[Gastrointestinal hemorrhage]. / Emorragie del tubo digerente.

Acute digestive system haemorrhage is a recurrent cause of hospitalization. As to the upper segment of the digestive system, ulcerous peptic disease is often the cause of this pathology, above all in Western Countries. As to the lower segment, colic diverticula and angiodysplasy represent the most common cause. Bleeding usually clears up spontaneously or with hemodynamic pharmacological help. In some cases, the situation does not improve because of bleeding persistence, so more complex diagnostic and therapeutic techniques are necessary. Instrumental diagnostics is based on endoscopy (once with flexible optical fibre instruments, now with videoendoscopy) whose diagnostic effectiveness is inversely proportional to the latency since the haemorrhagic occurrence. Success is evident in 90-95% of the cases within the first twelve hours. Mesenteric angiography and scintigraphy with marked erythrocytes can solve difficult diagnosis and topographic location on some serious occasions. In every case the risk of complication and death is closely related to the haemorrhagic consistency, the flow of the bleeding, the basic disease, the age and the presence of chronic diseases. The authors examine a personal survey taken from the hospitalization in their own ward during a period of a year.

[Invasion of the chest wall in primary lung neoplasms]. / L'invasione della parete toracica nelle neoplasie polmonari primitive.

The authors analyse a series of 5 patients who underwent pulmonary and parietal resection between 1990 and 1993 due to non.microcytoma bronchogenic carcinoma with invasion of the thoracic wall. The patients comprised four men and one woman aged between 45 and 69 years old. Thoracic pain was present in two patients. Pulmonary resection with extrapleural stripping was performed in two patients whereas a block resection from one to five ribs and the corresponding intercostal spaces was performed in the other three patients. The authors' approach is not to perform these operations according to rigid protocols but to adapt them according to the local status of tumour invasion. Therefore to resort to extrapleural resection when there is a free cleavage plane between parietal pleura and rib wall; resection in block of the wall where the carcinoma has infiltrated the endothoracic fascia or deeper. The authors do not report any major complications and record a postoperative mortality rate of 0%. In two cases the thoracic wall was reconstructed using a sheet of Gore-Tex which did not provoke rejection phenomena. Radiotherapy was carried out in cases with positive lymph nodes. The series presented here is too recent to provide significant data regarding survival. However, the only factor seen to influence prognosis in the five patients was the presence or otherwise of lymph node metastasis, irrespective of the histological type and operation performed. The five year survival rate of T3N0M0 patients is in fact similar to that of T2N0M0 patients.(ABSTRACT TRUNCATED AT 250 WORDS)

[Palliative endoscopic intubation of esophago-gastric neoplastic stenosis: analysis of factors that may influence immediate results]. / Intubazione palliativa endoscopica delle stenosi tumorali esofago-gastriche: analisi dei fattori che possono influenzare i risultati immediati.

The paper examines a series of 172 patients undergoing endoscopic intubation with plastic stent due to unoperable esophago-gastric tumoral stenoses during the period 1980-1991. An analysis of the data enabled the following conclusions to be drawn: (1) The majority of perforations occur during the treatment of distal stenoses (15%), anastomotic stenosis (20%) and extrinsic compression stenoses (23% vs 7% in the case of stenosing primary esophageal neoplasia). (2) Severe respiratory problems may occur during treatment of cervical stenoses. (3) Malfunctioning of prostheses is more frequent in the treatment of cardias stenosis (10%). Having a few technical comments on the subject of passing the guide thread through the most twisting and narrow stenoses, the authors express the wish that expandable metal prostheses will be more widely used in order to render the method less traumatic, increase the percentage of success (extending the indications regarding the site and type of stenosis) and reduce severe complications.

[Liver injury in abdominal trauma. Review of the literature and personal observations]. / Danno epatico nei traumi addominali. Revisione della letteratura e casistica personale.

In patients who suffered abdominal trauma, the liver is the most frequently involved organ, except the spleen. The % rises from 1520% to 30% if trauma is closed or open. Liver injury may spread from a simple parenchymal contusion to a break in vessels or biliary ducts. Life risk is related to hemorrhage. The mortality is due to: 1) extension of the injured liver surface, 2) possible damage to big vessels, 3) intra or extra abdominal associated injury in case of multiple trauma. It is important to known the kind of injury to choose the best therapy, not necessary surgical. The authors report on 15 patients with thoracoabdominal trauma and liver damage, comparing their cases with literature observations.

[Creation of a colostomy using a circular mechanical stapler]. / Confezionamento di ano praeter-naturale con suturatrice meccanica circolare.

The paper describes the method used to create a preternatural anus in terminal stomas using a mechanical circular stapler (Model EEA-31). Two methods are put forward: Chung's and Burke's methods (the latter of which was used by our department). A mechanical circular stapler has been used several times (13) to perform this type of stoma, with excellent esthetic and functional results, both immediate and long-term. It was only necessary to reoperate in one case in order to suspend the affected colic loop.

[Lesions of the duodenum from closed abdominal injury. A case report]. / Lesioni del duodeno da trauma addominale chiuso. Un caso.

Following a review of the literature, the paper reports a case of duodenal injury. This rare pathology most frequently affects the second half of the organ and may cause damage ranging from a simple hematoma to parietal laceration with peritonitis and/or retroperitonitis. Symptoms are often confusing and delayed, and together with chemical and instrumental tests do not always allow an early diagnosis to be made. Treatment varies according to the type of lesion and its location, and is often secondary to the general condition of the patient. Postoperative mortality appears to be limited to 11% if laparatomy is performed early (within 24 hours).

[Popliteal artery entrapment syndrome. Discussion of a case]. / La sindrome da entrapment dell'arteria poplitea. Discussione di un caso.

The paper reports a case of popliteal artery entrapment syndrome (3rd type) associated with poststenotic aneurysm with a single painful ischemic attack. Diagnosis was made following an accurate anamnesis and clinical examination using invasive and non-invasive instruments. Surgical therapy consisted of resection of the gastrocnemius muscle followed by a graft to the self inverted saphena vein.

[Surgical treatment of venous ulcer of the leg]. / Il trattamento chirurgico delle ulcere flebostatiche degli arti inferiori.

Personal experience on 53 cases of venous ulcers of the lower limbs is presented. By combining vascular and plastic surgery, in every patient treated, the complete regression of trophic lesions and earlier healing were obtained. Moreover the notable usefulness of other kinds of therapy such as elastic compression and sclerosing treatment is confirmed.

[Distal gastric volvulus as a cause of acute occlusion in paraesophageal hernia. Considerations on a clinical case]. / Volvolo gastrico distale come causa di occlusione acuta in ernia paraesofagea. Considerazioni su di un caso clinico.

A case of distal volvulus of the stomach as a cause of acute intestinal obstruction in a paraesophageal hernia is presented. The patient, an old woman aged 82, had been suffering from abdominal pain and vomiting for about 48 hours. She successfully underwent emergency operation for the reduction of hernia and plasty of the hiatus anterior the esophagus. On the basis of personal experience and review of literature data, stress is laid on the high incidence of paraesophageal hernia complications and the importance of early diagnosis and surgical repair is underlined.