The vesicosigmoidal fistula: diagnosis and surgical treatment.

The authors report their experience in the diagnosis and treatment of 10 cases of vesicosigmoidal fistula. In accordance with the literature the most frequent presenting symptoms were of urinary origin. For the diagnosis urography was helpful, cystography and cystoscopy allowed the observation of a fistulous orifice, while barium enema confirmed, or removed probable doubts about the nature of the intestinal pathology. Surgical treatment varied from one-stage to multi-stage procedures.

[Appendectomy and Crohn disease]. / Appendicectomia e morbo di Crohn.

The Authors, on the basis of the casuistry of the Verona Surgical Centre, concerning the interventions for Crohn's disease from 1973 up to 1983, and comparing the data of literature, study the problem of appendicectomy in Crohn's disease. They suggest the operation of appendicectomy both when there are signs of appendicopathy in course, joined to a pathology of the last ileum ansa, and in presence of apparently sound appendix and clear signs of ileum Crohn's disease. They think it opportune to avoid appendicectomy only in presence of clear signs of involvement of caecum by the morbid process.

[Decompressive transversotomy. Technic of performance and closure]. / La trasversostomia decompressiva. Tecnica di esecuzione e di chiusura.

The routine technique used by the Authors for performance of decompressive transversotomy in operations on the left colon and the rectum is described. The technique for extraperitoneal closure of the stoma is described in detail: the method is easy to perform and does not involve any noteworthy postoperative complications. Long-term follow-ups demonstrate that there are no functional disorders connected with adhesion of the organ to the abdominal wall.

[Angiomatosis of the colon; presentation of one case and review of the literature (author's transl)]. / Angiomatosi del colon. Presentazione di un caso e revisione della letteratura.

Following a brief introduction in which they outline the frequency of colonic angiomatosis and its characteristic symptom triad, the authors describe one case of this condition come to their observation and treated surgically. Next they discuss the classification, differential diagnosis versus other colonic diseases and disorders, available diagnostic aids, and therapeutic resources. They stress in particular the difficulty of diagnosing this condition correctly, to the point where definite recognition is often made only by exploratory laparotomy.

[Malignant schwannoma of the ileum: an extremely rare disease entity (presentation of a case and review of the literature)]. / Lo schwannoma ileale maligno: una entità morbosa estremamente rare (presentazione di un caso e revisione della letteratura).

The authors examine a case of malignant ileal schwannoma successfully treated in the Verona Surgical Clinic. They compare their experience with the data reported in the literature, confirming the extreme difficulty encountered in diagnosing the disease. Therapy is discussed, and the authors stress that, in the presence of an intestinal haemorrhage the origin of which traditional diagnostic investigations are unable to establish, one should always bear in mind the possibility of schwannoma despite its rarity.

[Surgical treatment of malignant colorectal neoplasms in the population over (our experience)]. / Il trattamento chirurgico delle neoplasie maligne del colon-retto nella popolazione al di sopra dei 75 anni.

The Authors examine a series of 95 operations in the Verona Surgical Clinic for colorectal carcinoma in patients aged above 75 and discuss the results obtained. The low mortality rate (2.95% for resections) and the acceptable incidence of morbidity confirm the validity of performing radical surgery for malignancies in very elderly patients, as is stressed in most of the relevant literature.

[Colonic hemorrhage caused by vascular dysplasia. Surgical treatment]. / Emorragie coliche da displasie vascolari. Trattamento chirurgico.

On the basis of their own clinical experience and the data provided in the literature, the authors examine the question of the surgical therapy of the two main dysplastic diseases of the colon, i.e. colonic angiodysplasia and angiomatosis. While the larger cavernous angiomas necessarily call for surgery, large-bowel angiodysplasia and capillary angiomas, which are disease falling primarily within the internist's sphere of competence, may be treated conservatively, when symptomatic, by endoscopic electrocoagulation, though a surgical approach may be contemplated in that small percentage of cases presenting coagulopathy or frequent, intense haemorrhages with a severe anaemic tendency.

[Extended surgical resections of locally diffuse colorectal carcinoma (clinical cases)]. / La demolizione chirurgica allargata nel carcinoma colo-rettale localmente diffuso (casistica clinica).

The authors report on a study population of extended operations for locally spread colon-rectum cancer in the Verona Surgical Clinic over the period from 1971 to 1987 (114 surgical demolitions for colon-rectum cancer out of a total of 1294 operations). They report an overall 5-year survival rate of 41% and a 3-year survival rate of 59% with a perioperative mortality rate of 1.75%. A number of aspects of such extended operations are discussed, and, in accord with most other reports in the literature, the authors confirm the validity of the choice of this type of surgery.

[Surgical treatment of anorectal melanoma (presentation of 2 cases)]. / Trattamento chirurgico del melanoma ano-rettale (presentazione di due casi).

The Authors describe 2 cases of anorectal melanoma, which underwent operation in the Surgical Clinic of Verona in the years 1981-83. They review the literature confirming the high malignancy of this neoplasm, the poor prognosis forecasting a demolishing surgical treatment only. They, at last, once again affirm the principle whereby the results of such surgery are proportional to the stage of evolution the neoplasm is caught in, and the difficulty to reach a precocious diagnosis is therefore one of the main reasons for the scanty remote results of such surgery.

[The role of decompressive transversotomy in surgery of the left colon and rectum (personal experience)]. / Il ruolo della trasversostomia decompressiva nella chirurgia del colon sinistro e del retto (nostra esperienza).

