[Parietal implantation after thoracoscopic surgery: a case report].

The Authors report the case of a patient who underwent video-thoracoscopic resection of a solitary pulmonary metastasis. She presented, after about two years, a local relapse (implantation) in the trocar site. Pathogenesis and surgical therapeutic problems are discussed as well

Atypical lymphoproliferative disorders. Castelmann’s disease. Case report and review of the literature.

Castleman's disease (CD) is a rare atypical lymphoproliferative disorder characterized by enlarged hyperplastic lymph nodes with striking vascular proliferations. CD is categorized as being either localized or disseminated and further subdivided into hyaline-vascular, plasma cell, or mixed histopathological patterns. Here we report a case of CD in a 15-year-old girl who presented with a solitary asymptomatic hyaline-vascular mass in the right supraclavicular space. In addition, we discuss the pathogenesis, clinical features and reported co-morbidities of unicentric and multicentric CD and evaluate effective treatment strategies based on the results of lymph node biopsy and careful staging. Surgical excision is curative for the localized variants of CD, either hyaline-vascular or plasma cell type. If complete resection is not possible, partial resection or radiotherapy may be useful to control possible systemic manifestations. Multicentric CD, regardless of the histological subtype, is a more aggressive clinical entity, commonly with a chronic or rapidly fatal course. Patients with multicentric CD do not benefit from surgical treatment and should be candidates for systemic therapy (steroids, combination chemotherapy, novel therapies), although this is still in a fairly experimental phase

[Treatment of pilonidal sinus with the Limberg's technique].

The Authors describe sinus pilonidalis disease and report their experience of two principal surgical techniques: the closed method and the Limberg cutaneous skin flap. They conclude that both the methods are recommended for a good clinical result

Cystic hygroma of the breast: a rare lesion

Lymphangiomas are congenital malformations of lymphatic vessels. More than 50% of these lesions are present at birth; 90% are diagnosed by the age of 2. These lesions do not expand very rapidly but they tend to infiltrate surrounding tissues; their degeneration into malignant tumors is an extremely rare occurrence. They are mostly located in the neck region and the axilla; breast lymphangioma is very rare. Surgery is usually performed for aesthetic reasons and in order to make a differential diagnosis with other, more common lesions. The surgical procedure involves the excision of the mass; other methods, such as radiotherapy and sclerotherapy, have proved to be completely ineffective

Breast lymphoma: diagnostic and surgical approach

Il linfoma della mammella è una patologia estremamente rara, specialmente se sono rispettate le quattro caratteristiche necessarie per poter definire la malattia primitivamente mammaria. La diagnosi differenziale con il carcinoma mammario, se non sospettato per altri motivi, è impossibile con le sole indagini cliniche; sarà infatti l’esame istologico, associato ad una serie di accertamenti con metodica immunoistochimica, a fornire una corretta tipizzazione della lesione. Ad eccezione dei rarissimi casi riconosciuti ad uno stadio estremamente iniziale in cui l’intervento chirurgico potrebbe avere un valore curativo, la guarigione definitiva è praticamente sempre affidata ai successivi trattamenti radio-chemioterapici. Il ruolo del chirurgo è, pertanto, limitato all’asportazione del tumore primitivo ed alla stadiazione della malattia. L’estensione dell’exeresi può variare da caso a caso, a seconda delle dimensioni, della sede del tumore e dei rapporti tra le dimensioni della massa neoplastica e il volume della mammella, orientandosi di volta in volta il chirurgo verso una tumorectomia, una quadrantectomia o una mastectomia semplice. La linfectomia, come si è detto, non riverste alcun significato terapeutico e, se necessario, la biopsia linfonodale può avere unicamente un significato di stadiazione

[Fournier syndrome: report of a clinical case]

The case of a Fournier's syndrome in a 58 years old patient is reported from the Authors that describe the ethiopathogenetic and therapeutic aspects. They analyse the importance of an early surgical treatment associated with antibiotic therapy and later a riparation of the lesions with a myocutaneous skin flap of TL

The influence of residents in the outcome of elective laparoscopic surgery: A prospective study comparing a teaching hospital and a private community hospital in Italy

OBJECTIVES: We compared the outcome of elective laparoscopic cholecystectomy (LC) in a teaching hospital and a private communityhospital to assess the impact of the involvement of residents. MATERIALS AND METHODS: The following parameters were studied prospectively in patients who underwent elective LC during the period from September 2014 to February 2016 in a teaching university hospital (group A) and in a private community hospital (group B): age, sex, body mass index (BMI), comorbidities, American Society of Anaesthesiologists (ASA) score, length of surgery from skin incision to skin closure, use of drain, 30-day perioperative morbidity and mortality, and length of postoperative hospital stay. RESULTS: The group A consisted of 93 elective LC and the group B of 167 elective LC. Operative time was significantly longer in group A. Intraoperative complications were similar and no conversion was necessary in both groups. An increased rate of postoperative complications was observed in group A. All postoperative complications were managed with conservative therapy. No mortality occurred. At logistic regression analysis, the only factor favouring the occurrence of complications was the hospital type. CONCLUSIONS: Our study shows that elective LC can be performed in a teaching hospital with comparable intraoperative morbidity and increased postoperative complications. The greater rate of morbidity found in the teaching hospital may be due to an increased vigilance linked to the presence of residents and not to the lack of expertise