[Surgery associated with intraoperative hyperthermia-chemotherapy in the treatment of malignant tumors of the digestive system with peritoneal carcinosis]. / Chirurgia associata ad ipertermochemioterapia intraoperatoria nel trattamento dei tumori maligni dell'apparato digerente con carcinosi peritoneale.

In the last two years the authors have treated 4 patients affected with malignant tumors of large bowel with very poor prognosis. In every cases they found large spreading to peritoneal cavity. These patients underwent to intraperitoneal hyperthermia-chemotherapy using a special device conceived by authors. This treatment produced promising results as related to life quality in these cases.

[Surgical methods in the management of urinary incontinence caused by genital prolapse: a review]. / Tecniche chirurgiche per l'incontinenza urinaria da prolasso genitale: contributo originale.

The authors, after of the different techniques mostly used in surgery to correct the urinary incontinence, illustrate their original technique adapted for UI caused by genital prolapse. At present, the Marchall-Marchetti-Krantz's and Goebell-Stoeckel's techniques are commonly used in this field. Since uterus lowering is the main cause of cystocele and subsequent urinary incontinence, their new technique has the principal purpose of holding the uterus permanently in it natural position. The authors limited experience is actually of only five cases; all the patients underwent an intervention of cystopexy according to their new technique described. The results obtained encourage and promote the usage of such a method, consenting them to go on with their experience.

Postoperative combined radiohyperthermia in Astler-Coller stages B2 and C distal rectal cancer.

Pelvic perineal recurrence rate is the major therapeutic problem after curative surgery of extraperithoneal rectal cancer, after lower anterior resection as well as abdomino-perineal resection: local failure rate is high, particularly for stages B2-C. Radiotherapy alone or in combination with chemotherapy proved to be an useful adjunct to surgery. Postoperative radiotherapy, with 40 to 50 Gy doses, has shown local improvement, but causing intestinal damaging. There is now evidence that hyperthermia enthances radiation effects, by killing radioresistant acid tumor cells. In order to give high postoperative radiation doses, without intestinal damage, and to kill acid tumor cells by hyperthermia, we developed a device, able both to displace intestinal loops and to produce combined hyperthermia. From 1993 to 1995, four patients with Astler-Coller stages B2 (2 patients), C1 (1 patient) and C2 (1 patient) distal cancer, were operated by Hartmann's procedure and treated with postoperative radio-hyperthermia with our device. Overall radiation dose delivered in the pelvic area was of 65 Gy, associated with three heating sessions at 43 degrees C for 30 minutes. Pelvic infection occurred in one patient; all pelvic byopsies were negative and no bowel damage was found. Three patients underwent recanalization, one had anasthomotic leackage. The C1 and C2 stage patients died from hepatic metastasis, 18 and 11 months after recanalization; one B2 stage patient is still under treatment and the other is alive and disease free 13 months after recanalization. Our technique allows to give high postoperative radiation doses, without small intestine damage, and to give a good hyperthermia for better control of local failure.

[A modified Thal cardioplasty in the management of advanced esophageal achalasia]. / Modifica dell'intervento di cardioplastica secondo Thal nel trattamento dell'acalasia esofagea avanzata.

A modified esophagocardioplasty with gastric patch in the treatment of advanced achalasia is presented. The technique was employed in 4 patients from 1977 through 1993 and satisfactory results were obtained in follow up studies up to 16 years. This procedure provides better passage through the esophagogastric junction with preservation of the antireflux mechanism.

[Use of pulsed expansion in lengthening of tubed cutaneous flaps. Experimental study]. / Sull'impiego dell'espansione pulsata per l'allungamento di lembi cutanei tubulati. Ricerca sperimentale.

The Authors describe an intermittent pulsed pressure methodic applied to bipedicle tubed flaps prepared on the back of the rabbit. Clinical, thermographic, and histological data have demonstrated the safety of the flaps and a microvascular bed increase larger than in inexpanded ones.

