively and 1 female of 60 years old, presented complaining of repeated episodes of mild epigastric pain. Laboratory tests (including tumor markers), a direct abdomen X-ray with enema, EGDS and total body CT scan were performed to study to better define the diagnosis. EUS showed the presence of tissue infiltrating the muscle layer all around the first part of duodenum. Biopsies performed found the presence of pancreatic tissue with focal areas of adenocarcinoma. Subtotal gastrectomy with Roux was performed. The histological examinations shows an annular pancreas of D1 with multiple focal area of adenocarcinoma. (T1aN0M0). Results We performed a follow up at 5 years. One patients died after 36 months for cardiovascular hit. Two patients, one male and one female, was 5-years disease-free. Discussion Annular pancreas is an uncommon congenital anomaly which usually presents itself in infants and newborn. Rarely it can present in late adult life with wide range of clinical severities thereby making its diagnosis difficult. Pre-operative diagnosis is often difficult. CT scan can illustrate the pancreatic tissue encircling the duodenum. ERCP and MRCP are useful in outlining the annular pancreatic duct. Surgery still remains necessary to confirm diagnosis and bypassing the obstructed segment.

The Authors correlated intraoperative mucohaemorrhoidal prolapse morphology, specimen histology, anal canal length and purse-string height.Between September-November 2010, 18 patients (9 grade III; 9 grade IV haemorrhoids) underwent stapled haemorrhoidopexy. Mean age was 54 years (range 38-78).Proctoscopic prolapse morphology, anal canal length, pursestring height and external component were evaluated intraoperatively and specimens sent for histology.Intraoperative findings were as follows: 2/18 patients showed no procidentia, 2/18 'haemorrhoid type' prolapse, 14/18 'rectal type' prolapse. Mean anal canal lenght was 3.5 cm (range 2.5-4.5); mean purse-string height was 4.5 cm from the dentate line (range 3.5-5.5); 10/18 patients carried external component. Histology showed mucosa/submucosa in 4/18 cases, muscolaris propria in 9/18, perivisceral fat in 5/18. No procidentia/'haemorrhoid type' prolapse showed only mucosa/submucosa at histolgy; a 'rectal type' morphology showed at least the muscolaris propria. An anal canal3.5 cm related to 'haemorrhoid type' prolapse, a pursestring ≤ 4 cm and mucosa/submucosa at histology. An anal canal ≤ 3.5 cm related to 'rectal type' prolapse, a purse string4 cm from dentate line and at least the muscolaris propria. One patient required analgesics for7 days. At three months, 1/18 patient presented urgency, 2/18 stool clustering. In 1/18 patient a moderate grade of external component persisted.A possible correlation among anoscopic phenotype, specimen histology, pursestring height, might exist and influence clinical outcomes.A positive correlation between specimen thickness, purse-string height and 'rectal type' morphology was found. Patients with higher anal canal showed haemorrhoidal pattern of prolapse, a lower purse-string and mucosa/submucosa at histology.Intraoperative prolapsing tissue morphology could represent a further criteria for surgical decision.

A case of acinic cell carcinoma of the breast is reported in a 26-year-old woman. She presented a lump in her right breast, that seemed to be a fibroadenoma. The open biopsy revealed a well-bordered fibroadenoma, together with a proliferation of cells characterized by serous acinar differentiation and eosinophilic cytoplasmic granules. Tumor cells stained for amylase, lysozyme, α-1-antichymotripsin, epithelial membrane antigen, S-100 protein, pan-cytokeratin, cytokeratin 7 and E-cadherin. Estrogen receptor, progesterone receptor, human epidermal growth factor receptor 2 overexpression, CD10, P63, smooth muscle actin, cytokeratin 5/6 were negative. The sentinel node was negative. 8 months after surgery she is in good clinical conditions without recurrence or metastases.

