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Aim of the study is to evaluate the causes of dumping syndromes following partial gastrectomies, and to report an unusual feature of dumping. A case of early dumping due to diverticular-like dilation of gastro-jejunal anastomosis is described with preoperative imaging and intraoperative picture. The surgical correction led to complete clinical remission; the common causes and physiopathological bases of dumping are reviewed and the role of en-Y gastro-jejunal reconstruction is underlined in order to reduce the risk of developing the syndrome.

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OBJECTIVE: Our institution's experience with low anterior resection for primary rectal cancer was reviewed to determine cancer treatment results and to identify risk factors for pelvic recurrence. METHODS: Ninety-two patients treated for primary rectal cancer between 1986 and 1997 were studied retrospectively. All cases was classified according to Astler-Coller. Median follow up was 46 months. RESULTS: Actuarial 5-year survival for all patients was 79%. Among 28 patients who relapsed, only 9 pelvic recurrence was detected with an actuarial rate of 15% at 5 years. Lymph nodes involvement were associated with increased risk for pelvic recurrence. DISCUSSION: Low anterior resection permitted by circular stapler provides good treatment for mid-rectal cancers and for some distal rectal cancers. Pelvic recurrence is not correlated with neoplasm localization, T stage and short distal resection margins, but only with the presence of lymph nodes involvement. This result increase the value of the hypothesis that search the pelvic recurrence origin in a extra-parietal disease respect anastomotic disease. CONCLUSION: Fundamental to prevent pelvic recurrence is the surgical technique that have to remove lymph node en bloc with the rectum doing a dissection along the endopelvic fascia to Denonvillers fascia so to take away completely the mesorectum.

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The Authors report a case of a 49 year old female patient with Gardner's Syndrome and adenocarcinoma of the Ampulla of Vater. In this case, adenocarcinoma of the Ampulla of Vater was associated with duodenal polyp (adenoma), which suggests that adenocarcinoma is the consequence of malignant of duodenal polyps. The world medical literature was reviewed and 29 cases of periampullary carcinoma complicating familial polyposis or Gardner's Syndrome were analyzed.

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Observation of three cases of rare thyroid pathology (medullary carcinoma, thyroid lymphoma, De Quervain's subacute thyroiditis) triggers a discussion of the need to take due account of such rare pathologies in preoperative differential diagnosis in order to avoid giving the wrong treatment. The fact that extemporary histological examination is no help in such situations is also discussed.

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A case of unilateral pulmonary oedema (UPO) caused by rapid re-expansion after drainage of a spontaneous pneumothorax is reported. If acute respiratory failure is noted at the moment of re-expansion the condition can be brought within safe limits by careful clinical observation and if necessary the use of assisted respiration.

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Preliminary experience with the combined use of 24 pH-metering and Holter ECG monitoring in the differential diagnosis of angina-like-pain (ALP) is reported. Twenty patients aged 24-65 (15 females and 5 males) all with angina-like-pain were studied. The aim of the study was to differentiate between oesophageal and cardiac causes of the various types of chest pain and to investigate the possibility of their coexistence. 50% of the ALP patients with a negative non-invasive cardiological report presented a pathological gastroesophageal reflux. In 5% of the cases simultaneous coronary insufficiency and pathological gastro-oesophageal reflux was noted. The importance of performing both Holter recordings and pH-metering before subjecting patients to coronarography is therefore emphasised.

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The incidence of the colonic and rectal polyps cancerisation in patients with Gardner's syndrome is very high. In these patients, on the other hand, the extraintestinal tumours very rarely degenerative in cancer. A case of mediastinal sarcoma in a patient with Gardner's syndrome is reported.

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