[Traumatic lesions of the spleen. Analysis of 35 cases]. / Le lesioni traumatiche della milza. Analisi di 35 casi.

A retrospective review of all the traumatic splenic ruptures from 1974 to 1988 was performed. Thirty-five patients were treated with splenectomy: 24 were males and 11 women. Teenagers and young adults were the most affected age groups. The mechanisms of injuries were: road accidents (78.8%), falls (12.1%), aggression, autoaggression and iatrogenic mishap (3%). Eighty per cent of the patients had associated injuries. Authors suggest a decisional algorithm to precise preoperative diagnosis and to treat the patients correctly. Mortality was 11.4% and primarily due to associated injuries.

[Traumatic lesions of the colon]. / Considerazioni sulle lesioni traumatiche del colon.

Four patients operated on at the Clinica Chirurgica II of IRCCS--Policlinico San Matteo of Pavia for trauma involving the colon were reviewed. All were males and their ages ranged from 14 to 84 years (mean 43.5 years). Injuries of the colon were found on 9 per cent of all patients operated on for abdominal penetrating injuries and on 6 per cent of patients with blunt injuries. The authors recall the pathogenetic mechanisms, clinical patterns, some grading systems proposed for quantifying the severity of the lesion. Our experience has shown that in blunt trauma the prognosis is worse because there were many associated organ injuries. These condition the early mortality for shock and exsanguination.

[Sigmoid volvulus]. / Considerazioni sul volvolo del sigma.

The authors report a retrospective study of four patients treated for sigmoid volvulus at the Clinica Chirurgica II of IRCCS Policlinico S. Matteo of Pavia between April 1974 and June 1989. They are collected from a series of 74 consecutive operations for colonic obstruction not related to hernias of the inguinal-crural region (incidence 5.4%). One patient died. The authors review the incidence, epidemiology, etiopathogenetic hypothesis, clinical patterns, nonoperative and operative therapeutic options of the affection. They emphasize the poor prognosis because the sigmoid volvulus usually occurs in elderly ill patients.

[A department of general surgery using the Diagnosis Related Groups (DRGs) system. Evaluation of the case series]. / Una Divisione di Chirurgia Generale mediante il sistema Diagnosis Related Groups (DRGs). Valutazione della casistica.

DRGs system allows the grouping in a single grad-bag code of a number of similar surgical procedures carried out in patients homogeneous for age, physical status, complication and so on with similar costs. Therefore this grouping method is useful for payment to hospitals. The Authors have coded with DRGs the surgical activity of a general surgery staff during a year to verify the image that DRGs bears. Seven hundred diagnoses of dismission were related to operated on patients while one hundred twenty seven were related to patients treated with medical therapy. The DRGs more numerous were 290, 258, 198, 162, related with thyroidectomy, mastectomy, cholecystectomy and herniorrhaphy.

[The surgery of liver trauma (clinical contribution)]. / La chirurgia dei traumi epatici (contributo clinico).

Authors perform a retrospective review of all hepatic injuries operated on between 1974 and 1990 at Clinica Chirurgica II (ex Patologia Chirurgica II, ex Semeiotica Chirurgica) of Policlinico San Matteo (IRCCS) of Pavia. Thirteen patients were treated, 9 men and 4 women, with age ranged from 13 to 68 years and a mean age of 38 years. They were 21% of all patients operated on for abdominal trauma. Penetrating wounds were present in only two cases (15%), the other patients (85%) were affected by blunt trauma. The mechanisms of injuries were: road accidents (77%), fall at work (8%), gun shot wound (8%), stab wound (8%). All patients had associated injuries. The mortality was 31%: one patient died for haemorrhagic shock and the other three for craniocerebral injuries. After reviewing the several haemostatic techniques advocated for the various types of hepatic injuries, the authors stress that, although most lesions are minor and can be managed by simple technique of haemostasis, often the prognosis is severe for the associated injuries.