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Aims and Background: The DIANA (Diet and Androgens)-5 study is a multi-institutional randomized controlled trial of the effectiveness of a diet based on Mediterranean and macrobiotic recipes and principles, associated with moderate physical activity, in reducing additional breast cancer events in women with early stage invasive breast cancer at high risk of recurrence because of metabolic or endocrine milieu. The intervention is expected to reduce serum insulin and sex hormones, which were associated with breast prognosis in previous studies., Methods: Between 2008 and 2010, the study randomly assigned 1208 patients to an intensive diet and exercise intervention or to a comparison group, to be followed-up through 2015. General lifestyle recommendations for the prevention of cancer are given to both groups, and the intervention group is being offered a comprehensive lifestyle intervention, including cooking classes, conferences, common meals and exercise sessions. Adherence assessments occurred at baseline and at 12 months and are planned at 36 and 60 months. They include food frequency diaries, anthropometric measures, body fat distribution assessed with impedance scale, one week registration of physical activity with a multisensor arm-band monitor, metabolic and endocrine blood parameters. Outcome breast cancer events are assessed through self report at semi annual meetings or telephone interview and are validated through medical record verification., Results: The randomized groups were comparable for age (51.8 years), proportion of ER-negative tumors (22%), axillary node metastasis (42%), reproductive variables, tobacco smoking, blood pressure, anthropometric measurements and hormonal and metabolic parameters., Conclusions: DIANA-5 has the potential to establish whether a Mediterranean-macrobiotic lifestyle may reduce breast cancer recurrences. We will assess evidence of effectiveness, first by comparing the incidence of additional breast cancer events (local or distant recurrence, second ipsilateral or contralateral cancer) in the intervention and in the control group, by an intention-to-treat analysis, and second by analyzing the incidence of breast cancer events in the total study population by compliance assessment score.

Senology is going to be an independent branch, but resistances to the acknowledgement of the senologist as a devoted professional are still under way. Nevertheless, in the last 20 years an irreversible educational training was traced out. The senologist is not only the surgeon who operates on the breast: he is also a clinician, a researcher and a philosopher. Restricting the senologist's role to that of a knife-user is by far reductive, as this does not put in its true light his huge knowledge: senology is first of all a cultural item. Europe is going to set up independent Breast Units because this is the only way to offer excellent services, whose final result will be the reduction of mortality and the improvement of quality of life.

Data concerning different risk factors for breast cancer based upon the results obtained in a study of 461 women are reported. Comparing this experience with other Italian and international series, it is concluded that the most reliable risk-index for breast cancer is the age of the woman, while less incisive, though prominent, are family history, immunodeficiency, hormonal metabolism and other environmental factors.

Data concerning different prognostic factors based upon results observed in a group of 212 women operated fro breast carcinoma and submitted to follow-up for 5 consecutive years from diagnosis are reported. Comparing this experience with other Italian and international series, it is concluded that the most reliable prognostic factors are the tumour's size and lymph-node status, while less incisive, though relevant, are the site of the tumour, invasiveness, the grade, the labeling index, hormonal receptor status, the levels of Ca 15.3 and of CEA and the age of the woman at diagnosis.

A clinical review of 11 years of surgery of the sphincter of Oddi is presented. 106 patients underwent operations on the papilla because of cholodocholithiasis, stone impacted in the papilla, papillitis. The authors show the most meaningful statistical data and express their own preference for papillosphincteroplasty rather than other types of operations. They finally stress the importance of a careful evaluation of the actual indications for this type of surgery.

The Authors shortly describe some of the main aspects of the primitive cancer of the gallbladder and then expose their 54 cases referred to the last 16 years. Upon it they discuss two points concerning the actual position of surgery of these tumors and the meaning of the cancer-cholelithiasis relation. They finally conclude that notwithstanding the introduction of sofisticated radiological techniques, diagnosis has not recorded improvements in precocity and remember the usefulness of every laparotomy in individuals 50 years over.

Three cases of diverticulum of the IV duodenal portion are presented. The Authors, after having summarized the general features of the duodenal diverticula, remembered the rareness of the ones of its fourth portion, describe the clinical cases and conclude synthetizing the main indications to this type of surgery: complicated diverticula, certainly symptomatic diverticula, of great size diverticula.

A retrospective study was carried out to show the uselessness of routine drainage after simple cholecystectomy. Cholecystectomy was performed in 1,425 patients with cholelithiasis; 164 (13 percent) were drained because of adhesions, concomitant pancreatitis, inadvertent injury, gangrene, empyema and perforation of the gallbladder. None of the complications for which the use of drainage after simple cholecystectomy is commonly advised were observed in any of the 1,261 patients without drainage.

A retrospective study was carried out to show the uselessness of the routine employment of the drainage after simple cholecystectomy. 1425 patients underwent cholecystectomy because for cholelithiasis; of these 164 (13%) were drained because of adhesions, concomitant pancreatitis, inadvertent damage, empiema, gangrena and perforation of the gallbladder. In no case of the 1261 patients without drainage it has been possible to demonstrate the presence of one of those complications for which the use of a drainage after simple cholecystectomy is commonly advised.