Vivere filosofando. Dalla paideia socratica alla coessenzialità tra etica e politica

Difficoltà di identificazione della sindrome MEN2B ad esordio infantile: iter diagnostico.

Trattamento simultaneo di metastasi epatiche e spleniche da carcinoma colo-rettale

Clinical anatomy of central cenous catheterization guided

CARCINOMA SHOWING THYMUS-LIKE DIFFERENTIATION (CASTLE). A CASE REPORT

INTRODUTION: Carcinoma showing thymus-like differentiation (CASTLE) is a rare malignant thyroid cancer. We report a case of CASTLE treated with surgery and adjuvant external neck radiation therapy.MATERIALS AND METHODS: We experienced a case of CASTLE in a 63-year-old man, who presented with a neck mass due to enlarged and hard thyroid gland, most notably in the right lobe, without palpable cervical nodes.RESULTS: Total thyroidectomy was performed for both diagnostic and therapeutic purposes. Histologic examination of the specimen showed a "thymus like" thyroid cancer; the tumor, partially circumscribed, lobulated, involved both lobes, and in more points reached the capsule of the organ and…

Contrast-enhanced versus baseline ultrasonography in the characterization of benign focal hepatic lesions

Puntura percutanea eco-guidata e puntura TC-guidata di neoformazioni endotoraciche

Puntura percutanea eco-guidata e puntura TC-guidata di neoformazioni endotoraciche Data: 2004 Dettaglio tipologia d'Ateneo: 3a - Articoli su riviste ISI (anche on line)

Syncronous colorectal carcinoma.

Tiroidectomia in urgenza per linfoma primitivo della tiroide: report di un caso ed indicazioni diagnostico-terapeutiche

Il drenaggio pleurico

Per definizione, il drenaggio è un presidio atto ad eliminare liquidi generalmente patologici da cavità naturali o neoformate. Il drenaggio di raccolte addominali non presenta particolari difficoltà poiché è sufficiente che il tubo di drenaggio sia ben posizionato, pervio, declive e di calibro proporzionato alla quantità e alla qualità del materiale da drenare. La sua assenza, anche se potrà ritardare o complicare notevolmente il processo di guarigione di una malattia, difficilmente comprometterà la vita del soggetto in maniera acuta e drammatica. Assai diverso è il drenaggio di raccolte intratoraciche, non soltanto per la assoluta necessità del suo impiego, ma anche per le modalità tecnich…

HSP10,HSP70 AND HSP90 IMMUNOHISTOCHEMICAL LEVELS CHANGE IN ULCERATIVE COLITIS AFTER THERAPY

Ulcerative colitis (UC) is a form of inflammatory bowel disease (IBD) characterized by damage of large bowel mucosa and frequent extra-intestinal autoimmune comorbidities. The role played in IBD pathogenesis by molecular chaperones known to interact with components of the immune system involved in inflammation is unclear. We previously demonstrated that mucosal Hsp60 decreases in UC patients treated with conventional therapies (mesalazine, probiotics), suggesting that this chaperonin could be a reliable biomarker useful for monitoring response to treatment, and that it might play a role in pathogenesis. In the present work we investigated three other heat shock protein/molecular chaperones:…

A case of splenic rupture: A rare event after laparoscopic cholecystectomy

Background Laparoscopic cholecystectomy (LC) is generally safe and well-accepted. In rare cases, it is associated with complications (intra- e postoperative bleeding, visceral injury and surgical site infection). Splenic lesion has been reported only after direct trauma. We report an unusual case of splenic rupture presenting after “uncomplicated” LC. Case presentation A 77-year-old woman presented with distended abdomen, tenderness in the left upper quadrant and severe anemia 12 hours after LC. Clinical examination revealed hypovolemic shock. Abdominal computed tomography confirmed the diagnosis of splenic rupture, and the patient required an urgent splenectomy through midline incision. Th…

Retrospective analysis of management of ingested foreign bodies and food impactions in emergency endoscopic setting in adults.

Background: Ingestion of foreign bodies and food impaction represent the second most common endoscopic emergency after bleeding. The aim of this paper is to report the management and the outcomes in 67 patients admitted for suspected ingestion of foreign body between December 2012 and December 2014. Methods: This retrospective study was conducted at Palermo University Hospitals, Italy, over a 2-year period. We reviewed patients’ database (age, sex, type of foreign body and its anatomical location, treatments, and outcomes as complications, success rates, and mortalities). Results: Foreign bodies were found in all of our 67 patients. Almost all were found in the stomach and lower esophagus (…

Schelling e Heidegger autori di Pareyson. Alle radici dell'ontologia della libertà

Ultrasound guided central venous catheterization of internal jugular vein on over 65-year-od patients versus blind technique

BACKGROUND AND OBJECTIVES: Performing a central venous catheterization (CVC) on older patients for long-term central intravenous therapy could be a very important procedure. It could be associated with a high incidence of related complications, especially on over 65-year-old, high risk, selected patients. METHODS: The authors analyzed the results of 72 central venous CVC of internal jugular vein performed on over 65-year-old patients with ultrasound (US) guide from January 1998 to April 2003. RESULTS: The average performing time was 4 min, with 98.7% of success, 0% of major complications, and 4.1% of minor complications (one mild vagal hypotension and two catheter dislocation). CONCLUSIONS:…

MULTIPLE ECHINOCOCCOSIS OF THE LIVER:EXPERIMENTAL STUDY BY COMPUTER THREE-DIMENSIONAL MODELING

High Levels of Exogenous C2-Ceramide Promote Morphological and Biochemical Evidences of Necrotic Features in Thyroid Follicular Cells

CD95 and ceramide are known to be involved in the apoptotic mechanism. The triggering of CD95 induces a cascade of metabolic events that progressively and dramatically modifies the cell shape by intense membrane blebbing, leading to apoptotic bodies production. Although the CD95 pathway has been abundantly described in normal thyrocytes, the effects of cell permeable synthetic ceramide at morphological and biochemical levels are not fully known. In the present study, we show that thyroid follicular cells (TFC) exposed to 20 μM of C2-ceramide for 4 h are characterized by morphological features of necrosis, such as electron-lucent cytoplasm, mitochondrial swelling, and loss of plasma membrane…

Permanent stenting in “unextractable” common bile duct stones in high risk patients. A prospective randomized study comparing two different stents

