[Surgery for complicated colonic diverticulitis. Our experience]. / Risultati del trattamento chirurgico nelle complicanze della diverticolite del colon. Esperienza dell'ultimo ventennio.

During the last two decades were observed 422 symptomatic patients with various degree of diverticular disease of the colon. 51 patients underwent surgery: 29 for stenosis (24) or occlusion (5), 4 for fistulas, 18 for perforation. The operations (26 emergencies, 25 elective) included: 21 cases of one-stage resection and anastomosis without protective colostomy, 16 with colostomy, 8 Hartmann's procedures, 7 Mikulicz's operations, 1 suturing of the diverticulum with colostomy. The incidence of complications was 17.6% (9 cases, 7 following emergency surgery and 2 after elective procedures). The intraoperative mortality was zero, while postoperative 5.8% (3 cases, 2 after emergency procedures and 1 following elective surgery). The best results (lowest morbidity and mortality rates) occurred with the radical procedures, especially the resection-anastomosis with or without colostomy, which allowed the removal of the septic focus from the peritoneal cavity and thus a shorter recovery in a high number of cases.

Bolus infusion of famotidine: effects on gastric pH by repeated 12-hour doses of 20 mg in postoperative patients.

This study was carried out to assess the efficacy of intravenous (IV) famotidine in suppressing gastric secretion over a 48-hour period. Twenty postoperative patients requiring a nasogastric tube received famotidine 20 mg IV every 12 hours and gastric pH was measured continuously by means of an indwelling probe. A baseline recording was performed over the first 4 hours and then the drug was infused every 12 hours (q12h) over a 15-minute period for the subsequent 48 hours. The mean pH value achieved during each time segment under active treatment was significantly higher (P < .001) than the mean basal value. Also the density distributions of minutes spent at the various pH units confirm that famotidine is highly effective (P < .001) in raising and maintaining gastric pH above 4.0 units during most of the drug-related period (44 hours). It can be concluded that repeated intravenous boli of famotidine 20 mg every 12 hours allow us to obtain an effective control of intragastric acidity. The antisecretory action is consistent over the total 48-hour period examined and therefore the use of intermittent infusion of famotidine seems to be advisable, as opposed to the recommended continuous IV administration of cimetidine and ranitidine. There is, however, a considerable intersubject variability in the antisecretory response to the drug.

Extension of lymph node dissection and survival in primary gastric cancer.

The histories of 429 patients who underwent surgery for primary gastric cancer at our ward from January 1970 to December 1985, were reviewed. All patients underwent surgery: potentially curative surgery, 54.8%, non-curative resection, 18.2%; palliative surgery, 27%. Nodal status was as follows: N0, 28%; N1, 17.7%; N2, 44.5%; N3, 9.8%. The incidence of N0 cases was significantly increased in Stage T1 and T2 disease compared to Stage T3 and T4 lesions (p < 0.001). In Stage T3 and T4 patients the incidence of distant metastases increased if lymph node involvement was also present (p < 0.005). In patients without nodal metastases 5-year survival was 70% (median survival: 60+ months) whereas, in patients with lymph node involvement survival was 32% (median survival: 24 months) (p < 0.001). Our data suggest that elective extensive lymph node dissection (R2) is indicated in all patients because survival is improved by this procedure. We recommend R3 lymph node dissection only in macroscopic N3 node involvement patients.

[Treatment of large bowel obstruction. Experience with intra-operative wash-out of the colon]. / Il trattamento delle ostruzioni del grosso intestino. Nostra esperienza sul wash-out intraoperatorio del colon.

The treatment of colorectal obstructions is a surgical problem. The surgeon can choose between primary resection with anastomosis and the staged operations. The one stage procedures need colon decompression or intraoperative colonic lavage. In our experience between 1990 and 1993, 23 patients required an emergency intervention for colon obstruction; between them 13 patients were affected by a left colonic obstruction and were treated with a staged procedure (like Hartman operation) in 9 cases and with intraoperative colonic wash-out with primary anastomosis in 4 cases. The last group had a good postoperative course without an increased incidence of anastomotic leakage (no one in our limited experience). Compared with staged surgery, immediate resection and anastomosis had significant advantages for the patients because: 1) the quality of the life is better (absence of colonstomy); 2) the cumulative hospitalization is reduced (15 days vs 32 days); 3) there is a reduction in operative risk and in the cumulative intra- and postoperative immunodepression. The correct evaluation of the effect on the long-term survival of these factors needs larger series and of longer follow-up.

[Nuclear DNA content in tumors of the colon and rectum. Relationship between ploidy and site of the neoplasm]. / Contenuto nucleare di DNA nei tumori del colon-retto. Rapporto tra ploidia e sede della neoplasia.

The DNA distribution pattern was determined 30 colo-rectal carcinomas. The DNA content in individual cells was measured according to a cytophotometric method based on light transmission measurement of Feulgen-stained nuclei. The DNA non diploid carcinomas were significantly more common from the left (descending and sigmoid) colon and rectum (P = 0.0002). No relationship existed between DNA pattern and age, sex, Dukes' stage, tumor grade.

[Chronic anemia due to Meckel's diverticulum. The diagnostic and therapeutic considerations]. / Anemia cronica da diverticolo di Meckel. Considerazioni diagnostico-terapeutiche.

