[Severe pelvic injuries: indications and techniques of skeletal fixation]. / I traumi complessi del bacino: indicazioni e tecniche della stabilizzazione scheletrica.

The aim of this work is to assess the role of immediate Hoffmann's external fixation frame and delayed posterior internal fixation in the management of severe pelvic injuries. We have also analysed the role of selective arteriography and embolization for controlling pelvic fractures hemorrhage and the relationship between embolization and external fixation in the management of severe bleeding. We reviewed 112 patients with severe pelvic injuries admitted to our hospital from 1986 to 1998 (71 males, 41 females). The average age was 39.8 years, mean ISS 31.2. Unstable pelvic ring fracture was present in 59 (52.6%) patients at admission in the emergency room: hemorrhagic shock in 43 patients (38.3%). Fourteen (12.5%) patients died. Eight deaths (57%) were directly caused by hemorrhagic shock, two secondary to major caval lesion, three brain lesions and two respiratory failure. The last patient died secondary to MOF. Twenty-three patients (20.5%) with unstable fracture underwent pelvic fracture ring fixation surgery: eleven (9.8%) Hoffmann's anterior external fixation frame (hemorrhage control in all patients) and eight (7.1%) delayed internal posterior fixation. Six (5.3%) patients underwent arteriography and embolization: hemorrhage was stopped in all cases and no patient died in this group.

[Epidemiology of severe thoracic trauma at a multiregional urban hospital. Analysis of 5 years]. / Epidemiologia del trauma toracico grave in un Ospedale urbano multizonale. Analisi di 5 anni.

The authors re-examined 198 cases of severe chest trauma presented in their hospital in 1983-1987. They analyse the clinical conditions, the diagnostic and therapeutic procedures, the results and complications and evaluate each patient according to the ISS code to compare them with the literature data, for the dead patients they classify the lesions according to the autoptic examinations. They confirm in this the validity of the ISS that can be well correlated with: mortality, length of survival and length of hospitalisation, they indicate important prognostic factors such as: age, association with extra thoracic lesions and number of intrathoracic lesions. Plotting the mortality in function of the time, they stress the need for an expert team in the first hours after trauma to manage such patients.

[Surgical therapy of perforated duodenal ulcers: suture versus highly selective vagotomy. Immediate and remote results (case series from 1978 to 1990)]. / Terapia chirurgica delle ulcere duodenali perforate: rafia versus vagotomia superselettiva. Risultati immediati e a distanza (casistica dal 1978 al 1990).

The aim of this study was to compare the results of high selective vagotomy and simple suture in the treatment of perforated duodenal ulcer. Among 150 patients admitted in our institute from 1978 to 1990, 96 were treated with simple suture while 54 underwent high-selective vagotomy (42 with pyloroplasty). In our study with high-selective vagotomy we had no surgical mortality and low morbidity. The overall clinical results according to the Visick evaluation, were recorded as excellent or good, in 90.9% cases in the group of patients treated with high-selective vagotomy versus 40% in the group with simple suture, after a similar period of follow-up. The recurrence of ulcers after high-selective vagotomy was of 6%, compared with 32.6% in simple suture patients. The results of high-selective vagotomy performed for perforated duodenal ulcers were compared with those of a group of duodenal ulcers not complicated treated with high-selective vagotomy too; the better results of this last group may be due to higher technical difficulties in presence of peritonitis. High selective vagotomy is therefore a safe procedure in the management of perforated duodenal ulcer, and moreover obtains good long-term results in the control of peptic disease.

[Heller's extramucosal cardiomyotomy under endoscopic control. The long-term results]. / Cardiomiotomia extramucosa secondo Heller sotto controllo endoscopico. Risultati a distanza.

Twenty-five patients underwent Heller cardiomyotomy with Nissen fundoplication, made through an abdominal incision under endoscopic control. Long term results were evaluated according to clinical, radiological, manometric and 24-hour esophageal pH-metric studies. Clinical results were excellent in 44% of the patients, good in 40%, fair in 4% and bad in 12%. The four unsatisfactory results are due to recurrence of dysphagia in one case and to appearance of GER in the others. Postoperative X-ray controls and manometric tests showed a significative decrease in the esophageal diameter, in resting and post swallowing LES and esophageal body pressure. The 24-hour pH test showed an abnormal percentage of time with pH less than 4 in two patients, and a direct connection with clinical and endoscopic results. Endoscopic control of myotomy allows us to define precisely the extension of the functional stenosis and to eliminate completely the dysphagia. In the postoperative evaluation the 24-hour pH monitoring allows an early identification of GER, and the prevention of possible complications even in the absence of any clinical sign.

[Comparison of mechanical and manual anastomoses in emergency gastric resection]. / Confronto fra anastomosi meccaniche e manuali nella resezione gastrica in urgenza.

Hundred and twenty-one patients underwent emergency subtotal gastrectomy for complications related to peptic ulcer (86) and malignant diseases (35). According to the type of anastomosis performed (manual or mechanical) patients were divided into two groups: 81 with hand-sutured anastomoses (double layer) and 40 with stapled anastomoses. The latter were more commonly used in the Roux-en-Y reconstruction and Billroth 1 gastrectomy. Median operating time (192' versus 190'), hospital stay (15.2 versus 13.5 days), postoperative complications (38% versus 32.5%) and anastomotic or duodenal stump leakage (7.4% versus 5%) showed no significant difference between groups. Therefore, in emergency subtotal gastrectomy mechanical anastomoses allow to obtain results comparable to the more used manual ones.

[Surgical treatment of 100 patients with perforated pyloric ulcer. Immediate and follow-up results]. / Trattamento chirurgico di 100 pazienti con ulcera pilorica perforata. Risultati immediati e a distanza.

The aim of this study was to assess the results of different surgical treatments in 100 patients admitted from 1972 to 1984 with perforated pyloric ulcer. Forty-six patients were treated with simple suture, thirty-two patients underwent high selective vagotomy with pyloroplasty, 13 patients were submitted to truncal vagotomy with pyloroplasty and 9 to gastrectomy. This study has shown that high selective vagotomy and pyloroplasty for perforated pyloric ulcer can be performed as safely as simple closure. The overall clinical results according to the Visick classification were recorded as excellent or very good in 85 per cent of patients treated with high selective vagotomy with pyloroplasty versus 38 per cent with similar results in simple closure patients. We conclude that high selective vagotomy with pyloroplasty is not less effective for treatment of pyloric perforated ulcer than for duodenal ulcer; simple closure should be reserved for patients treated long time after perforation and with advanced age or in patients with serious associated pathology.