BACKGROUND: Endoscopic sphincterotomy (ES) and stone extraction is the treatment of choice for bile duct stones. Therefore, if ES and conventional stone extraction fail, further treatment is mandatory. Insertion of a biliary endoprosthesis is an effective option. MATERIALS AND METHODS: We treated 30 high-risk patients (17 women and 13 men, mean age 82 years) affected by difficult common bile duct stones. The patients were randomly assigned preoperatively using closed envelopes (blind randomization) into two groups to receive insertion of polyethylene or hydrophilic hydromer-coated polyurethane stent, respectively. Follow-up was achieved by contacting referring physicians and patient's relat…

Surgical Treatment of Coledochal Cyst Associated with an Aberrant Posterior Hepatic Duct: Report of a Case and Brief Literature Review

Choledochal cysts (CCs) are rare congenital cystic or fusiform dilatations of the biliary tree that can involve the extrahepatic and/or intrahepatic biliary tree. We report a case of huge type I CC associated with an aberrant posterior hepatic duct. A 52-year-old man presented with a 3-week history of upper right abdominal pain and jaundice and serologic sign of obstructive jaundice. Ultrasonography (US), magnetic resonance cholangiopancreatography and endoscopic retrograde cholangiopancreatography were performed with the diagnosis of CC type I according to the classification of Alonso-Lej and Todani-Watanabe. The indication for surgical resection was posed. The cyst was completely resected…

UNA VERITà PER ME. ITINERARI KIERKEGAARDIANI

La preparazione intestinale alla colonscopia. Esperienza personale e breve review della letteraura

Comparison of central venous catheterization with and without ultrasound guide

Purpose: To compare the effectiveness, safety and time needed to perform central venous catheterization (CVC) in the presence or absence of an ultrasound (US) guide. Methods: Between January 1999 and February 2002 we performed CVCs in 196 patients: 105 patients received US guided CVC (group I) and 91 patients had CVC without US guide (group II). Results: The average time to perform CVC was shorter with US guide (4 vs 7min). The utilization of the US guide was also associated with improved success (98.09% vs 91.2%, p < 0.025) and lack of major complications (0% vs 9.8%, p < 0.001). Conclusions: US-guided CVC affords an easier, safer and more rapid cannulation of a central vein. It is especia…

Per un'etica della terza età

HSP60 and HASP10 overexpression in metastatic colon cancer

Il posizionamento di protesi biliare per stenosi biliare post-operatorie. Nostra esperienza.

OBJECTIVE: To describe the management and outcome after endoscopic treatment of 23 patients with post-operative benign bile duct stricture (BBDS) managed in Authors' Department from 1991 to 2000. BACKGROUND DATA: The management of the postoperative bile duct strictures remains a challenge for even the most skilled biliary tract surgeon and endoscopist. The 1990s saw a dramatic increase in the incidence of bile duct strictures from the introduction and widespread use of laparoscopic cholecystectomy. The management of these injuries, short-term outcome and follow-up have been reported. METHODS: Data were collected retrospectively on 23 patients treated in the Service of Diagnostic and Operati…

L’uso del hrTSH nel follow up del microcarcinoma tiroideo in pazienti sottoposti a tiroidectomia totale

Herpes Simplex Esophagitis in Immunocompetent Host: A Case Report

Introduction. Herpes simplex esophagitis is well recognized in immunosuppressed subjects, but it is infrequent in immunocompetent patients. We present a case of HSE in a 53-year-old healthy man. Materials and Methods. The patient was admitted with dysphagia, odynophagia, and retrosternal chest pain. An esophagogastroduodenoscopy revealed minute erosive area in distal esophagus and biopsies confirmed esophagitis and findings characteristic of Herpes Simplex Virus infection. Results. The patients was treated with high dose of protonpump inhibitor, sucralfate, and acyclovir, orally, with rapid resolution of symptoms. Discussion. HSV type I is the second most common cause of infectious esophagi…

Endometriosi intestinale: una causa oscura di rettorragia clinica

Prevenzione dell’occlusione delle protesi biliari mediante somministrazione di levofloxacina e acido ursodesossicolico.

One of the main advances in biliopancreatic endoscopic therapy has been the ability to palliate patients with biliary obstruction by placement of a stent during ERCP, but this is often complicated by clogging of the stent with subsequent jaundice and/or cholangitis. Stent clogging may be caused by microbiological adhesion and biliary stasis. Therefore, the use of antibiotics and choleretic agents such as levofloxacin and ursodeoxycholic acid has been investigated to see whether they prolong stent patency. Ninety patients with strictures of the biliary tract and untreatable macrolithiasis with endoscopically inserted stents were randomized into two groups: 49 subjects in group 1 (levofloxaci…

ATLANTE DI ENDOSCOPIA DIGESTIVA (esofago, stomaco, duodeno)

Lobo azygos: variante anatomica spesso misconosciuta

Synchronous liver metastases from colorectal carcinoma

Immunophenotypical characterization of a case of pulmonary metastatic biphasic synovial sarcoma: anatomoclinical aspects and short review of literature

Comparative analysis of Hsp10 and Hsp90 in large bowel healthy mucosa and adenocarcinomas

Heat shock proteins (Hsps) are an important class of molecules with various functions. Their classic role is to assist other proteins in folding and re-folding and, when proteins are defective or irreversibly misfolded, to drive their degradation. For this reason, some Hsps are also named molecular chaperones. During evolution, this class of proteins has also acquired extrachaperoning roles such as participation in immune system regulation, cell differentiation, programmed cell death and carcinogenesis. Hsp10 is a partner of Hsp60 in the Hsp60/10 folding machine, but numerous scientific studies have shown that Hsp10 may also play other roles. In fact, Hsp10 seems to have an immunomodulatory…

La tecnica del rendez-vous nel trattamento palliativo degli itteri neoplastici: nostra esperienza

Introduction: "Rendez-vous" technique (RV) assume contemporaneous percutaneous transhepatic choledochal drainage (PTCD) and endoscopic (ERCP) approach to make easier biliary cannulation when it fails for anatomic, neoplastic or iatrogenic causes, in subject unresectable at presentation ("not fit for surgery"). Matherials and methods: Over a 3 years period 618 ERCP were performed in the Service of Digestive Endoscopy in Section of General and Thoracic Surgery, 59 of whom (9%) failed for non-visualization of ampulla of Vater (25%), intradiverticular ampulla (54%) or anatomic defects (21%). Were attempted 44 pre-cut: 14 failed (close biliary stricture), and we proceed to RV. Results: 11/14 (79…

La tracheostomia in urgenza

Anastomosi meccaniche versus anastomosi manuali nella chirurgia del retto. Esperienza personale.

