Annali italiani di chirurgia
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The knowledge of anatomical lymphatic drainage pathways between lung and mediastinum and metastatic spread patterns of lung cancer forms the basis for the modern TNM classification for the staging of lung cancer. Clinical and anatomical studies divided pulmonary nodes into intrapulmonary and bronchopulmonary, the latter distinguished into lobar and hilar nodes. Mediastinal nodes are grouped into anterior prevascular, tracheobronchial, paratracheal and posterior nodes. The different pathways of lymphatic drainage of the lungs to the mediastinal lymph nodes are presented with the consequent surgical implications.
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Review Comparative Study
[Primary chemotherapy in operable breast carcinoma].
We have reviewed the current status of primary chemotherapy for resectable breast cancer. Available findings indicate that the most immediate benefit of this treatment approach consists in an important tumor shrinkage, enabling to significantly increase the rates of breast conserving approaches. In spite of the logical and scientific rationale, available data from prospective randomized studies do not provide evidence of a clear superiority of primary chemotherapy over adjuvant chemotherapy. ⋯ Should there be no benefit to the use of primary drug treatment, then the biologic consequences of primary tumor removal, as observed in experimental models, are not likely to be of clinical significance. Nonetheless, since primary chemotherapy can achieve long-term results similar to those obtained with postoperative drug treatment while increasing the frequency of breast-sparing approaches, women can be offered a choice to maintain their body integrity. Should improved pathological complete remission rates from more effective regimens of primary chemotherapy translate into improved survival compared with the classical postoperative modality, then, regardless of the tumor diameter at diagnosis, our overall strategy for the management of operable breast cancer will require a radical departure from the traditional dogma.
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Review Case Reports
[Laparoscopy in an abdominal emergency: the diagnosis and therapy in 3 clinical cases of acute abdomen].
Authors report three cases of acute abdomen due a probable appendicitis and submit to laparoscopic procedure. In the first case acute abdomen was due to a bowel obstruction secondary to an ectopic pregnancy; in the second case acute appendicitis was associated with a rare congenital malformation (atresia of uterus); in third case acute abdomen was due to a rare case of torsion of accessory spleen in an adult. In all the cases laparoscopy demonstrated the elective procedure in urgency, permitting the diagnosis and the surgical treatment of acute abdomen with the post-operatory advantage of the technique.
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Historical Article
[Surgery of lumbar disk hernia: historical perspective].
Although the clinical picture of discogenic sciatica is well known already in the ancient world, it is not until 1933 that WJ Mixter and JS Barr provide the correct pathogenetic interpretation and suggest surgery as the treatment of choice. The work of the American Authors was however based on the knowledge acquired during the previous centuries starting with Domenico Cotugno, who first suggested the neurogenic nature of sciatica (1764) and later with the neurologists of the french school Valleix, Lasègue, Dejerine, Sicard who elucidated the semeiology and debated in detail the etiopathogenesis of the condition. The german pathologists Schmorl and Andrae (1927-29) are to be credited for their contribution to the pathology of intervertebral disc, recognizing the frequency and degenerative (not neoplastic) nature of nucleus pulposus herniation. ⋯ Mixter and Barr used laminectomy and a transdural route although a more limited approach to the spinal canal had already been proposed by the italian Bonomo (1902), unknown to many. Love, of the Mayo Clinic (1937-39) introduced the extradural/interlaminar approach while Caspar and Yasargil (1977) applied the concepts of microsurgery to the procedure. The latest advances are represented by percutaneous and endoscopic techniques.
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The purpose of carotid surgery is to prevent the incidence of stroke in patients with cerebrovascular disease. It's important, therefore, to find the most useful methods of cerebral protection and flow monitorization during carotid endarterectomy. It is well known that patient's clamping tolerance changes according to his anatomical and physiopathological conditions (contralateral carotid patency, stenosis, occlusion), and compensative circles efficiency (Willis). ⋯ Authors show their 10 years (1986-1996) experience of 624 carotid endarterectomies performed on 580 patients evaluated by: -symptomatic or asymptomatic lesions -mono-bilateral stenosis -general or loco-regional anaesthesia -clamping tolerance -carotid shunting -intra-postoperative complications (temporary or persistent). According to results, authors propose loco-regional anaesthesia in carotid endarterectomy as a simply available and at low costs method to monitorize cerebral functions. In addition it has low rate complications, few contra-indications and may be selected like first-choice anaesthesiological method.