To reassess selection criteria for Sentinel Lymph Node Biopsy (SLNB) in patients with thin melanoma (Breslow ≤ 1 mm).Between January 2004 and November 2010 we observed 6 patients with lymph node metastasis from early melanoma (Breslow ranging from 0.3 mm to 0.9 mm, not ulcerated tumor, mitosis/ mmq1). Nobody had received a prior study of sentinel lymph node so all patients underwent enlarged lymphadenectomy of concerned lymphatic stations and cancer re-staging.The pathological examination of lymph nodes has always confirmed metastatic melanoma. The average followup is currently 51,5 months: 3 of 6 patients presented recurrence that in one case led to death.In the event of a thickness1 mm the probability of finding a positive sentinel lymph node is about 7%. Recent data have demonstrated a significant survival advantage to early therapeutic lymphadenectomy in melanoma.Our experience, supported by the cases described and the literature, leads to propose the technique of SLNB to all patients with melanoma thicker than 0.5 mm, given the low morbidity and the important prognostic role of the procedure, in addition to the possibility of reducing the incidence of lymph node metastases.

Transanal microscopic surgery is an important application of minimally invasive surgery of rectum, allowing realization of complex transanal intervention.During the period between January 2002 and December 2010, seven patients, five men and two women, average age 75 years, with early rectal cancer recurrence were selected for this type of surgical palliative procedure. The selection of the patients is made by: transrectal ultrasonography, colonoscopy and abdominal ultrasonografy, to rule out liver metastases, CT with and without enema, PET CT. Follow-up is approximately 12-30 months.The pathologic staging confirms the complete excision of recurrences. Then patients are referred for more complementary therapies.The significance of conservative treatment for local recurrence of rectum adenocarcinoma is still controversial because the recurrence is an expression of tumor spread not controlled by oncological surgical and radio/chemo therapyIn selected subjects such as the elderly, based on equal oncological treatment, the reduction of surgical trauma, preservation of anatomical integrity and resolution of symptoms are important results.

Introduction Transanal microscopic surgery is an important application of minimally invasive surgery of rectum, allowing realization of complex transanal intervention. Patients and Methods During the period between January 2002 and December 2010, seven patients, five men and two women, average age 75 years, with early rectal cancer recurrence were selected for this type of surgical palliative procedure. The selection of the patients is made by: transrectal ultrasonografy, colonoscopy and abdominal ultrasonografy, to rule out liver metastases, CT with and without enema, PET CT. Follow-up is approximately 12-30 months. Results The pathologic staging confirms the complete excision of recurrences. Then patients are referred for more complementary therapies. Discussion The significance of conservative treatment for local recurrence of rectum adenocarcinoma is still controversial because the recurrence is an expression of tumor spread not controlled by oncological surgical and radio/chemo therapy. Conclusion In selected subjects such as the elderly, based on equal oncological treatment, the reduction of surgical trauma, preservation of anatomical integrity and resolution of symptoms are important results.

In this paper we wanted to evaluate the impact of pain reduction on the evolution of "difficult-to treat" ulcers, using Radiofrequency analgesia in pulse-dose modality.We have performed a randomized trial to evaluate the efficacy of the RF in PD mode to reduce the healing time of ulcers of difficult management as outpatient for spontaneous and provoked pain. We enrolled 23 patients, including 7 males (30%) and 16 females (70%), aged between 53 and 79 years (mean age = 67.2) sorted according to the first letter of the last name in ascending order and assigned alternately to one or another group.In Group A healing was obtained in 33% of patients (4/12), with an average healing time of 6 months while in Group B healing has been obtained in 81% of patients (9/11) with an average time of 3 months (range 1-5 months) Student's T was performed to compare the average recovery time among the two groups; moreover we have analyzed the proportions of healed patients in the group A and B.Healing time significantly decreased in group B (p = 0,013079). Even the cure rate has changed favorably, in a statistically significant way.According to the literature related to the use of the RF pulse dose, there is a greater effectiveness of this technique in respect of the classical PRF, in terms of immediate and long-term reduction of pain and this impacts positively on the course of ulcer healing.