Bilateral lung and liver hydatid cyst

Introduction. Thymomas (THs) are rare epithelial tumors of the thymus gland. In this study we report our personal experience in the management and surgical treatment of THs. Case reports. We report two clinical cases treated with combined therapy (surgery followed by adjuvant therapy). Results. Total transternal thymectomy was performed in both patients. The post-operative course was uneventful. The patients received adjuvant radiotherapy and chemotherapy. No relapse has been observed during follow-up. Discussion. THs are usually slowly growing tumors with similar incidence in both sexes. They occur through a wide age range, with a peak in the fifth and sixth decades. Distinctive features r…

Le complicanze della fibrobroncoscopia. Revisione della letteratura

Fiberoptic bronchoscopy is the gold standard to study and eventually treat tracheobronchial pathology. Performance of fiberoptic bronchoscopy enhances diagnostic precision and has not well documentated risks for the patients. This review examines the international literature of the last 30 yrs about the indication, complications and their prevention during bronchoscopy.

Hsp60 and Hsp10 overexpression in metastatic colon cancer.

Il trattamento chirurgico della idatidosi epatica: nostra esperienza

Prevenzione delle complicanze in chirurgia tiroidea: la lesione del nervo laringeo ricorrente. Esperienza personale su 313 casi

Introduction: Thyroidectomy poses many challenges for the surgeon who undertakes endocrine surgery and iatrogenic injury of inferior laryngeal nerve (ILN) is one of the most serious (0-20%). We report our personal experience of a series of 313 thyroidectomy with intraoperative identification of ILN. Methods: 313 patients (253 females, 60 males, whose age was between 17 and 86 years, mean 41 years) had undergone thyroidectomy in our Operative Unit from January 2000 to January 2004. Among them, 259 patients underwent total extracapsular thyroidectomy, 38 subtotal thyroidectomy, 5 istmo-lobectomy and 11 were completions of thyroidectomy in patients who had previously undergone a first thyroid …

Endoscopic Resection of a Large Colonic Lipoma: Case Report and Review of Literature

Colonic lipomas are uncommon, benign, submucosal adipose tumors that are usually asymptomatic. Large lipomas can cause symptoms such as constipation, abdominal pain, rectal bleeding and intussusception. We report the case of a 60-year-old man with a history of lower abdominal pain and pseudoobstructive symptoms. Colonoscopy revealed a large polypoid sessile lesion in the sigma. We used a standardized technique of polypectomy, preceded by submucosal injection of dilute 5 ml polygelin with epinephrine 1:10,000 solution, to fully resect large colonic lipomas. The lipoma size was 3.5 cm. No bleeding or perforation developed. Histology showed the polyp to be a submucosul lipoma. On follow-up, th…

A rare cause of acute cholecystitis

Port-site hernia following laparoscopic cholecystectomy: personal experience and literature review

Background The purpose of our study is to define the real incidence of port-site hernias (PSH) following laparoscopic cholecystectomy (LC) through a long-term follow-up and to evaluate the significance of several technical and patient-related factors. Materials and Methods A total of 513 consecutive patients who underwent LC at Section of General and Thoracic Surgery of the University Hospital of Palermo in the period between January 2008 and January 2012 were retrospectively examined. The pneumoperitoneum at 12 mmHg was always established with Hasson’s technique at the umbilical site. Surgery was performed using the French technique. Closure of the fascial defect was performed only at the …

Trattamento dei versamenti pleurici secondari a neoplasia maligna: nostra esperienza

Obbietivi:Il versamento pleurico di natura maligna ( VPM) è indice di malattia neoplastica avanzata associato a bassa aspettativa di vita.A [UTF-8?]tutt’oggi il trattamento mira essenzialmente a migliorare la qualità di vita. Metodi: dal Gennaio 2000 al Settembre 2004, sono stati trattati 90 pazienti affetti da VPM ( età media 55 anni).La neoplasia primitiva nel 40% dei casi era di origine polmonare, nel 25% mammaria e nel 35% di altra sede. Ventisei pazienti sono stati sottoposti solamente a toracentesi evacuativa a causa delle scadenti condizioni fisiche ( pazienti con indice di Karnovski < 30%), mentre i restanti 64 pazienti sono stati sottoposti a toracentesi e pleurodesi chimica con …

Severe rectal bleeding after transrectal US-guided prostate biopsy. Case report

CASE: The Authors report their experience about a case of severe rectal bleeding after transrectal ultrasound-guided prostate biopsy. INTERVENTION: After correct and sure diagnosis, the patient was submitted to resolutive endoscopic haemostatic treatment (failure of haemostatic mechanical manoeuvres, emergency colonscopy, haemostasis with sclerotherapy, heat bipolar probe and Argon Plasma Coagulation). RESULTS: Complete recovery (immediate stop bleeding). Follow-up (1 year) negative. CONCLUSIONS: Rectal bleeding after prostate biopsy is a important but rare complication of prostate cancer screening, potentially lethal. Best knowledge of causes and risk factors may improve the diagnosis and …

Trattamento chirurgico del carcinoma midollare della tiroide. Esperienza personale

Introduction: Medullary Thyroid Carcinoma (MTC) is a rare malignancy of the parafollicular C cells of the thyroid gland. Aim of our study is reporting retrospective analysis of our experience about the surgical treatment of MTC, especially pointing on limphadenectomy. Patients and methods: from January 2000 to March 2006, were performed 546 thyroidectomy, 6 of them for MTC (1.09%): 5 sporadic and 1 familiar. All the patients were operated with standard technique (total thyroidectomy) and submitted to endocrinologic and instrumental follow-up. Results: in our experience, we do not registered early or late complications as bleeding, laryngeal nerves lesions and parathyroid lesions or intra-po…

BRAFV600E mutation, TIMP-1 upregulation, and NF-κB activation: closing the loop on the papillary thyroid cancer trilogy.

BRAFV600E is the most common mutation found in papillary thyroid carcinoma (PTC). Tissue inhibitor of metalloproteinases (TIMP-1) and nuclear factor (NF)-κB have been shown to play an important role in thyroid cancer. In particular, TIMP-1 binds its receptor CD63 on cell surface membrane and activates Akt signaling pathway, which is eventually responsible for its anti-apoptotic activity. The aim of our study was to evaluate whether interplay among these three factors exists and exerts a functional role in PTCs. To this purpose, 56 PTC specimens were analyzed for BRAFV600E mutation, TIMP-1 expression, and NF-κB activation. We found that BRAFV600E mutation occurs selectively in PTC nodules an…

Linfangioma cistico addiminale: un'origine dbattuta.

