[Cystic lymphangioma of the adult: our experience and review of literature]

Cystic lymphangioma is an uncommon benign pathology, usually reported in children, rarely in adult. Its embryopathogenesis is still controversial: it seems to arise from the lymphatic vessels, mainly in the cervico-cranial district. It is macroscopically characterised by multiple cystic non-communicating concamerations. Definitive diagnosis used to be intraoperative and was usually an unexpected finding. Nowadays, with modern imaging technologies, CT and MRI, diagnosis can be assumed before intervention even though certain diagnosis can still be reached only with histological examination. Imaging techniques can help for a precise mapping of the lesion and definition of its limits with the other structures, improving therapeutic success. Various therapeutical options are reported in literature, but complete surgical excision is still considered the best approach and the most successful. The Authors report their experience and review the literature on cystic lymphangioma in adult.

[Deep venous thrombosis after leg amputation. Review of the argument]

Patients undergoing lower extremity amputation are perceived to be at high risk for deep vein thrombosis (DVT). DVT can cause micro or macro pulmonary embolism and often the post-thrombophlebitic syndrome. The chronic condition can affect patient quality of life and his residual working capacity. Usually the echo-Doppler or the color-Doppler is used as a prevention and diagnostic method, identifying patients at high risk. Following the Authors examine and report the Literature opinion about the topics.

[Angioneurosis due to vibrating tools with special reference to plethysmographic and Doppler vascular diagnosis]

Angioneurosis, together with bones and joints disorders, represents the most frequent clinical syndrome due to vibrating instruments. The authors report a general presentation of the disease, particularly focused on indications, usefulness and methods of plethysmography and Doppler C.W., as noninvasive diagnostic procedures.

[Jejunal adenocarcinoma: case report and review of the literature]

Adenocarcinoma of the jejunum is a rare tumor. The diagnosis is often difficult and not early. The Authors report a case recently observed in their clinical practice and successfully operated, reporting also what's in the literature about.

[Retrorectal hamartomatous cysts or "tail gut syndrome": a case report and review of the literature]

Retrorectal cyst hamartomas or so called tail gut syndrome are dystopic lesions, rarely reported in Literature, characterized by the presence of cysts lined by mucous-producing ciliated epithelium. The Authors report a case, recently observed and surgically treated, in a 55 year old male, hospitalized because of an abscess and fistula in the right buttock diagnosed to be a cyst hamartoma. The Literature is reviewed as well.

[Abdominal tuberculous lymphadenitis simulating pancreatis cancer]

The Authors report the case of a patient symptomatic for fever, weight loss and abdominal pain submitted to abdominal sonography and CT which identified a mass of the pancreatic head. The patient underwent laparotomy plus biopsy; the istologic and bacteriological diagnosis demonstrated a tuberculous lymphoadenitis in spite of a normal cutaneous tuberculin test. Abdominal localization of TBC infection therefore is increasing in epidemiological studies, and thus it must be included in the differential diagnosis of subdiaphragmatic disease.

[Vascular bench surgery in renal transplant]

The development in the number of patients for renal transplants has not been matched to the kidneys supplied. On this subject the authors think that this chronic deficit could be improved by making use of all the organs by using a series of technical means during bench surgery; which enable optimisation of use of kidneys with vascular abnormalities or those injured upon removal. The authors report their experience of 450 renal transplants operated between January 1981 and December 1985 and of the evolution vascular bench surgical techniques which enable use of a considerable number of kidneys which would otherwise have been discarded. Moreover, it helped the implant, shortened surgery time without prolonging hot ischemia, and did not increase the number of complications.

[Renal transplantation in patients over 60 years of age. An increasing clinical reality]

The elevation of the uremic population age, the longer survival of dialysis, the increasing number of elderly donors, together with the safer surgical, anesthesiological and immunological procedures have led all over the word to an improvement of over 60s patients transplantation program, with very good results. The authors present their own experience of renal transplantation in elderly recipients and a review of what is reported in the literature on the question.

[Pregnancy in women undergoing a kidney transplant. Our experience and a review of the literature]

The chances of pregnancy for uremic women are usually very low, because of hormonal balance changes which determine a strong reduction in fertility. Epidemiological studies reveal that pregnancy in hemodialyzed women in fertile patients 4.6-6 months after a well functioning kidney transplant, one fertile transplanted woman over 50 can become pregnant. In the first transplant era, pregnancy after kidney transplant was considered "a big hazard", especially because of the possible side-effects of immunosuppression drugs on foetus development, and the risk of a worsening in the mother's renal function. Therefore, women were strongly recommended to avoid pregnancy. More recently, several reported papers have shown that pregnancy can be safely carried on also by transplanted women, under careful criteria and monitoring. Our experience too, even if limited in number (4 patients) reported in this article confirms this conviction.

[Technique of vascular reconstructive bench surgery in pancreas transplantation]

Vascular reconstructive bench surgery has become a basic step in pancreas transplantation, in order to prevent vascular thrombosis. The Authors describe their experience, also reporting literature results.

[Interstitial radiotherapy with 125I in non-resectable pancreatic carcinoma]

The authors analyze results of 220 patients suffering from pancreatic cancer treated in their department from 1982 to 1992. Among these patients 24 of them underwent surgical operation for positioning of radioactive pills. The discussion is on indication and results of this technique, considering also what's reported in scientific literature on the argument.

