[Reoperations in hyperparathyroidism]. / I reinterventi nell'iperparatiroidismo.

Reoperative parathyroidectomy (PTx) is challenging for the surgeon. Before reintervention it is essential to evaluate the operative notes and pathology reports from the previous operation, the localization exams (sestaMIBI scintigraphy and ultrasound) and IOPTH assay are also essential. The surgeon is supposed to perfectly know the anatomy and embryology of parathyroid glands and experience with parathyroid surgery is still the most important predictor of success in reoperative PTx. Reinterventions in HPT have good results with a resolution of hyperparathyroidism in 85-90% for primary HPT and in 70% for secondary and tertiary HPT. Authors present their experience of 76 reinterventions after HPT I and 85 reinterventions after HPT II and III over a total of 2072 parathyroidectomies, carried out between January 1975 and October 2009.

[Repair of large laparoceles]. / La riparazione dei grandi laparoceli.

The authors report a series of 100 incisional hernias operated on and consider general and local problems in repair of wide hernias. They underline some rules in order to obtain a strong reconstruction, with minimal relapse risk and to avoid adverse systemic effects produced by the intervention itself. Now they consider synthetic meshes to be apt for the treatment of the largest hernias, in order to reinforce or to repair the fascial defect, as meshes are strong, easy to use and are well tolerated by tissues and have a good resistance to infection.

[Extension of thyroidectomy in the treatment of benign nodular thyroid diseases]. / Estensione della tiroidectomia nel trattamento delle tireopatie nodulari benigne.

A series of 268 benign nodular goitres, operated on in a 10-year period, is presented. Subtotal thyroidectomy was the chosen operation; however, during the first period of our experience, when the goitre was obviously limited to one lobe we performed unilateral lobectomy in some cases. After surgery no patient received hormone therapy without previous evaluation of thyroid function. Thyroid function was evaluated after surgery and alterations were corrected. As recurrent goitre was a rare occurrence and complications of subtotal thyroidectomy are low, we do not support total thyroidectomy for nodular goitre. In order to avoid recurrences hemithyroidectomy no longer must be performed: the surgical treatment of nodular goitre is carried out by subtotal thyroidectomy, leaving little residual thyroid, to spare parathyroids and inferior laryngeal nerves, which is usually enough for adequate hormone production; in the case of TSH raising, thyroxine must be given.

[Palliative treatment of pancreatic carcinoma. Comparison between 2 successive observation periods]. / Il trattamento palliativo del carcinoma pancreatico. Confronto fra due successivi periodi di osservazione.

Explorative laparotomies and palliative surgery for pancreatic carcinoma have been reduced due to improved diagnostic tools, the spread of laparoscopic techniques and the growing use of external biliary drainage and endoprostheses. By comparing two successive observation periods the authors point out that, owing to the good results obtained, mini-invasive surgery is more frequently used in the management of obstructive jaundice than biliodigestive surgical derivations. Of these, hepatico-jejunostomy is preferable to duodenal anastomosis due to the latter's frequent involvement by the primary tumour. The authors also consider it inappropriate to increase operative morbidity through the systematic association of gastroenteric with biliodigestive derivation, except in cases of symptomatic or radiologically or endoscopically ascertained duodenal stenosis and when the objective finding of visceral involvement leads to the supposition of its imminent obliteration. The indications for surgical splannicectomy have also been reduced with the spread of percutaneous alcoholization of the celiac plexy in cases which resist analgesic treatment using a parenteral route.

[Endoscopic and intraoperative ultrasonography in staging of stomach neoplasms]. / Ecografia perendoscopica ed intraoperatoria nella stadiazione delle neoplasie gastriche.

In Japan a better prognosis of gastric cancer has been achieved by early diagnosis and wide, careful lymphectomy. This is not true in western countries. Thus the Authors believe that rational surgical strategy and the careful use of advanced diagnostic tools would produce a better outcome. The Authors report the new diagnostic methods that they adopt in every case of gastric neoplasm: endoscopic ultrasonography, which also proved useful in submucosal tumors, like lymphomas; parenteral nutrition, immune status assessment for a possible use of immune response modulators, single-dose antimicrobial prophylaxis, antithrombotic prophylaxis, autologous blood storage, in order to reduce transfusion-linked risks. Surgical strategy is also reported, which includes wide resection with adequate margins, R2 lymphectomy and intraoperative assessment of disease extension by ultrasonography.

[Ketoprofen in the prevention of postoperative pain in abdominal surgery. A multicenter study]. / Il ketoprofene nella profilassi del dolore postoperatorio in chirurgia addominale. Studio multicentrico.

Two-hundred-forty-eight patients undergoing abdominal surgery were admitted to a multicentric clinical trial. The patients were randomly assigned to a single i.v. dose of ketoprofen or acetylsalicylic acid, 15 minutes after the end of operation. Ketoprofen showed a better analgesic activity with a statistically significant difference at 2 and 4 hours after administration. Two patients treated with ketoprofen reported vomiting and skin rash respectively. The results of this study confirm the efficacy of ketoprofen for the prophylaxis of postoperative pain in abdominal surgery.

[Eosinophilic gastroenteritis and ascites. Clinical case]. / Gastroenterite eosinofila ed ascite. Caso clinico.

We report the case of a patient with recurrent subocclusive episodes and diarrhea (no malabsorption) associated with ascites, in the absence or liver, kidney or heart disease. The demonstration of hypereosinophilia in the peripheral blood and in the ascites fluid and the failure to identify parasitic or haematological disorders have led to a through examination of the stomach (Endoscopy, Echoendoscopy), small bowel (X-rays and Computerized Axial Tomography) and colon (colonoscopy) in a search for parietal lesions. The absence of segmental lesions and the observation of CAT images of diffuse, regular thickening of the ileum and of the mesentery, coupled with the monotonous clinical history spanning over three decades, have led to a diagnosis of eosinophilic gastroenteritis with involvement of the serosal layer. Serosal involvement is rare in eosinophilic disease of the gut; in analogy with other cases reported in the literature, steroids have improved clinical symptoms and normalized the hematological picture.