Common bile duct stones in cholecystectomized patients (chapt. 28) in Biliary lithiasis Basic science, current diagnostic and therapeutic approaches di C. Cordiano e G. Borzellino

The incidence of retained or primary stones is approximately 2-5% after LC and 5-15% after common bile duct exploration: in principle, these patients are in need of further intervention. Residual common bile stones are called secondary when they originate in gallbladder and later pass down through the cystic duct into the common bile duct.

Il ruolo della ERCP nell’era della colecistectomia videolaparoscopica. Nostra esperienza

Vantaggi degli ultrasuoni nel posizionamento di un agocannula nella vena giugulare interna (nuove note di tecnica)

The authors analized the result of 175 central venous ca he- terization CVC. of internal jugular vein performed with the ultrasound guide (US) from January 1998 to October 2002. The average performing time was 45 minutes. 98.2% of success and 4% of complications (one pagal hypotension, one artery puncture, four catheter dislocation, one haeiuatoinai). The US guide CVC is a safe procedure with short performing time, low rate of failures and complications and high rate of success: it is helpful in all patients with vascular anatomical variations, with not visualized or Land marks and with coagulation disorders.

Il trattamento chirurgico dell’idatidosi epatica: nostra esperienza e considerazioni diagnostico-terapeutiche

Common Bile Duct Stones in Cholecystectomized Patients

The incidence of retained or primary stones is approximately 2–5% after conventional and laparoscopic cholecystectomy (LC) and 5–15% after common bile duct exploration (CBDE) [1]: in principle these patients are in need of further intervention [2, 3].

CD1A expression in Barrett's oesophagus: new role for an old molecule against metaplastic progression

Linfangioma cistico addominale; un’origine dibattuta

Il carcinoide bronchiale: revisione della letteratura recente

Objective: Yo evaluate methods of diagnosis and treatment, and the long term survival of patients treated for bronchial carcinoid tumor by the review of recent literature. Methods: The Authors conducted a retrospective study on internet-based-evidence of patients treated for bronchial car-cinoid tumor since 1993 to 2004. Symptoms, diagnosis, operative approach and survival were assessed. Conclusions: On the basis of the review of the international literature, the Authors affirm that the 5 and 10-year probability of survival are closely linked to the histological type of carcinoid, to the presence of nodal and distant metastasis. Owing to the potential malignancy of these tumours, preference…

Intradiverticular Ampulla of Vater: Personal Experience at ERCP

Introduction. Conflicting results have been reported about the true impact of intradiverticula ampulla (IA) on the technical success and complication rate of endoscopic retrograde cholangiopancreatography (ERCP). Patients. A total of 500 patients who underwent ERCP were divided into two groups according to the presence (group A, 81 patients) or absence (group B, 419 patients) of IA. Success rate, difficulty at cannulation, findings at ERCP, and procedure-related complications were retrospectively reviewed. Results. Successful cannulation was achieved in 100% of group A patients compared to 98% of group B patients (P = ns). There was a significant difference in the type of cannulation that w…

Corpi estranei gastrici: i bezoari. A proposito di due casi

Objective: The authors report their experience about the treat merit of two cases of gastric bczoar, treated in curative mode, the first endoscopically and the second with surgical intervention. Setting: Operative Unit of General and Thoracic Surgery, Department of General and Emergency Surgery, Organ Transplantation. Policlinico, University of Palermo. Imerventaiion: The patients were submitted to curative treatment, one with endoscopic treatment (mechanical frag- mentation of phytobezoar and fragments extraction via-over- tube), the second with surgical gastrotomy {stamp trichobezoar). There were no procedure- related complications. Results: the two patients were curative and radically tr…

Surgical treatment of liver hydatidosis: our experience with diagnostic and therapeutic consideration

Objective: The Authors report on their experience in diagnosis and treatment of liver hydatidosis (LH). Materials and methods: From January 2000 to December 2003, we observed 24 patients (10 male = 42% and 14 female = 58%, male/female ratio 1:1.4, range of age 23 - 80 years, mean age 45.25 years). The most frequent initial symptom was hepigastric and hypocondriac pain (82.6%), meanwhile acute abdominal pain was only in 26.1%. In one half of cases performed radical surgery (total pericistectomy), in 35% of cases the AA subtotal pericistectomy and only in 17% the AA partial pericistectomy. Only one left hepatectomy during total pericistectomy we performed. Major complications were registered,…

Colecistectomia videolaparoscopica. Nostra esperienza

La tiroidectomia totale di principio nel microcarcinoma papillare

60KDa chaperonin (HSP60) is over-expressed during colorectal carcinogenesis

The aim of the present study was to evaluate the expression of the heat shock protein 60 (HSP60), a mitochondrial matrix-associated protein belonging to the chaperonin family, in colorectal adenomas and cancers, comparing them to normal colonic tissues and hyperplastic polyps. We performed both immunohistochemistry and Western blot analysis for HSP60. Immunohistochemistry resulted positive in all tubular adenomas and infiltrating adenocarcinomas. By contrast, normal tissues and hyperplastic polyps were negative. Quantitative analysis showed that tubular adenomas with different levels of dysplasia did not present statistical differences concerning HSP60 positivity. In addition, carcinomas al…

C-12 Clinical And anatomical features of facial nerve in the surgery of parotid gland: our recent experience.