[Malignant neoplasms arising "de novo" after a kidney transplant. Our experience and a review of the literature]

The incidence of "de novo" cancers in kidney transplanted patients, especially because of immunosuppressive treatment, seems to be increased. The authors analyse their experience and review the literature.

[Diverticulitis of the appendix: a rare cause of acute abdomen]

Diverticulosis of the vermiform appendix, either single or multiple, congenital or acquired, is rather infrequent and usually asymptomatic. However, it may be complicated by flogosis configuring an acute abdomen hardly recognizable from an acute appendicitis not related to the diverticular disease. The Authors report a case of acute appendicular diverticulitis surgically treated. A brief review of the literature is also reported.

[Malignant schwannoma of the omentum. Considerations in a clinical case]

Authors describe a rare case of malignant schwannoma of the omentum. The diagnosis of schwannomas is often late because of the absence of early clinical signs. Clinical, diagnostic and histopathological considerations of these neoplasias are described in this work.

[Isolated unilocular hydatidosis of the kidney: a rare clinical event]

The authors report a case of granulomatous hydatid disease of the kidney recently observed in a 47-year-old female patient with a preoperative diagnosis of nephrolithiasis. The rarity of the location and the likely asymptomatic nature of the disease are, in the authors opinion, of clinical and scientific interest.

[Extensive resections in rectal carcinoma. Our experiences]

The authors review their experience in the surgical management of rectal cancer. They analyze rectal malignancies and their recurrences from natural history to surgical strategies and survival rates. In particular, the need to perform extended operations in order to offer patients a better prognosis is discussed.

[Multiple hamartomas of the bile ducts (MBDH) or von Meyenburg's complex]

Multiple bile duct hamartomatosis of the liver or so-called von Meyenburg's syndrome, is an infrequent disease related to a dysembryogenic error. The authors discuss clinical features, diagnostic methods and possible related pathologies. Data reported in the literature are also received.

[Aneurysms of the visceral arteries: the diagnostic problems and therapeutic strategies]

Intestinal artery aneurysms are a rare clinical condition, usually asymptomatic. However, sometimes they occur as vascular emergency, with a mortality rate of about 75%. Therefore, their occasional diagnosis should be carefully considered as an indication for elective surgery. The authors report their experience in the surgical management of 3 cases of intestinal artery aneurysms respectively involving the splenic, the gastroduodenal and the inferior mesenteric artery. A review of the literature is also presented.

[Intrahepatic jejunostomy by trans-scission approach in neoplasms of the superior biliary confluent (SBC)]

The Authors consider the trans-scission approach as a quick and safe alternative approach for doing intrahepatic bilio-intestinal anastomoses for the surgical treatment of well confined cancers of hepatic hilus (type I and II of Bismuth e Corlette). This approach should be recommended particularly when the presence of anatomical variations makes the hilar approach hazardous.

[Primary intrahepatic calculosis: hepatic lithotomy or hepatectomy?]

The authors discuss about the different surgical approaches in the management of primary intrahepatic stones, conforming their experience to literature reports. In the future they hope for a more conservative treatment on the basis of the good results obtained with percutaneous transhepatic fiber cholangioscopy (P.T.C.S.) and ultrasonographic extra-body lithotripsy recently adopted in the clinical practice.

[Kidney transplantation in the HBsAg+ patient. Our experience]

HbsAg serum positivity in patients on the waiting list for kidney transplant and modifications of survival rate and transplanted kidney function deriving from this clinical situation are nowadays a matter of investigation and scientifical controversy. Authors analyse data deriving from their own series of renal transplant in HbsAg+ patients comparing them with literature.

[Endometriosis of the distal ileal loop. A clinical case report]

Intestinal endometriosis is a rare lesion characterized by a difficult differential diagnosis with other intestinal diseases. The authors report the case of a woman suffering from endometriosis involving the distal ileal loop.

[Carcinoma of the distal choledochus: its differential diagnosis and surgical treatment. Our experience]

Carcinomas of the biliary tree present very difficult problems in diagnosis and treatment. Low common bile duct tumors, excluding papillary tumors, are rare but not easily detectable preoperatively and correctly treated. Authors report their clinical experience on the argument.

[A rare thyroid vascular anomaly: a unique thyroid artery arising from the right carotid bifurcation]

The evidence of thyroid vascular anomalies is is frequent and may manifest itself with an anatomic alteration. The absence of the inferior thyroid artery is reported in 1% of the cases, while a thyroid artery arising from the common carotid artery has been found in 2% of examined patients. In the observed case we retain that the rarity is not only due to the contemporary presence of two anomalies, but also to the presence of an anomalous vessel which arises from right carotideal bifurcation and bloody supplies either right lobular or left lobular of thyroid, thus resulting the sole gland's arterial vessel.

[Prosthetic salvage operation in patients on hemodialysis]

The use of PTFE, vascular prosthesis (Gore-Tex), in the vascular access for hemodialysis, is a very reliable and exploited method. Thrombosis is the most frequent complication. The prosthetic "salvage operation" allows an immediate functional recovery. The authors examine their series from 1986 on, analyzing the surgical technics employed and the results obtained.