[Diagnosis of the spontaneous subarachnoid hemorrhage with short bleeding or long evolution: report of one case]. / Diagnóstico de la hemorragia subaracnoidea espontánea de escasa cuantía o de larga evolución: a propósito de un caso.

Subarachnoid hemorrhage implies the presence of blood within the subarachnoid space from some pathologic process. The initial study of choice is an urgent Cranial Computed Tomography scan, but its sensitivity declines with time. So that it is recommended that patients with severe sudden headache but normal Cranial Computed Tomography scan, should have a lumbar puncture performed, more than 12 hours after the onset of symptoms, to rule out subarachnoid hemorrhage. The methods for distinguishing among traumatic lumbar puncture and true Subarachnoid hemorrhage include the erythrocyte level, the "three tube test", D-dimer assay and ferritin in cerebrospinal fluid. But the best technique is the xanthochromia o yellow-to-orange cerebrospinal fluid supernatant, measured spectrographically. We report a case of a young woman with a subarachnoid hemorrhage diagnosed by xanthochromia after 18 days after the onset of bleeding.

[Aberrant pancreas in gastric site]. / Il pancreas aberrante a sede gastrica

The conclusions contained in recent and past literature regarding the heterotopic pancreas are reviewed. A case of accessory pancreas located in the stomach, whose clinical, radiological and endoscopic aspects simulated a carcinomatous process, is reported. The case is studied anatomo-pathologically and important aspects, including surgical, noted.

[Clinical considerations on retroperitoneal liposarcoma. Report of 2 cases]. / Considerazioni cliniche sul liposarcoma retroperitoneale. Presentazione di due casi

Liposarcoma is one of the more common tumours of the soft retroperitoneal tissues. It usually occurs in aged subjects and displays a marked contrast between its malignant histological picture and its protracted, poorly symptomatic clinical picture. Eventually, compression or invasion of nearby organs appears, whereas the patient's general condition is not affected. Two personal cases are described.

[Multiple diverticulosis of the small intestine]. / La diverticolosi multipla del piccolo intestino.

A case of jejunum-ileum multiple diverticulosis observed during a cholecystectomy due to cholelithiasis, is reported. Stress is laid on this unusual localization of diverticulosis in the small intestine. The clinical picture can be silent or present an acute or chronic symptomatology and radical surgical treatment can performed or not. When the disease involves all the intestine, without presenting serious inflammatory phenomena and without clinical symptoms (as in the case observed), medical and not surgical treatment can be envisaged.

[Intrapericardial diaphragmatic hernia]. / Ernia diaframmatica intrapericardica.

A case of intrapericardial diaphragmatic hernia with stomach and colon migration is reported. Stress is laid on the problem of early diagnosis, as the condition is usually asymptomatic: the scpra-umbilical median laparotomy approach route is proposed.

[Hepatic echinococcosis. Surgical treatment]. / L'echinococcosi epatica. Terapia chirurgica.

After some general observations on liver echinococcosis (epidemiology, liver topographic anatomy, diagnostics), various surgical techniques proposed for the treatment of this disease are described. Case series observed from 1967 to 1978 and the technique of choice, cystotomy with partial cysto-resection, are presented. The favourable results obtained are underlined.

[Surgery of malignant neoplasms of the esophagus]. / La chirurgia delle neoplasie maligne dell'esofago.

A series of malignant cancers of the oesophagus operated in the period 1968-1978 is reported. The importance of preoperative denutrition is considered and the various nutritional techniques are outlined, with a note on their advantages and defects. Right intrathoracic oesophagogastroplasty carried out in malignant cancers of the middle third of the oesophagus is particularly discussed. This surgical technique is held to be preferable to intestinal transpositions in substitution of the oesophagus, and the results obtained in this series support the opinion.

[Diverticular disease and its treatment]. / La malattia diverticolare e il suo trattamento.

