[Our experience with the use of Absolok polydioxanone resorbable clips in laparoscopic surgery]. / Nostra esperienza sull'utilizzo delle clips riassorbibili in polidiossanone Absolok in chirurgia laparoscopica.

BACKGROUND: The study aims to evaluate the efficacy of resorbable clips in polydioxanone in laparoscopic surgery. METHODS: The authors report their personal experience regarding the use of Absolok (ABL) resorbable clips in laparoscopic surgery. Out of a total of 745 laparoscopic operations performed from September 1992 to February 1997, 438 included the use of resorbable clips in place of metal clips, both for cystic duct section during cholecystectomy and vascular structures, or to lock continuous sutures. ABL clips were also used for major vessels (e.g. mesenteric artery) during laparoscopic colic resections. RESULTS: In all cases when they were used, ABL never gave rise to complications, such as biliary outflow or hemorrhage caused by the dislocation of the clips themselves. CONCLUSIONS: The authors conclude by affirming the value and safety of this type of clip.

[Postgastrectomy metabolic problems]. / Problemi metabolici del gastrectomizzato

A synoptic pattern is drawn up to synthesize the morpho-functional alterations and metabolic disturbances arising from total gastrectomy, while a comparison is made with those arising from massive resections of the small intestine (so-called short intestine syndrome). Emphasis is placed on the desirability of rebuilding the gastric reservoir and maintaining duodenal continuity through interposition of a loop. Among the various available techniques, preference is given to the Mouchet-Camey method, which seems to respond better than others to expectations of the patient's good metabolic recovery.

[Bronchogenic cyst of the lung and pulmonary tuberculosis. Presentation of a case]. / Cisti broncogena del polmone e T.B.C. polomonare. Presentazione di un caso.

The paper considers a clinical case of multiple bronchogenic cysts associated with a pneumonitic process of TB character, operated successfully by means of an upper right and middle bilobectomy. No similar case was found in literature. The malformations were of congenital origin, characterised histologically by a cavity, the walls of which contain elements proper to the bronchus: cartilage and ciliate columnar epithelium. The squamous metaplasia is rare, and the neoplastic transformation very rare. From the clinical point of view a distinction is made between asymptomatic cysts, in which the clinical picture is dominated by compressive phenomena affecting the surrounding structures, or sometimes by infection due to supervening bacterial, mycotic or--as in our case--tubercular contamination. The therapeutic indication is exclusively surgical, with methods of exeresis varying according to the extent and location of the morbid process.

[Oncocytoma of the lung: presentation of 1 case (author's transl)]. / L'oncocitoma del polmone: presentazione di un caso clinico.

The Authors describe one case of pulmonary oncocytoma successfully treated by ablative surgery. The patient was a man aged 38 with an asymptomatic nodule, about the size of a walnut, in his right lower lobe. The whole right lower lobe was removes surgically, and histological examination resulted i na diagnosis of pulmonary oncocytoma. In the discussion, the authors point out that this type of malignancy is extremely rare, with only 7 cases reported in the more recent literature to the best of their knowledge.

[Cancer of the gastric stump (author's transl)]. / Il cancro del moncone gastrico.

On the evidence of 24 cases of cancer of the gastric stump the authors discuss the real incidence of this dread complication; they conclude that starting 8 years after primary surgery, all patients carrying a gastric stump must be regarded as high-risk subjects for malignancy; further, they recommend that pyloro-gastrectomy after Billroth (II) be considered for execution in young patients with all possible reluctance.

[Our experience in the use of "traction" endoprosthesis as a palliative treatment of cardial carcinoma]. / La nostra esperienza nell'uso delle endoprotesi "a trazione" quale trattamento palliativo del carcinoma cardiale.

The Authors review the methods of palliative treatment of cardial carcinoma, and particularly report some results obtained through the application of oesophageal endoprostheses (by Celestin and by Haring), following the traction method, in 38 patients. The global mortality amounted to 8 cases (21%). In 12 patients (31%), complications such as stoppage or dislocation of the prosthesis were observed. In two cases the perforation of oesophageal wall occurred, with spontaneous resolution in one of the two patients and serious mediastinitis and exitus in the other. The Authors' present trend is toward the use of push type endoprosthesis, because of the lower mortality reported in literature.

