[Splenic artero-venous fistula and portal hypertension. A case report with review of the literature]

Splenic artero-venous fistula (SAVF) is a rare but potentially curable cause of pre-hepatic portal hypertension. About 100 cases have been reported in the world medical literature. The Authors report a case of 46-year-old man with a splenic artery aneurysm and a large SAVF treated by surgical resection of splenic vessels and splenectomy. The literature about SAVF is reviewed to recognize etiology, anatomical location, main symptoms at presentation, diagnostic findings and management of this rare syndrome.

[Sequential endoscopic and laparoscopic and one-step treatment of cholecysto-choledochal calculosis. New perspectives for the surgeon]

The Authors describe 132 cases of sequential treatment of cholecysto-choledochal lithiasis by videolaparoscopic cholecystectomy after endoscopic Common Bile Duct (CBD) clearance and 3 endoscopic sphincterectomy and CBD stone extraction during laparoscopic cholecystectomy. No complications occurred during the procedure. Even though the second one is not a routine method undoubtedly represents the best solution when the surgeon meets an unexpected choledocholithiasis. However, laparoscopic CBD exploration requires a good experience of the surgeon and currently there are not sufficient data to support this procedure.

[Gastric leiomyoma. Our cases]

The authors describe 3 cases of gastric leiomyoma which they observed in the ten-year period 1980-1990. The most important aspects of this pathology are illustrated, emphasizing on one hand the slight incidence, also due to their underestimation, the seat represented by the body and gastric antrum, the asymptomatic submucosal growth or with atypical symptomatology; on the other hand, the low malignant potential linked above all to the voluminous bulk of the neoplasm.

[Oncocytoma of the kidney: a diagnostic and therapeutic dilemma]

Renal oncocytic tumours are uncommon and controversial in both their diagnosis and therapy. The need for correct cytological diagnosis is emphasised and total nephrectomy proposed as the elective surgical treatment owing to the real possibility of malignancy and multicentric diffusion. Conservative management should be reserved for bilateral tumours or where the tumour occurs in a solitary kidney.

[Radiation-induced intestinal injuries]

Postoperative radiation after the removal of radiosensitive tumours may cause acute or chronic intestinal lesions. In some cases severe complications requiring one or more operations may arise even years later and unfortunately the morbidity and mortality rates are high. The paper presents a discussion of the clinical onset of these pictures as well as diagnostic and therapeutic possibilities in the light of personal experience and information obtained from the literature.