Lung tumors invading the chest wall are classed as belonging to the T3 group and are considered potentially resectable. Their management, however, is controversial, and extrapleural resection, when possible, is preferred to en bloc resection which is regarded as a far more invasive and dangerous operation. Five year survival rates for completely resected cases range in the literature from 25 to 35%, but survival rates are much worse if lymph node metastases are present. These poor outcomes have prompted the development of combined surgical approaches: preoperative radiation therapy, with or without chemotherapy, has been used with an improvement in resectability rates, but only modest results in terms of median survival; in a number of case series, increased operative morbidity and mortality have been reported with this approach. The present report relates to 122 patients treated by en bloc (20 cases) or extrapleural (102 cases) resection, 31 of whom also received neoadjuvant treatment. The operative mortality was 4.6%. Median survival was 17 months after en bloc resection and 19 months after extrapleural resection. Though no statistically significant difference was found, extrapleural resection would appear to yield better results than the en bloc procedure.

Adult↗

PubMedDate not supplied

[Surgical treatment of inguinal hernias with local anesthesia].

Fifty-nine cases of inguinal hernia repair with local anesthesia are shown. The authors stress the advantages of this safe technique permitting an immediate postoperative ambulation and an early discharge of patients, thus reducing complications related a long term bed-stay.

Adult↗

PubMedDate not supplied

[Conservative treatment of splenic trauma].

Authors present a series of 19 patients accepted for a splenic trauma. Four cases underwent TNO and 15 splenectomy, associated in 9 of them to autotransplant in omental pouch. Authors stress the importance of the conservative management of spleen injuries, to preserve its hematologic and immunologic functions.

Adolescent↗

PubMedDate not supplied

[Bilateral retroperitoneal lymphadenectomy in tumors of the testis: anatomo-clinical considerations].

Bilateral retroperitoneal lymphadenectomy is usually indicated for non-seminomatous testis tumour at stage IIA and IIB. For seminoma is generally used radiotherapy, although some Authors prefer the surgical approach. Radical retroperitoneal lymphadenectomy must be bilateral, because metastatic cell can often spread to the contralateral lymph nodes. Lymphadenectomy is used not only for therapy, but also for staging: thus clinical evaluation and other diagnostic techniques are not always correct (30% of understaging). Permanent sexual disfunction can follow radical surgery, due to extensive retroperitoneal dissection and exeresis of lumbar sympathetic nerves; so it is proposed, for stage I tumors, a monolateral or limited retroperitoneal lymphadenectomy. Eight patients with non-seminomatous testicular tumours are reported by the authors; 2 (stage I) were treated with monolateral, 4 (stage IIA and IIB) with bilateral retroperitoneal lymphadenectomy; in 2 patients (stage IIC and IID) chemotherapy was followed by debulking surgery. Relapses were observed between 3 and 19 months. Sexual dysfunctions after surgery were present in 5 patients (69%); in all of these a bilateral retroperitoneal lymphadenectomy was performed.

Adolescent↗

PubMedDate not supplied

[Adrenal hemorrhagic cysts: apropos of a clinical case and review of the literature].

Adrenal cysts are uncommon lesion and present complex problems in differential diagnosis. The treatment options are not univocal. Starting from the study of a personal case the authors review the existing literature and discuss the problem of diagnosis and treatment.

Adrenal Gland Diseases↗