[Diagnostic and prognostic value of CEA and GICA in colo-rectal tumors. A caseload contribution]. / Valore diagnostico e prognostico del CEA e del GICA nei tumori colo-rettali. Contributo casistico.

The Authors analyse the clinical usefulness of serum levels' determination of Carcinoembryonic Antigen (CEA) and Gastrointestinal Cancer Antigen (GICA) in 152 patients with colorectal cancer, admitted to their Hospital from November 1982 to March 1989. The sensibility for primary diagnosis of each tumor marker is not very high but there is a relationship between the stage and the histological characters of the disease, especially when the markers are considered at the same time. Preoperative serum level determination of CEA and GICA can be considered a good prognostic index: infarct the increase of the levels is generally due to metastatic tissue or local recurrence. This was confirmed during patients follow-up by further tests which revealed recurrence of the disease.

[Laparocele: a review of the literature and analysis of case histories]. / Il laparocele: revisione della letteratura e analisi di una casistica.

We analyze a group of 64 laparoceles from which it emerges a per cent distribution in the different regions and a correlation between the dimensions of the lesion and the relative regions in agreement with the data usually given in the literature. Furthermore we point out a clear dependence on pathogenetic factors of general and local order. Is therefore recognized the necessity of preventing their insurgence and reducing the risk of relapses through appropriate laparotomy incisions, with adoption of a suitable surgical technique and the correction of systemic diseases. The voluminous laparoceles are responsible of cardiac, respiratory, coagulative diseases, that must be scrupulously judged for an appropriate therapeutical approach. The surgical treatment, as well as for the cases of bigger dimensions, has mostly availed itself of an elementary technique (simple approach, apposition "en paletot" splitting of the fasciae). In the necessity of strengthening weak parietal tissues or of replacing vast losses of matter, we have limitedly resorted to autologous grafts, while good results have been observed with the lyophilized dura mater.

[Actinic lesions of the small intestine requiring surgery. Case reports]. / Le lesioni attiniche del tenue di pertinenza chirurgica. Contributo casistico.

Radiation enteropathy is a disease that seldom requires surgical treatment, in the chronic variety. We report the findings of four cases we operated in an attempt to identify the weak points of surgery involving a high percentage and morbidity of mortality. NPT (total parenteral nutrition) can favour a positive evolution with total rest of the bowel and with reinstatement of normal nutrition.

Pancreatic somatostatinoma.

The Authors describe a case of somatostatinoma in the pancreatic tail, characterized by the absence of a specific symptomatology, with the exception of a slight hyperglycaemia. The patient underwent a surgical operation of pancreatic resection and splenectomy, and now enjoys very good health. They have examined literature from 1977 to 1988, and overall the 30 cases of pancreatic localization, describing the symptomatology, the pathological anatomy, the therapy, and evaluating the malignity degree. Then the Authors could notice that the prognosis of these neoplasms is often fatal, both for the frequent tumor metastatization, and for the difficulties in making an early diagnosis. The therapy is essentially surgical.

[Etiopathogenetic considerations on local recurrence after excision of rectal carcinoma]. / Considerazioni etiopatogenetiche sulle recidive locali dopo exeresi di carcinoma rettale.

A series of 77 cases of rectum carcinoma observed in a six year period, is presented. Sixty-one patients underwent radical operation and 57 of them have been regularly followed up. The incidence of local relapses has been 12.28%, with a majority of perianastomotic forms. It turned out to be proportional to the aboral distance and to primitive neoplasm staging, but not to histologic differentiation degree. Staplers were used and therefore the choice between resection or amputation was determined by the degree of loco-regional infiltration of the neoplasm. The frequency of local relapses turned out not to be related to the type of operation, but the impossibility to the exeresis of perirectal tissues involved by neoplastic process.

[Analysis of a series of cases of liver metastasis of colorectal carcinoma]. / Analisi di una casistica di metastasi epatiche da carcinoma colo-rettale.

The Authors present a six years case-report concerning 135 patients operated on colo-rectal carcinoma (82 of them are still followed up). The incidence of hepatic metastases (synchronous and metachronous) has been 30.37% in all. The preoperative ultrasonography has shown an 11% about margin mistake to visualize secondary lesions of liver. They have acknowledged the intraoperative ultrasonography very useful to visualize occult metastases and to guide an exeresis operation. The resectability of hepatic metastases from colo-rectal cancer has been of 12.19%. Synchronous forms have been rarely operable (5.88%) because they are constituted by multiple and disseminated lesions. They have found an higher incidence of operable forms among the metachronous metastases (42.85%), whose average time of appearance from the primary operation has been about 13 months. The operative mortality and the complications following hepatectomy have been null. The average survival time from operation has been over 22 months. Therefore they recognized the importance of a careful follow-up to find precociously operable lesions.

Thymostimulin prophylaxis of postoperative infections in anergic patients.

The rate of postoperative infections is significantly increased in anergic patients. The authors evaluated prospectively, in a controlled, randomized and stratified study, the efficiency of thymostimulin in reducing postoperative infections in 42 such patients. Excluded were those who were malnourished in whom preoperative alimentation corrected the anergy. The incidence of infections was significantly (p less than 0.05) reduced in thymostimulin-treated patients (4.8% versus 28.6%).