[Surgical treatment of umbilical hernia in children. Our experience]. / La correzione chirurgica dell'ernia ombelicale in età pediatrica. Esperienza personale.

AIM: To identify the main parameters which, differently correlated, indicate in which case, age and modality umbilical hernia in children should be surgically repaired. METHODS: The authors report personal experience on 319 children with umbilical hernia observed in the last 7 years. In 72 cases, on the basis of the evaluation of some parameters, a surgical correction was performed with the technique described. RESULTS: All the procedures were performed in "day surgery". There were no early complications, neither anesthetic nor surgical. All children showed a good recovery of all functions (feeding, intestinal canalization, walking about) and activities. No middle and long-term complications were observed. CONCLUSIONS: Umbilical hernia needs a surgical repair only in a few cases and after a careful evaluation of some parameters (age, sex, kind of hernia, size and consistency of the hernial porta, protrusion and expansion). The surgical procedure should guarantee either the safe and prompt repair or the cosmetic result; the use of some devices (anesthetic and surgical) allow to obtain excellent results.

[The use of surgical endo-prosthesis in the treatment of choledocolithiasis in the elderly. Personal experience]. / L'uso delle endoprotesi chirurgiche nel trattamento della litiasi della VBP nell'anziano. Esperienze personali.

BACKGROUND: The usefulness of biliary endoprostheses in some selected elderly patients affected by hepato-choledocolithiasis is described. METHODS: In the Department of Surgery, University of Perugia, 119 elderly patients were surgically treated for choledocholithiasis from January 1999 to December 2000. In 44 selected cases#151;oldest patients with thinner hypovascularized ectasic choledochal wall#151; a permanent transpapillary polyurethane prosthesis was placed, after choledocolithotomy with or without sphinterotomy; sometimes prosthesis was placed under the duodenal mucosa. RESULTS: Endoprosthesis had a long duration and gave good results in canalization and periprosthetic flow, in absence of biliary stasis and/or angiocholitis. Only one patient had prostheses displacement. CONCLUSIONS: On the basis of personal experience and considering physiopathology and pathogenesis of biliary stones in the elderly, the authors underline, in selected cases, the need of stenting the hepatocholedochal lumen with the aim of avoiding collapse.

[Peripheral nerve tumors of the thoracic wall: 2 case reports]. / I tumori dei nervi periferici della parete toracica: descrizione di due casi clinici.

The Authors discuss about thoracic wall neoplasms examining in particular neurogenic tumors, their origin, most frequent locations, and biological behaviour. Two cases are reported and preoperative diagnosis as well as surgical techniques and results obtained are discussed.

[Rectosigmoid junction neoplasms: our experience]. / Le neoplasie della giunzione sigma-retto: esperienze personali.

The Authors report their experience with 25 patients operated for colorectal junction neoplasms from January 1998 to December 2002 in the Section of Oncological Surgery, at Perugia University. According to the international literature, the Authors maintain the absolute functional and anatomical individuality of this part of the large bowel, underlining the peculiarity of the sigmoidal junction neoplasms respect all the others colic sites regarding clinical manifestations, symptoms developing and biological behaviour. The characteristics seem also capable of changing the surgical choice as well as the prognosis of the disease.

[Gastric cancer in the geriatric patient: our experience]. / Il cancro gastrico nel paziente in età geriatrica: nostra esperienza.

The Authors report their experience in the management of 68 patients aged over 70 years affected by gastric cancer: 64 of them were operated. After some considerations on patients status, nutritional and immunological conditions, operative risk and cancer characteristics the Authors, on the basis of the results obtained, discuss about the opportunity of surgical therapy and relative adequate surgical techniques in the elderly.

[Hemidiaphragmatic reconstruction: the evaluation of 3 clinical cases]. / La ricostruzione dell'emidiaframma: valutazioni su tre casi clinici.

The Authors after a review of the embriology, physiology and pathophysiology of diaphragm, report three cases of congenital or acquired diaphragmatical hernias. They discuss advantages and disadvantages of different surgical techniques on the basis of their technical experience as well as results obtained.

[Day surgery and one day surgery in pediatric surgery: personal experience]. / "Day surgery" e "one day surgery" in chirurgia pediatrica: esperienze personali.

The Authors report their experience with 738 children observed and operated for minor diseases in the period January 1989-June 1993. The children were hospitalized for day surgery or one day surgery. After some surgical, anaesthesiological, and postoperative pathophysiological considerations, and on the basis of their results (reduced local and general postoperative complications), the Authors confirm the benefit of this type of organization in terms of reduced nosocomial infections, reduced psychological traumas and increased socio-economic advantages.

[Intestinal invagination in childhood: etiopathogenetic evaluations and details of surgical technique]. / L'invaginazione intestinale in età pediatrica: valutazioni etiopatogenetiche ed accorgimenti di tecnica operatoria.