Heat shock protein 60 levels in tissue and circulating exosomes in human large bowel cancer before and after ablative surgery

BACKGROUND: Heat shock protein 60 (Hsp60) is a chaperonin involved in tumorigenesis, but its participation in tumor development and progression is not well understood and its value as a tumor biomarker has not been fully elucidated. In the current study, the authors presented evidence supporting the theory that Hsp60 has potential as a biomarker as well as a therapeutic target in patients with large bowel cancer. METHODS: The authors studied a population of 97 subjects, including patients and controls. Immunomorphology, Western blot analysis, and quantitative real-time polymerase chain reaction were performed on tissue specimens. Exosomes were isolated from blood and characterized by electr…

La legatura elastica nel trattamento della emorragia da rottura di varici esofagee

Regression of primary low-grade gastric mucosa-associated lymphoma by eradication of Helicobacter pylori infection: case report

Objective: the Authors report their experience in diagnosis and treatment of one case of primary low-grade gastric lymphoma of mucosa associated lymphoid tissue (MALT); recent international literature review. Experimental Design: complete clinical report. Diagnostic, clinical and prognostic indication, evaluation of effectiveness of eradication therapy and short follow-up. Setting: Operative Unit of General and Thoracic Surgery. University "Paolo Giaccotie" of Palermo. Intervention: treatment of H. Pylori infection (lansoprazole, amoxicillin and metronidazole twice a day for 14 days; after that, lansoprazole for another 4 weeks), according to international guide-lines. Results: H. Pylori wa…

Il nervo ricorrente che non ricorre

Pancreas aberrante: una causa rara di epigastralgia

Objective: The Authors report their experience about a case of aberrant pancreas that lead epigastralgia. Design: Report of 1 case and endoscopic treatment (upper endoscopy + EUS + endoscopic polipectomy + endoscopic biopsy of the base. Surgical effectiveness evaluation. Setting: Section of General and Thoracic Surgery. Department of General Surgery; Emergency and Organ Transplantation. Policlinico "Paolo GiacconePalermo. Intervention: After correct and sure diagnosis, the patient was submitted to endoscopic polipectomy with radical and curative intention. Results: Complete recovery. Hematochemical and endoscopic follow-up (1 months) negative. Conclusions: Diagnosis of aberrant pancreas is …

Role of videoassisted thoracoscopy procedure in the diagnosis and treatment of malignant pleural mesothelioma

Toracentesi e pleurodesi nel trattamento dei versamenti pleurici. Esperienza personale

Virtual broncoscopy in the preoperative assessment of airways stenosis

Trocar-related abdominal wall bleeding in 200 patients after laparoscopic cholecistectomy: Personal experience

AIM: To determine the complications and incidence of the first and second access-related vascular injuries induced by videolaparoscopic cholecistectomy. METHODS: We retrospectively reviewed vascular injuries in 200 consecutive patients who underwent videolaparoscopic cholecistectomy from 2003 to 2005. One hundred and one patients with placement of radial expanding trocars were assigned into group A and 99 patients with placement of pyramidal tipped trocars into group B. All the patients were submitted to open access according to Hasson for the first trocar. RESULTS: Bleeding did not occur at the intraoperative cannula-site in group A. However, it occurred at the intraoperative cannula-site …

Il trattamento dei tumori stromali gastrici (GIST). Revisione della letteratura e descrizione di un caso

background: Gastrointestinal stromal tumors (GIST) are rare mesenchimal tumors that are characterized by constitutive overexpression of the tyrosin-kinase receptor KIT (CD 117). The authors analyse the basis of the treatment of gastric GIS, starting form the study of a recent observed case. Experimental design: Report of one case treated with endoscopic resection. Evaluation of treatment and 2-years follow- results: The treatment of gastric GIS I must be modulated on prognostic, genetic and molecular factors. These factors are the basis of the formation and growth of GIST. conclusions: Complete surgical extirpation without rupture remains the only curative treatment of localized favourable …

Il trattamento endoscopico delle pseudocisti pancreatiche.

Aim: the Authors report their experience about the endoscopic treatment of pancreatic pseudocysts (PP). Patients and methods: report of 10 cases; evaluation of effectiveness, morbidity and mortality of treatment. Setting: Section of General and Thoracic Surgery, AOUP “Paolo Giaccone”, University of Palermo. Procedure: endoscopic drainage was performed in all 10 patients, with 2 cysto-gastrostomy, 5 cysto-duodenostomy and 3 trans-papillary cystic drainage. Results: 100% successful; one case of bleeding post-procedure (10%), one case of sepsis (10%) and one case of stricture of fistula between PP and duodenum. Conclusion: endoscopic drainage of PP is a safe and simple treatment, with high rat…

Sorveglianza endoscopica del colon-retto. Ruolo del Narrow Band Imaging (NBI)

La gastrectomia percutanea endoscopica (PEG) metodo pull: nostra esperienza

Stump appendicitis. A case report

Highlights • Stump appendicitis (SA) is a rare, but noteworthy, diagnosis that warrants early detection. • Delay in the diagnosis of SA may result in serious complications like stump gangrene, perforation and peritonitis. • More research is needed to identify strategies to prevent SA. • We underline the emergent role of lower endoscopy to clarify diagnosis resolve the symptoms. • Surgeons need to have a heightened awareness of the possibility of SA.

Una rara complicanza precoce delle anastomosi digestive meccaniche:l’emorragia.

Introduction: Bleeding from mechanical digestive anastomosis is an uncommon complication (0.9-3.2%) often self- limiting but potentially lethal if not evidenced intraoperatively or in the immediate postoperative. Material and methods: The Authors retrospectively report incidence of anastomotic bleeding after stapled anastomosis (11/163 = 6.7%) and analyse probable causes. In 6 of 11 patients (54%) intraoperative bleeding was stopped after manual reinforce of anastomosis (3/6) or stopped spontaneously (3/6). In 5 patients (45%), 1 with gastro-jejunal anastomosis, 2 with ileo-colonic anastomosis and 2 with colo-rectal anastomosis, they used endoscopy and endoscopic treatment in emergency. Res…

Use of BICAP in a case of colon angiodysplasia

This paper reports on a case of colonic bleeding from an angiodysplastic lesion of the ascending colon in a 71-year-old diabetic woman, resulting in severe anemia in the patient, who was treated using the BICAP electrocoagulation system. The present report includes a description of this technique, which involves the use of a 7-F hemostatic probe connected to a 25-W BICAP source.

Presence of white bile in malignant biliary obstruction is associated with poor prognosis: personal preliminary observations

OBJECTIVE: The chemical composition and clinical significance of white bile in patients with malignant obstructive jaundice were evaluated in a prospective study. MATERIALS AND METHODS: 115 consecutive patients with inoperable malignant biliary obstruction underwent endoscopic placement of 10 Fr straight, plastic biliary stents, Amsterdam-type. Bile was aspirated during the endoscopic procedure and a blood sample was taken. Patients were divided into two groups: those with white bile and those with yellow bile. The groups were compared for decremental fall in bilirubin, cholangitis after stent insertion, and survival. RESULTS: Thirty-five patients (15 men, 20 women; mean age 54 years) under…

Cholangitis prevention in endoscopic Klatskin tumor palliation: air cholangiography technique.