[Anatomo-surgical study on a new technique of nephropexy]. / Studio anatomo-chirurgico su di una nuova tecnica di nefropessi.

The Authors carried an autoptic study on ten cadavers in order to clarify and if necessary modify some aspects of the nephropexy technique which was modified and improved by them. Two main conclusions are reported. First, the approach is better obtained by a prolonged incision to the twelfth rib. Second, possible damage to the diaphragm and to the lung are avoided with this technique. Furthermore, the study provides information about the preparation and suture of the capsule.

[Peritoneal oxygenation-dialysis as a temporary treatment of intestinal infarction]. / L'ossigenazione-dialisi per via peritoneale come trattamento provvisorio dell'infarto dell'intestino.

The interval preceding the growth of irreversible lesions in an abdominal apoplexy is variable (3-48 hours). It may be used to improve the ischaemic viscus oxygenation, also compensating possible metabolic imbalances. 16 rabbits were used for research, in which apoplexy by the ligature of the arteria mesenterica superior was induced. Dialysis-oxygenation peritoneal treatment was carried out for 8 rabbits, the results of which were evaluated on the basis of the intestine macroscopic morphologic aspect; on the basis of the hematic phosphates values and in enteral biopsy. The oxygenation-dialysis produced a rapid improvement in enteral hue and in enteral motility, an important increase of PO2 and a reduction of hematic phosphates compared with the control group. Histologic examination did not show any significant variation. The attempt to increase general oxygenation by supplying PO2 via the peritoneum, was partly successful (10-15%). The aim of oxygenation the ischaemic enteral zone was successful. This due to elimination of CO2 and toxic products using dialysis. This simple method seems to be effective but further tests on swine would be necessary for clinical applications.

[Colostomy control using an original occluding device. A clinico-experimental study]. / Il controllo delle colostomie mediante occlosure originale. Studio clinico-sperimentale.

After having examined different methods as to continence colostomy, the authors introduce their own control system for the stoma. The study was carried out on 6 colostomized patients. Preliminary, the intraluminal pressure in closed colostomy was recorded. Pressure waves, largely varying from patient to patient, were obtained as to frequency of waves and pressure values. The same variations were observed during meals waking and sleeping. Sometimes the patients suffered from serious disorder, but in most cases they did not feel pain. A catheter, provided with an inflatable balloon for closing the stoma, formed the system tested. It was also provided with a second intraluminal low-pressure inflated balloon, connected with an external compensating chamber. As a result of the system the pressure dropped down to about 1/6 compared with the reference values observed under the same conditions. In addition, the continence was complete and the patient did not suffer from any disorder in non-stop recordings up to 24 hours. We believe that the system may be useful for colostomized patients if carefully carried out.

A pilot study of metoclopramide, dexamethasone, diphenhydramine and acupuncture in women treated with cisplatin.

A total of 26 women who submitted to cisplatin chemotherapy received as antiemetic treatment a combination of metoclopramide, dexamethasone and diphenhydramine. Acupuncture according to traditional Chinese medicine was also carried out. The results were compared with those obtained in a similar group of women with cancer, who were treated in the same setting with the same antiemetic combination but without additional acupuncture. Acupuncture was shown to increase complete protection from nausea and to decrease the intensity and duration of nausea and vomiting. However, the difficulties of performing acupuncture routinely in daily practice are a hindrance to its wider use.

Large aneurysm of the superior mesenteric artery.

This report describes a rare case involving a large aneurysm of the superior mesenteric artery (S.M.A.) in a 53-year-old female. Diagnosis was made by X-ray and echography and confirmed by CT-scan and arteriography showing the lesion to be atherosclerotic in origin with several thrombi on the wall of the artery. Resection of the aneurysm and venous reconstruction was performed. Recovery was uneventful. Angiography one month later demonstrated patency of the bypass. At six months the patient is presently asymptomatic.