The Authors present 6 cases of oesophageal leiomyomas operated on during the past 15 years at the Institute of Surgical Pathology of the University of Turin and compare the results with those in the literature. The pre-operative diagnosis was not always possible and often difficult: it was however, helped by many clinical and instrumental examinations. The treatment of choice was surgery, usually by enucleation or occasionally by gastroesophageal resection. There was no operative mortality and no recurrences have been observed.

Adolescent↗

PubMedDate not supplied

[The treatment with biosynthetic growth hormone (GH) of familial short stature].

The effect of growth hormone (GH) treatment in non-GH deficient subjects has been amply studied over the past few years. Although the results of these studies are encouraging, there are still no definitive data since the findings are not comparable due to the different characteristics of the populations examined. In the present study the authors examined the following parameters: stature, height SDS, growth rate, bone age and final height prediction according to Tanner, pubertal stage, before and after treatment with biosynthetic GH at a dose of 1.4 IU/kg of bodyweight for 12 months. The population treated consisted of 10 subjects (5 males and 5 females) aged between 7.3 and 9.5 years old, all prepubertal, with "familial short stature", selected according to the following criteria: stature below the 3rd centile, normal growth rate, normal GH response to stimuli using clonidine and insulin, correlation with parental stature between 25th and 75th centile, bone age correlated to chronological age, absence of other pathologies. After 12 months height SDS moved from -2.75 +/- 0.26 to -2.23 +/- 0.25 (p < 0.5); the growth rate changed from 5.75 +/- 0.63 to 6.66 +/- 0.56 (p < 0.05). No abnormal acceleration of bone age as observed: it moved from 8.2 +/- 0.62 to 9.5 +/- 0.72; all subjects continued to be prepubertal. The expected final stature changed from 154 +/- 2.38 to 159 +/- 0.7 (p < 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

Age Determination by Skeleton↗

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[External saphenous vein excision with mini-phlebectomy].

The surgical treatment of the varicosities of the short saphenous vein is one of most controversial matter of modern phlebology. The anatomy of this vessel, that is deep, and is accompanied by the sapheno external nerve, can be very varied species for that which concerns the sapheno popliteal joint. The traditional surgery as the sclerotherapy exposes the patient to risks and failures. For such reasons the authors believe that the modern technique of stab evulsion phlebectomy could be formatted like the treatment of choice of the venous pathology of the short saphenous vein. Synthesizing, the stab evulsion phlebectomy consists of the removal of the varicosities of the lower limbs through incisions of the skin of 1-3 mm using special surgical instruments with hook (Chrochets). The technique doesn't foresee neither stitching neither vascular binding, and could be performed on local anesthesia and in ambulatory regimen. The results of the technique and the absence of complications suggests its adoption of principle in the treatment of the incompetence of the short saphenous vein.

Humans↗

PubMedDate not supplied

Endoscopic ultrasonography for preoperative staging of gastric carcinoma.

BACKGROUND/AIMS: To assess the accuracy and limitation of endoscopic ultrasonography in preoperative staging of gastric cancer, we performed a prospective study on 99 patients. MATERIAL AND METHODS: Ninety-nine patients with gastric cancer had preoperative staging with endoscopic ultrasound (EUS) and CT. RESULTS: The depth of infiltration (T parameter) was correctly defined by EUS in 58/65 patients (89%). The lymph node involvement (N parameter) was correctly classified in 44/65 patients (68%), the sensitivity was 74% and the specificity was 54%. The most frequent cause of understaging T parameter was microscopic tumor invasion, whereas overstaging was due to peri-tumor inflammation. CONCLUSIONS: We believe that EUS is a reliable method, superior to all diagnostic tools, in the evaluation of locoregional extension of gastric cancer.

Endosonography↗

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Primary multiple epithelioid leiomyosarcoma of the liver.

Sarcomas represent only 1-2% of primary malignant tumors of the liver. We report the twenty first case of primary hepatic leiomyosarcoma in the literature. Metastases from gastrointestinal tract, female genital system and lung have to be excluded before confirming diagnosis of a primary neoplasm. Extensive involvement of the liver parenchyma contraindicated surgery, the treatment of choice when the tumor is solitary or multiple but located in one lobe. Chemotherapy, as employed in our patient, is the alternative therapeutic option in inoperable cases, but its role has to be clarified.

Adult↗

PubMedDate not supplied

[Cholecystectomy by minilaparotomy].

The authors relate their experience of 62 cases of minicholecystectomy. This procedure is compared to "open" conventional and laparoscopic cholecystectomy. Report results and the analysis of the literature shows that the technique of cholecystectomy by minilaparotomy is a valid option to laparoscopic cholecystectomy and represents a clear improvement compared to conventional cholecystectomy.

Adult↗

PubMedDate not supplied

[Mirizzi's syndrome].

Two cases of Mirizzi's syndrome are reported. The syndrome consists of: external compression of the common bile duct due to a benign lesion (Type I)--presence of a cholecystobiliary fistula with impacted stones and partial or total obstruction of the hepatic duct (Type II). Clinical signs are non-specific and suggest at first sight an obstructive jaundice. Ultrasonography shows dilatation of the upper biliary tract with narrowing of the biliary tract below the dilatation. ERCP often proves mandatory for diagnosis. Therapeutical procedures are reported.

