Clinico-pathological features, treatments and survival of malignant insulinomas: a multicenter study.

Introduction: Management of malignant insulinomas is challenging due to the need to control both hypoglycaemic syndrome and tumor growth. Literature data is limited to small series.

Aim Of The Study: To analyze clinico-pathological characteristics, treatments and prognosis of patients with malignant insulinoma.

Autoimmune hypoglycaemia caused by alpha-lipoic acid: a rare condition in Caucasian patients.

Insulin autoimmune syndrome (IAS), a rare cause of autoimmune hyperinsulinaemic hypoglycaemia, is relatively well known in Japan. The incidence in Caucasians is less than one-fifth of that reported in Japanese people, but it is becoming increasingly recognised worldwide in non-Asians as well. Drugs containing sulphydryl groups are known to be associated with the disease in genetically predisposed individuals.

Impact of disease status on outcome in relapsed and refractory multiple myeloma treated with lenalidomide.

The introduction of immunomodulatory drugs such as lenalidomide combined with dexamethasone (Len/Dex) has improved the outcome of patients with relapsed/refractory multiple myeloma (RRMM). Few data are currently available which investigate whether paraprotein relapse represents an indication for starting a new treatment. The aim of our retrospective, single-center study was to analyze the impact of disease status (relapsed/refractory) and type of relapse (clinical/paraprotein) on response rate and time-to-next-treatment (TNT).

[Liver haemangioma: current surgical indications. Our experience].

Hemangiomas are the more frequent benign liver tumours. Therapeutic approach at these neoplasms is changed in the last years because has resulted that massive haemoperitoneum from a spontaneous rupture of the hemangiomas is a rare occurrence. From a personal review of 124 liver resection performed for traumatic and organic, benign and malignant, pathologies, the Authors present two cases of symptomatic liver haemangioma surgically treated Excluding emergency induced by tumour hemorrhage, actually indications to surgical treatment are controversial.

[Appendicectomy: laparoscopic versus open treatment. A case survey].

Aim: Laparoscopy is actually the gold standard approach in many surgical procedures: this consideration is still controversial as to appendectomy.

Methods: From 2000 to 2004 we have performed 257 appendectomies: 51 (20%) in laparoscopic approach. Preoperative diagnosis has been formulated on blood parameters, abdominal or, sometimes, transvaginal ultrasonography.

[Malignant carcinoid of the last ileal ansa. Report on 2 consecutive clinical cases].

Carcinoid tumors are very rare neoplasms, arising from enterochromaffin cells, classified in Apud system, exhibiting an intermediate malignancy, because of their long lasting clinical silence and low evolution to advanced stage. At the same time, these features unfortunately cause a high incidence of lymphatic and liver metastases, visible at first diagnostic approach, which are also determined by aspecific symptoms and signs, especially involving jejunal and ileal carcinoids, as the two cases described, and by very frequent absence, in current clinical practice, of pathognomonic carcinoid syndrome. Two carcinoids located into the distal ileal ansa, strictly adjacent to the ileocecal valve, are reported; the first tumor, accompanied by lymphonodal positivity, the second by a solitary hepatic metastasis, requiring segmentectomy of the liver, in addition to right hemicolectomy.

[Common bile duct injuries during videolaparocholecystectomy].

In the years an increase of last biliary injuries during laparoscopic cholecystectomy was observed. At present this occurrence rate is 0.1-3.

[Metabolic preparation for surgical operations and the problem of chronic shock].

Surgical patients with a chronic energy deficit display a particulare metabolic situation known as chronic shock, marked by deficient utilisation of energy. The picture is related to functional disorders of the cell enzymes, following incomplete resynthesis due to the lack of substrates. The main features are: a) lactic metabolic acidosis due to anaerobic oxidation, usually with insufficiency of the Krebs cycle; b) exaggerated protein catabolism, due to utilisation of amino acids as the energy substrate; c) incomplete utilisation of the (mostly endogenous) substrates available, with lactacidaemia, aminoacidaemia, and increased lipidaemia.