[Paraesophageal hiatal hernia]. / Ernia iatale paraesofagea.

Paraesophageal hiatal hernia is an uncommon disease but it frequently presents in aged people, causing chronic vague abdominal symptoms up to surgical emergencies from incarceration, strangulation or obstruction. The authors describe the physiopathology and clinical anatomical features of paraesophageal hiatal hernia. Important diagnostic radiological and instrumental aspects are then illustrated, versus sliding esophageal hiatal hernia. There are followed by a description of possible complications of this lesion and therapeutic implications.

[The role of endoscopy in the hemorrhagic complications of gastroduodenal ulcer]. / Ruolo dell'endoscopia nella complicanza emorragica dell'ulcera gastro-duodenale.

The hemorrhage is a fairly frequent event in the evolution of the gastroduodenal peptic ulcer syndrome. The mortality rate has remained approximately unchanged, in spite of the progress in instrumental diagnosis and medical therapy, in the last decade. The authors examine 163 cases of digestive hemorrhage from gastroduodenal ulcers, observed in the last five years (1984-1988), with particular reference to the medical or surgical treatment undertaken, and to the mortality rate. Gastroduodenal ulcers, in 340 cases of upper digestive hemorrhage, represented nearly half the lesions, registered in the same period. Duodenal ulcers (D.U.), were found in 124 patients (34.4%) and gastric ulcers (G.U.) in 39 patients (11.47%), 113 (91.1%) patients with D.U., and 33 (84.6%) patients with G.U. were treated by medical therapy. The mortality rate in this group was 6.16%. II patients (8.9%) with D.U. and 6 patients (15.3%) with G.U. were operated on. The surgical mortality rate was high at 35.2%. Total mortality rate was 9.2%. The endoscopic exam was useful for diagnostic bleeding investigation and contributed to therapeutic decisions. Active bleeding lesions were found in 38.4% of patients with G.U. and in 32.3% with D.U. In 61.6% of patients with G.U. and in 67.7% with D.U., the lesions had already stopped bleeding; but in both lesions nearly 40% of cases, presented signs of a recent hemorrhage. The prognosis and natural history of the hemorrhage, was not changed by an immediate exam. The clinical reports and the data furnished, especially from continuous bleeding and rebleeding lesions, could be useful in identifying a sub-group of patients who could obtain better results by surgical treatment within a suitable time. The endoscopy, besides selecting and contributing to a better therapeutic strategy, through haemostasis technic, could reduce mortality rate from gastroduodenal ulcer lesions.

[Kidney failure during acute pancreatitis. A unique aspect of multiple organ failure]. / Insufficienza renale in corso di pancreatite acuta. Un particolare aspetto della M.O.F.

Eighty-two patients with acute pancreatis observed in the last seven years were included in prospective trial of monitoring protocol comprising: multiple organ failure and non invasive imaging of pancreatic lesion. One organ failure noted in the 60.9%, M.O.F. with three organ failure represented in the 21.9%. Renal failure was confirmed in 18.9%, trough nine clinical and biological index, become with shock in 73% and with extensive necrosis in 53%. ARF appeared with functional picture and normal diuresis in 73.3% and with organic failure in 26.7%. Index of specific mortality was 33.3%, while the comprehensive index of mortality in the study group was 12.9%, with a significant incidence in the half of deaths.

[Primary resection in occlusions caused by cancer of the left colon]. / La resezione primaria nelle occlusioni da cancro del colon sinistro.

Based on a survey of 47 cases of left colonic occlusive cancer operated on at the Emergency Surgery Department-University of Rome "La Sapienza", the authors concluded that in such condition, when the patient is not seriously ill, the Hartmann procedure is a valid alternative to the anastomosis-resection because: a) it solves intestinal obstruction in a short time with consequent improvement of general conditions; b) it allows to perform the second oncologically radical operation early with less risk of neoplastic spread. The latter procedure, therefore, is carried out under better conditions, relative to the stage of the disease and the status of the patient.