[Cystic pancreatic tumors. Review of literature and proposal of a diagnostic-therapeutic pathway]. / I tumori cistici del pancreas. Revisione della letteratura e proposta di un percorso diagnostico-terapeutico.

In this paper the Authors consider the epidemiological, clinical, pathological, instrumental, chemical and physical findings of every type of pancreatic cystic lesions. They perform a critical examination of each of them. In this way, they can identify the most important features of every single class. A pathway consisting in four main groups of instrumental and chemical tests (abdominal ultrasonography / EUS, CT, MR, FNA / biopsy/ assay of tumoral markers and amylase of cystic fluid) was chosen to know all these informations according to careful principles of specificity, sensitivity and diagnostic accuracy taken from international scientific literature. In each subgroup of cystic pancreatic tumor, at last, the most reliable therapeutic project is suggested according to the common international scientific agreement.

[The surgical treatment of gastric carcinoma. Evolution in surgical technique and staging in a series of 194 patients]. / Trattamento chirurgico del carcinoma dello stomaco. Evoluzione della tecnica chirurgica e della stadiazione in una serie di 194 pazienti.

AIM: Surgery is, at present, the only potentially curative treatment for gastric carcinoma. The curability depends upon the extension and localization of the tumor and, particularly, the lymphatic involvement and the presence of distant metastases. The aim of this paper is to describe the personal experience during the last 2 decades and analyze the results of the surgical approach which has changed over the time. METHODS: One-hundred and ninety-four consecutive patients have been reported (127 male and 67 female, with a median age of 65.8 years), affected by gastric carcinoma and subjected to surgical procedures from 1987 to 2000. Because of the wide period of time which it refers to, this study is overlapped by a radical change in the staging rules of gastric carcinoma, according to the publication, in 1997, of the 5th edition of the TNM. This has made necessary to divide the series into 2 different groups. The 1st group is composed of 123 patients (63.4%), staged according to TNM-1987; the 2(nd) group is composed of 71 patients (36.6%) staged according to the TNM-1997. A D1 lymphadenectomy was used as treatment protocol until 1995. Subsequently, a D2 lymphadenectomy was performed in the most part of potentially curable patients. The reconstruction after total gastrectomy was carried out in all cases with Roux technique. In distal gastrectomies a Billroth 2 technique was performed in 89.3% of the cases and a Billroth 1 technique in 10.7% of the cases. RESULTS: The operative mortality observed on the total of patients was 1.5% (3 cases). With a median follow-up of 83 months (minimal 24, maximum 180 months), 134 patients were died, 50 are alive and 10 have been lost. The total median survival, in the 2 groups, was 24 months. We have observed a trend to improvement of survival for patients with carcinoma in stage II and III operated after 1997. CONCLUSION: The treatment of unresectable gastric cancer, i.e. palliative surgery, is the best choice when possible in comparison to other surgical procedures (gastroenteronastomosis, jejunostomy), endoscopic procedures (dilatation, endoprosthesis, laser, percutaneous endoscopic gastrostomy) and medical therapies. In order to choose the best palliative treatment, a careful evaluation of the non-curability signs is necessary to avoid high risk surgical interventions in patients with a low expectation of life.

[Definite colostomy using a circular stapler: a technique to be reconsidered]. / La colostomia definitiva mediante stapler circolare: una tecnica da riconsiderare.

Personal experience on a particular utilization of circular stapler is reported. At the beginning the fast and easy execution emphasized its use. However, the constant appearance of a late complication was observed, i.e. the progressive stenosis of the stoma. This event occurred even when maximal size of the instrument was used and it reappeared after repeated procedures of instrumental or surgical dilatation. The effective validity of this technique was evaluated by the Authors. On the other hand, the Burk alternative technique, with a second purse-string on the cutaneous ring seems to prevent the stenosis. However, it is slow and difficult as traditional procedure. The causes of the neostoma stenosis performed by circular stapler, reported by the Authors in 100% of cases, are easily explained with the absence of biological barrier of colonic mucosa that normally prevents excessive tissue growth.

[Critical considerations on circular staplers]. / Alcune considerazioni critiche sugli staplers circolari.

After a careful review of the literature and a critical evaluation of personal experience on stapling technics in visceral anastomoses, some critical considerations on circular devices are reported. The Authors emphasize the well known qualities of staplers which brought to their routine use in digestive surgery. Some complications exclusively due to an "imperfect" firing of the instrument are then reported. Personal experience on a particular utilization of circular stapler for definitive colostomy is also reported. The Authors finally suggest some simple technical improvements.

Mesenteric artery embolectomy: a case report.

A case of successful superior mesenteric artery embolectomy with bowel resection is reported. Superior mesenteric artery embolization must be strongly suspected in a patient with atrial fibrillation, presenting sudden abdominal pain and an unremarkable examination. Extensive use of abdominal angiography is strongly recommended, since successful results depend on early diagnosis. This "second look" procedure may be limited, on the basis of careful clinical observation. Should any doubt persist regarding bowel viability, a duodenoenteric anastomosis is recommended.