Personal experience of 135 operations on the left colon and the rectum, with simultaneous formation of decompressive transversotomy, is presented. According to the Authors, decompressive transversotomy is the sole method capable not of avoiding anastomotic dehiscences, but of ensuring that they do not become clinically manifest, and hence of reducing the mortality connected therewith. The doubts sometimes raised with regard to the method seem in the Authors' opinion to be linked to technical shortcomings in performance of the transversotomy itself.

[Insular tumours of the pancreas (author's transl)]. / Tumori insulari del pancreas.

The use of immunohistochemistry and radioimmunological assay of the pancreatic polypeptides in the plasma has contributed substantial advances to the histophysiopathology and preoperative diagnosis of tumours of the endocrine pancreas and the related functional syndromes. Consequently, in addition to furthering knowledge on clinical pictures already known for some time, it has been possible to define new categories of the disease which were previously misunderstood or confused with others. The physiopathology and diagnostic methodology (clinical, biohumoral and instrumental) of each main known syndrome (insulinoma, Zollinger-Ellison Syndrome, Verner-Morrison disease and glucagonoma) are described in detail; there are notes on hormonal syndromes that are not fully known and which constitute a field of research in evolution (pluriendocrine and carcinoid syndromes, polypeptidoma, somatostatinoma, nesidioblastosis). The problems of preoperative preparation, intraoperative diagnostic tactics and surgical technique are illustrated. Lastly the possibilities of alternative therapeutic treatment are outlined.

[Our experience in the surgical treatment of diverticular disease (I: Election)]. / La nostra esperienza nel trattamento chirurgico della malattia diverticolare (Nota I: L'elezione).

The authors review their patient population with regard to the surgical treatment of diverticular disease. This population consists of 76 cases, 30 of which were subjected to elective surgery. They conclude by stating that, in the light of their experience, the most effective elective operation is resection of the tract affected by diverticuli followed by and end-to-end anastomosis with the protection of a decompressive transversostomy.

[Our experience in the surgical treatment of Arbuthnot Lane disease]. / La nostra esperienza nel trattamento chirurgico della malattia di Arbuthnot Lane.

In the light of their experience, the authors review the data reported in the literature regarding Arbuthnot Lane Disease. The therapeutic indications are examined, and the results of the various types of surgery proposed are compared.

[Synchronous abdomino-perineal amputation (global evaluation of the intervention in our experience)]. / L'amputazione addomino-perineale sincrona (valutazione globale dell'intervento nella nostra esperienza).

In the light of their experience, the Authors examine the validity of synchronous abdomino-perineal resection. Their study population consists of 224 such operations. On the basis of the results achieved, the conclusion is reached that there is still no realistic alternative today to synchronous abdomino-perineal resection for the treatment of malignancies whose lower borders lie at a distance of less than 6.5 cm from the anal margin.

[Trans-sphincteric approach by the Mason method in the local excision of neoplasms of the medium third of the rectum]. / L'accesso trans-sfinterico secondo Mason nell'asportazione locale delle neoplasie del III medio del retto.

The authors report on the trans-sphincteric access to the rectum according to Mason's technique for the local excision of rectal tumors. On the basis of their experience, they confirm that this technique is easy to perform and that it is reliable as regards preservation of anal continence.

[Behavior of TBII (TSH receptor binding immunoglobulins) in multinodular struma]. / Sul comportamento delle TBII (TSH receptor binding inhibitory immunoglobulins) nello struma multinodulare.

The authors consider the behaviour of TBII (TSH receptor binding inhibitory immunoglobulins) in multinodular goiter, in relation to the functional status of the thyroid classified on the basis of T3, FT4, TSH IRMA. The samples were collected from 53 patients with normal T3, FT4 and TSH; 14 patients with T3 and FT4 in normal range and TSH less than 0.15 milli U/l; 8 patients with T3 and/or FT4 above the superior limits of normal range and TSH less than 0.15 milli U/l and from a control group of 10 patients with Grave's disease. TBII was measured by radioreceptor assay and the index resulted less than 15% in all the patients with eufunctioning or hyperfunctioning multinodular goiter. Mean value in biochemically hyperthyroid patients was 6.25% and in euthyroid patients was 5.69%. The difference was statistically not significant. Moreover, significantly elevated levels of TBII were found in 60% of patients with Grave's disease.

[Complications of thyroidectomy: hemorrhage]. / Complicanze della tiroidectomia: l'emorragia.

The authors report their experience in haemorrhage after thyroid surgery. Haemorrhagic complications occurred in 5 cases in a series of 1803 sequential thyroidectomies (incidence: 0.27%). In particular, incidence was 1.9% after interventions for thyroid neoplasias (adenoma and carcinoma) and 0.18% after interventions for non-neoplastic thyroid pathology. Haemorrhage occurred always after "total" operations, even if monolateral. Causative and contributing factors, precautions and measures helpful in reducing the incidence and the potential dangerousness of haemorrhagic complications are discussed.

[Perforations in neoplasms of the colon]. / La perforazione in corso di malattia neoplastica del colon.

The authors show their experience about the surgical treatment of colonic perforations in course of neoplastic disease. Their casuistry is compared with those of other centres.

[Surgical treatment of cancer of the splenic flexure]. / Il trattamento chirurgico del cancro della flessura splenica.

The authors report their experience in the surgical treatment of the cancer of splenic flexure. The neoplasiae arising in such place are usually diagnosed in a more advanced phase than in the other colon segments. This results in a survival at a shorter interval.

[Cystadenoma of the bile ducts]. / Il cistadenoma dei dotti biliari.

The authors describe one case of cystadenoma of the bile ducts removed by left hemi-hepatectomy. They stress the importance of a complete angiographic examination, both in the arterial and in the venous return phase, for diagnostic purposes and correct planning of the surgical procedure.