Intussusception in childhood, especially the idiopathic type, is herein considered. The Authors evaluate some etiopathological aspects on the basis of their experience in 34 patients, and affirm the need of an early and correct diagnosis. They also consider therapeutical management and surgical approach, evaluating local and general conditions of the patient as well as time passed since the onset of symptoms. Finally the importance of an accurate diagnostical examination during the quiescent period and some details of the surgical technique are stressed.

[Intestinal invagination in adults: 3 case reports]. / L'invaginazione intestinale nell'adulto: osservazioni su tre casi clinici.

The Authors report their experience in the surgical management of three adults affected by intussusception. The different symptoms and different diagnostic approach, compared to those of childhood, induced the Authors to some evaluations on pathophysiology of intussusception in adults. On the basis of the different pathogenesis some differential criteria between the two forms are stressed, finally suggesting a systematic surgical approach in adults.

[Evaluation of risk factors in oncologic surgery]. / Valutazione dei fattori di rischio in chirurgia oncologica.

The Authors carried on a retrospective study of risks factors in oncologic surgery based on a univariate analysis. The study includes 337 patients hospitalized for neoplastic pathology from January 1991 to June 1995. In agreement with Literature the most important risks factors were represented by associated pathologies, TNM staging and ASA classification. The opportunity of a correct preoperative evaluation of risks factors is recommended to assure the best conditions for the surgical patient and to rescue to surgery patients otherwise considered not surgically manageable.

[Primary biliary peritonitis without perforation in childhood: etiopathogenetic evaluations and 2 case reports]. / Peritoniti biliari primitive senza perforazione in età pediatrica: valutazioni etiopatogenetiche ed osservazioni su due casi clinici.

The Authors review biliary peritonitis. After some evaluations on etiopathogenesis, biliary peritonitis without perforation in childhood is discussed. The rarity of this form is considered as well as etiopathological hypothesis, difficulties of diagnosis and surgical management. Two cases of primary biliary peritonitis without perforation observed and operated in two children are reported.

[Surgery of hyperthyroidism. Personal experience]. / Gli ipertiroidismi di interesse chirurgico. Esperienze personali.

The Authors report their experience in the management of surgical hyperthyroidism, evaluating the different clinical pictures and the possibility of non surgical treatment. Advantages and disadvantages of both hemithyroidectomy and total thyroidectomy, are also described. The Authors conclude affirming their preference for techniques such as total hemithyroidectomy or thyroidectomy in some types of hyperthyroidism.

[Total thyroidectomy with preservation of the parathyroid glands]. / La tiroidectomia totale con conservazione delle paratiroidi.

The operative treatment of thyroid pathology has to be distinguished for benign and malignant pathology. The major complications associated with thyroid surgery are injury to the recurrent laryngeal nerve and hypoparathyroidism. Postoperative hypoparathyroidism is rarely the result of inadvertent removal of all parathyroid glands but, non commonly, is due to disruption of their blood supply. Postoperative hypoparathyroidism results in patients with symptomatic hypocalcemia, transitory and permanent hypoparathyroidism. Subtotal thyroidectomy is used for the treatment of benign thyroid pathology while tumors are treated by total thyroidectomy with neck dissection.

[Advanced gastric cancer in the elderly. Oncologic evaluation & considerations of operative technique]. / Il cancro gastrico in fase avanzata in età geriatrica. Valutazioni oncologiche e considerazioni di tecnica operatoria.

The Authors reviewed their series of 28 consecutive elderly patients operated on for gastric cancer in the Division of General and Oncological Surgery--Department of Surgery and Surgical Emergencies of the University of Perugia from January 1993 to December 1994. Thirteen subtotal gastrectomies associated with resection of the nearby organs in 5 cases, six total gastrectomies, two gastrojejunal bypass, and seven atypical resections of the middle third of the stomach were performed. The Authors focus their attention on this atypical technique pointing out the advantages compared to other procedures as well as criteria for patients selection. Gastric resection of the middle third seems a worthwhile procedure for well selected elderly patients, resulting in a good quality of life with low morbidity and mortality.

[An update on parathyroid surgery]. / Attualità in tema di chirurgia delle paratiroidi.

The operative management of patients with hyperparathyroidism is controversial. High rates of persistent hypercalcemia and postoperative hypoparathyroidism are seen in multiple hyperplasia and bilateral neck exploration. Patients undergoing unilateral neck exploration with removal of a single parathyroid adenoma have a rapid clearance of PTH which declines within hours after surgery. There is a sensitive immunometric assay (IRMA) for the intact molecule which demonstrates a decline in 15 minutes during surgery. Intraoperative measurement of PTH may be complementary to surgical skill and histopathologic information and may modulate extension of neck exploration.