Dettori G

Asymptomatic Gastric Perforation by a Toothpick

Background: Many cases of gastric perforation with peritonitis, pylephlebitis, hepatic abscesses, or lethal bleeding, caused by ingested long and sharp objects, are reported in the literature. Methods: During a right hepatectomy for a giant hemangioma, a wooden toothpick was found between the two layers of the hepatogastric ligament. It was not possible to find the passage of the foreign body through the gastric wall. The patient did not report any correlated symptoms. Results: There was no sign of inflammation around the toothpick, which was enveloped in thin scar tissue. The removal of the foreign body was performed without complications. Conclusions: The peculiarity of our case is the total absence of symptoms during and after the perforation. Despite the benign evolution of our case, toothpicks must be considered as potentially dangerous, like other pointed objects, and, therefore, removed immediately.

99mTc-Tetrofosmin Pinhole-SPECT (P-SPECT) and Radioguided Sentinel Node (SN) Biopsy and in Breast Cancer Axillary Lymph Node Staging

We compared 99mTc-Tetrofosmin P-SPECT with radioguided SN biopsy in 101 T1/T2 BC pts to predict axillary lymph node status. The day before surgery all pts underwent lymphoscintigraphy (LS) to mark the SN, following subdermal injection of 99mTc-colloidal sulphur surrounding the breast lesion. LS was combined with pre and intraoperative gamma probe. Previously, all pts had also undergone P-SPECT. ALND was performed in all cases. The SN(s) was detected in 97/101 cases (96%) by LS and gamma probe; in the 4 missed cases P-SPECT predicted lymph node status. In the 97 comparable cases, radioguided SN biopsy showed a slightly higher accuracy than P-SPECT (94.8% vs 93.8%), but a higher false-negative rate (14.3% vs 8.6%); P-SPECT had a higher NPV (95.2% vs 92.5%). The two procedures when combined achieved 100% accuracy. Radioguided SN biopsy alone had 100% accuracy only in pts with BC < 15 mm. P-SPECT had 3 false negative cases, 2 of which were micrometastatic SNs, and 3 false positives. P-SPECT identified 81.2% of cases with a single node, determined the exact number of nodes in 82.6% of cases with 1 to 3 node and correctly classified 93.7% of pts as having < or = 3 or > 3 metastatic nodes. Radioguided SN biopsy seems indicated in selected, early stage, small BC pts, while P-SPECT shows a high sensitivity independent of primary tumor size, giving additional important preoperative prognostic information. The two procedures combined provided a better axillary lymph node status prediction in T1/T2 carcinomas, and could thus improve ALND pt selection.

Labial mucosa and combined labial/bladder mucosa free graft for urethral reconstruction

One-stage urethral reconstruction was performed using a free graft of labial mucosa and combined labial/bladder mucosa. We present the results of this technique in 12 cases that had a minimum follow-up period of 3 years. Eleven patients had medium penile or posterior hypospadias and one had chordee penis without hypospadias. Urethroplasty with labial mucosa was performed by two techniques: labial mucosa used alone or combined with bladder mucosa. The labial mucosa was harvested from the inner surface of the upper and/or lower lip, depending on which method was used. Seven patients, six with medium penile or posterior hypospadias and 1 with chordee without hypospadias, were given a labial mucosa graft alone; the urethral gap was 3.5 to 6 cm. The other five cases, all with posterior hypospadias, were treated by combined labial/bladder mucosa graft urethroplasty: the urethral gap was 6 to 13 cm. Follow-up (at 3 to 4 1/2 years) showed no complications apart from a urethral fistula in one patient and mild stenosis on the anastomosis in four cases, which required urethral dilatations in the first month after surgery.

NEONATAL ACUTE APPENDICITIS IN AN INGUINAL-HERNIA

Acute appendicitis is very rare in the newborn, representing only 0.1%–0.2% of childhood cases. The usual form is intra-abdominal appendicitis with perforation and diffuse peritonitis. It is exceptional to find neonatal acute appendicitis developing inside a patent processus vaginalis. We describe a case of this kind in an 18-day-old infant who survived and is doing well.

Primary Torsion of the Greater Omentum: A Difficult Diagnosis

Torsion of the greater omentum is an uncommon cause of acute abdomen and it is extremely difficult to identify preoperatively. Clinical features are aspecific and diagnosis is usually obtained at emergency operation. We report a case of primary omental torsion and discuss the diagnostic and therapeutic aspects of this pathology.

Role of serum carcinoembryonic antigen in preoperative diagnosis of cancer in patients with thyroid nodules

Serum carcinoembryonic antigen (CEA) was measured by double antibody radioimmunoassay technique in 95 normal subjects and in 258 patients with thyroid nodules. All the normal subjects and the patients with benign nodules had normal CEA values. Increased serum CEA levels (above 50 ng/ml) were found in all medullary and undifferentiated (giant cell) carcinomas. After surgery, the CEA fell within the normal range in the patients with medullary carcinoma. High levels of CEA were also present in 26% of differentiated carcinomas. A relationship between high CEA values and the presence of metastatic disease was not found. Measurement of serum carcinoembryonic antigen may be useful in the preoperative diagnosis of cancer in patients with thyroid nodules.