Aged↗

PubMedDate not supplied

Evaluation of leiomyoma of the esophagus with endoscopic ultrasonography.

Fourteen patients with suspected leiomyoma of the esophagus were studied by endoscopic ultrasonography, computed tomography, endoscopy and barium swallow. The results were correlated with the histology of the resected specimens: in 2 patients with a peduncolated leiomyoma originating from the second echographic layer, endoscopic resection was performed. Endoscopic ultrasonography was superior to other imaging techniques in detection and staging of leiomyoma because it can determine the layer of origin, the direction of the growth and the consistency of the tumor.

Adult↗

PubMedDate not supplied

Endoscopic ultrasonography in the evaluation of leiomyoma and extramucosal cysts of the esophagus.

BACKGROUND/AIMS: Leiomyoma is the most common type of benign esophageal tumor, whereas extramucosal cysts of the esophagus are congenital anomalies frequently asymptomatic in the adult and in most cases detected incidentally on chest x-ray. It is worthwhile considering these conditions together, because they present similar diagnostic and surgical problems. Conventional imaging tests do not lead to a precise diagnosis. The purpose of this study was to evaluate the use of endoscopic ultrasonography in the diagnosis of, and planning of treatment modalities for, these conditions. METHODOLOGY: Fifteen patients with esophageal leiomyoma and seven patients with extramucosal esophageal cysts were studied with endoscopic ultrasonography using an Olympus GF- EU-M3 instrument with a 7.5-12 MHz echoprobe. In all patients, the results of endoscopic ultrasonography were compared with the histology of the resected specimens. RESULTS: The histology of the resected specimens confirmed the endosonographic diagnosis in all patients. No malignancy was found in any specimen. CONCLUSIONS: Endoscopic ultrasonography is very accurate in visualizing these lesions and differentiating cystic from solid submucosal esophageal masses; in addition, the test can establish the exact location of the mass in relation to the esophageal wall and mediastinum. Therefore, endoscopic ultrasonography has a great impact in confirming the diagnosis of leiomyoma and extramucosal cysts of the esophagus and facilitates therapeutic decision-making because of its capacity to clearly define the size, layer of the origin, and pattern of the mass.

Adult↗

PubMedDate not supplied

Can laparoscopic cholecystectomy be a day surgery procedure?

BACKGROUND/AIMS: Gallbladder surgery by videolaparoscopy (VL) is now able to obtain the same goals as traditional surgery, and is associated with comparable or better results both in terms of positive surgical outcome and patient satisfaction. With public health spending under growing social and administrative pressure, and continuous efforts focusing on enhancing the efficiency of both surgical instruments and operating procedures, it is a most attractive, albeit initially challenging, prospect to regard video-laparoscopic surgery as day-case surgery. Herein, the authors assess the outpatient treatment option, due to recent technical developments and relevant major organizational and professional implications, and consider the feasibility of day-case surgery projects which should soon be implemented. METHODOLOGY: From January 1994 to December 1996, 1,334 patients underwent videolaparoscopic cholecystectomy. Of these, 898 were women and 436 men. In 1,034 of the laparoscopies gas was used and 300 were performed without gas. Out of the total 1,334 patients who were submitted to the videolaparoscopic cholecystectomy procedure with or without the use of gas, 72 (5.4%) were treated on an outpatient basis. RESULTS: In our series, 93.5% of patients reported normal post-operative functions within 24 hours; 90.2% of patients were able to take oral fluid on the same day of the operation and had normal bowel peristalsis within the first post-operative day. CONCLUSIONS: The authors assess the outpatient option treatment, due to recent technical developments and relevant major organizational and professional implications, and consider the feasibility of a day-case surgery project which should soon be implemented.

Adolescent↗

PubMedDate not supplied

Laparoscopic Lin operation for the treatment of polycystic liver disease.

Non parasitic hepatic cysts are a clinical entity that is often associated with polycystic kidney disease. We report the case of a 75 year-old woman who presented with symptomatic but non complicated polycystic liver disease. The treatment consisted of laparoscopic fenestration of a large simple cyst located in the left hepatic lobe. The postoperative course was uneventful and the patient remains free of symptoms at 18-months follow-up. Selected patients with symptomatic but uncomplicated polycystic liver disease and favourable anatomy benefit from laparoscopic fenestration of the cysts with low morbidity and hospital stay.

Aged↗

PubMedDate not supplied

Extended membranous tracheobronchial rupture after tracheal intubation.

Membranous tracheo-bronchial rupture due to tracheal intubation has been infrequently reported. We present a previous unreported case of an extended membranous tracheo-bronchial laceration successfully repaired, on an emergency basis, through a right thoracotomy and cervicotomy with primary multiple interrupted sutures without the use of a free patch. We believe that in this complication the prognosis is generally good and much more linked to the underlying disease than to tracheal rupture.

Aged↗