[Bleeding gastroduodenal ulcer: indications for surgical intervention]. / Ulcere gastroduodenali sanguinanti: indicazioni all'intervento chirurgico.

The best chance for a patient with a bleeding gastroduodenal ulcer is: "a diligent doctor and a reluctant surgeon". It is necessary to evaluate clinical and endoscopic elements and to check haemodynamic and general conditions of the patient. A better prognosis is ensured by prompt initiation of therapy. All patients with a bleeding since 12 hours or rebleeding must be selected for urgent surgery. The success of surgical intervention is the result of an exact indication and the most correct surgical procedure. Selection of patients for surgery must ensure careful local haemostasis and control of hyperchlorhydria.

[Traumatic rupture of the diaphragm]. / Rotture traumatiche del diaframma.

A survey based on 122 personal observations of traumatic rupture of diaphragm, involving stomach and spleen herniation into the chest, is presented. The importance of clinical symptoms for proper diagnosis and treatment is discussed, in relation to the different trends in the literature.

[A case of hernia of the liver following a traumatic lesion of the diaphragm]. / Considerazioni su un caso di ernia del fegato conseguente a lesione traumatica del diaframma.

The authors describe a case of liver -hernia ensuing a right diaphragmatic rupture. This is a rare event. However, the difficult diagnosis and possible ways of surgical access are discussed.

[Cystic dilatation of the choledocus]. / Dilatazione cistica del coledoco.

Choledochal cyst is an uncommon congenital lesion of the pancreatobiliary system. The pathologic features are cystic dilatation of the common bile duct, normal liver parenchyma, a normal intrahepatic biliary system and partial obstruction of the terminal common bile duct. More than 1400 cases have been reported in tre literature, 83 per cent of which have been diagnosed in patients below the age of 30. A triad of abdominal pain, jaundice and a palpable abdominal mass in the right hypocondrium has been classically associated with this condition. Ultrasonography and CT scanning are usually successful in demonstrating the mass. Cholangiography by the endoscopic retrograde approach may demonstrate the cystic dilatation of the common bile duct. The precise relation ship of the cyst to the biliary tree should be demonstrated by cholangiography at operation. The common type I fusiform cyst is currently treated either by excision combined with a biliary intestinal anastomosis of by anastomosis of the cyst to the intestinal tract. Treatment of the rare type II diverticulum consist of simple excision, while the rare type III choledococele is treated by transduodenal excision of the cyst wall. The current mortality rate of choledochal cyst treated by surgical decompression is 5 to 10 per cent. A case of choledochal cyst in a 58 years old woman is described. The anatomopathologic, clinic features and therapeutic lines are pointed out.

[Gallstone ileus, observations on 13 cases]. / Ileo biliare, considerazioni su 13 casi.

The authors expose some considerations about clinical features of this unusual condition. Thirteen cases of gallstone ileus are reported. The medium age was 70 years. The postoperative course was regular for 12 cases, and only one patient died seven days after the operation.

[Biliary drainage in neoplastic obstructive icterus]. / I drenaggi biliari nell'ittero ostruttivo neoplastico.

The authors consider the use of endoscopic or transhepatic bile drainage to regress jaundice and cholestasis before surgical treatment (radical or palliative) or like an alternative to it.

[Diagnosis and therapy of splenic injuries]. / Diagnosi e terapia dei traumi splenici.

The purpose of this work is a critical revision of spleen traumatism treatment. We have examined 46 patients which we treated by total splenectomy. We examined the recent literature on spleen functions and we tried to punctualize the newest methods for conservative treatment of the spleen.

[Surgical therapy of recurrent varicocele]. / Terapia chirurgica del varicocele recidivo.

In the surgical treatment of recidivous varicocele, has been adopted in eight patients a personal technique that varies in some points from the Ivanissevich's one. Large dissection and resection of the spermatic vein in peritoneum back zone for 6-8 cm. length, prier ligature of all possible collaterals. In four cases has been applied the microsurgical technique, anastomosing the veins of the spermatic plexus to the saphena vein. Checks performed at distance of time haven't shown any relapsing case. The microsurgical technique should give the more immediate normalization of spermatogenesis.

[Acute pancreatitis: retrospective study on the treatment of 45 cases observed in a general surgery department]. / Pancreatite acuta: indagine retrospettiva sul trattamento di 45 casi osservati in una divisione di chirurgia generale.

The Authors have developed a retrospective study of 45 patients, suffering from acute pancreatitis and hospitalized at a general surgery Departement during a period of two years. The purpose of the study was to evaluate the validity of the classification of acute pancreatitis in three degrees (slight, moderate, serious), suggested by Hollender to prognostic and therapeutic aims.

[Open and closed injuries of the abdomen (review of 107 surgically treated cases)]. / Traumi aperti e chiusi dell'addome (revisione di 107 casi sottoposti ad intervento chirurgico).

The authors relate about 107 cases of multiple injuries observed from 1975 to 1984. The causes of trauma, the different injuries caused by trauma, the association of different injuries intra and extra abdominal are examined; the diagnostic procedure, the results obtained, mortality, complications. The studied patients are divided on the basis of the trauma occurred. These data support the position that, in patients with severe multiple injuries, certain criteria, as rapidly increasing abdominal distension or uncorrectable hypotension and isolated rigidity of abdominal wall, eliminate the need for diagnostic examinations and make these procedures unwise waste of valuable time.

[Liver lesions in abdominal traumatology]. / Le lesioni epatiche nella traumatologia addominale.

Hepatic traumas are one of the most common sequelae of abdominal injuries. The Authors report 24 cases of hepatic traumas about a casuistry of 104 patients, that, in the decade '74-'84, had an abdominal traumatism. The quality of injuries, the therapeutic actions, and results are described.

[Total parenteral nutrition in the treatment of acute pancreatitis]. / La nutrizione parenterale totale nel trattamento della pancreatite acuta.

The authors refer their experience in the treatment of the acute pancreatitis by total parenteral nutrition. The study has been carried on twelve patients selected on the basis of prognostic factors of gravity by Ranson. The total parenteral nutrition proved to be useful as a therapy of support, causing the functional rest of the gland and assuring to the patient a caloric and proteic contribution strict necessary to overcome the serious hypercatabolic state which is determined.