INTRODUCTION: Endoscopic biliary drainage is the treatment of choice for inoperable hilar cholangiocarcinoma (so-called Klatskin tumor). Cholangitis is the main complication post-endoscopic retrograde cholangiopancreatography (ERCP) in Klatskin patients, specially when medium contrast is injected into biliary tree that could not be subsequently drained. Bacterial cholangitis is the principal cause of mortality in these patients. The aim of this study is to analyze cholangitis rate resulting from the use of air versus iodine contrast to obtain cholangiography during ERCP. METHODS: In 9 years, 188 inoperable Klatskin patients were recruited and divided into two groups: iodine (A) or air (B) c…

The importance of pyramidal lobe in thyroid surgery

Pyramidal lobe (PL) is an embryological remnant of the thyro-glossal duct; its incidence varies from 15% to 75% but data concerning its size are lacking and limited to autoptic and radiologic evidences. Aim of our study is to elucidate the intraoperative frequency, location and surgical management of the PL.604 total thyroidectomy were performed between 1999 and 2007 in Unit of General and Thoracic Surgery of the University Policlinico of Palermo. The intraoperative incidence of PL was 12% (57% male, 43% female, mean age 42.5 years), but only about 50% were identified preoperatively with ultrasonography (US) (4% false positive) or with Tc-99m pertechnetate scintigraphy (8% false positive).I…

Endoscopic palliative management of esophageal and tracheal rupture

The increasing number of patients requiring intensive care and airway support has led to a growing recognition that significant short- and long-term morbidity may be associated with the use of artificial airways; this is despite significant improvements in the materials used in laryngeal tubes, which aim to decrease the trauma associated with long-term intubation. We present the first case, to our knowledge,of huge, nontraumatic, esophageal perforation, widely communicating with the trachea, and which was treated successfully with double endoscopic stent placement.

Ultrasound (US) guided central venous catheterization of internal jugular vein on over 65-year-old patients versus blind technique.

Background and Objectives Performing a central venous catheterization (CVC) on older patients for long-term central intravenous therapy could be a very important procedure. It could be associated with a high incidence of related complications, especially on over 65-year-old, high risk, selected patients. Methods The authors analyzed the results of 72 central venous CVC of internal jugular vein performed on over 65-year-old patients with ultrasound (US) guide from January 1998 to April 2003. Results The average performing time was 4 min, with 98.7% of success, 0% of major complications, and 4.1% of minor complications (one mild vagal hypotension and two catheter dislocation). Conclusions The…

Cystic mucinous adenocarcinoma of the lung: a case report.

Abstract Mucinous cystic tumors of the lung are uncommon, the preoperative pathologic diagnosis is difficult and their biological behavior is still controversial. We report the case of a patient with a clinically benign cystic lesion that post-operatively showed to be consistent with an invasive adenocarcinoma arising in a mucinous cystadenoma of the lung, We underline the difficulty of the clinical pre-operative diagnosis of this cystic neoplasia radiologically mimicking a hydatid cyst, and we report the negative TTF1 immunostaining potentially misleading in the differential diagnosis with metastatic mucinous carcinomas. Finallly, we evidence the presence of a pre-existing mucinous benign …

Malattia di Fournier: caso clinico e revisione della letteratura

OBJECTIVE: The authors report their experience in diagnosis and treatment of one case of Fournier's gangrene; recent international literature review. EXPERIMENTAL DESIGN: Complete clinical report. Diagnostic, clinical and prognostic indication, evaluation of effectiveness of surgical treatment (debridement and necrosectomy) and follow-up; comparison between indications and multidisciplinary approach proposed by international literature. SETTING: Operative Unit of General and Thoracic Surgery. University "Paolo Giaccone" of Palermo. INTERVENTION: Repeated surgical treatment previous multimodal approach, according to international guide-lines. RESULTS: Complete recovery with "restitutio ad in…

Juxtapapillary duodenal diverticular bezor as an exceptional cause of biliary stent obstruction. Case report.

INTRODUCTION: we describe the first case in literature of biliary stent obstruction by bezoar impaction in a iuxtapapillary duodenal diverticulum. CASE REPORT: this case illustrates an juxtapapillary duodenal diverticulum and bezoar in it causing obstructive jaundice in subject with two biliary stents for cholangiocarcinoma (Klatskin's tumor) in the absence of bile duct stones. RESULT: successful treatment with endoscopic stent removal and diverticulum toilette. Obstructive jaundice was cured after endoscopic removal of the bezoar and stent substitution. DISCUSSION: the presence of a bezoar and its possible contribution to the pathogenesis of pancreatitis in the presence of periampullary ex…

Tiroidectomia in urgenza per linfoma primitivo della tiroide

Objective: A case of acute wheezing causing primitive thyroid lymphoma observed ay the Operative Unit of General and Thoracic Surgery of the University "P. Giaccone" of Palermo, Italy, is reported. Experimen tal design: Diagnostic, clinical and prognostic indication, evaluation of effectveness of radical surgical treatment and follow-up. Intervention: Emergency radical surgical treatment (debulking) and surgical tracheostomy (tracheal infiltration) Results: Complete recovery with "restitutio ad integrum". No relapse were recorded ad short follow-up. Conclusions: Total thyroidectomy in front of uncertain cytology with the suspect of Hashimoto's treatment or acute wheezing nr localized neopla…

La palliazione endoscopica dell’ittero ostruttivo da carcinoma inoperabile del pancreas. Nostra esperienza

Aim of the study: Few patients with pancreatic cancer are eligible for resection. In the remainder; estimation of prognosis is important to optimise various aspects of care, including palliation of biliary obstruction and trial of chemotherapy. The aim is to refer our personal experience about the palliation with endoscopic stenting in patients with unresectable pancreatic cancer. Methods: The Authors reviewed retrospectively 132 patients affected by unresectable pancreatic cancer who underwent palliative interventions with endoscopic stenting from 2000 to 2004. Results: Jaundice dramatically decreased in 86% of patients within 36 hours, in 12% within 48 hours and in 2% after two days. As c…

Secondary aortoduodenal fistula.

