[Intestinal anastomosis with biodegradable ring]. / Anastomosi intestinali mediante anello bioframmentabile (BAR).

The authors report their experience using biofragmentable anastomosis ring (BAR) in bowel anastomosis. Starting January 1993 to February 1994, 46 intestinal anastomoses were performed using BAR, and particularly 39 end-to-end colo-colostomies, 2 end-to-side colo-colostomies and 5 end-to-side ileo-colostomies. 35 patients were affected by colonic neoplasm, 5 patients by diverticular colonic complications- and 5 patients by several unusual bowel diseases. Four emergency operations were performed, while 42 patients had an accurate bowel preparation before surgery. In this series of patients one case of preoperative mortality is reported, due to massive pulmonary embolism. Instead several minor complications occurred in other patients, such as paroxysmal atrial fibrillation (one case), basal pleuritis (one case), hyperpyrexia (three cases), temporary subocclusion or delayed canalization (five cases). Only one patient suffered from intestinal occlusion induced by adhesions and a second laparotomy was required. Delayed canalization seems to be caused by the small size of the BAR employed (25 mm) or by inadequate intestinal preparation, that usually occurs in emergency operations. After surgery all patients were followed up and 18 of them were examined by coloscopy six months after surgery. No clinical problem connected with bowel anastomosis was reported and all anastomosis looked quite previous and resilient. No anastomotic stenosis was found. In our experience and from recent reviewed reports, BAR seems to be a rapid, effective and safe device for sutureless bowel anastomosis.

[Role of surgery in the treatment of acute hemorrhagic non-variceal lesions in the upper gastrointestinal tract]. / Ruolo della chirurgia nel trattamento delle lesioni emorragiche acute non varicose del tratto gastro-intestinale superiore.

From January 1993 to December 1994, out of 244 cases of upper gastrointestinal hemorrhage observed 25 patients underwent surgical treatment. Twenty-nine bleeding varices were excluded from this study. Early endoscopy revealed the source of bleeding almost in all cases (84%). All patients received, at the time of admission, medical treatment associated in 7 cases (28%) to endoscopic injection therapy. Emergency surgery indications were massive bleeding persistent bleeding, rebleeding and macroscopic findings of lesions. The aim of this report is to verify the respective roles of medical, endoscopic and surgical therapies in relation to the nature of the bleeding lesion and the entity of the hemorrhage. Results with regard to indication, clinical data, surgical technique were compared with literature data.

[Thyroid carcinoma in hyperthyroid syndromes]. / Il carcinoma tiroideo nelle sindromi ipertiroidee.

The relationship between hyperthyroidism and carcinoma of the thyroid is still uncertain. The incidence of thyroid carcinoma ranges from 0.3 to 16.6%. Between 1984 and 1994 the Authors observed 9 patients affected with thyroid cancer and toxic nodular goiter (4 patients) or Basedow disease (2 patients) or scintigraphic evidence of single hyperfunctioning nodule (3 patients). Six out of the 9 cases were diagnosed as papillary cancer, while three as follicular cancer. A carcinoma was diagnosed before operation in only one case, while in the other 8 patients, the diagnosis was obtained by histological examination of the specimen. Four patients underwent subtotal thyroidectomy, while five patients underwent radical lobectomy. All patients are alive and in good health; the average follow-up was 48 months.