[The laparoscopic treatment of common bile duct lithiasis]. / Trattamento laparoscopico della litiasi della via biliare principale.

Nowadays the laparoscopic cholecystectomy has become the main surgical therapy in the treatment of cholecysto-lithiasis. At the beginning the treatment of cholecysto-choledochal lithiasis was the sequential endoscopic-laparoscopic therapy. In fact, the endoscopic sphincterotomy allows transpapillary ablation of Common Bile Duct (CBD) stones, and the laparoscopic cholecystectomy completes the therapy. Recently we have brought the full-laparoscopic of CBD lithiasis. This has become possible on account of an improved intraoperative laparoscopic diagnostics and a better technical experience of the laparoscopic surgeon. Intraoperative examination of CBD requires suitable instruments: cholangiography is still a basic examination and now is easily performed in laparoscopy without a considerable increase of the surgical time; choledochoscopy allows an intraluminal inspection of completes the examination, supplying further detailed information. Afterwards the laparoscopic approach allows the transcystic ablation of stones, using a Dormia probe or through a choledochotomy, but is previously required for the surgeon a high-level operative and technical ability about laparoscopic surgery, in order to perform an excellent preparation of the CBD and precise stitches, making knots with extra corporeal or intra-abdominal technique. Clinical results in patients until now fully-laparoscopic treated are quite good and encourage the CBD lithiasis therapy by a mini-invasive approach, which has the advantage that's not requested the sacrifice of a sound papilla.

The treadmill test in the assessment of peripheral arterial occlusive disease.

Results of a study using the treadmill test on 32 patients with peripheral Fontaine's stage II arterial disease are described. The aim of the study was to evaluate the utility of the test in assessing useful information concerning the site of the lesion. Patients were divided in three classes depending on the arterial segment involved (iliac-femoral, femoro-popliteal, associated lesions) as resulted from the velocimetric and angiographic evaluation. Ankle pressure and WI, at rest and after stress test, PFWD and RT were evaluated. The authors conclude that data achieved with the dynamic test are related to the arterial involvement, allowing to differentiate obstructive and stenotic lesions, but do not give information concerning the site of the lesion. Nevertheless it is a valuable means of highlighting arterial lesions well compensated at rest and with normal pressure values.