[Complicated Spigelian hernia. A case report]. / Ernia di Spigelio complicata. Caso clinico.

Prompted by the observation of a case of lateral ventral Spigelian hernia complicated by strangulation and manifested by symptoms of small intestine occlusion, the authors describe the anatomo-surgical characteristics of the abdominal site of this pathology. They analyse the various diagnostic and subsequently surgical options available to the surgeon when dealing with this pathology. This is achieved with reference to data reported in the current international literature on the subject. Lastly, the authors provide a series of evocative images obtained during the diagnosis of the patient treated and of the results achieved following surgery and a 1-year follow-up after the operation.

[The use of the BAR-Valtrac-type pressure stapler in surgery of the large intestine]. / L'impiego delle suturatrici a pressione tipo BAR-Valtrac nella chirurgia del grosso intestino.

A total of 148 patients underwent colon resection between June 1993 and November 1994 at the General Surgery Division of Busto Arsizio Hospital; anastomosis was performed using BAR Valtrac in 58 patients (39%), namely 28 males and 30 women with a mean age of 66.3 years. Surgery was elective in 90% of cases and in 84% of patients was secondary to neoplastic pathologies. Recanalisation occurred within a mean of 5.5 days after surgery, whereas the average hospital stay was 14.4 days. The authors report the absence of mortality and the low morbidity levels connected to the use of this anastomotic technique. Emphasis is also laid on the absence of anastomotic stenosis in all endoscopic controls performed to date.

[Mechanical entero-enteral anastomosis in surgery of the upper digestive tract]. / L'entero-entero anastomosi meccanica nella chirurgia del TGE superiore.

The authors analyse the results relating to the use of a technical variation of entero-enteroanastomosis preparation in the reconstruction of the continuity of upper digestive tract with a defunctionalised Roux en Y loop. This variation includes the use of a circular Proximate ILS mechanical stapler. The series examined, operated during the period June 1993 to November 1994, includes a total of 57 patients, of which 51 with gastric neoplasia. 43 cases underwent total gastrotectomy with R1-R2 lymphoadenectomy and 8 cases underwent gastroresection; a further 3 emergency operations were performed for benign pathologies responsible for upper digestive tract hemorrhage. Moreover, in the 3 remaining cases 2 cysto-jejunal derivations for pancreatic pseudocysts were also performed using the same method, together with 1 hepaticojejunostomy secondary to calculosis of the common hepatic duct. Attention is focused on the analysis and description of the operating technique in order to identify the basic key stages as accurately as possible. In conclusion, the authors indicate that, in view of the excellence of results and the simple and rapid technical execution of this entero-enteroanastomosis, the use of this method was amply justified and undoubtedly advantageous both for surgeons and patients.

[Amyloid goiter]. / Il gozzo amiloide.

Amyloid goitre, defined as diffuse hyperplasia of the thyroid due to infiltration of amyloid substance, has been rarely reported as in confirmed by the latest reviews of the literature. This paper reports the case of a 23-year-old patient with a long history of systemic amyloidosis probably secondary to a Mediterranean fever with diffuse lymphoadenopathy, hepatosplenomegaly and chronic renal insufficiency, who was referred to our attention due to a struma which had increased in volume over the past few years. Aspirated needle biopsy showed the presence of amyloid and the patient underwent total thyroidectomy; the histological test confirmed amyloid struma. The postoperative evolution was normal and characterised by a slight but transient deterioration of renal function. The authors stress the importance of cytological tests using aspirated needle biopsy under polarised light and after Congo Red staining; this is the only test which enables a preoperative diagnosis to be made, thus conditioning the choice of surgery, even if full thyroidectomy is almost certain given the size of the goitre and the systemic pathogenesis of amyloidosis.

[Diverticulitis of the right colon. Presentation of a clinical case]. / La diverticolite del colon destro. Segnalazione di un caso clinico.

The recent observation of one case of diverticulitis of the right colon led to an evaluation of clinical diagnostic and therapeutic aspects of this comparatively rare condition, on the basis of reported data. Preoperative diagnosis is very difficult because it clinically resembles acute appendicitis in many ways, or because of the objective observation of a mass in the right iliac fossa. Instrumental examinations require preparation times that are often incompatible with the degree of surgical urgency. In the reported case, the inflammatory process was modest and treatment was straightforward, there being no diagnostic doubts. This confirms the fact that in so-called "usual" cases, the idea surgical approach must be as conservative as possible. In so-called "hidden" cases, on the other hand, the doubt as to the nature of the pathology often leads to extensive surgery, such as right hemicolectomy.

[Papillary carcinoma in thyroglossal duct cyst remnant: review of the literature and presentation of a clinical case]. / Carcinoma papillare in cisti del residuo del dotto tireoglosso: revisione della letteratura e presentazione di un caso clinico.

The authors report a case of papillary carcinoma arising from thyroglossal duct remnant. It was the only case observed in the last 20 years among 9000 thyroidectomies performed. After a survey of Literature, the role of total thyroidectomy combined to Sistrunk's technique is underlined.

[Benign parietal tumors of the stomach]. / Tumori parietali benigni dello stomaco.

The anatomo-pathological picture, symptomatology, diagnostic means and treatment of tumours deriving from the muscular (leimyomas, leiomyoblastomas), nervous (neurilemmomas) and connectival (lipomas) structures of the stomach are considered and 9 cases observed between 1968 and 1979 at the General Surgery Division of Busto Arsizio Hospital are reported.

[Malignant ano-rectal melanoma]. / Il melanoma maligno ano-rettale.

Malignant melanoma of the anus, anorectal junction and ampulla respectively was observed in 3 patients treated at the Busto Arsizio Hospital's General Surgery Division in the period 1967 to 1978. An account is given of the anatomopathological picture, symptoms, treatment, and prognosis of these forms.

[Splenectomy. Medical and surgical indications (observations on 95 cases)]. / Splenectomia. Indicazioni mediche e chirurgiche (osservazione di 95 casi).

95 splenectomies carried out at the General Surgery Division of the Busto Arsizio Circolo Hospital between 1967 and 1977 are reported. After some brief historical notes, stress is laid on those forms of primary or secondary splenopathy which are receptive to surgical intervention. Splenectomies with surgical indication (traumatic ruptures during other operations for various conditions) are distinguished from those with medical indication: Cooley, Werlhoff, Hodgkin, hair cell leukaemia, Banti. The clinical, haematological and physiopathological aspects responsible for splenic change are considered for each individual disease on the basis of personal experience.