4 Citazioni su Scopus PURPOSE: Follow-up should identify metachronous colonic neoplasms and precancers, suture line recurrences, and isolated liver or pulmonary metastases. For some sites of failure the surgical re-resection and multimodal approaches increase disease-free survival and quality of life. The aim of our study was to evaluate the role of the different follow-up plans and the carcinoembryonic antigen directed second-look surgery. METHODS: One hundred-sixty patients radically resected for Dukes B or C colorectal cancer were evaluated by a follow-up plan (plasma carcinoembryonic antigen every 2 months; echography every 6 months; chest x-ray every 12 months; and colonoscopy at 1 year and then every 3-5 years). RESULTS: Eighty-nine recurrences were detected (55.6 percent). In 72 recurrences plasma carcinoembryonic antigen elevation was present. Eight carcinoembryonic antigen directed second-look surgeries were performed: in four patients surgical evidence of recurrence was found (two isolated liver metastases were radically resected); two patients with no surgical evidence of recurrence developed a surrenalic isolated metastases and pelvic and hepatic recurrences; two patients had a five-year disease-free survival. In the 17 symptomatic patients with no carcinoembryonic antigen elevation diffuse disease was present, not resectable for cure. Four solitary liver metastases, one metachronous colonic neoplasm, and one suture line recurrence presented a five-year survival. CONCLUSIONS: The authors emphasize that carcinoembryonic antigen-directed second-look surgery is not acceptable for elevated costs. Intensive follow-up plans are superflous, while the monitoring of the carcinoembryonic antigen and instrumental restaging as an indicator of solitary liver metastases and mucosal lesions are very useful.-----------Sourcerecord Id Scopus 21088-------http://www.scopus.com/record/display.url?eid=2-s2.0-0028333776&origin=resultslist&sort=plf-f&src=s&sid=0AD5eOPNu-6AaFmiQCtIjHm%3a70&sot=aut&sdt=a&sl=37&s=AU-ID%28%22Benassai%2c+Giacomo%22+6602920646%29&relpos=15&relpos=15&searchTerm=AU-ID(\"Benassai, Giacomo\" 6602920646)---------------http://apps.webofknowledge.com/full_record.do?product=UA&search_mode=GeneralSearch&qid=1&SID=Q1i@gpCm9b3mdEmO@n6&page=4&doc=31

Articolo presente su PubMed Central. Sourcerecord id Scopus 28558 http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3194374/ Background.More minimally invasive techniques are currently available for the surgical oncologist in the optimal staging of biliopancreatic cancer. With the increased age of population we can see an increase of age-related diseases, such a cardiovascular disease, hypertension, arthritis and other malignancies. With the development of endoscopy, laparoscopy, ultrasonography and biopsy equipment, more minimally invasive techniques are currently available for the surgical oncologist to provide a better optimal diagnosis and strategy, followed by an appropriate surgical treatment of biliopancreatic cancer. Improvement in the diagnostic and surgical care of elderly cancer patients will have a final impact on disease and overall survival rates of the different types of cancer treatment. Materials and methods.We retrospectively reviewed the records of patients between January 2001 and December 2008 who had either a mass in the biliopancreatic area classified as clinically resectable. Tumours were considered to be resectable when there was no evidence of distant extra pancreatic disease or involvement of lymphnodes outside the classic margins of resections. Occlusion or encasement of the superior mesenteric artery or vein, celiac artery or portal vein were used as a criteria for unresectability. Twenty-eight patients over 65 and under 75 years (middle age 69) with primary biliopancreatic cancer were submitted to operations for potentially operative resection. In all cases staging laparoscopy was performed just prior to planned open exploration and resection. Results.Twenty seven patients underwent laparoscopy exploration for potential resection. Two of five patients (40%) with distal cholangiocarcinoma survived at 5 years after DCP. Eighteen patients (66.6%) had unresectable disease identified at laparoscopy and fourteen were able to convert to laparotomy palliative surgery while for the others laparoscopy spared an unnecessary laparotomy. In four patients it was possible to perform a laparoscopy palliative surgery. Conclusions.Laparoscopy may have a role in the staging of patients with biliopancreatic malignancies, in particular, for reduction of unnecessary exploratory laparotomy. Moreover, even in old age, duodenocephalopancreasectomy, properly planned and executed, resulted in reduction of operative mortality and morbility and a clear long-term survival.