Diverticular disease of the colon is being seen with increasing frequency. Not infrequently, the first attack of diverticulitis may result in serious and potentially fatal complications. A period of observation and conservative management is necessary to determine the outcome of a particular attack. Approximately 30% of symptomatic patients require surgical intervention. Controversy still surrounds the appropriate operative approach to be employed in the management of diverticular disease, moreover when it presents with a complication. In general, resection is the procedure of choice for perforating diverticulitis. There is an emerging role for down-staging interventions in the recent literature; with few exception, there is no role for three-stages procedure for diverticular disease. In the setting of stage I or stage II disease (Hinchey classification) primary resection with anastomosis is safe and should be performed. Proximal colostomy formation may be carried out at the discretion of the surgeon if warranted by such local circumstances as contiguous inflammation or macroscopic contamination. For patients with stage III and stage IV disease endcolostomy with Hartmann closure of the rectum is the procedure of choice, although anastomosis with proximal stoma may prove to be an acceptable alternative. We reviewed the changing patterns in the operative treatment in 46 patients admitted to our Division for perforated diverticulitis. We performed the resection with anastomosis in 39 patients with perforation at the II stage; in 7 patients with generalized peritonitis (stage III-IV by Hinchey) we preferred Hartmann intervention in 4 cases and the three-stages procedure in 3 cases. We had no death at all. From 1979 to 1994 we noticed an increasing use of down-staging procedures.

[Treatment of Crohn's disease in the acute phase]. / Studio sul trattamento del morbo di Crohn in fase acuta.

The authors sent a questionnaire containing a series of questions dealing with acute manifestations of Crohn's disease, to eminent surgeons of different surgical schools. Results are interesting because differences are quite evident. In terminal ileitis mimicking acute appendicitis, 75% of surgeons perform an appendectomy. In the case of on acute intestinal obstruction, resection of the diseased bowel with primary anastomosis is preferred. In case of free perforation of the lesion, abdominal and massive hemorrhage, answers need to be analyzed in details.

[Tumors of the large intestine in acute phase]. / I tumori del grosso intestino in fase acuta.

A retrospective study was carried out on 406 patients operated on for tumours of the large bowel in the acute stage between 1975 and 1985. 285 cases were operated immediately, 53 for acute perforations and 232 for complete occlusions, whereas 121 were operated on with deferred urgency. The surgical approach was generally conservative in 230 cases while in 159 immediate tumour resection was carried out. In the event of conservative operation, a second resection was possible in 94 cases (51.36% of survivors). Immediate resections had a five year survival better than those carried out in several stages (27.50% against 18.28%). However, the immediate postoperative course reported lower mortality. The present study and reported data show that surgical treatment of obstructions and neoplastic perforations of the large bowel is not completely standardised.

[Hepatic artery aneurysm as a cause of hemobilia]. / L'aneurisma dell'arteria epatica come causa di emobilia

1) Haemobilia must be kept in mind as a cause of gastrointestinal haemorrage. 2) The presence of an hepatic artery aneurysm gives a peculiar triad of symptoms: abdominal pain, gastrointestinal haemorrage and jaundice. 3) Selective angiography is the elective diagnostic aid. 4) The diagnosis may be difficult also at operation, because the aneurysms can be very small. 5) The most used surgical treatment are ligation of the hepatic artery, the excision of aneurism, the endoaneurysmorrhaphy or the end-to-end anastomosis.

[Transduodenal papillosphincteroplasty]. / La papillo-sfintero-plastica transduodenale.

On the basis of a thourough anatomosurgical study of Vater's ampulla and after a critical survey of all surgical techniques for the sphincter of Oddi, the indications for and technique of total papillosphincteroplasty are presented. The results obtained in 544 total papillosphincteroplasties, their possible complications and failure supported by long-term (from 6 months to 7 years) follow-up are discussed. The conclusion is drawn that papillosphincteroplasty is to be considered the surgical technique of choice in the treatment of benign pathology of the main bile way.

[Cholecystosis]. / Le colecistosi

Cholecystosis conditions include those diseases of the gallbladder whose aetiopathogenesis is to be sought in a hyperplasia of the tissues making up the cholecystic wall (hyperplastic forms) and in an overload of this wall on the part of organic substances or minerals such as lipides or calcium salts (thesaurismosic forms). After discussing the classification, pathological anatomy, aetiopathogenesis, frequency, symptomatology, laboratory and radiological examinations, prognosis complications and treatment of these conditions, a personal series of 36 surgically treated cholecystoses is reported.