Search

Neuroendocrine tumours (NET) are a heterogeneous group of neoplasms deriving from a system of diffuse neuroendocrine cells in organs and tissues, defined as the "diffuse neuroendocrine system". Over the period from 1996 to 2005 42 patients with gastroenteropancreatic (GEP) NET were observed (M.F ratio: 1.5:1; mean age 58 years; > 60 years for all localisations except the appendix [< 39 years]). Twenty-three were tumours of the appendix, colon and rectum, corresponding to 55% of all those affecting the digestive tract: 8 appendix (35%), 6 right colon (26%), 4 left colon (17%) and 5 rectum (22%). The NET diagnosis was formulated in all cases on the basis of histological and immunohistochemical examinations. The mean follow-up period was 5 years (range: 1-10). In the RO-RI cases no relapses occurred and those who were not disease-free were treated with somatostatin analogues and/or chemotherapy. NET of the appendix, colon and rectum are rare, despite being the most frequent among the GEP tumours, and are difficult to diagnose, and therefore sometimes pose problems of surgical therapy, which, when performed in time, may be curative. NET of the appendix measuring <2 cm, localised in the distal part without local infiltration, can be treated by simple appendicectomy and removal of the mesenteriole; otherwise, right hemicolectomy is indicated. The surgical treatment of tumours of the colon, except for well differentiated cases measuring <2 cm with a pedunculate structure such as to allow safe endoscopic removal, consists in radical hemicolectomy with lymphadenectomy. Carcinoids of the rectum measuring <1 cm and 1 cm to 2 cm, in the absence of other negative prognostic factors, can be treated locally by transanal endoscopic microsurgery (TEM) or minimally invasive transanal surgery (MITAS). Tumours measuring >2 cm or presenting muscular invasion and/or lymph-node metastases (malignant carcinoids), regardless of tumour diameter, are submitted to radical operations, as in the case of carcinoma of the rectum. Extensive disease which is no longer curable with surgery alone is treated with chemotherapy and bio-chemotherapy, but it is above all treatment with somatostatin analogues that plays a major role in symptom control.

Peri-inguinal hernias are rare defects of ventral lateral abdominal wall, just above the inguinal region. These hernias are due to congenital defects of internal oblique and transverse muscles. Since their rarity and the complex anatomy of the region, their correct classification is still debated. It is possible to make diagnosis by clinical examination; imaging can help the physician to recognize this rare pathology. The Authors describe a case of strangulated peri-inguinal hernia, that required urgent surgery.

Chemodectomas are rare tumors arising from paraganglionic cells located at the level of carotid bifurcation. They are usually benign and non functioning, presenting as a slow growing cervical mass. A preoperative diagnosis is mandatory, based on doppler color flow imaging and angiography. Surgery is the only therapy providing total eradication of this tumor. Subadventitial resection is the most established technique, although resection of a large mass may require carotid replacement by interposition graft. Cranial nerve palsy and stroke are the perioperative complications most frequently encountered. The Authors report here a case of carotid body tumor and a review of the literature in order to define clinical characteristics of the tumor and proper diagnostic and therapeutic approaches to this rare neoplasm.

Patients with previous type A hepatitis have not sequelae; but these are frequent and significant in forms of hepatitis B and non B. Reported data concern ambulatory revision since one to twelve years later of 78 patients hospitalized in the acute stage of illness by the Division of Medicine of the Fiorenzuola d'Arda Hospital.

The Authors propose epidemiological studies on 179 patients hospitalized for viral hepatitis in the Department of Medicine of Fiorenzuola D'Arda Hospital from 1966 to 1977. The Authors prove, besides, the worrying incidence of disease and locate two zones of different frequency of hepatitis in the considered territory; they advise any possible causes of thys; they put forward any proposals about the control of disease.