Articolo presente su PubMed Central. Sourcerecord Id Scopus: 28558 http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3194399/ Background.The majority of indications for surgery in melanoma are for the treatment of primary tumor and lymph node metastases. During the last decade, the Sentinel Node Biopsy (SNB), from a research procedure, has become standard of care in most institutions. SNB is normally considered for patients with melanoma > 1 mm and generally about 20% are positive; however, the risk of a positive SNB in a melanoma < 1 mm is still 5%. Usually when SNB is positive a complete lymphadenectomy is performed. Materials and methods.In the period 2004-2009, 18 elderly patients (median age 68 years) affected by cutaneous melanoma (mean Breslow’s thickness = 3.77 mm), after SNB histologically confirmed regional lymph node involvement, underwent complete lymph node dissection (CLND). We treated 11 of them with groin dissection, in 3 cases bilateral; 4 patients underwent axillar dissection, in one case bilateral; 2 patients underwent neck dissection and another patient underwent groin-axillar dissection. We treated bilateral groin involvement with laparoscopic access for dissection of lumbar-aortic, iliac and obturator lymph nodes. Results.Disagreeing with literature, 12/18 (67%) of these patients had positive lymph nodes, a high percentage if compared with younger patients’ data. Currently the average follow-up is 25 months. In our sample CLND has a crucial prognostic role (16% vs 41% of deceased in CLND – and CLND + patients respectively). Conclusions.Elderly melanoma patients are characterized by a higher tumor stage and, in patients with nodal metastases, the prognosis is independently affected by older age. In case of positive SNB the CLND plays a notable prognostic role and a presumable therapeutic role.

2 citazioni su Scopus http://www.sciencedirect.com/science/article/pii/S1590865808004337 http://www.scopus.com/record/display.url?eid=2-s2.0-67349129737&origin=resultslist&sort=plf-f&src=s&st1=benassai&st2=g&sid=oNVoDQG_UHipYnJz9G131SP%3a210&sot=q&sdt=b&sl=30&s=TITLE-ABS-KEY-AUTH%28benassai+g%29&relpos=5&relpos=5&searchTerm=TITLE-ABS-KEY-AUTH(benassai g) An 81-year-old presented with a 5-day history of increasing abdominal pain, distension, and vomiting. Her bowels were not active for 2 days, but she was passing flatus. Laboratory examination showed a haemoglobin of 9.7 g/dL (≤14 g/dL), haematocrit of 29.7% (≥41%), leucocytes of 13.6/nl (≤10.0/nl), creatinine of 3.7 mg/dL (≤1.1 mg/dL). A plain abdominal X-ray showed small bowel distension; abdominal CT with contrast media showed a large gallstone in the lower ileum. Distended bowel loops were shown as a sign of a small intestinal ileus. Pneumobilia was not present (Fig. 1). Due to the weakened state of the patient and the concurrent diseases (coronary heart disease, congestive heart failure, renal insufficiency), an operation was considered unsafe and an endoscopic removal of the stone was tried. Colonoscopy revealed a large gallstone obstructing the distal ileum (about 10 cm above the ileo-cecal valve) The mucosa was diffusely edematous (Fig. 2). The stone was mobile and it was possible to grab the stone with a Roth net device (US Endoscopy, Mentor, OH, USA), to remove it from the site of impaction and finally retrieve the stone trough the anus. The stone measured 3.5 cm × 3.5 cm × 3 cm. The patient rapidly recovered and was discharged 5 days later. Gallstone ileus occurs almost exclusively in the elderly and accounts for 25% of mechanical small-bowel obstructions in patients over the age of 65, with a mortality of 15%. Early surgical intervention is the mainstay of treatment for gallstone ileus but has a mortality of 12–50%. Colonoscopic retrieval may be technically possible, carries small risks compared with surgery, and requires a shorter period of rehabilitation [1], [2] and [3].