Aorto-duodenal fistulae (ADF) are the most frequent aorto-enteric fistulae (80%), presenting with upper gastrointestinal bleeding. We report the first case of a man with a secondary aorto-duodenal fistula presenting with a history of persistent occlusive syndrome. A 59-year old man who underwent an aortic-bi-femoral bypass 5 years ago, presented with dyspepsia and biliary vomiting. Computed tomography scan showed in the third duodenal segment the presence of inflammatory tissue with air bubbles between the duodenum and prosthesis, adherent to the duodenum. The patient was submitted to surgery, during which the prosthesis was detached from the duodenum, the intestine failed to close and a ga…

SINGLE ACCESS THORACOSCOPY IN BENIGN AND MALIGN PLEURIC PATHOLOGY

(OBJECTIVE) Jacobeus and Bethune performed thoracoscopy under local anaesthesia, already on early 1900. A single access associated with local anaesthesia aims to improve procedure tolerance, shorten recovery and reduce costs. (METHODS) Premedication consists of atropine 0.01 mg/kg and midazolam (0,02-0.04 mg/kg). Pain control and sedation was obtained by remifentanile (0.05-0.1 mcg/kg/min). Local anaesthesia was made with lidocaine and ropivacaine. An incision of 20 mm is realised at 6° intercostal space for the “single-access-technique”, and two incisions for the “2-trocars-technique” (15 mm at 5°space - 10 mm at 6°/7°space). The 5 mm 0° camera is preferred for single-access technique. The…

An uncommon cause of pneumothorax

Causa rara di ostruzione delle vie aeree: linfoma tiroideo

Acute onset of esophageal duplication cyst in adult. Case report.

Esophageal duplication (ED) cyst is unusual congenital disorder of the foregut, accounting for 10% to 15% of duplications of all foregut cysts. We report a case of esophageal duplication with acute clinical presentation, treated successfully with surgical resection.46-year-old man with acute dysphagia and gastroesophageal reflux of 2 weeks duration, showed submucosal bulging mass in the posterior wall of the middle third of oesophagus, fluid-filled cystic structure, dyshomogeneous, low-attenuation mass with smooth borders compatible with an hemorrhagic esophageal duplication cyst. With the suspect of acute presentation of a complicated esophageal cyst, the patient underwent surgery by right…

Endoscopic cytology in biliary strictures. Personal experience

The differential diagnosis between malignant and benign biliary strictures is the cornerstone of the management of jaundiced patients. The aim of our study is to define the role of cytology of the bile withdrawn during endoscopic retrograde cholangiopancreatography (ERCP), to reach a diagnosis of the nature of biliary stricture.This retrospective study was conducted on 67 consecutive patients affected of ingravescent obstructive jaundice who underwent ERCP+/-PTE (percutaneous transhepatic endoscopic)+bile withdrawn+stenting. We founded hilar stricture in 21 patients (31.3%), middle third the common duct stricture in 17 (25.3%), and lower third stricture in 28 patients (41.4%). In one patien…

Hsp10: Anatomic distribution, functions, and involvement in human disease

There is growing evidence that molecular chaperones/heat shock proteins are involved in the pathogenesis of a number of human diseases, known as chaperonopathies. A better molecular understanding of the pathogenetic mechanisms is essential for addressing new strategies in diagnostics, therapeutics and clinical management of chaperonopathies, including those in which Hsp10 is involved. This chaperonin has been studied for a long time as a member of the mitochondrial protein-folding machine. However, although in normal cells Hsp10 is mainly localized in the mitochondrial matrix, it has also been found during and after stress in other subcellular compartments, such as cytosol, vesicles and sec…

A stinging wasp in the stomach: accidental endoscopic diagnosis of a systemic anaphylactic reaction.

of a proton pump inhibitor and prokinetic treatment. Because of her medical history, an upper gastrointestinal (GI) endoscopy was performed. We discovered, in the proximalpartof theantrumonthegreater curvature, an intact dead wasp with its sting visible and an underlying slightly swollen red welt in the area of the sting

Duodenal Signet Ring Cell Carcinoma in a Celiac Patient

Celiac disease results from damage to the small intestinal mucosa due to an inappropriate immune response to a cereal protein. Long-standing or ‘refractory’ celiac disease is associated with an increased risk of autoimmunity and malignancy. We produced a brief literature review starting from a case of duodenal cancer in a celiac patient. The patient with an history of celiac disease since six months presented with acute manifestation of gastric outlet syndrome. A duodenal stricture was diagnosed at upper gastrointestinal endoscopy and confirmed by abdominal computed tomography. He was successfully treated by segmental duodenal resection. In the resected specimens, the diagnosis was duodenal…

Virtual broncoscopy in the preoperative assessment of peripheral airways stenosis

L’utilità del drenaggio biliare transepatico percutaneo ecoguidato negli itteri ostruttivi

A case of left bowel ischemia after right hernioplasty

Clinical and anatomical features of facial nerve in the surgery of parotid gland: our recent experience

Il gozzo cervicomediastinico

INTRODUCTION: Aim of the study is to discuss the diagnostic and therapeutic problems of substernal goiter (SG). MATERIALS AND METHODS: The Authors retrospectively analyzed 12 patients (3.1%) with substernal goiters among 379 patients undergoing surgical treatment for thyroid diseases from January 2000 to 2005, and evaluated the clinical data, preoperative diagnostic findings, surgical treatments, histopathological results, and postoperative complications. RESULTS: The most common symptoms were a cervical mass (100%) and dyspnea (16%), but 50% of the patients were asymptomatic. Chest radiography provided the first evidence of a substernal goiter in 100% of the patients. The AA performed tota…

Complicanze in chirurgia tiroidea: ipoparatiroidismo sintomatico post-operatorio.Incidenza, note di tecnica chirurgica, prevenzione e trattamento.