[The Shouldice plastic surgery: our clinical experience]. / Plastica secondo Shouldice: nostra esperienza clinica.

The Authors present cases of groin hernioplasty using the Shouldice method; the method used for more than six years, such as elective technique to treat groin hernia, is evaluated on the basis of results of complications and recurrences. A careful clinical check of patients operated on over one year at least, allows confirmation of the efficiency of the method, because it results in a low percentage of recurrence and complications, plus a low social and economical cost. For these reasons it is proposed that the method is applied in day surgery.

[Palliative treatment of esophageal cancer]. / Trattamento palliativo del cancro dell'esofago.

The AA. describe the indications, the technique and the complications of application of oesophageal endoprosthesis (Celestin or Haring) for palliative treatment of oesophageal cancer and they value the results of 34 applications of these prosthesis that were executed about Surgical Clinic in Verona with satisfactory results during the period 1974-77. They show the improvement of survival conditions in these patients, the rareness of complications, the absence of absolute contra-indications.

[Lipoid pulmonary granuloma in Parkinson's disease. Presentation of clinical case]. / Il granuloma polmonare lipoideo nel morbo di Parkinson. Presentazione di un caso clinico.

The authors describe one case of lipoid granuloma of the lung in a patient with PARKINSON'S disease. The cause of this pulmonary sequel is probably to be found in the alteration of the mechanism of deglutition, typical of PARKINSON'S disease, with aspiration bronchopneumonia and subsequent evolution to granuloma formation. In the case presented (a man of 64) the X-ray picture resembled the irregular mass opacities and bronchial amputations characteristically associated with cancer of the lung. As the actual anatomical extent of the process exceeded the limits indicated by radiological examination, the whole left lung was removed at surgery; histological studies, however, revealed the essentially benign nature of the lesion. The patient was discharged in due course of time as surgically cured. There was no major deterioration of his neurological status either at discharge time or at later rechecks.

[Gastric metastasis of melanoma (report of a clinical case)]. / Metastasi gastrica da melanoma (presentazione di un caso clinico).

The Authors report a case of gastric metastasis from melanoma of the skin, occurring 6 years after removal of the primary neoplasm. The metastasis, which was characterized by conspicuous alimentary tract haemorrhage, called for emergency surgery consisting in a total gastrectomy with oesophago-jejunal anastomosis according to Roux. The Authors then go on to review the literature on the subject, stressing the frequency of gastrointestinal metastases in skin melanomas with an incidence affecting up to 60% of cases in autopsy series. After examining the main clinical aspects, endoscopic appearances and r-ray findings, the Authors deal at some length with prognosis, pointing out that isolated metastases may constitute a surgical indication in view of the cases of fairly good long-term survival reported in the literature.

[Retroperitoneal neurilemmoma (considerations on 4 cases)]. / Il neurilemmoma retroperitoneale (considerazioni su 4 casi).

The authors show 4 cases of retroperitoneal neurilemmoma, surgically treated by simple excision of the tumour. From the general observations, as well as from the analysis of the literature, they can remark the rareness of the location in such anatomical region. The clinical symptoms are common to those of the region retroperitoneal tumours, and are due to the compressive effect developed by the tumour on the contiguous structures. As regards the diagnostic procedures, they emphasize the primary value of axial computed tomography in the evaluation of the retroperitoneal pathology. The diagnosis cannot be but histologic, and is based upon the presence of the typical histologic pictures according to Antoni A and B types.

[Pancreas transplant today: review of the literature]. / Il trapianto di pancreas oggi: revisione della letteratura.

The authors, after analysing the world literature concerning the pancreatic transplantation, dwell in considering the problems involved in the indications and techniques of the transplantation itself. Among the several problems expecting an ultimate solution, the improvement of prophylaxis, diagnosis and treatment of rejection seems to heavily affect the future of this surgery.

[A case of duodenal duplication in the adult]. / Su di un caso di duplicazione duodenale dell'adulto.

