[Cholangiojejunostomy of the duct of the 3d segment. Palliative treatment of cholestatic jaundice caused by neoplastic obstruction of the hepatic hilus]

Cholangiojejunostomy of the duct of the III segment in the palliative treatment of mechanical jaundice from neoplastic obstruction of the hepatic hilus. The neoplastic obstruction of the liver hilus has an almost total absence of forewarning clinical signs and therefore results in surgery at a late stage when the patient is not susceptible to radical treatment. It is therefore necessary to use palliative treatment in order to resolve the serious jaundice, the main cause of a quick death. Among the palliative treatment the Authors report their experience of intrahepatic cholangiojejunostomy of the duct of the III segment that they consider the most suitable technique for its ease of execution, its constant anatomical situation and the peripheral position of the anastomoses in relation to the neoplastic lesion. This allows a lasting biliary decompression with a good residual life.

[Acute obstruction of the abdominal aorta]

The acute occlusion of abdominal aorta is a rare event that may have severe clinical results. Personal experience in three cases of acute thrombosis treated in emergency surgery are presented. Aorto-iliac thromboendarterectomy, aorto-bifemoral bypass and thrombectomy with Fogarty catheter were performed. In the first case, after the operation, a renal ischemia occurred. The second and the third patient died after seven days and twenty-four hours respectively.

Su di un caso di carcinoma a cellule chiare in nefroma cistico multiloculare

A case of adenocarcinoma of the kidney in a multilocular cystic disease is reported. The many diagnostic pitfalls of this rare association are underlined and the diagnostic role of selective renal artery angiography, which removed all doubt about the lesion.

[Urachal cyst. A case report and review of the literature]

The pathology of urachal disease is rarely seen. This article refers to a case of urachal cyst in a twenty-five-year-old male. In order to discuss the pathogenic, clinical and therapeutic aspects of this rare pathology, it is necessary to carry out a complete revision of the literature. Diagnosis is helped by ultrasound and CT scan of the lower abdomen, while fistulography is necessary when there is cutaneous drainage. The treatment consists of surgical approach which includes complete en-bloc excision of the cyst together with possible urachal residue. Such treatment is indispensable in order to avoid acute infection and/or malignant degeneration, frequent complications which are very serious.

Idiopathic eosinophilic pneumonia and pregnancy: report of a case

A case of chronic eosinophilic pneumonia and pregnancy is reported. In 1989, a 24-year-old woman with chronic eosinophilic pneumonia became pregnant. We decided not to stop steroid therapy. Except for premature preterm rupture of the membrane she had a uneventful pregnancy and a male infant with no distress syndrome.

[Small-cell carcinoma of the bladder: description of a case and review of the literature]

Small-cell carcinoma (also known as oat-cell carcinoma) is a rare tumor that previously concerns the lung; small-cell carcinoma of the bladder is extremely rare (0.5% of all bladder malignancies). The Authors report here the case of a 78th years old man. Fourteen months before our observation he was submitted to a partial cystectomy for a small-cell carcinoma of the bladder cupola. There was no evidence of extra-vesical location at that moment and the patient was not submitted to any adjuvant therapy. At the moment of our observation the disease was very advanced and the patient died in a few time. The Authors discuss about the therapy of bladder small-cell carcinoma in the few cases described by the literature and about the survival of those patients. A radical surgical treatment in association with an adjuvant chemo- or radiotherapy appears as a better way to treat these patients. On account of this case the Authors agree with this choice and conclude that only a combined treatment can allow a better survival.

[A high-resolution computed tomographic study of the pulmonary interstitium in systemic autoimmune diseases]

This study was aimed at assessing the diagnostic capabilities of radiologic imaging in systemic autoimmune diseases. Forty-one patients (37 women and 4 men, mean age: 57.9 years, range: 37-73) were examined: 17 of them had rheumatoid arthritis, 8 Sjögren's syndrome, 11 progressive systemic sclerosis, 3 systemic lupus erythematosus, 1 mixed connective tissue disease and 1 undifferentiated connective tissue disease. The clinical features were compared with chest X-ray and HRCT findings. Functional lung examination (spirometry) was performed in 30 patients and in 22 of them chest X-ray findings could be compared with HRCT results since the examinations were performed on the same day. Seventeen patients complained of dyspnea (41.4%) and CO diffusion was reduced in 53% of the investigated patients. Chest films showed interstitial changes in 14 of 22 patients (63.6%), while HRCT findings were abnormal in 90.2% of the patients. Significant changes in HRCT patterns were detected only in 7 of the patients complaining of dyspnea (41.1%) and in 5 of the patients with reduced CO diffusion. In conclusion, HRCT proved to be much more sensitive than plain chest films. Dyspnea and functional respiratory tests correlated poorly with HRCT findings.

Sternum resection and nephrectomy together in renal carcinoma with solitary sternal metastasis

The role of surgery and adjuvant therapy in renal tumors with metastasis is considered purely palliative. However, in cases of solitary metastasis, an aggressive surgical approach is justified by results reported in current literature, in terms of survival rate and quality of life. In bone metastasis there are additional functional problems related to the site of the lesion and to the extend of the excision. In the reported case, the tumor became evident with a serious compressive cervical-mediastinal simptomatology, due to a solitary sternal metastasis, that was resected along with the primary renal tumor.

[Surgery in aneurysms of the abdominal aorta in an outlying hospital]

Abdominal aortic aneurysms have become more frequently recognized due to an improved diagnostic approach and prolonged longevity. Therefore it can be argued that aneurysmal pathology must be entirely dealt with, including its surgical therapy, in outlying non-specialized hospitals. Elective surgical treatment of aortic aneurysms is mandatory in order to acquire the technique that will provide a satisfactory efficiency and reliability in the emergency treatment of ruptured aortic aneurysms. The basic supports of aortic aneurysm surgery in outlying hospitals are the availability of postoperative intensive therapy, a competent surgeon staff and an improved diagnostic approach in order to recognize those aneurysms which are operable by the staff and those requiring very complex reconstructive procedures such as thoraco-abdominal aortic aneurysms which must be transferred to highly specialized centres. An angiography service should be set up since it represents an important support for the operation of abdominal aneurysms; however in practice it proved to be non-essential in the present case. In contrast the intensive postoperative unit must be considered vital in view of the patient's risky conditions. The experience reported here is really positive as regards expanding aneurysms given elective surgery, in which cases there was no mortality either intra- or post-operatively. The follow-up varied from 3 to 7 years. Only one ruptured aneurysm was dealt with and the outcome was fatal owing to anuria caused by severe haemorrhagic shock. However, we cannot expect an acceptable efficiency level in emergency aneurysmectomy if the diagnostic and therapeutic approach does not guarantee full reliability in cases of elective aneurysmectomy.

Iatrogenic vascular injuries following lumbar disc surgery. Case report and review of the literature

Iatrogenic vascular injuries are unusual complications of lumbar disc surgery. The incidence of such injuries is very low but probably underestimated because clinical manifestations may be extremely variable depending on the extension of trauma whether artery or vein are injured or both. Diagnosis is suspected when early signs of retroperitoneal hemorrhage appear, but may often be delayed for weeks or years because formation of a pseudoaneurysm or an arteriovenous fistula which may be of gradual onset and produce only a few symptoms at the onset. Prompt diagnosis and aggressive treatment can hope to improve current mortality of more than 50%. A case of venous and arterial injury is reported, successfully operated on with an original technique of ilio-caval patching to avoid caval ligation. A review of the literature shows the predisposing factors and complex anatomy of such injuries, the clinical picture and the management of the emergency.