Acta bio-medica de L'Ateneo parmense : organo della Societa di medicina e scienze naturali di Parma最新文献

This research has considered the phenomenon of juvenile suicide which took place for over twenty years in the provinces of Parma, Piacenza and Brescia (1971-1994). In this period, in the considered provinces, have occurred 138 cases of suicide, among youngs not older than 25 years. Sources of this research have been the Courts of Brescia and Piacenza as well as the Institute of Forensic Medicine of the Hospital of Parma. An apposite schedule of survey for the data has been used; this schedule has permitted to fix the useful indexes, following the parameters of the personal information, of the happening of events during the years, the months and the hours, of the employed means, of the motive and the possible previous attempts. The results of the research seems to show an explicative approach which underlines among the youngs' suicide, and beyond the Ego weakness, a desperate attempt to communicate. The possible preventive strategies should stimulate above all sensibility and competences of adults to understand the trouble signals for fronting them: in this way, these signals would be prevention occasions, not only for the involved youngs, but also for the context.

The wide-spreading use of mammography in clinical approach and in screening programmes contributed to a sensible modification in the population of patients affected by breast malignancies. A special increase has been recorded in non-palpable breast tumors. The Authors have analyzed a total of 135 patients with impalpable breast lesions during the period 1990-1997. All patients underwent fine needle stereotactic aspiration for cytology and in the meantime the lesions were marked with charcoal suspension and within 15 days time a surgical open biopsy was performed. The subgroup of malignant lesions was then surgically treated either with radical quadrantectomy or mastectomy. The results of the analysis confirmed that fine needle biopsy is an imperfect test because of its low sensibility and impossibility of distinguishing between infiltrating and "in situ" carcinomas; the stereotactic tattooing of the lesions is reliable for surgical approach. The rate of in situ carcinomas is remarkably higher than in non selected group of patients affected by palpable cancers. Pathologic staging confirms that non-palpable tumors are of better prognosis and they should benefit in large majority of a conservative surgical treatment.

The carcinoma in situ of the breast is a noninvasive variant of breast cancer which has an favorable prognosis with appropriate management. The widespread use of mammography has contributed to its increased rate of diagnosis. Special attention to the problem of in situ carcinoma is justified by the increasing frequency of its recognition and the controversy surrounding the proper treatment. Carcinoma in situ (CIS) of the breast can be divided in two categories, depending on where it arises: ductal carcinoma in situ (DCIS) and lobular carcinoma in situ (LCIS). The two histologic kinds of this cancer have distinct pathologic and biologic characteristics, with different therapeutic implication. The author, on the basis of literature on the topic, reviews present studies of DCIS and LCIS with a particular care for the pathology, the diagnostic approaches and the current treatment of these tumors.

The Authors treated at the Physiotherapy Service of the Clinic Orthopedic in Parma, 31 patients affected by shoulder's calcific tendonpathie++ were treated with E.D.T.A. bisodium salt they were painful and showed functional restriction besides they all shared a crystal's hydroxyapatite deposition. It was considered the pain by the Scott-Huskisson analogous--visual scale and the radiographic variation of calcification. It was noticed that with minimum pharmacological doses satisfying therapeutical results were achieved. That was not only as far as pain was concerned (disappeared in 29 patients (93.5%), but it was also obtained a significant reduction (4 patients 13%) or in some cases the disappearing of calcifications (25 patients 80%).

The aim of this work is to describe the three years experience in hepatic resections for primitive and metastatic liver tumors. Of the 90 patients considered initially only 33% was admitted to radical surgical treatment, after a complete clinical and instrumental evaluation. Twenty of them was affected by liver metastases, most of which from colo-rectal cancer; ten had hepatocellular carcinoma developed on hepatic cirrhosis. All the patients affected by HCC underwent pre-operative chemoembolisation (TACE). Regional chemotherapy (TACI) was performed in synchronous metastatic tumors before surgical treatment. Surgical resection in HCC was extremely limited, removing at most 35% of total liver volume. For metastatic tumors 12 major resections and 8 minor resections was carried out. Postoperative complications occurred in 13.3%, including one death for digestive bleeding. A relationship between intraoperative risk factors, such as blood loss and transfusions was registered. The actuarial surviving rate was 47.5% for HCC and 48.3% for colo-rectal metastases at three years. Finally, preoperative CEA levels was the only factor significantly related to long term prognosis of patients affected by liver colo-rectal metastases.

Vesico-vaginal fistula (VVF) is still an unpleasant complication of female genital system surgery. We report the case of a 57-years-old woman undergone to neoadjuvant radiotherapy and afterwards abdomino-perineal resection who developed after one months a VVF.