Meckel's diverticulum is a frequent embryologic residual organ. The importance of considering this diagnosis in the young adult presenting chronic hypochromic [correction of hyperchromic] anemia, despite the difficulties of the same, is emphasized. The condition to be satisfied is the complete excision of Meckel's diverticulum, to avoid leaving ectopic mucosa residuals, so we think it useful to resect an ileal sleeve.

[Adenocarcinoma of the anal glands. Description of a clinical case and review of the literature]. / Adenocarcinoma delle ghiandole anali. Descrizione di un caso clinico e revisione della letteratura.

Adenocarcinoma of the anal glands is a rare slow-growing tumor with a more favorable prognosis compared with colorectal adenocarcinoma, especially if an early diagnosis is established. Clinical symptoms of this disease, often associated with a fistula in ano as in the reported case, include: perianal pain, rectal bleeding and presence of perianal mass. Also perianal Paget's disease may be a not rare association with adenocarcinoma of the anal glands. We believe, therefore, that a histological examination of the resected fistulas in ano should be performed, in searching for the presence of mucinous granules. In addition, it's very important to carry out a careful examination of those patients presenting pruritus ani or eczematous lesions of the anal region. In fact adenocarcinoma of the anal glands may be due to a chronic irritation of the epithelium over a period of years. Radiation therapy and chemotherapy have proved not to provide survival benefit in the treatment of this disease; the same result is obtained with a local excision of the lesion. The only chance for cure, therefore, is early diagnosis followed by radical operation. Miles abdominoperineal resection represents the approach of choice we have adopted for our patient. A radical groin dissection should be carried out only if there are metastases to the inguinal nodes. If necessary, abdomino-perineal resection may be folowed by adjuvant irradiation.

[Spectroscopic analysis of biliary calculi: correlations of the type of calculi and clinical data of 25 consecutive surgical patients]. / Analisi spettroscopica dei calcoli biliari: correlazioni tra tipo di calcoli e dati clinici di 25 pazienti chirurgici consecutivi.

The Authors considering cholelithiasis as an heterogenic pathological entity report their experience of 25 surgical consecutive patients: 20 with cholesterol or combination gallstones and 5 with black pigmented gallstones. In this series the most frequent factors associated with cholesterol gallstones were LDL hypercholesterolemia and hypertriglyceridemia; while the most frequent factors associated with black pigmented gallstones were hepatopathies. The most frequent symptom was dyspepsia. Only the black pigmented and the mixed gallstones were associated with jaundice and pancreatitis. According to the Literature infection is associated to brown pigment gallstones in 95% of cases, in this series infection is rarely associated with other types of gallstones. Treatment with oral bile salts is useful only in pure cholesterol gallstones, so the distinction among different types of gallstones is useful not only for a better knowledge of their pathogenesis but also for a correct choice of the therapeutic options.

[The reliability of the grading assessment of the biopsy samples in malignant colorectal neoplasms]. / Attendibilità della valutazione del grading sui prelievi bioptici per le neoplasie maligne colo-rettali.

The authors evaluate the results of preoperative bioptic grading compared with those obtained from postoperative specimens. Altogether, there was nonagreement in 45% of cases; therefore there is the risk of underestimating the biological aggressiveness of the disease. In fact, 68% of patients who were assessed as G1 in preoperative staging were found to have a higher degree of neoplastic dedifferentiation.

[Therapeutic strategies in the treatment of esophageal cancer: our experience]. / Strategie terapeutiche nel trattamento del cancro dell'esofago: nostra esperienza.

Esophageal cancer has a poor prognosis. The Authors in reviewing esophageal carcinogenis stress the importance of an early diagnosis to improve surgical results and compare their experience with those of other Authors.

[Sclerosing adenocarcinomas of the hepatic hilum]. / Gli adenocarcinomi sclerosanti dell'ilo epatico.

The authors report their series of 7 adenocarcinomas of the hepatic hilum. Five patients with a stage IV tumor underwent palliative surgery while the remaining 2 patients underwent radical surgery. One patient died and 3 reported postoperative complications. Overall survival was 2 years and 6 months: these results can be considered satisfactory taking into account the advanced stage and the bad prognosis of this type of tumor. The aim of a better quality of life may represent a reasonable indication to surgery.

[Esophagectomy without thoracotomy: indications and our experience]. / Esofagectomia senza toracotomia: indicazioni e nostra esperienza.

In this paper the Authors report their experience of Orringer operation in 12 patients with oesophageal cancer observed from 1978 to 1992, and stress the possibility to extend the indications to Akijama oesophagectomy without thoracotomy for the treatment of malignant tumors of the entire oesophagus.

Sonographic appearance of primary retroperitoneal cysts.

The sonographic findings observed in four patients with primary retroperitoneal cysts were reviewed. All lesions presented as fluid-filled masses with anechoic content and regular margins; all increased through transmission. Preoperative location of the cysts within the retroperitoneal space was possible in all cases by either real-time ultrasound (US) analysis of the different relationships of the kidneys and the cysts during respiratory movements or the anterior displacement of surrounding structures. A differential diagnosis among retroperitoneal lesions containing fluid is difficult and cannot be obtained with imaging methods alone. However, preoperative knowledge of both the retroperitoneal location of the disease process and its fluid content may help to narrow the diagnostic possibilities, thus allowing the surgeon to more accurately plan the therapeutic approach to the patient.