Factors affecting prognosis in patients with short bowel syndrome

Aim of the study is to analyse physiopathological implications of massive intestinal resection and factors affecting prognosis in patients with short bowel syndrome. Twenty massive intestinal resections were performed. The causes of bowel resection were: intestinal infarction (11 cases), Crohn’s disease (5 cases), small bowel volvulus (4 cases). All intestinal resec - tions were more than 50-60% of the intestinal length. In eighteen patients intestinal anastomosis was performed immediately. In all the patients postoperative therapy with parenteral nutrition (PN) was performed. The operative morbidity and thirty-day mortality were respectively 30% (6 cases) and 35 % (7 cases). The diarrhea was the dominant symptom. The average weight was 20% lower compared to the initial weight. The length of residual small bowel and type of anastomosis strongly affect survival of patients underwent massive intestinal resec - tions. Parenteral nutrition (PN) has great importance in postopera - tive treatment. A useful treatment, in severe short bowel syndrome, can be small bowel transplantation

Parathyroid cancer as rare cause of primary hyperparathyroidism. Case report and review of the literature

L’iperparatiroidismo primario raramente è causato da un carcinoma ella paratiroide, che colpisce più frequentemente le donne nella 4ª- 5ª decade di vita. Il carcinoma delle paratiroidi si riscontra infatti nello 0.5% fino al 5% dei pazienti con iperparatiroidismo primario. La diagnosi di carcinoma non è semplice, e in molti pazienti con iperparatiroidismo primario non è possibile nè pre-, nè intra-operatoriamente. Molti carcinomi paratiroidei sono iperfunzionanti, con elevati livelli ematici di paratormone, e quindi sintomatici più frequentemente rispetto alle forme benigne. Riportiamo il caso di una donna di 52 anni sottoposta a paratiroidectomia della unica ghiandola iperfunzionante, in cui l’esame istologico ha rivelato un carcinoma. In questi casi la chirurgia rappresenta l’unica terapia efficace, anche se è frequente una ripresa locale di malattia. La diagnosi pre-operatoria non è semplice e molti elementi che ne suggeriscono la malignità sono controversi. In accordo con quanto riportato in letteratura, riteniamo che la guarigione definitiva del carcinoma delle paratiroidi sia difficilmente conseguibile. Dopo due anni di follow-up la nostra paziente è in buone condizioni generali e libera da malattia. Un accurato follow-up è di fondamentale importanza per una diagnosi tempestiva di ripresa di malattia e per attuare un reintervento con il fine di ottenere il controllo dell’ipercalcemia che può essere causa di complicanze anche letali

Fibromatosi della parete toracica e mammaria. Casi clinici a confronto

ntroduction: Desmoids of the chest wall are benign and rare tumors that usually arise from the fascia of the pectoralis major muscle, uncommonly from the mammary gland. These tumors sometimes can be locally aggressive, infiltrating surrounding tissues. Clinically they can appear suspicious for malignancy, as palpable and firm masses infiltrating the pectoral muscles. Case reports: We report the cases of a two young women with an extra-abdominal desmoid. The first case is a pectoralis major desmoids; the patient underwent a wide excision with clear margins and after a follow-up of 12 months is disease free. The second case is about a desmoid arising from the mammary gland. This patient had a wide mammary resection, but one mammary margin was closed; in consideration of the need of a more aggressive surgery in front of a benign disease, the patient refused a further treatment with knowledge of the risk of recurrence. Discussion: The desmoid tumors are rare and benign diseases that can present serious problems in the differential diagnosis with malignant diseases. In the management of these tumors surgery has a key role with the goal to obtain a good local control through a wide excision with clear margins, avoiding, when it’s possible, aggressive procedures. Conclusions: Management of desmoid tumors sometimes is difficult and may take in consideration the need of an aggressive surgery in front of a benign disease. A radical excision with a good cosmetic result must be the goal of each surgeon

L’iniezione subareolare per la biopsia del linfonodo sentinella nei tumori multipli della mammella

