Laparoscopic cholecystectomy in adult patients with sickle cell disease.

Cholecystectomy is a common surgical procedure performed in patients with sickle cell disease (SCD). Postoperative complications, including acute painful vaso-occlusive crisis and acute chest syndrome, have been described frequently after either traditional or laparoscopic cholecystectomy (LC). It's still not clear if preoperative blood transfusion, hyperhydration, intraoperative body temperature conservation may reduce complications rate. The Authors reviewed the charts of seven patients with SCD operated on LC for symptomatic gallbladder lithiasis and describe their perioperative management. In 3 patients preoperative endoscopic removal of stones was achieved. Five patients with HB lower than 9 g/dl and/or HbS higher than 40% were transfused preoperatively and all the patients were hyperhydrated. Intraoperative monitoring was achieved for early recognition of ventilation to perfusion mismatch and acid-base balance or temperature modifications. The Authors reported only one case of postoperative lower extremities pain. This study suggests that LC is a safe procedure in SCD if appropriate monitoring and perioperative management are achieved.

[Development of anesthesiological techniques in the surgical treatment of inguinal hernia]. / Evoluzione del trattamento anestesiologico nella terapia chirurgica dell'ernia inguinale.

The Authors describe the evolution of their anesthesiological techniques in the surgical repair of inguinal hernia. In this study they compare indications, complications, costs, hospital stay, length of surgery, postoperative pain and return to work after operations performed under local, spinal and general anesthesia. In their experience inguinal hernia treatment with local anesthesia and a tension-free technique is the preferred method of surgical repair.

[Local anesthesia in the treatment of inguinal hernia]. / L'anestesia locale nel trattamento dell'ernia inguinale.

Local anesthesia is the most common technique used in the surgical treatment of inguinal hernia. The introduction of synthetic prosthesis, which are resistant to infection, has to the development of surgical techniques used in local anesthesia, in a day hospital setting. These techniques permit a lowering of hospital costs and a reduction of the incidence of complications and recurrences. Over the last few years the authors have been performing a modified Lichtenstein repair or the Rives technique in local anesthesia. In this study they present their data on 52 patients surgically treated in the period 1997-1998, and discuss the advantages of their technique.

Ultrastructural changes of the pulmonary parenchyma after experimentally induced endotoxic shock in dogs with and without drug protection.

The authors describe the ultrastructural alterations of the pulmonary parenchyma produced in dogs by endotoxic shock, and they examine the effects that a 'secretolytic' drug (bromexine) has in modifying those changes. In the animals under shock there is a complete breakdown of the normal structure of the pulmonary parenchyma. According to the authors, these lesions are caused by the damage of the lining layer and of the cells which produce the constituents of the surfactant system. In dogs under shock and treated with bromexine the authors have seen a better organization of the pulmonary parenchyma: the cellular limits of the pneumocytes of types I and II were more clearly defined and the osmiophilic bodies were increased both in number and volume. The authors conclude that the damage of the lining layer and of the pneumocytes of type II plays an important role in the development of the ARDS and they say that bromexine can improve clinical and morphological aspects of that syndrome.

[Bochdalek's hernia with retroperitoneal contents in adults]. / L'ernia di Bochdalek a contenuto retroperitoneale nell'adulto.

The authors report a case they had the opportunity to observe, surgically treated (thoraco-phrenotomy, removal of the herniated mass, repair of the diaphragmatic breach). They illustrate the genesis of such abnormality, its incidence and symptomatology. The Authors, moreover, dwell upon the diagnostic problems caused by Bochdalek's hernia with retroperitoneal contents, and upon the advantages shown by the thoracic way of aggression in the light of their own experience.

Immunologic alterations and active aspecific immunotherapy in lung cancer patients.

An immunologic study was undertaken on 89 lung cancer patients and on the basis of results obtained so far, a protocol of active, aspecific immunotherapy by living bacterial vaccines (BCG) and/or synthetic immunopotentiator (methisoprinol) was carried out. First results obtained in patients undergoing immunostimulation are reported together with the observation that while positive humoral effects seem present in stage I and II patients, in cases of spread of the disease results are substantially negative.

[The automatic stapling devices: a real progress in the resections of pulmonary tissue (author's transl)]. / Le suturatrici meccaniche: un reale progresso nelle exeresi polmonari parenchimali.

The Authors describe their experience in the resections of pulmonary tissue performed with the use of American automatic staples TA and GIA after having illustrated the surgical techniques allowed by them, and in most use, the Authors conclude by reviewing the numerous advantages, both operatory and clinical, of the metallic suture applied by the staplers, which confirm the validity of their use in pulmonary resections.

