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Aim: Radio-frequency thermal ablation (RFTA) may prolong the survival of patients with small hepatocellular carcinoma (HCC) associated with cirrhosis. The aim of this study was to evaluate efficacy and safety of RFTA., Methods: We performed the Kaplan-Meier analysis to estimate the survival rate in 69 consecutive patients with HCC (mean age 66+/-6.5 years; 44/25 male/female; 56 Child-Pugh class A and 13 Child-Pugh class B) treated by RFTA. A single lesion was observed in 60/69 (87%), two lesions in 8/69 (11.6 %), and 3 lesions in 1/69 (1.4 %) of patients. The tumor size was = or <3 cm in 60/69 (87%)., Results: Twenty-two patients died during follow-up. Overall survival rates were 81%, 66%, and 46% at 1-, 2-, and 3-years, respectively. Cancer-free survival rates were 64% at 1 year, 30% at 2 years and 25% at 3 years. The 3-years rate of appearance of separate new lesions and local recurrence were 27.5% (19/69) and 26 % (18/69)., Conclusions: Our study shows that patients with HCC and compensated cirrhosis may benefit from RFTA treatment, especially for tumors = or <3 cm. Nevertheless, the high rate of recurrence (both local and distant) points out the palliative role of this therapy.

The use of an external oblique muscle-cutaneous flap in the reconstruction of large chest wall defects after mastectomy is described. The flap is drown as a V-Y advancement-rotation flap, laterally based, on the ipsilateral abdominal wall. The flap extends from the posterior axillary line to the linea alba, vascular supply is provided by the musculo-cutaneous perforating arteries of the intercostal vessels. Mobilization starts medially including the anterior rectus sheath, décollement continues between the external and the internal oblique muscles as far as the posterior axillary line. The abdominal wall, after flap mobilization, is reinforced by the plication of the internal oblique sheath. The flap was used in 13 patients with major anterior chest-wall defects after mastectomy. In one patient a marginal skin necrosis of about 2 cm was observed. The flap described differs from other external oblique flaps already described in several technical innovations that allow to obtain better functional and esthetic results.

Catheter migration, represents a rare, mechanical complication following the use of totally implantable venous devices. A case, in which the catheter was inserted into the right internal jugular vein by percutaneous route, without radiological control, is described. Following the chemotherapy infusion drugs, the patient developed a catheter displacement and subcutaneous extravasation. Etiological hypotheses and modalities of prevention are discussed.

Objective: To evaluate long-term effects of cholecystectomy on typical gallstone symptoms and associated digestive syndrome., Design: Clinical prospective study on selected patients., Setting: First Surgical Clinic--Catania University., Subjects: 143 gallstone patients, divided in highly symptomatic Group 1 (79) and mild symptomatic Group 2 (64), who underwent cholecystectomy during period 1991/92., Main Outcome Measures: 125/143 patients compiled a set questionnaire to detect any subjective postoperative disorders and to evaluate whether they were similar to preoperative symptoms or were new ones., Results: 125/143 patients completed the 12-month follow-up programme, which revealed a 30% (38/125) with postcholecystectomy symptoms and 13.4% (17) with a postcholecystectomy syndrome. Moreover, 10% (13) of the patients reported the same digestive symptoms as before treatment. Statistical analysis confirmed that cholecystectomy was efficacious in curing gallstone related symptoms and digestive disorders in both Groups with a general improvement in clinical picture (p > 0.01). No significant statistical difference in the incidence of postcholecystectomy dyspeptic symptoms was found between the 2 Groups., Conclusion: Cholecystectomy is often efficacious in curing both typical gallstone related symptoms and digestive syndrome. Cholecystectomy patterns of failure in curing digestive disorders is unpredictable preoperatively on the basis of clinical features of the disease.

The authors present a case of bilateral adrenal pheochromocytoma that occurred at their observation and surgically treated with a bilateral adrenalectomy. The authors review the literature in order to discuss the diagnostic and therapeutic option to treat these cases. They stress the importance of preoperative abdominal TC an MIBG scintigraphy and the importance of pre and intraoperative assessment to exclude extra adrenal localization of pheochromocytoma.