Introduction: Total thyroidectomy has a definite role in the management of malignant and benign thyroid disorders, with minimal complications and rare postoperative mortality. Even though thyroid surgery is quite safe, mechanical damage, devascularization or inadvertent removal of the parathyroid glands are possible. The aim of this study is to report report the personal surgical experience and to define some of the pathologic and clinical characteristics of unintentional parathyroidectomy and post-thyroidectomy hypocalcemia Materials and methods: A retrospective-observational study was carried on 313 thyroidectomies from January 2000 to January 2004 (60 males and 253 females), mean age 41 …

Syncronous adenomatous polyps and colorectal carcinoma

PER UN'ERMENEUTICA DELL'IRONIA. I PRESUPPOSTI SOCRATICI DELL'EDIFICAZIONE KIERKEGAARDIANA

Is Nasobiliary Tube Really Safe A Case Report

A case of esophageal ulcer caused by nasobiliary tube is described. This tool is not routinely considered to be a cause of major complications in the literature and to our knowledge, this is the first report of this kind of complication in nasobiliary tube placement. A 72-year-old patient presented with Charcot’s triad and was demonstrated to have cholangitis with multiple biliary stones in the common bile duct. Biliary drainage was achieved through endoscopic retrograde cholangiography, endoscopic sphincterotomy, biliary tree drainage and nasobiliary tube with double pigtail. The patient presented odynophagia, dysphagia and retrosternal pain 12 h after the procedure and upper endoscopy rev…

F3 the advantage of ultrasound-guided FNA of pleura in the diagnosis of the malignant pleural effusion

Complications of elective esophago-gastro-duodenoscopy (EGDS). Personal experience and literature review

Abstract INTRODUCTION: Although upper gastrointestinal (GI) endoscopy is reasonably safe, it is not perfectly so. The complication rate is about 0.1% for EGDS. Aim of this study is to schedule and evaluate all possible complications, starting from personal experience in Operative Unit of Surgical Endoscopy. PATIENTS AND METHODS: We evaluated all EGDS performed at the Operative Unit of Surgical Endoscopy of Policlinico in Palermo between January 2000 and January 2008. A single staff of endoscopists performed diagnostic and therapeutic exam. All complications were tabulated and scheduled to identify possible risk factors or indicators procedure- or patient-related. RESULTS: 5.258 patients (43…

Ruolo del palloncino intragastrico riempito ad aria (Heliosphere Bag ®) nel trattamento dell’obesità grave. Esperienza personale.

Bile leaks after videolaparoscopic cholecystectomy: duct of Luschka.

Pleural fluid collection and ultrasound guided percutaneous drainage

High levels of exogenous C2-ceramide promote morphological and biochemical evidences of necrotic features in thyroid follicular cells

CD95 and ceramide are known to be involved in the apoptotic mechanism. The triggering of CD95 induces a cascade of metabolic events that progressively and dramatically modifies the cell shape by intense membrane blebbing, leading to apoptotic bodies production. Although the CD95 pathway has been abundantly described in normal thyrocytes, the effects of cell permeable synthetic ceramide at morphological and biochemical levels are not fully known. In the present study, we show that thyroid follicular cells (TFC) exposed to 20 microM of C(2)-ceramide for 4 h are characterized by morphological features of necrosis, such as electron-lucent cytoplasm, mitochondrial swelling, and loss of plasma me…

Trattamento endoscopico di un caso di “gastric outlet syndrome” dopo gastroplastica verticale sec. Mason

Presentazione degli Atti del Convegno

Asymptomatic Bone Cement Pulmonary Embolism after Vertebroplasty: Case Report and Literature Review

Introduction. Acrylic cement pulmonary embolism is a potentially serious complication following vertebroplasty. Case Report. A 70-year-old male patient was treated with percutaneous vertebroplasty for osteoporotic nontraumatic vertebral collapse of L5-S1. Asymptomatic pulmonary cement embolism was detected on routine postoperative chest radiogram and the patient was treated with enoxaparin, amoxicillin, and dexamethasone. At the followup CT scan no further migration of any cement material was reported; and the course was uneventful. Discussion. The frequency of local leakage of bone cement is relatively high (about 80–90%), moreover, the rate of cement leakage into the perivertebral veins (…

Imprescindibilità della coscienza morale

What to do when endoscopic retrograde cholangio-pancreatography fails? Personal experience.

A Strange Case of Left Bowel Ischemia after Right Hernioplasty

We report the first observed case of a young man who suffered of large and unsuspected left bowel ischemia following an elective right open hernioplasty. A 54-year-old man had a 2-year history of right inguinal reducible mass and was admitted to hospital for an elective day case open inguinal hernioplasty for a direct right inguinal hernia. Apart from mild hypertension controlled with ACE inhibitor, he was medically fit and well. The patient was submitted to open tension-free mesh repair with polypropylene preshaped mesh with local infiltration anesthesia and additive sedation with midazolam. The local anesthesia and surgery were uneventful and he was discharged home on the same day as per …

Benign gastric polyps and Helicobacter pilori infection

Comparasion of central venous catheterization with and without ultrasound guide

PURPOSE: To compare the effectiveness, safety and time needed to perform central venous catheterization (CVC) in the presence or absence of an ultrasound (US) guide. METHODS: Between January 1999 and February 2002 we performed CVCs in 196 patients: 105 patients received US guided CVC (group I) and 91 patients had CVC without US guide (group II). RESULTS: The average time to perform CVC was shorter with US guide (4 vs 7 min). The utilization of the US guide was also associated with improved success (98.09% vs 91.2%, p<0.025) and lack of major complications (0% vs 9.8%, p<0.001). CONCLUSIONS: US-guided CVC affords an easier, safer and more rapid cannulation of a central vein. It is especially…

Pneumotorace da frattura del terzo laterale della clavivola. Caso clinico e revisione della letteratura

INTRODUCTION: the clavicle is one of the most commonly fractured bones, accounting for up to 4-10% of all adult's fractures. These fractures are comparatively easy to manage and typically heal with routine immobilisation. CASE REPORT: a 28 year old man had direct driving trauma to the left shoulder and reported a displaced fracture of the third lateral of left clavicle and an apical pneumothorax. The pneumothorax was treated by the insertion of a chest drain under local anaesthesia. The chest drain was removed 12 days after the injury and the patient was transferred in Traumatology for specific therapy. RESULT: 6 months after the accident, the clavicular fracture had united and the chest ra…

Tree dimensional computer model in a case of azygos lobe discovered during adenocarcinoma surgery

Medicus ac philosophus: esigenza d'interdisciplinarità in medicina

Cisti broncogena diaframmatica associata ad ernia di Bochdalek

Linfangioma cistico mesenterico. Descrizione di un caso e revisione della letteratura.

Objective: The Authors report their experience in diagnosis and treatment of one case of mesenteric cystic lymphangioma; recent international literature review. Experimental Design: Complete clinical report. Diagnostic, clinical and prognostic indication, evaluation of effectiveness of radical surgical treatment and follow-up. Setting: Operative Unit of General and Thoracic Surgery. University "Paolo Giaccone" of Palermo. Intervention: Radical surgical treatment, according to international guide-lines. Results: Complete recovery with "restitutio ad integrum". No relapse were recorded at short follow up. Conclusions: Even when asymptomatic and discovered incidentally, LCM must be treated sur…

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