[Recurrence of varicose veins after treatment. Multicenter study by the Italian Doppler Club, Clinical and Technological Society]. / La comparsa di varici dopo loro trattamento. Studio multicentrico del Doppler Club Italiano Società di Clinica e Tecnologia.

BACKGROUND: The first results of a multicentric study dealing with recurrent varicose veins after surgery are presented. The aims of the study are: identifying the type of varicose vein, specifying the most frequent complaints (esthetical or functional), locating the causes of recurrence, establishing the causes and the most frequent seat of recurrence, clarifying whether it is enough to call recurrent all the varicose veins which appear after surgery or whether it is necessary to distinguish various typologies. METHODS: 194 patients (139 women and 55 men) aged 51.6 average (range 28-87), have been studied up to now with duplex and color scanner following a precise protocol which consisted of three stages: before treatment, within 2 months from treatment and after recurrence of varicose veins or venous insufficiency symptoms. RESULTS: Recurrent varicose veins represented 65.7%, residual ones 14.3%, new ones 2.5%. It has not been possible to identify the type of varicose vein in 8.3% of cases. Stripping of the great saphenous veins was carried out in 88% of cases, short stripping in 4.1%, stripping of the short saphenous veins in 6.9%. Recurrent varicose veins were due to technical error in 78.7% of cases, to diagnostic error in 9.2%, to unidentifiable causes in 12% of cases. CONCLUSIONS: Data relating to the prospective study of the research will be published in subsequent papers.

Stages I and II non-Hodgkin's lymphoma of the gastrointestinal tract. Retrospective analysis of 79 patients and review of the literature.

We reviewed the medical records of 79 patients with primary gastrointestinal lymphoma (GI-NHL), defined according to the criteria of Dawson et al. (without involvement of liver, spleen, peripheral or mediastinal lymph nodes, or bone marrow), observed and treated in our institution between 1973-90. The most common disease site was the stomach (70 patients), followed by the small bowel (five patients) and the large bowel (four patients). The stage was IE in 36 cases and IIE in 43. Radical surgery or surgical debulking was the main therapeutic approach (67 patients); 12 patients received only chemotherapy, eight of whom had tumors considered unresectable at laparotomy. After surgery, most of the patients received chemotherapy; radiotherapy (RT) was given to only four patients. Surgically calculated overall survival (OS) rates at 5 years for the patients treated with surgery plus chemotherapy were 64% (radical surgery) and 46% (surgical debulking with microscopic lymphoma residue). For the 12 patients treated with chemotherapy alone, OS at 5 years was 0%. Our findings, in accordance with most published data, suggest that surgery, together with stage and tumor size, remains an important prognostic factor of survival in primary GI-NHL, especially when it is radical. In patients with negative prognostic factors (bulky disease, high-grade histologic type, microscopic residue, and stage II), postoperative chemotherapy and RT decrease the risk of distant failure and local recurrence.

[Dynamic computed tomography in the prognostic assessment of acute pancreatitis]. / Tomografia Computerizzata dinamica nella valutazione prognostica delle pancreatiti acute.

Pancreatic necrosis is a well-known risk factor for infectious complications in the patients affected with acute pancreatitis. Dynamic CT with i.v. administration of a large bolus of contrast medium can establish the diagnosis of necrotizing pancreatitis. A series of 49 cases of severe acute pancreatitis was reviewed, and early CT investigations were seen to fail to detect pancreatic necrosis in 22 instances, versus 27 positive cases. In the group of patients with no necrosis, the clinical course was uneventful or characterized by mild complications which regressed spontaneously or by means of adjuvant medical treatment. On the contrary, 17 patients with necrotizing pancreatitis developed severe complications requiring intensive treatment. These complications occurred in 50% of the patients with < 50% of pancreatic necrosis, while the figure rose to 77% whenever more extensive involvement was observed. Our results show that the presence and extent of pancreatic necrosis must be diagnosed as early as possible for prognostic and therapeutic purposes; this can be done by the routinary use of dynamic CT with the administration of large amounts of contrast media at high flow rates.

[Intestinal angiodysplasias. Diagnostic and therapeutic problems]. / Le angiodisplasie intestinali. Problemi diagnostici e terapeutici.

The cases are presented of 9 patients with intestinal angiodysplasia observed in 1979-85 in the surgery departments of San Carlo Borromeo Hospital, Milan. Diagnostic problems are discussed with particular reference to angiographic and endoscopic methods. Surgical treatment gave good results. Recurrent bleeding may depend on the inadequate assessment of the extension of the lesion or on the existence of other unrecognised intestinal sites.

[A case of perirenal myxoid liposarcoma]. / A proposito di un caso di liposarcoma mixoide peri-renale.

Radical operation of a right perirenal myxoid liposarcoma is reported. Retroperitoneal sarcomas, in fact, show little response to antiblastic and radiation management. It is pointed out that angiographic diagnosis is an essential prelmiminary to correct surgical indication, particularly since the clinical picture may well be indistinct and poorly specific.

[The role of lumbar sympathectomy. Review of the cases performed between 1950 and 1955 (author's transl)]. / Le rôle de la sympathectomie lombaire. Revue de cas traités entre 1950 et 1975

This reviews 839 isolated lumbar sympathectomy performed between 1950 and 1975. The patients are stratified by decades and grouped in 3 periods : 1950 to 1959, 1960 to 1969 and 1970 to 1975. In the first period most patients were between 50 and 59 years old; in the last period most were between 60 and 69 years old. At this time direct vascular reconstruction had become more frequent. The approach described by Pearls was used exclusively in the last period. Isolated lumbar sympathectomy yields a symptomatic improvement. Best results are obtined in peripheral and isolated lesions.