Primary tumors of the jejunum-ileum are rare and constitute about 2% of gastrointestinal neoplasms. The first clinically reported small bowel tumor was a jejunal carcinoma described in 1824 by Sorlin. The authors reviewed our surgical experience of 9 patients treated at the Department of General Surgery of the "E. Franchini" Hospital of Montecchio Emilia (Re) during a 13-years period from 1984 to 1997. On the basis of literature on the topic, the following are taken into consideration, the history, the incidence, the epidemiology, the aetiopathogenesis, the clinical characteristics, the diagnostic, the surgical therapy of these tumors. The subjects included 6 males and 3 females. The average age of the patients was 66 years, with a male predominance ratio of 2:1. Of the seven primary malignant tumors observed, two patients had adenocarcinomas, two had leiomyosarcomas, two had lymphomas and one carcinoid. The benign tumors were respectively leiomyomas and small intestinal stromal tumor. The most common signs and symptoms were abdominal pain and obstruction of the intestine. Preoperative diagnosis was established in 4 of these patients only by roentgenographic examinations, in 2 by ultrasound scan, in 2 by ultrasound scan and computed tomography, in 1 by endoscopic examination. All the 9 tumors were resected: in 7 patients (77.7%) the resection were considered as curative and in 2 patients (22.3%) palliative. All operated patients were staged by the TNM-classification using pathological and surgical reports. The staging of the disease was the following: 2 patients with stage 1 (T2N0M0), 2 patients with stage II (T4N0M0), 3 patients with stage III (1 with T3N1M0 and 2 with T4N1M0), 2 patients with stage IV (T4N1M1). Survival correlated with the different TNM stage: the median survival time was 60 months for stage I, 60.5 months for stage II, 40 months for stage III and 18 months for stage IV.

Purpose: To evaluate the efficacy of early enteral nutrition in management of patients operated by major urologic surgery and to demonstrate her advantages versus total parenteral nutrition.

Materials and methods: 20 patients, operated by radical cystectomy and urinary diversion by ureteroileocutaneostomy, Padua ileal bladder or ureterosigmoidostomy are inserted in our study: 12 were treated by early enteral nutrition for 8 days and eight by total parenteral nutrition for the same period: in each group nutritional and immunological parameters at day -1, +3 and +7, the length of postoperatory stay, the incidence of complications, with particular respect for infections have been evaluated and correlated one to each other.

Results: We have no death in each group; in the first group no gastroenteric allergy to the nutrient, less incidence of venous catheter and surgical wound infections (respectively p < 0.01 and p < 0.005); we have no significant decrease of postoperatory stay length; the effective problem in this group was the incidence of diarrhea, that in one case have made necessary the suspension of enteral nutrition. Enteral nutrition costs were about half of those of total parenteral nutrition.

Conclusions: We believe that early enteral nutrition is an effective and safe nutrition method in patients operated by major urologic surgery: with this is possible a better nutrition, that reduce the incidence of postoperative complications, mainly infections, and maybe the length of postoperatory stay (our champion is too small for statistical evaluation), that may lead to a decrease in management costs of these patients.

Endometriosis is ectopic endometrial tissue that responds to hormonal stimulation and is found 8-15 per cent of all menstruating women. Endometrioma in/or close to a surgical scar is rare and occurs in 0.1 per cent of women who underwent cesarean section. When localized at the abdominal wall, the disease presents as a painful swelling resembling other lesions, such as hernias, post-operative ventral hernias, hematomas, granulomas, abscesses, and tumors. Endometriosis of the abdominal wall may not be considered in the differential diagnosis of masses detected in/or close cesarean scar. Three cases are reported here. All of them underwent surgery and the error of the pre-operative diagnosis was revealed by histology in two cases. Actually, only one case was suspected pre-operatively.

In the present work we report the results of an investigation on cultures of bone marrow mononuclear cells collected from normal donors and patients with chronic myelogenous leukaemia and cultures of the human osteosarcoma cell line "MG-63" and the human osteoblastic cell line "HOBIT". We have examined the combined effects of hematin and 14.4 KeV gamma-radiation from a Mössbauer source. Growth stimulation has been observed when hematin is added to normal cultures, while growth inhibition is observed when hematin is added to tumor cultures. Different degrees of growth inhibition were observed in both cultures when hematin alone and hematin plus gamma-rays were administered to the cultures. No significant effect could be attributed to irradiation alone, while hematin plus irradiations show a large inhibition that expected for pure additive effects.