L’emorroidectomia secondo Milligan-Morgan e la mucoprolassectomia con stapler. Valutazione clinica comparativa dei risultati

The aim of this retrospective study was to assess the results of treatment for hemorrhoids by Milligan-Morgan hemorrhoidectomy and by stapled mucoprolapsectomy in terms of operative time, postoperative pain, lenght of hospital stay, incidence of early and late complications, time to return to work and to normal social activities and patient satisfaction. Between January 2002 and December 2003, a total of 65 patients with hemorrhoids (35 men and 30 women with a mean age of 46.9 years) underwent surgical treatment: 41 patients underwent conventional hemorrhoidectomy and 24 patients stapled mucoprolapsectomy. All patients were contacted by phone or were reviewed in the outpatient clinic with a mean follow-up of 2 months (range 8-31). The Authors emphasize that it is difficult to make an objective comparison between hemorrhoidectomy and stapled mucoprolapsectomy because the two procedures are completely different in terms of rationale and technique; however, stapled circumferential mucosectomy in their experience causes less postoperative pain and bleeding and can be considered a valid therapeutic option for third- and fourth-degree disease

Primary squamous cell carcinoma of the liver: an unexpected pathological finding

Abstract Background Primary squamous cell carcinoma of the liver is a very rare cancer requiring a complete diagnostic investigation, as it presents some differences from other primary hepatic malignancies. We describe the case of an elderly patient with primitive squamous cell carcinoma of the liver treated by percutaneous microwave ablation and transarterial chemoembolization. Case presentation Although the pathogenesis remains uncertain, a possible transformation of the biliary epithelium caused by chronic inflammation or metaplasia and subsequent malignant transformation of preexisting benign hepatic cysts has been suggested. A critical review of the existing literature was performed by focusing on the pathogenesis, clinical presentation, and the suggested therapeutic strategies. Conclusion A multidisciplinary approach is needed to face rare hepatic malignancies where there are no clear guidelines

Considerations about the experience in experimental microsurgery in Catania University

In the 1980s and 1990s Microsurgery has had a great diffusion in Italy. Our group, who worked in University of Catania, Sicily, got in touch with Sun Lee, the father of Experimental Microsurgery, and applied actively the microsurgical techniques both in the experimental and clinical field.Several Courses have been organized in Catania to involve young doctors who have been charmed by this new surgical branch.It is our opinion that in the present time Microsurgery could play an important role in the training of the general surgery residents. An experimental microsurgical training, together with simulators, could guarantee a more complete training of the residents, helping them to be familiar with surgical instruments and suture materials, improving their skill in performing microvascular anastomoses (carotid and femoral arteries) and more complex surgical operations (portocaval shunt) and leading them to a valid research activity

Echinococcosis — Rare Locations and Uncommon Clinical Manifestations

Echinococcosis is a zoonotic infection caused by tiny tapeworms of the genus Echinocococcus. Cystic Echinococcosis, also known as hydatid disease, is caused by Echinococcus granulosus and rarely by Echinococcus multilocularis

Il trattamento chirurgico laparoscopico delle cisti idatidee epatiche: tecnica personale

Il trattamento delle cisti idatidee epatiche è ancor oggi ampiamente dibattuto. Alle modalità di trattamento tradizionali, quali le terapie mediche antiparassitarie, le procedure radiologiche e gli interventi chirurgici a cielo aperto, si è di recente affiancata la procedura laparoscopica. Molti aspetti riguardanti il trattamento laparoscopico delle cisti idatidee rimangono a tutt’oggi controversi. L’utilizzo dell’approccio mini-invasivo proposto in letteratura da alcuni autori è gravato da un’incidenza di recidive dallo 0 al 9%, in follow-up da 3 a 49 mesi. Inconvenienti della tecnica laparoscopica sono le difficoltà di controllo dello “spillage” e la disseminazione peritoneale, nonché l’incompleta aspirazione delle cisti a contenuto denso. Gli Autori hanno rivisto i dati della letteratura e descrivono una tecnica personale al fine di evitare gli inconvenienti descritti e di ridurre l’incidenza delle recidive postchirurgiche

La nostra esperienza nel trattamento chirurgico dei tumori mesenchimali dello stomaco

Gli Autori hanno eseguito lo studio retrospettivo di una serie di 22 malati operati per tumore mesenchimale gastrico nel periodo dal 1974 al 2003 al fine di rivedere i casi alla luce delle più moderne acquisizioni istopatologiche ed immunoistochimiche e di analizzare il valore diagnostico delle manifestazioni cliniche, delle indagini strumentali impiegate e dei principi che hanno regolato la tattica chirurgica. Gli Autori concludono sottolineando come non esistano segni e sintomi specifici della patologia che consentano un orientamento diagnostico. L’esame endoscopico svolge un ruolo diagnostico importante, mentre la TC è l’esame più attendibile per la definizione della sede, dei rapporti e della diffusione della neoplasia. L’obiettivo del trattamento deve essere la completa asportazione del tumore con un margine di clearance di 2-3 cm

Delayed presentation of a metastatic choroidal melanoma to the liver: The latency of an elective metastatic localization

Introduction: Choroidal melanoma is the most common primary intraocular malignant tumour and the second most common type of primary malignant melanoma in the body. Biologically, cutaneuous and ocular melanoma may be considered different, in terms of both metastatic diffusion and metastatic latency. The principal target organ for metastasis of the ocular melanoma is the liver.This distinctive behaviour is also sustained by different metastatic latency, as some patients present with metastatic ocular melanoma several years after the treatment of the primary tumor. Presentation of case: A 60 year-old male who had undergone left ocular enucleation for choroid melanoma 20 years ago was referred to our department with a three months history of diffuse abdominal pain, fever, weight loss and massive ascites. Abdominal ultrasonography (US) and total body computed tomography (CT) scan were performed and revealed diffuse liver metastases, associated with peritoneal carcinosis, bilateral adrenal metastases and a large mass in the left kidney compatible with another secondary localization. An ultrasound guided fine needle agobiopsy (FNA) of liver lesions was performed and the pathological findings led to the diagnosis of liver metastasis from choroidal melanoma. The patient died a few weeks later for hepatic failure. Discussion: Currently, there is no consensus regarding the optimal follow-up in terms of screening modality or time interval after the treatment of the primary ocular melanoma. Conclusion: Patients with gastrointestinal symptoms and a history of choroidal melanoma should be investigated for the presence of gastrointestinal or liver metastases, although the original primary malignancy was diagnosed years before the patient’s presentation

Isolated pancreatic metastasis from melanoma. Case report

Pancreas is frequently site of isolated metastasis, approximately in the 40% of cases in patient with previous history of malignant neoplasia, more frequently from renal cell carcinoma. The melanoma metastasis can also interest the pancreas in case of disseminated disease (50% of the cases); more rarely the pancreas is site of isolated metastases from melanoma. The treatment of the pancreatic metastases from melanoma is controversial: the therapeutic choices are few and the role of surgery is not well defined. If the metastasis are confined to the pancreas, the surgical treatment can be useful for better long time survival. We report a rare case of melanoma with pancreatic isolated metastasi in a patient with a previous melanotic metastasis to the inguinal lymph nodes without evidence of primitive tumor