Transanal Endoscopic Microsurgery (TEM) is a novel technique, first introduced by Buess and coworkers in 1983 for the treatment of large sessile polyps of the rectum. Due to the excellent results the indication was then extended also for the removal of low risk early adenocarcinomas (pT1, G1-G2). TEM allows, by using an operative proctoscope of an outside diameter of only 4 cm., all the conventional surgical manoeuvers within the rectal lumen, up to 20 cm. from the anal verge. The Authors report a consecutive series of 53 patients submitted to TEM over a 37 month period; apart from 7 patients excluded for different reasons, postoperative diagnosis showed 30 adenocarcinomas (65.2%), 15 adenomas (32.6%) and 1 epidermoidal carcinoma (2.2%). The low recurrence rate observed both for adenomas (0%) and pT1 adenocarcinomas (9%) coupled with the optimum vision allowed by the 6-fold magnified stereoscopic view, make this technique the method of choice for selected patients with these kind of pathologies.

Adenoma↗

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[Unusual location of hydatid cysts: clinical and therapeutic aspects].

Among patients treated for hydatidosis, unusual sites are observed in 5-30% of cases, with highest rates in endemic areas; on these basis during the diagnostic work up of masses arising from peritoneum, spleen, mediastinum, kidney and muscle, this possibility should be always taken into account. In fact, only a preoperative diagnosis allows a correct therapeutic approach, especially when synchronous lesions coexist. In this paper the Authors report their experience in the treatment of 66 (5.2%) hydatid cysts developed in unusual sites, out of 1275 patients treated for hydatidosis from 1949 to 1993. They discuss the main pathogenetic and clinical features as well as the therapeutic management of these atypical lesions.

Echinococcosis↗

PubMedDate not supplied

Axillary-to-contralateral brachial artery by-pass in the treatment of arm ischaemia.

Axillary-to-contralateral brachial artery by-pass was applied in two female patients affected by unilateral obstructive lesion of the subclavian artery with significant symptoms of arm ischemia. The result, at 10 and 12 months of follow-up, is good. The technique and its advantages are shortly outlined.

Adult↗

PubMedDate not supplied

[Surgical treatment of recurrent gastroesophageal reflux].

From 1972 to 1994, 66 patients underwent 67 Belsey MK IV antireflux repairs in our unit. Fifteen of the 67 patients or 22% had previously undergone antireflux surgery (10 hiatal repairs and 5 antireflux repairs). Obstructive symptoms were present in one patient who had previously undergone a Nissen fundoplication whereas all other patients presented recurrent reflux. There were no operative complications and only one hospital mortality (6.6%). Long-term results were good-to-excellent in 62% of all patients and fair in 15% of all patients; failures constituted 23% of all cases and were due to recurrent reflux symptoms. In the literature of the last 20 years, two groups can be identified, one group consisting of 142 patients treated surgically after unsuccessful Nissen fundoplication, the other group consisting of 438 patients who underwent 580 operations due to failure of the more common antireflux procedures used today. Recurrent reflux was the most frequent cause of failure in both groups (48% in the first and 58% in the second group). With respect to obstructing symptoms (26% and 32% respectively), these were due to a tight wrap in those patients who underwent a Nissen fundoplication and to peptic stenoses in those patients who underwent other surgical procedures. In 25% of patients who underwent a Nissen fundoplication, the cause of failure was the so-called "Slipped Nissen", responsible for both obstructing symptoms and reflux. In 60% of patients treated for failure following a Nissen fundoplication, the same surgical procedure was used. In the second group, only 20% of all patients underwent a Nissen fundoplication while 20% underwent esophageal resections and another 20% other antireflux surgical procedures. The differences in mortality and morbidity in the two groups (0-2% vs 0-12% and 0-33% vs 21-73%) are probably related to a higher incidence of the thoracic approach in the second group. Good-to-excellent results were achieved in 60-100% of patients treated for failure after a Nissen fundoplication and in 58-60% in those patients treated for failure of other various surgical procedures.

Adult↗

PubMedDate not supplied

[Localized fibroma: a rare tumor of pleural origin].

Localized fibroma represents a rare entity arising from the pleura. Currently its histogenesis and clinical behaviour are still controversial. A case of a 64-year-old male is here presented; clinical and histopathological features are then discussed on the basis of a review of the Literature. At present, an en-bloc resection of the tumor, including wide margins of the surrounding lung tissue, seems to be the most appropriate surgical choice.

Adult↗

PubMedDate not supplied

The role of surgery in the treatment of primary gastric lymphoma.

BACKGROUND: The aim of the study was to analyze the results of surgical treatment in early and advanced primary gastric lymphoma and to evaluate predictive factors for long-term outcome. MATERIAL AND METHODS: A retrospective study of 92 patients resected for primary gastric lymphoma was conducted. Sixty-eight (74%) patients underwent a curative resection 10 (11%) patients had palliative resection and 14 (15%) patients were deemed unresectable: 33 patients (36%) had a stage IE tumor, 12 (13%) stage IIE1, 22 (24%) IIE2 and 25 (27%) stage IVE. RESULTS: Follow-up ranged from 1 to 336 months (means 44 +/- 70 months, median 18 months). Cumulative actuarial 10-year survival rate was 49.1%. Ten-year actuarial survival rates were 78.9% for stage IE and 100% for stage IIE1 whereas 5-years survival rates were 0% for stage IIE2 and 21.7% for stage IVE (P < 0.00001). CONCLUSION: Surgical treatment is the front line therapy for IE and IIE1 stages of primary gastric lymphoma.

Adolescent↗