AMPULLECTOMIA E CARCINOMA GIGANTE DELLA PAPILLA DI VATER

The case of a giant carcinoma of Vater's papilla is reported. The clinical/diagnostic paths and therapeutic indications for ampullectomy are analysed on the basis of the good survival rate observed more than five years after transduodenal excision and in the light of the most recent literature. The authors believe that accurate, early diagnosis and histological typing is fundamental for an appropriate selection of patients when complex surgical decisions have to be taken. They consider ampullectomy to be a valid therapeutic option, certainly in the case of benign neoplasias, and duodenocephalopancreasectomy (DCP) to be the operation of choice for the treatment of ampullar and periampullar m…

TRATTAMENTO CHIRURGICO D' URGENZA DI ANEURISMA GIGANTE DELL'ARTERIA SPLENICA NELL'ANZIANO

CARCINOMA CON CELLULE CON CASTONE INSORTO SU POLIPO GASTRICO

AIM: The authors signal a case of gastric polypoid signet ring cell carcinoma, of particular interest for its rarity like show from the review of the literature, which is the first to have been described after Tabaru's citation. METHODS: The study has been carried out at the Department of Surgical and Oncological Sciences of the University of Palermo. It has been based on 2000 cases analysed from June 2001 to December 2003. RESULTS: The authors advance some and emphasizes the diagnostic flow chart and therapeutic choices adopted. CONCLUSIONS: We agree that the endoscopic polypectomy is surgical procedure of first approach, but modifying the therapeutic guideline in relation to histologic ex…

ILEO BILIARE: DIAGNOSI E TRATTAMENTO. CASE REPORT

The authors present a case of gallstone intermittent ileus caused by the passage of a big gallstone (about 4 cm in diameter) in the intestinal lumen, through a cholecystoduodenal fistula. They emphasize the peculiarity of the case for the characteristics of symptoms and for casual diagnostic check-up with a ultrasonography. The disease is not frequently diagnosed; today it has a safe recognition by modern imaging. The symptoms can be intermittent and, even when there are the classic signs of intestinal occlusion, the site of the occlusion is various. With a timely endoscopical or surgical approach (open or laparoscopic) it is possible to reduce mortality of patients treated in emergency.

Il ruolo della manometria intraoperatoria nel trattamento chirurgico dell'acalasia esofagea

Versione italiana Introduzione. Gli Autori riportano i risultati della loro esperienza sul ruolo della manometria intraoperatoria (MI) nel trattamento chirurgico dell'acalasia. Pazienti e metodi. Sono stati presi in considerazione 239 pazienti affetti da acalasia osservati dal 1994 al 2006; solo 79 hanno continuato l'iter diagnostico-terapeutico e 31 sono stati sottoposti ad intervento chirurgico di miotomia longitudinale secondo Heller, associando in 25 una plastica antireflusso secondo Dor e in 6 una plastica antireflusso secondo Nissen. In 24 pazienti su 31 è stata eseguita una MI con la individuazione delle zone di alta pressione (HPZ). Risultati. I pazienti sottoposti ad intervento di …

Adrenal incidentaloma: case report and synthesis of indication and thresholds of surgery therapy].

With the term of incidental mass, any mass is identified, occasionally discovered with imaging techniques, in the absence of specific symptoms. In 1982, the term "incidentaloma" was introduced to indicate lesions detected on adrenal regions, found unexpectedly. The incidence percentages vary from 0.6%-3% in CT followed by other indications , to 10% and 25% in all patients who underwent an ultrasound, CT or MRI. An appropriate diagnostic protocol is mandatory to identify and to choose the proper treatment for the functioning lesions, as well as the malignant or potentially malignant lesions (1, 2). Incidentalomas with diameters under 1 cm seem to not have a pathologic significance, and are c…

gastric polypoid lesions. Our ecperience.

BACKGROUND AND AIM: The Authors report the results of their experience on polypoids lesions of the stomach and on endoscopic polypectomies. PATIENTS AND METHODS: A study on 2000 OGD (oesophagogastroduodenoscopy) has been carried out on 95 patients with polypoid lesions. The authors have analysed the associations existing between histological type and symptomatology and localisation of the lesion and the status of the Helicobacter pylori and the risk of cancerization. The data were confronted with the ones already available. RESULTS: In the majority of the cases, the polypoid lesions were asymptomatic, the localization changed according to the histological type, with the antrum as the most a…

Pseudocisti pancreatiche infette: Note di tecnica

Introduction. Starting from the observation of 9 cases of giant infected pancreatic cysts, which occurred from 1994 to 2004 at the Department of Oncological and Surgical Studies, the Authors' aim has been to evaluate whether a more thorough necrosectomy, carried-out under videoendoscopic control, associated with a nose-gastro-cavity tube, which ensures a continuous cleansing of the newly-formed cavity, and an appropriate positioning of the drainages, could reduce the morbility and allow a shorter recovery of the infected psuodocysts. Patients and methods. Of 73 cases of acute pancreatitis, observed from 1994 to 2004, 9 showed severe and acute pancreatitis, which included giant pseudocysts, …