A. Racalbuto

Monitoring carcinoembryonic antigen in colorectal cancer: Is it still useful?

The results of a study conducted to determine the usefulness of carcinoembryonic antigen (CEA) monitoring in the follow-up of patients with resected colorectal cancer are reported herein. The subjects of this study were 125 patients in whom CEA had been determined preoperatively and 239 patients in whom CEA had been monitored postoperatively. The results revealed increased preoperative CEA in only 24% of the subjects, and that this increment was correlated with subsequent more advanced tumor stage and a higher recurrence rate (P<0.01). The postoperative CEA level exceeded the threshold in 71% of the patients affected by recurrence, 94.4% of whom developed liver metastases and 50%, nonhepatic recurrence. This marker showed elevated sensitivity for liver metastases (99%), whereas the sensitivity was lower for nonhepatic recurrence of the disease (94%). Thus, we concluded that CEA monitoring can be useful for preoperative colorectal tumor grading, even if its validity in the early diagnosis of recurrence is problematic, especially in terms of radical repeated surgery and survival.

Usefulness of microsurgery in the training of the general surgeon

It is a common opinion that general surgery is the first step for whoever approaches a surgical discipline, and that whoever practices training in general surgery should learn the rudiments of each surgical branch. The role of microsurgery in the training of the general surgeon has not been well‐established. Clinical applications of microsurgery in general surgery are few and are rarely required, and have been connected strictly to restricted indications. However, we think that microsurgery could be very useful to the general surgeon because it allows the execution of experimental research on rats, the only possibility permitted by law. In these studies the microsurgeon can perform many times and in a short time the same surgical operation, thus improving his skill, and easily getting familiarity with surgical instruments and sutures.

Retroperitoneal abscesses — rare causes and atypical manifestations: Report of two cases

Retroperitoneal space abscesses are a life-threatening illness which is difficult to diagnose and treat because of both their rarity and insidious clinical manifestations. The insidious development of this illness is a challenge for all medical and surgical subspecialists. The discovery of the real source of the infection is very important but not always possible, and knowledge of the anatomy and borders of the retroperitoneal space is helpful in understanding all such atypical cases and for establishing a definitive treatment. Two cases are reported that are both characterized by rare causes, uncommon development, and atypical manifestation. The normally undefined inferior borders of some parts of the retroperitoneal space or previous retroperitoneal surgery could have been the cause of the abnormal and misleading development of the abscesses. Chronically infected organs can be the true origin of this abscess, and their discovery in a nonemergency situation is mandatory for complete surgical treatment. These cases show that knowledge of the anatomy of the retroperitoneal space is important to establish the suspicion of an abscess, to understand its manifestations, which are sometimes caused by a rare pathophysiology, and to initiate appropriate treatment.

Favourable anatomical variation for the resection of a Klatskin tumour

The liver and the biliary tract are rich in anatomical variations, knowledge of which is important for the surgeon. A case of an anatomical variation is reported, which allowed easy and oncologically correct resection of a Klatskin tumour. The variation consisted of abnormally long right and left extrahepatic ducts and an abnormal distal bifurcation, with a cystic duct joining the distal end of the right duct. A favourable modification of surgical strategy could be obtained by an oncologically correct resection of a Klatskin tumour avoiding a liver resection and also allowing easy reconstruction. Complete biliary exposure was necessary to reveal the rare, pre-operatively unrecognized, but favourable situation. In the absence of clear contraindications extended biliary dissection is to be recommended to avoid errors in the evaluation of the resectability of hilar biliary cancers.

Malignant sigmoid-duodenal fistula: case report and review of the literature

Background Colonic-duodenal fistulas are rare, and may be secondary to benign or malignant conditions. Malignant duodenocolonic fistulas may also develop in patients with right colon or hepatic flexure carcinoma or duodenal malignancy. The sigmoido-duodenal malignant fistula is exceptional and, to our knowledge, only two previous cases have been reported. The first case was treated in our Institution in 1981 and published by Russello [1] and the second was reported by Melissas in 2002 [2] in the literature. We present the third case of malignant fistula between the duodenum and sigmoid colon in a 84-years-old male patient.

Idiopathic Myenteric Ganglionitis Underlying Acute 'Dramatic' Intestinal Pseudoobstruction: Report of an Exceptional Case

Inflammation of the myenteric plexus of the gastrointestinal tract is a very rare pathological condition, with few reports in the medical literature. This pathological condition causes atonic gut motor dysfunction and is principally secondary to other diseases, being reported nearly solely as a paraneoplastic phenomenon in neuroendocrine lung tumors, including small cell carcinomas or neuroblastomas. In addition it can also be associated with disorders of the central nervous system, although it has rarely been described in Chagas disease. It has been named ‘idiopathic myenteric ganglionitis’ because no apparent causes can be demonstrated. We report the clinicopathologic findings of an exceptional case of a young woman affected by severe chronic constipation suddenly changing into acute intestinal pseudoobstruction with dramatic evolution. Relationships between ganglionitis, idiopathic constipation and acute intestinal pseudoobstruction as well as therapeutic implications are discussed.

Rectal prolapse treatment in elderly patients

Background Rectal prolapse in elderly patients can cause considerable discomfort causing bleeding, itching, wet anus and tenesm. In older patients the gold standard treatment uses a perineal approach. Success obtained by using circular staplers in the treatment of internal prolapses, associated or not with haemorroids or obstructed defecation, may represent a new method of choice if applied with the appropriate modifications, to the external rectal prolapse, for its speed, simplicity and possibility to be performed under local anesthesia, and even in elderly patients with debilitated conditions.