The authors describe a rare case of duodenal duplication presenting in adult life; the complete preoperative investigations did not substantiate. The diagnosis which can be accomplished in most cases only intraoperatively. The diagnosis is mainly based upon knowledge of the condition and upon pathologic examination.

[Our experience with selective proximal vagotomy]. / La nostra esperienza in tema di vagotomia prossimale selettiva.

The authors show a casuistry of 125 operations of SPV, and comment on the clinical and physiopathologic presuppositions justifying the indications to SPV in the field of gastroduodenal peptic pathology. They report the results of the gastric probings, both basal and after stimulation with pentagastrin in the pre- and postoperative phase, and after a year. They face the problem of pyloroplastics, and appraise the elements indicating and contra-indicating it in association to SPV.

[Clinical results after proximal selective vagotomy (considerations on 42 cases)]. / Risultati clinici dopo vagotomia selettiva prossimale (considerazioni su 42 casi).

The authors report the results of a 6-8 year follow-up of 42 patients treated by selective proximal vagotomy with pyloroplasty for gastric or duodenal ulcer disease. On the basis of Visick's classification, the patients broke down into the following categories: Cat. 1: 66.6%; Cat. 2: 26.1%; Cat. 3: 2.3%; Cat. 4: 4.7%, with 92.7% belonging to the first two categories. These data are in agreement with other data reported in the literature, and show no significant differences as compared to follow-up one year after surgery.

[Epithelial splenic cysts]. / Cisti splenica epiteliale.

The authors describe a case of an epithelial cyst of the spleen treated successfully by splenectomy. Diagnostic techniques and the principles adopted in treatment this rare disease are discussed.

[Surgical therapy of gastro-esophageal reflux (clinical contribution)]. / Terapia chirurgica del reflusso gastro-esofageo (contributo clinico).

The Authors, on the basis of 119 cases of gastroesophageal reflux, submitted to intervention at the Surgical Department of Verona from 1970 up to 1983, seize this opportunity for some remarks about the problem: in fact, its physiopathology is still discussed, and numerous were the surgical techniques suggested for its treatment. 56 patients, treated according to Nissen-Rossetti's technique, and 16, in whom the antireflux plastic operation was complemented by a selected proximal vagotomy with pyloroplastics, were remote-checked. The good results got till now mean the SPV + P can be usefully associated to the antireflux plastics for hiatal hernia.

[Surgical therapy of gastric carcinoma in an advanced stage (clinical cases)]. / Terapia chirurgica del carcinoma gastrico in fase avanzata (contributo clinico).

The Authors study the casuistry of the Verona Surgical Clinic concerning the interventions for gastric cancer; they particularly study 35 cases of plurivisceral demolition for neoplasm in advanced phase. After a discussion of the data supplied by the literature; the Authors, as a conclusion, suggest not to consider the overcoming of the gastric barrier in multivisceral sense as a rigid element for the exclusion of these patients from surgery, although they exclude widely demolitive interventions in seriously weakened patients, or in bearers of such spreadings as to involve tremendous operative risks, not rewarded with a satisfactory advantage.

[2 cases of enterorrhagia caused by Meckel's diverticulum. Problems of diagnosis and therapy]. / Su due casi di enterorragia da diverticolo di meckel. Problemi di diagnosi e terapia.

The authors study two cases of enterorrhage due to Meckel's diverticulum. They particularly emphasize the importance of two instrumental inspections: enema and abdominal scintigraphy with 99mTcO4, in the diagnostics of this malformative pathology, and the treatment with H2-blocking substances with the purpose to stop hemorrhage, circumstantiate the diagnostic suspicion, and operate electively.

[Pancreatic fistulas: evaluation of medical treatment in 50 observed cases]. / Fistole pancreatiche: valutazione del trattamento medico in 50 casi osservati.

The authors, on the basis of their experience concerning the observation and treatment of 50 patients sucering from "pure" pancreatic fistula, appraise the results of the therapy adopted. From their experience it results the Total Parenteral Nutrition (TPN) is the choice protection in such patients. They report some encouraging preliminary results through the use of Somatostatin.