In questo studio abbiamo eseguito una iniezione in sede subdermica di 99m Tc legato ad albumina ed una iniezione subareolare (SA) di colorante per eseguire il mappaggio linfatico ascellare e la biopsia del linfonodo sentinella (BLS) in pazienti con tumori multifocali e multicentrici della mammella al fine di valutare l’affidabilità e l’accuratezza di questa tecnica; abbiamo inoltre confrontato i risultati con un gruppo di pazienti con tumore unifocale della mammella. Da gennaio 1999 a marzo 2006 sono stati realizzati in 250 pazienti il mappaggio linfatico ascellare e la BLS seguiti da linfoadenectomia ascellare completa. Una analisi retrospettiva ha dimostrato che 32 12.8%) di queste pazienti avevano tumori mammari multipli, evidenziai all’esame istopatologico finale, 218 (87.2%) avevano un tumore unifocale. Nell’analisi statistica la dimensione del tumore mostra una differenza significativa fra i due gruppi (p=.01) con lesioni di più grandi dimensioni nei tumori multipli. Fra questi, l’istotipo più frequente è stato il lobulare infiltrante associato o meno al lobulare in situ (p=.001). L’interessamento metastatico linfonodale è stato significativamente più elevato nei tumori multipli rispetto a quelli unifocali (p=.001). La percentuale di falsi negativi (FN) è stata del 5.8% nei tumori multipli e del 9.6% nelle forme unifocali. L’accuratezza della metodica è stata del 96.8% nei tumori multipli e del 97.6% nei tumori unifocali. La sensibilità è stata del 94.4% e del 91.2%, rispettivamente nei tumori multipli e unifocali. In questo studio forniamo una ulteriore evidenza che il mappaggio linfatico ascellare può essere eseguito anche nelle pazienti con tumori multipli. L’iniezione subareolare del colorante dimostra una alta percentuale di identificazione del linfonodo sentinella ed una bassa percentuale di FN per cui questa tecnica può essere consigliata per la BLS nelle pazienti con tumori multipli della mammella

Micrometastasi nel linfonodo sentinella e fattori predittivi per metastasi nei linfonodi non sentinella nel carcinoma della mammella

The increasing number of sentinel lymph node biopsy in patients with early stage breast cancer increased the diagnosis of micrometastasis. The clinical importance of micrometastasis is still discussed. The aim of this study is to evaluate the incidence and the risk factors for metastasis in the axillary non-sentinel lymph nodes in patients with early stage breast cancer and micrometastatic sentinel lymph node. Method: Data about the axillary sentinel and non-sentinel lymph nodes collected from January 2000 to December 2008 were reviewed retrospectively. In the patients with micrometastatic sentinel lymph nodes, the incidence of non-sentinel metastasis was correlated with some features of the primary tumour, such as the T status, the grading, the proliferation index and the peritumoral lymphvascular invasion. Statistical univariate analysis was performed. Results: The sentinel lymph node biopsy was performed in 370 patients with early stage breast cancer, and 87 metastatic lymph nodes were found. Macrometastasis were 63, micrometastasis were 23 and only 1 case of isolated tumour cells was found. In the patients with micrometastatic sentinel lymph node, 7 patients (30,4%) had involvement of non-sentinel lymph nodes. The grading, the proliferation index and the peritumoral lymphvascular invasion were statistically significant. Conclusions: The presence of micrometastasis in the sentinel lymph node is associated to a high risk of metastasis in the non-sentinel lymph nodes, specially in tumours with aggressive features, such as high grade, high mitotic pattern, peritumoral lymphvascular invasion. These results suggest that even in micrometastatic sentinel lymph nodes we must perform axillary lymph node dissection

GIST gastrico: aspetti clinici diversi della stessa malattia

Introduction: GIST are mesenchymal tumours of the gastro-intestinal tract, that occurs frequently in the stomach. They are often asymptomatic, but may present as an acute or recurrent bleeding at first clinical presentation. CT scan and endoscopy may be helpful for diagnosis, while PET in more useful in the follow-up. Molecular analysis with the detection of the KIT (CD117) marker, may suggest the diagnosis in the 95% of cases. Surgery is the treatment of choice, but a multidisciplinary approach is very important to achieve a good result and to improve the prognosis of these tumours. Case reports: We report three cases of gastric GIST that presented in different clinical ways: massive bleeding with liver matastasis, completely aymptomatic, and locally advanced gastric tumour with massive bleeding and consequent incomplete resection. All the three patients had total gastrectomy but only in one case we performed a radical surgery. Molecular therapy let us achieve a good control even in the advanced disease. Discussion: The clinical, radiological and pathological features of these tumours and their impact on prognosis are discussed. The size and the proliferation index are the most important factors predictive for a good outcome. Conclusions: Gastric GIST is a multiform tumour that may have different clinical presentations. A radical surgical approach followed by molecular therapy is the gold standard