[Immunological monitoring of patients with carcinoma of the lung. Study method and preliminary research]. / Il monitoraggio immunologico di pazienti con carcinoma del polmone. Metodo di studio e ricerche preliminari.

It is by now an established fact that the status of the immune system stands in some relationship with the onset and evolution of malignancy. To clarify this relationship the authors investigated the immune system of patients with pulmonary carcinoma, with special regard to the functions of the T and B lymphocyte lines. After suitable explanation of their experimental protocol, which involved immunological monitoring and the study of relationships between immunological changes and the extent and histological type of malignancy, and also the effects of any treatments being administered, the authors describe the results obtained in 18 preoperative patients. The study revealed an overall diminution of cell-mediated immune activity: less strongly positive DNCB skin tests, reduced capacity for making E rosettes, reduced blast transformation with PHA. With B lymphocytes the EA rosette test was often depressed, whereas antibody titers were normal or even above normal, and the pokeweed blast test was invariable above normal values. These preliminary results show that at the time of diagnosing malignancy, the greater aggressiveness characteristic of the less differentiated cellular types, or of stages of diffuse malignancy, is associated with overpowering of cell defenses and (within certain limits) enhancement of the humoral response.

[Irrigation of colostomized patients]. / L'irrigazione dei colostomizzati.

After a brief recall of the main problems of post-colostomy patients, the authors describe the method of colonic irrigation, which affords the complete discharge of fecal matter and continence over the ensuing 24 hours. The authors give an account of the results obtained with this methodology at the Stoma Center of Catania; and they conclude that the method in question, applied correctly and appropriate cases, seems to represent the treatment of first choice for the postoperative management of colostomy cases.

[Heterotopic pancreas in a gastric site]. / Il pancreas eterotopico a sede gastrica.

The authors describe two cases of heterotopic pancreas tissue involving the stomach. After some general comments on the frequency and anatomopathological aspects of this disease, they discuss the clinical features and modern technics for the diagnosis of heterotopic pancreas tissue, with special emphasis on gastroscopic detection and execution of aimed biopsy specimen collection. Last, they discuss the indications for surgical treatment of the disease.

A new method for the study of lining-layer and pulmonary alveolar walls with electron microscope.

The authors describe an original method for the setting up of pulmonary parenchymal preparations to be observed with electron microscopy. The salient aspects of this method are: the material fixed with a supersaturated uranyl acetate solution and colored, after simple dehydration and inclusion in Epon 812, with bismuth subnitrate. With this method it is possible to obtain a good definition of the morphological aspects and a greater contrast of the phospholipidic structures of the pulmonary parenchyma.

[Indications and limitations of bronchography in surgery of carcinoma of the lung]. / Indicazione e limiti della broncografia nella chirurgia del carcinoma del polmone.

Starting from a consecutive series of 53 bronchographies performed under local anesthesia, in subjects with carcinoma of the lung ascertained by operation, the Authors analyse both the bronchographical aspects which most frequently come under the surgeon's observation, and the usefulness of this investigation in formulating the operating plan. As regards carcinomas of the large and medium bronchi, the bronchographic aspects they found most frequently are occlusion (82%) both in the form of sudden arrest and in the form of a cone image and stenosis (18%). In peripheral carcinomas, on the other hand, most characteristic bronchographic signs are identified as occlusion (58%) (amputation and stenosis) and dislocation (38%) with rigidity of one or more small calibre bronchi (rigid impairment). On the basis of their experience the Authors conclude that bronchography constitutes an almost indispensable examination for diagnostic purposes in malignant neoplasias, especially in the initial stage, when located outside the field of action of bronchoscopy, and can supply elements indispensable in the preoperative operatability judgement. In fact it not only gives very reliable information on the anatomical situation of the bronchus, as well as on the site and presumed starting-point of the neoplasia, but also supplies more approximate elements with regard to the extent of the neoplasia and any presence of lymphoglandular metastases.

[Diverticula of the duodenum. Clinico-diagnostic and therapeutic considerations]. / I diverticoli del duodeno. Considerazioni clinico-diagnostiche e terapeutiche.

On the basis of a study of the most recent clinico-statistical contributions on diverticula of the duodenum and personal experience, based on observation of 72 cases, the Authors set out a modern review of the subject. After emphasizing that diverticula of the duodenum are responsible for clinically evident and uncharacteristics sympatoms in only about 10-20% of cases, the Authors discuss the most modern procedures for diagnosis of diverticula of the duodenum. Lastly there is a full discussion of the indications for operation and the different surgical possibilities for treatment of the disease.