The paper describes a very rare case of obstructing antral neurinoma with associated gastric volvulus. Pathogenetic mechanism of this association, which has never been reported in the literature, is discussed. The authors also focus their attention on the diagnostic difficulties and the choice of therapy. A hiatoplasty and a Billroth II gastrectomy were performed in the described case.

Pancreatoblastoma is a very rare tumor of the pancreas, affecting children in the first decade of life. Ultrasound and CT scan may be useful but pre-operative diagnosis is often quite difficult. High level of seric alpha-fetoprotein could be suggestive of pancreatoblastoma. The definitive diagnosis is however made by histologists when an organoid structure, well encapsulated, consisting of acinar cells with zymogen-like granules and squamoid corpuscle is demonstrated, sometimes associated with mesenchymal tissue (mixed-type pancreatoblastoma). Immunohistochemical studies may help in differentiating pancreatoblastoma from papillary cystic tumors, acinar cell carcinomas and endocrine pancreatic tumors of the pancreas. We report a case of mixed-type pancreatoblastoma in a 12-year-old female patient, located in the head of the pancreas. The treatment has been surgical, consisting of a duodeno-cephalo-pancreasectomy. Neither radiotherapy nor chemotherapy has been performed. The patient is alive, without recurrence, four months after the operation. Diagnostic, therapeutic and prognostic aspects are discussed.

When deobstruction by Fogarty catheter fails, the axillofemoral bypass can be considered as a therapeutic solution of the acute ischaemia of the limb. The authors discuss a case occurred in their experience and focus their attention on the therapeutic potentiality of this kind of revascularization. As a matter of fact it is important to consider that the operation should not only eliminate the acute ischaemia, but also correct the atherosclerotic lesions that led to it. Therefore, if deobstruction by Fogarty catheter does not restore a good inflow, in high risk patients with acute arterial thrombosis of the limb, there is a well indication for extra-anatomic revascularization.

The major advantage offered by the "double stapling technique" in the treatment of low rectum cancers is sphincter preservation while respecting oncological criteria of radicality. The authors report their experience in surgical treatment of rectal neoplasms, considering a 24 patient group observed between 1989 and 1991, when new staplers were available in Italy. They also present primary results obtained with modified Knight-Griffen technique evaluating a series of 10 patients with rectal cancers placed between 5 and 10 cm from the anal verge. The authors describe surgical procedures and, analyse the complication rate, report a 10% anastomotic leak with no clinical stenosis and 20% relapses. Showing a 2-year follow-up data, a 61.1% surviving actually free of disease in the all 24-patient group is referred. The authors conclude that double stapling technique, while safe and effective, should be always performed accordingly to oncological radicality, reminding that the aim of surgery is the treatment of cancer and sphincter saving should be considered secondary.

The aim of the study was to evaluate the clinical use of a GABOB by-product in the treatment of exogenous post-concussion syndrome. Thirty-six patients affected by this syndrome were included in the study and divided into two groups. Patients in the first group were treated with the drug, while patients in the second group were not treated. Variations in the average time taken for symptoms to disappear in both groups showed a statistically significant difference in favour of the drug-treated group of patients. Following an analysis of the results it was possible to affirm that the drug had a statistically significant effect in patients affected by medium-severe symptomatology.

The aim of the study was to evaluate and control the therapeutic validity of Somatostatin administration and the clinical benefits of parenteral nutrition during acute pancreatitis. We selected 31 patients with 1st and 2nd degree pancreatitis according to Ranson's classification. Diagnosis was based on clinical and humoral data and confirmed by echography and CT examinations. The most common etiological cause was biliary++ lithiasis (74.2%). All the patients in the study were split into two groups and received conventional treatment. The therapeutic schedule administered to group 1 included somatostatin (250 micrograms/h for 72-96 h), while group 2 received total parenteral nutrition with 2,000-2,500 Kal/day trough a central vein. The data obtained from our study demonstrated that both somatostatin and parenteral nutrition are valid tools during the acute phase of the disease. It must be pointed out that the former significantly influences the clinical course and allows a precise control of the painful symptomatology, the objective picture and the curve of the main hematochemical parameters. Parenteral nutrition betters the anabolic response of the organism during the acute phase and carries out an indirect antienzymatic response, so favouring a quicker recovery than observed in the group treated with somatostatin.