[The so-called spontaneous hematoma of the anterior rectus abdominis reproducing syndromes of acute surgical abdomen]. / Considerazioni sui cosiddetti ematomi spontanei dei muscoli retti anteriori riproducenti sindromi di addome acuto chirurgico.

Personal experience of spontaneous haematoma on the anterior straight muscles of the abdomen over 15 years is reported. True spontaneous haematoma on the anterior straight muscles of the abdomen are extremely rare, even exceptional and must be distinguished from those haematomas, improperly called spontaneous that are, in fact, clearly traumatic in origin. Personal observation suggests that true spontaneous haematoma is the expression of a pathological rupture of the muscle and/or the epigastric blood vessels that in its turn reflects a serious basic pathology.

[Acute phase proteins as markers of septic risk in surgical patients]. / Le proteine di fase acuta (APP) quali markers di rischio settico nel paziente chirurgico.

A heterogeneous group of surgery patients at septic risk was studied through monitoring of acute phase proteins (APP). Plasma levels of 8 acute phase proteins (C-reactive, alpha-1 antitrypsin, fibrinogen, ceruloplasmin, transferrin, albumin, prealbumin, alpha-2 macroglobulin) were measured in the pre- and postoperative period of septic surgery patients suffering from disease processes in various sites and with different aetiopathogenesis. The experiment is related to some interesting research proposed by authors in the Shock Physiopathology Study Centre of the Catholic University of Rome and their results. The constant finding of increased values of PCR, fibrin, cerul, alpha-1 Tryp in the septic risk surgery patient and their normalisation following treatment is particularly significant. In these same cases, a depression or, depending on circumstances, normal findings of Transf, alpha-2 Macro, Albu and Prealbu were observed. The results point to the practical utility an high reliability of APP changes as markers of septic risk.

[Our experience concerning acute phase proteins (A.P.P.) in the monitoring of surgical patients at risk of infection]. / Nostra esperienza in tema di proteine di fase acuta (A.P.P.) nel monitoraggio del paziente chirurgico a rischio settico.

Continuing researches on the monitoring of acute phase proteins (A.P.P.) as markers of septic risk in the surgery patient, a series of 50 patients suffering from pathological processes classifiable as follows has been examined: 1) acute biliary pancreatitis 18 cases; 2) acute hepatobiliary pathology without pancreatic impairment 26 cases; 3) burn 2 cases; 4) particularly serious sepsis in immunodepressed subjects 4 cases. The constant finding of increased values of PCR, fibrin, cerul, alpha 1-Trip in the surgery patient at septic risk and their normalisation after treatment is, in single cases, particularly significant and perfectly consistent with the clinical entity of the infectious process. In immunodepressed surgery patients showing deficiency in nitrogen balance and suffering from endotoxin shock a marked, persistent decrease in alpha 2-Macro, Tranfs, Albu and Prealbu parameters was noted. The reduction in these four A.P.P. can, in the Authors' experience, be considered a diagnostic indicator of sepsis of extreme gravity and an unfavourable prognosis finding regarding the course of the disease process.

[A case of colo-colic (transverse colon) invagination of voluminous polypoid lipoma in an adult]. / Considerazioni a proposito di un caso di invaginazione colo-colica (colon trasverso) da voluminoso lipoma polipoide in soggetto adulto.

A rare case of complete colo-colic invagination of the portion of the proximal transverse colon at the splenic flexure determined by voluminous submucous lipoma is reported. After a short review of the literature, some anatomoclinical remarks and a comment on surgical indications are presented.

[Our experience with recurrent biliary calculosis after cholecystectomy]. / La nostra esperienza sulla calcolosi biliare ricorrente dopo colecistectomia.

Recurrent calculi of the main bile way may be recurrent or residual. Recurrent stones are yellow-brown, crumbly and earthy and contain high quantities of calcium palmitate; residual stones, on the other hand, are firmer, round or berry-like, usually faceted and contain cholesterol, bilirubinate and carbonate of calcium (aragonite, vaterite, etc.) but never palmitate. Residual stones at times also present a peripheral "shell" presenting palmitate and this shows that a new component determined by bile changes is added to the cholesterol stone, which represents the central core, because of stasis and biliary infection. The distinction of calculi into residual and recurrent is also made on the basis of the classic morphologic and clinical criteria described in the literature, also and above all on the basis of specific, objective scientific criteria deriving from in-depth clinical study of the patient, the chemical study of the bile, morphological, mineralogical and structural study of the stone. The following are considered in particular: instrumental examinations made during hospitalisation and operation; pH, enzymatic activity (phospholipase, trypsin and amylase) and examination of bile cultures; morphological, microscopic examination (electronic scan microscopy) and mineralogical examination (X-ray diffractometry and infrared spectroscopy) of the calculus. A personal series of recurrent calculosis of the main biliary way is considered, special attention being paid to a case that was particularly interesting in relation to the fact lithiasic recurrence occurred just 10 months after the previous operation and the fact that biliary stasis was not determined by stenosis of the papilla which proved fully patent.

[On lymph node excision in malignant neoplasms of the splenocolic fold]. / Considerazioni in tema di linfectomia nelle neoplasie maligne della flessura splenocolica.

The latest findings on lymphatic draining of the splenocolic flexure are recalled in a discussion of lymphadenectomy in the surgical treatment of cancer of the left corner of the colon. The main features of the lymphatic down flow ways of this colon segment justify extended exeresis operations as described by Madden and Welti: they also mention colon resection, removal in one block of the spleen and the caudal corporal portion of the pancreas with the lymph node stations of the pancreatico-lienal group invaded by cancer. Some observations are made regarding experience of twenty-five years at various Hospital Surgeries and twenty operated patients: stress is laid on the importance of intraoperative biopsy of the pancreatico-lineal lymph nodes for the purposes of correct staging and for programming extended surgical exeresis.