Biomedical subjects
Publications and source records attributed to M S Saviano.
The authors present two case reports of mesenteric cystic neoformations which they themselves observed and, with the help of the literature regarding this pathology, discuss the problems of both diagnosis and treatment.
Gastrointestinal carcinoids are infrequent but at the same time hardly rare tumours. They are often chance findings but, as is clearly reported in the literature, their potential malignancy should not be overlooked. They are most commonly localised in the appendix. The authors describe two case reports of carcinoid tumours of the appendix, one of which was diagnosed during left hemicolectomy due to Crohn's disease and the other during acute appendicitis. Prognostic and therapeutic problems are discussed in the light of the most recent literature.
Eight cases of Meckel's diverticulum observed by the authors are reported. Different investigative methods, clinical and surgical aspects are discussed. Even asymptomatic Meckel's diverticulum discovered incidentally at surgery should usually be removed.
Pulmonary hamartoma is a rare benign tumor often found by chance. Only in 10% of cases are some calcifications like "pop corn". Fibrobroncho-scopy is help only in endobronchial forms; they don't reach 10% of cases. Computed Tomography and transparietal biopsy can be diagnostic. In the uncertain cases and in presence of symptoms, thoracotomy with exeresis of tumor is justified.
The authors present a case of neonatal intestinal duplication. Etiopathogenic view and the diagnostic and therapeutic problems are discussed. Echotomographic examination can provide useful diagnostic input, as in this case, even at a prenatal stage.
The paper reports the authors' personal experience regarding the use of magnetic resonance imaging in the diagnosis of cryptorchidism. The result of the study of 13 patients with non-palpable gonads, who all underwent surgical confirmation (with positive outcome in 66% of cases), encourage the use of this non-invasive method with a high anatomic resolution, which can be used to diagnose both the site, dimensions and possible structural alterations of the gonad.
The spread of mechanical staplers now makes it possible to perform anastomoses in anterior resections of the rectum that are easier and safer than manual ones. Certain related problems are well known, particularly in patients with narrow pelvis and, in low anastomoses, the fashioning of the tobacco pouch on the distal rectal stump. The technique of transutural mechanical colorectal anastomosis with circular stapler after closure of the rectal stump with linear stapler is described in detail. Advantages of the technique are: anastomoses that are technically easier and safer because making of the tobacco pouch on the distal rectal stump is avoided; pollution of the operating field is reduced to the minimum; there are no problems related to differences in lumen of the colorectal stumps.
The Authors refer some diagnostic and therapeutic observations about pelvic-perineal recurrence after abdominal-perineal excision of rectum (AAP). They analyze new possibilities of diagnostic instrumentation, in particularly TC and RM scanner, comparing the results and valuing the sensibility and specificity in a selected group of patients.
The paper reviews the current methods of surgery for inguinal hernia in children. This is a relatively common pathology but there is still no consensus regarding the most important aspects, namely "who" should be operated, "why", "when", "what methods should be used", and "what results are achieved" The excellent outcome in addition to the rarity of relapse in cases of uncomplicated hernia, opposed to emergency operations due to strangulation which are accompanied by a significant rate of mortality, justify, with rare exceptions, early intervention once the diagnosis has been confirmed.
After a description of the basic criteria for the correct formulation of Multiple Choice Questions (MCQ) for use in the assessment of different levels in the intellectual process (memorising, data interpretation, problem solving) a package of computer programs for the use of MCQ in the assessment of what has been learned in a General Surgery course in the Faculty of Medicine and Surgery are presented. The MCQ is a valuable didactic tool that can well supplement though not replace oral examination for assessment at all stages of a course.
A cost/benefit analysis has been carried out of the follow-up of abdomino-perineal amputation of the rectum for cancer in the light of the objectives pursuable with this practice and the diagnostic techniques available today. As regards early diagnosis of a return of the disease, it is necessary to distinguish between long-term recurrence, hepatic or pulmonary for example, in relation to their greater potential capacity for surgical exeresis and local pelviperineal recurrences which are more rarely susceptible to radical exeresis in spite of the introduction of computed tomography and nuclear magnetic resonance in the diagnostic/therapeutic routine. As for diagnosis and management of metachronous polyps as a prevention of metachronous cancer, the importance of periodic trans-stomal pancolonoscopic control of the residual colon in all patients emerges. Finally, in cost/benefit terms, the objective of a psychophysical rehabilitation of the colostomized patient is advantageous with a marked reduction in welfare expenditure for the community.
The Author critically analyzes the aims of curative surgery for rectal cancer, i.e. radical colonic resection, lymphoadenectomy, conservation of adequate post-surgical functionality of the remaining colon. Nowadays, therapy does not end with the exeresis of the primary cancer as an isolated stage but rather includes adequate follow-up to prevent metachronous cancer by detecting and removing recurrent adenomas. But it also includes early diagnosis of any recurrence of the primary cancer to facilitate adequate treatment.
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