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Metastatic involvement of brachial plexopathy is a rare condition that is often associated with advanced systemic breast cancer and the role of surgeon appears to be restricted because radio-chemotherapy is better recommended in this setting. We report a case of a 64-year-old woman that presented a very delayed breast cancer metastatic lower trunks lesions without associated radiation injury, treated by surgery. MRI of plexus and CT of chest and axilla are methods of choice in preoperative radiological evaluation. Neurosurgeon effort is restricted to provide pathologic diagnosis (confirm of metastasis), adequate pain control and improvement of neurological function. So that surgical exploration and neurolysis should be performed as soon as possible after appearance of neurological deficits before denervation signs occurs. General surgeon presence should be warranted for more radical removal of remain lymph nodes and metastatic nodal infiltration of adjacent anatomical structures (vessels and so on) when detected by preoperative radiological work-up.

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The chordoma is a rare mesodermic tumor derived from the notochord which arises and growths inside the vertebral bodies. It is a slow development tumor with late clinical manifestations, rarely metastatic often with local reoccurrences. The treatment of choice of this tumor is surgical and the access must be individualized to the single clinical case: anterior, posterior or combined antero-posterior respect to the spine. Recently videolaparoscopy has been proposed when an anterior approach is indicated without increased morbidity or mortality. Chemotherapy is not indicated because low tumoral responsness. Radiotherapy is indicated as a palliative procedure when a surgical approach ca't be radical. Its application is useful to treat pains and to control the post-operative course increasing the disease-free interval. The authors report the case of an old symptomatic lady with a chordoma in the sacral region. The patient underwent subtotal absportation an anterior transperitoneal approach. Because the extension of the tumor, its biological characteristics and the patient's age the authors adopted this less invasive approach.

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BACKGROUND: The role of Hartmann's operation has been revised during the past few years in the context of emergency colorectal surgery: it represents an obligatory choice that enables the simultaneous treatment of the primary disorder and the complication. This study aims to emphasise the importance of this unique surgical choice and to stress that surgeons should not underestimate it. METHODS: The authors review the literature on the subject and make a retrospective analysis of 228 cases of colorectal surgery from 1988 to 1997 in which Hartmann's operation was performed in 16 patients with the following indications: Hinchey's stage III and IV peritonitis secondary to perforating diverticulitis of the sigma (elective indication) or occlusion of the left colon when preparation could not be accomplished in spite of intraoperative washout. RESULTS: Post-Hartmann recanalisation was successfully performed in 14 patients. CONCLUSIONS: The authors' experience and these results concord with the general view that this operation should be reserved for selected cases, in particular colorectal emergencies of a perforating nature; it is less appropriate for intestinal occlusion, although it is always preferable to be too prudent by resorting to Hartmann's operation or protective colostomy rather than risk anastomotic dehiscence.

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A case of primary hydatidosis of major muscle dorsal is reported. Hydatid cyst, though known to occur in many areas of the body, is rare in skeletal muscle. Echinococcosis of muscle is caused by the larval stage of Echinococcus granulosus or, rarely, by the more aggressive Echinococcus multilocularis. Although Echinococcus is the most common cause of liver cyst, hydatidosis of muscle appears to be uncommon, as muscle is involved in only 3% of echinococcal infection. We report a case of a 65 year old woman, of rural origin, with an infestation of the major muscle dorsal. We discuss the serologic and instrumental diagnosis, methods and the hypothesis of a primary muscular localization and surgical and clinical management of these atypical lesion. This authors recommend total pericystectomy Postoperative results were satisfying: no recurrence but one was found at follow up.

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Authors report their own experience referring to 12 pancreas traumatic lesions and they analyse the most updated and controversial aspects of such pathology. Concerning clinical detection, in spite of better chances of diagnosis given by computed tomography, delays and diagnostic difficulties are still considerable, both pre-operatory especially in isolated closed traumas, and during laparotomy for the detection of the lesion and check-up of a possible wirsung section. In most cases pancreatic lesions are of lesser degree, belonging to the I and II stage according Lucas' classification and can be treated with an external drainage performance. We have no choice but such conservative approach in the more serious cases, whenever a ductal lesion exists, if the patient suffers from hemodynamic lability and it is worth reducing the time of the operation and hematic losses or in those cases where serious associated lesions exist which require a priority treatment. While body and tail lesions can be successfully treated with distal pancreasectomy technique, in serious cephalic traumas there is a limited experience and it doesn't exist a common view on the matter. In these cases we believe to be useful to perform resections only as the last chance, since we prefer to perform alternative operation such ad internal drainage on jejunal ansa or pylorus exclusion. This last operation seems to achieve better results in terms of morbidity and mortality.

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