Abstract: AIM: Nowadays the incidence of tuberculosis is increasing in some population groups (subjects immigrated from developing countries, affected from HIV infection, or undergoing immunosuppressive therapy) and to the development of multidrug-resistance. The clinical manifestations, routine laboratory and radiographic analyses of abdominal tuberculosis are nonspecific and surgery plays a fundamental role because 25-75% of such patients are operated. METHODS: Six patients, 4 male and 2 female (age 23-62 years) underwent laparotomy or laparoscopy. Five patients were not European, 1 was Italian. The surgical indications were: intestinal occlusion in 3 patients; perforation in 1 patient; peritonitis in 2 patients. RESULTS: The most frequent clinical manifestations were pyrexia, weight loss, anemia, ascites. Chest X-ray was normal in all patients. All patients were found ARB-negative in sputum and in ascitic fluid, while 1 was positive to culture of sputum and 3 of ascitic fluid. In all patients histopathologic examination showed typical findings of tuberculosis. CONCLUSIONS: The surgical indication is made for diagnostic aim or due to the presence of complications. Laparoscopy is the gold standard in the diagnosis,since it allows whole exploration of abdomen and taking of sample for biopsy and ascitic fluid to find micobacterium. In fact, abdominal tuberculosis is a paucibacillar disease and rarely it is possible to demonstrate the direct presence of M. Tuberculosis, but nowadays the methods of the genome amplification allow to demonstrate the sequence of the chromosomial DNA of M. Tuberculosis from small fragments of bioptic material.

Abstract: Chordoma is a rare neoplasm arising in the cerebrospinal axis from nothochordal remnants. The commonest location is in the sacrococcygeal area, then in the sphenooccipital region and less frequently in other parts of the vertebral column. Chordoma has been found in all age groups, but the greatest incidence was found between the fifth and the seventh decades: there is a male predominance. Signs and symptoms of chordoma are related to tumor location and are often present for a long period of time because of the slow growth of the neoplasia. Sacrococcygeal chordomas may produce lower back pain, bladder or anorectal dysfunction or mass. Three histologic subtypes are currently considered: conventional, chondroid and dedifferentiated chordoma. Comparing with conventional chordoma, chondroid chordoma shows a better prognosis while dedifferentiated chordoma has a worse prognosis. However the malignant potential of chordoma is most likely due to incomplete surgical excision because of the multifocality of the neoplastic growth. For that reason, local recurrence is common and accounts in large part for the mortality for this tumor. The best treatment consists of a wide surgical excision coupled with adjuvant radiation therapy. We report a case of sacrococcygeal chordoma arised in a 48 year-old-man; the clinical features of the tumor showed a close resemblance with a pilonidal cyst. When the diagnosis of conventional chordoma was done the patient were treated by surgery and by intraoperative radiotherapy followed by external radiotherapy. This peculiar therapy was adopted in the attempt to reduce the risk of local recurrence. Six months after this treatment the patient was well and no signs of local recurrence was found by the magnetic resonance imaging.

Abstract: We conducted a multicentric phase II study on advanced gastric cancer to determine the efficacy and toxicity of treatment with epidoxorubicin (EPI) plus high doses of leucovorin (LV) and 5-fluorouracil (5-FU). Thirty-seven patients with measurable disease were enrolled into the trial and treated with EPI 75 mg/m2 on day 1 and LV 200 mg/m2 plus 5-FU 450 mg/m2 from day 1 to 3, the cycle being repeated every 3-4 weeks from a median of five cycles per patients. The response rate was 49% in 35 evaluable patients, with two complete remissions and 15 partial responses. Median response duration was 12.4 months; median survival for responding patients was 17.3 months, which was significantly longer than 8.7 months for non-responding patients. General toxicity was usually mild, myelotoxicity was moderate and there was no evidence of cardiac toxicity. These results show that EPI-LV-5-FU is an effective regimen for advanced gastric carcinoma. The efficacy of this combination should now be tested as an adjuvant therapy in resectable gastric cancer.

Abstract: The rare event of a bilateral leiomyoma of the epididymis is illustrated. The tumors were located near the tail of the epididymis in a man aged 58, which furthermore presented hydrocele and had been previously operated because of bilateral inguinal hernia. The differentiation with inflammatory pseudotumor, leiomyosarcoma and adenomatoid leiomyoma is discussed.

Abstract: From January 1974 to December 1990, 619 patients were submitted to surgical treatment for gastrointestinal carcinoma: 10 cases (1.61%) of non-Hodgkin's lymphomas were observed (4 of the stomach, 3 of the small intestine, 1 of the colon, 2 of the rectum). There were 5 men and 5 women, mean age 57.1 years (range 34-80). In 6 patients the diagnosis was performed with radiological investigations, in 4 with ultrasonography too. Endoscopy biopsy was unfit for diagnosis in the gastric localizations, while it was positive in both rectal localizations. Seven patients were operated and no postoperative morbidity or mortality was observed. The role of surgery is discussed, diagnosis for staging and therapy alone or associated with chemotherapy and/or radiotherapy.

Abstract: The Authors describe a rare case of obstructive jaundice secondary to solitary nonparasitic cyst of the liver. The anatomopathology, embriological and clinical aspects are analyzed with emphasis on the importance of the instrumental investigation in differential diagnosis of malignancy. Finally they describe the indications to various surgical and non surgical treatment.

Abstract: The Authors report a case of voluminous hemorrhagic pseudocyst of the left suprarenal gland. The anatomo-pathological classification of adrenal cysts is described, in particular with reference to the etiopathogenetic hypotheses regarding the formation of hemorrhagic pseudocysts. Lastly, the importance of using instrumental tests for a correct diagnosis is underlined and the surgical indications of accidentally discovered asymptomatic cysts are discussed.