[Non-surgical treatment of liver trauma]. / Il trattamento non operatorio dei traumi epatici.

The aim of the study was to assess the role of non-operative treatment in haemodynamically stable patients with liver trauma. Over the period from 1996 to July 2000, out of a total of 2,048 patients with abdominal trauma, 124 open and 1,924 closed, we observed 77 hepatic lesions, consisting of 55 closed traumas and 22 penetrating traumas. Non-operative treatment was implemented in 18 patients (32.7%) with closed liver traumas. In addition to serial clinical examinations of the abdomen, the patients receiving non-operative treatment were submitted to thorough haemodynamic monitoring and complete blood counts in the intensive care unit. After an abdominal CT scan at entry, patients were submitted to abdominal ultrasonography 6, 12 and 24 hours after admission. Only two patients required transfusions, one presenting a pelvic fracture and the other a triple fracture of the femur, tibia and fibula. There was no mortality. A biloma was present in one case, successfully treated by means of a US-guided drainage puncture. It is patients with major cranial traumas that pose most problems for conservative treatment. Fifty percent of non-therapeutic laparotomies in our series were performed in patients with severe cranial traumas. It is precisely in these patients that an improvement in diagnostic capability is most desirable.

Intestinal infarction: report of 98 cases.

The Authors conducted a retrospective study on 98 patients with intestinal infarction observed from 1987 to 1999 in the Emergency Care Unit of the Loreto Hospital, Naples. In our hospital there are over 20,000 admissions, 3,900 of whom in the Emergency Care Unit. Intestinal infarction accounts for 0.049% of all admissions and 0.45% of emergency surgery admissions. About 500 laparotomies are performed annually, 1% of which for intestinal infarction. All patients in this series were operated on within 10 hours of admission. The following procedures were performed: 31 jejuno-ileal resections; 26 right hemicolectomies associated with small intestine resection; 5 upper mesenteric artery embolectomies plus wide gut resections (3 also underwent second-look operations within 36 hours of the initial surgery with further gut resection); 1 Hartmann's and 5 Volkmann's operations (all of these patients had colonic gangrene); 30 (30.5%) underwent exploratory laparotomy due to massive infarction. The prognosis of intestinal infarction is still ominous. Our mortality rate is 68%. Both clinical and laboratory data are non-specific and delayed diagnosis is the main cause of this mortality rate. Abdominal CT is an accurate and sensitive diagnostic tool. TPN enables us to achieve good nutritional support even for wider resections.

[Current indications for video-laparoscopic surgery of adrenal gland neoplasms]. / Indicazioni attuali at trattamento video-laparoscopico delle neoplasie surrenaliche.

Recent advances in pathophysiology of the adrenal glands suggest new indications for adrenalectomy. In open surgery large incisions are needed to remove a small gland; on the contrary, laparoscopic procedures offer new possibilities. The present study is a review of the literature on indications, contraindications and surgical technique of laparoscopic adrenalectomy. Evaluations of these initial experiences are favourable, however, due to the small number of patients operated and to the short follow up, a definitive opinion on the role of laparoscopic surgery for adrenalectomy has to be formulated.