Citato 93 volte in letteratura internazionale (Fonte: Scopus.com) ---- http://www.scopus.com/record/display.url?eid=2-s2.0-0034009904&origin=resultslist&sort=plf-f&src=s&sid=1BklTwBDkRxWaxt9FLi7YAz%3a70&sot=aut&sdt=a&sl=37&s=AU-ID%28%22Benassai%2c+Giacomo%22+6602920646%29&relpos=7&relpos=7&searchTerm=AU-ID(\"Benassai, Giacomo\" 6602920646) ----- Background and Objectives: Recent reports have demonstrated improvement in the 5-year actuarial survival for patients with resected ductal adenocarcinoma. The purpose of this study is to determine the factors favoring long-term survival after pancreaticoduodenectomy. Methods: Between 1974 and 1995, 75 patients with pancreatic head carcinoma underwent pancreaticoduodenectomy in our department. Results: Overall postoperative mortality rate was 5.3% and morbidity was 24%. Median survival following resection was 17 months. Estimated 1-, 2-, and 5-year survival rates were 68%, 46.7%, and 18.7%, respectively. Five-year survival was greater for node- negative than for node-positive patients (41.7% vs. 7.8%, P < 0.001) and for smaller (

23 citazioni: 22 su Scopus e una citazione presente in GoogleScholar ("Das Taxol-Buch" di Volker Bartsch THIEME Ed. 2004 ISBN 3-13-105462-X) ----- Paclitaxel and vinorelbine are among the most active new agents in metastatic breast cancer. Both in vitro and in vivo studies have shown that the combined administration of these two microtubule-targeting agents is feasible and worthwhile. Based on the promising preclinical data, patients with metastatic breast cancer no longer amenable to conventional treatment were entered into a phase I/II study in which the vinorelbine dose was fixed at 30 mg/sqm and paclitaxel was started at 90 mg/sqm and then subsequently escalated by 30 mg/sqm per step. Cycles were repeated every 21 days. Hematopoietic growth factor support was provided from the 4th dose level onwards. Grade III neutropenia was observed only in 2 patients treated at the 5th dose level. Thrombocytopenia never reached grade 3. Neurotoxicity was considered dose-limiting, since grade 3 peripheral neuropathy occured in all three patients treated at the 6th dose level. Other toxicities were mild. Paclitaxel 210 mg/sqm and vinorelbine 30 mg/sqm was the selected combination for phase II. Overall response rate in 34 evaluable patients was 38% (95% confidence interval (C.I.), 22% to 54%). In particular, 3 complete responses (9%) and 10 partial responses (29%) were observed. The observed level of antitumor activity, with an overall response rate of 38% and a median duration of response of 12 months, is of interest, since the study was targeted only to anthracycline-pretreated patients, most of whom had adverse prognostic features. The evaluation of a combination of vinorelbine and paclitaxel as first-line therapy in metastatic breast cancer seems worthwhile and is currently undergoing.

http://www.sciencedirect.com/science/article/pii/S0748798312009936# ------- Background: According to current guidelines, the treatment for thin melanoma (T1a) is limited to surgical excision with a margin >1 cm. The prognostic factors in treatment planning must surely be re-evaluated, because we have encountered distant recurrence in patients with early melanoma so treated. Methods: Between January 2004 and November 2010, we observed 6 patients with lymph node metastasis from early melanoma (Breslow depth, 0.3 - 0.9 mm, not ulcerated tumor, mitosis/mm2

Androgen, progesterone and estrogen receptors were analyzed in 12 primary colonic cancers and 16 primary rectal cancers. Androgen and progesterone receptors were positive in some colonic cancers and rectal carcinomas; however, none of the specimens analyzed showed estradiol receptor. Sourcerecord Id Scopus 21088-------http://apps.webofknowledge.com/full_record.do?product=UA&search_mode=GeneralSearch&qid=1&SID=Q1i@gpCm9b3mdEmO@n6&page=6&doc=60------- 25 citazioni Web of Knowledge