[Treatment of short bowel syndrome]. / Trattamento della sindrome da intestino corto.

On the basis of personal experience and the latest reports in the literature on the treatment of short bowel syndrome, the clinical and therapeutic aspects of the malabsorption syndrome arising after removal of long segments of the small intestine are analysed with emphasis on the salient features and particularly the critical phase constituted by the transfer from parenteral to enteral and oral nutrition whose importance for the maintenance of life is objectively confirmed by the adaptive response of the remaining small bowel (compensatory hypertrophy).

[A case of leiomyoblastoma of the stomach. Clinical and anatomopathologic considerations]. / Su un caso di leiomioblastoma dello stomaco. Considerazioni cliniche ed anatomopatologiche.

Gastric leiomyoblastoma or Martin's myoid tumour or Stout's smooth muscle cell bizarre tumour is a rare benign mesenchymal neoplasia that may become malignant. A personal clinical case is reported and the most important anatomopathological and clinical aspects are reviewed, stress being laid on the importance of identifying the macroscopic and histological features that can point with certainty to malignity and so influence the choice of surgery. This, depending on the situation, may tumorectomy, gastric resection or gastrectomy with exeresis of any metastases.

[Results of endoscopic treatment of choledochal calculosis and cicatricial stenosis of the papilla]. / Risultati con il trattamento endoscopico nella calcolosi del coledoco e nella stenosi cicatriziale della papilla.

The results obtained with endoscopic papillo-sphincterotomy in the treatment of gallstones and cicatricial stenosis of the papilla are reported. The treatment proved effective in 91.3% of patients with papillary stenosis and the incidence of side-effects (cholangitis, pancreatitis, bleeding, perforation) was 7.5%. Endoscopic PST hitherto restricted to cases judge inoperable due to serious concomitant pathologies may be a valid alternative to surgery wherever total sphincter dysfunction can be ascertained.

[Treatment of recurrent or residual calculosis of the choledochus. A comparison of the technics]. / Il trattamento della calcolosi recidiva o residua del coledoco. Tecniche a confronto.

The results of treating residual or recurrent calculosis of the choledochus for the purpose of obtaining elements for deciding whether or not to carry out a given operation in a particular group of patients are reported. Although they do not offer elements of certainty, the results still make it possible to arrive at an indication for endoscopic papillotomy in elderly patients in poor general condition with one or a few calculi and non-dilated choledochus, for choledochotomy in patients with choledochus of normal diameter and with multiple calculi, or for an intervention of biliodigestive drainage (particularly choledochojejunostomy) in patients with multiple calculosis and with dilated choledochus. In cases in which the apparatus of Oddi is the site of an irreversible inflammatory process and has lost its function, transduodenal papillosphincterotomy is justified.

[Treatment of perforated duodenal ulcer. Our experience]. / Trattamento dell'ulcera duodenale perforata. Nostra esperienza.

Personal experience in the treatment of perforated duodenal ulcers is reported. The 78 patients concerned were divided into two groups (operated on before or after the introduction of anti-HZ antihistamines) and were encountered between 1-1-1972 and 30-12-1986. The results were generally satisfactory: mortality (operative and postoperative) 5.1%; postoperative complications 6.4%; recurring ulceration 1-5 years after surgery 6.4%. The most successful operations (lowest death and complication rates, shortest hospital stay) were simple suturing and suturing combined with superselective vagotomy. Analysis of the results show that the success of the operation was significantly influenced by the following factors: patient's age and general condition, associated diseases, time of onset of the ulceration prior to perforation and above all the length of time between the perforation and the operation i.e. the presence or absence of peritonitis. Simple suturing should always be used where possible, particularly now we have the anti-H2 drugs. Superselective vagotomy combined with suturing is the definitive surgical treatment of choice and produced no deaths or complications in the 13 patients given this treatment.

[Conservative treatment of simple, uncomplicated diverticulitis. Preliminary study for evaluating the effectiveness of a method of topical therapy: rectal perfusion]. / Trattamento conservativo della diverticolite semplice non complicata. Studio preliminare sulla valutazione dell'efficacia di una metodica di terapia topica: rettolusi.

Transit times and distribution modalities of an oily mixture used as a vehicle for drugs administered by rectal perfusion in topical therapy in patients with uncomplicated diverticulitis of the colon have been examined. X-ray study makes it possible to state that the technique is mainly indicated in descending colon and sigmoid localisations, segments in which the oily mixture distributes homogeneously and massively in all patients treated.

[A case of leiomyosarcoma of the small intestine. Clinical and anatomopathologic considerations]. / Su un caso di leiomiosarcoma del tenue. Considerazioni cliniche ed anatomopatologiche.

Leiomyosarcoma of the small intestine is a malignant mesenchymal tumour composed of smooth muscle cells from the muscular coat or, rarely, from muscularis mucosae, which in the majority of cases is characterised by a clinically silent development and by an unfavorable prognosis. The considerable difficulty of obtaining a histological definition of the degree of malignancy of the leiomyosarcoma is also typical. The paper reports a clinical case and summarises its main clinical and anatomopathological aspects. In particular, the difficulties of clinical and histological diagnosis of the degree of malignancy are underlined, together with the fact that these have a considerable influence on the possibilities and results of surgical therapy and survival rates.

[A case of small-cell carcinoma of the rectum]. / Su un caso di carcinoma a piccole cellule del retto.

A case of oat-cell carcinoma of the rectum prompted the authors to undertake a review of the literature. The main histological aspects allowing an accurate diagnosis are stressed. This is a rare form of highly malignant neoplasm of uncertain origin (probably similar to that of carcinoids) with a very marked tendency to metastasize, even to distant organs; it is characterized by substantial cellular polymorphism with small-sized elements, very little cytoplasm, a large hyperchromic nucleus, barely visible nucleoli and histochemical reactions typical of neuroendocrine cells.

[Leiomyosarcomas of the small intestine]. / I leiomiosarcomi del tenue.

The main clinical and anatomico-pathological aspects of small bowel leiomyosarcomas are stressed. These are rarely observed malignant tumours, which sometimes prove difficult to diagnose and have a poor prognosis. Also characteristic is the substantial difficulty often encountered in defining the malignancy grade histologically.

The sites of hormone storage in normal and diseased parathyroid glands: a silver impregnation and immunohistochemical study.

The results of Grimelius' silver impregnation method and of two immunohistochemical methods for the demonstration of the sites of storage of parathyroid hormone (PTH) were compared in a series of parathyroid glands from 39 patients affected by either hyperplasia or adenoma and from 10 normal subjects. An indirect immunoperoxidase method using an anti-bovine PTH serum gave unsatisfactory results. In contrast a biotin-streptavidin immunoperoxidase method using an antibody against the 44-68 amino acid sequence of human PTH yielded similar results to those with Grimelius' silver impregnation method. This supports the view that argyrophil granules correspond to the secretory granules of PTH. The degree of silver impregnation, however, varied considerably in duplicate sections, probably because of difficulties in standardization of the Grimelius' method. The biotin-streptavidin method appeared more sensitive and was reproducible. The immunohistochemical demonstration of PTH may prove useful in defining the sites of hormone storage in normal and pathological conditions.