[Familial adenomatous polyposis. Problems encountered with rectum preservation in surgical treatment and life expectancy]. / La poliposi adenomatosa familiare. Problemi offerti dalla conservazione del retto nel trattamento chirurgico ed aspettative di vita.

Familial adenomatous polyposis is a genetically inherited disease with very high risk of colorectal cancer and with a large expression of multiple extracolonic malignancies. In recent years two surgical options are available for the treatment of FAP: total colectomy with ileorectal anastomosis and restorative proctocolectomy with ileoanal reservoir. The preservation of the rectum offers good quality of life and good functional results, but needs an accurate surveillance of the rectal stump and screening for the development of cancer. Restorative proctocolectomy is reserved for patients with large or confluent polyps of the rectum, for older patients and for those who had already had an ileorectal anastomosis and who develops subsequently large adenomas at increased risk for rectal cancer. Prophylactic procedures of surveillance, screening and surgery have reduced in patients at risk the incidence of colorectal cancer. But recently an increased number of malignant extracolonic tumors (gastric cancer, duodenal and periampullary cancer, small intestinal cancer, adrenal and thyroid cancer) and abdominal desmoid tumors, that causes a significant mortality, has been documented. The knowledge of the extracolonic features of FAP suggests a careful follow-up of the patients and the prevention and treatment of upper gastrointestinal cancers and desmoid disease.

[Massive hemorrhage caused by colonic diverticulosis]. / L'emorragia massiva da diverticolosi colica.

Massive hemorrhage from diverticular disease of the colon is a very difficult problem in abdominal emergency surgery. The pathogenesis of bleeding colonic diverticulosis is strictly correlated to the angioarchitecture of the colonic diverticular wall. Here the vasa recta penetrate the colonic wall from the serosa to the submucosa through connective tissue septa. Injurious factors arising from the colonic or diverticular lumen can produce an eccentric damage to the luminal side with intimal thickening, segmental weakening of the artery and its rupture with massive bleeding. Conventional barium enema is not able to show the source of the hemorrhage in the majority of the bleeding patients; colonoscopy, as primary emergency procedure, has significant positive findings in 41.5%-83.7% of patients. Radionuclide bleeding scans have a sensitivity rate of 86%-94%. Emergency arteriography localizes the bleeding source in higher rates ranging from 58% to 86% and is successful after intraarterial infusion of vasopressin or embolization in 47%-92% of patients. Surgical treatment for continued bleeding from diverticular disease is controversy. Segmental resection should be performed on patients with localized bleeding sources (positive arteriogram). Laparotomy, anterograde irrigation and intraoperative colonoscopy are indicated in patients with multiple bleeding sites and negative arteriography. Because the right colon is the most common site of bleeding in same cases is necessary to perform a subtotal colectomy with ileorectal anastomosis. Blind resections particularly in the elderly patients present high rebleeding rate (> 60%) and high mortality (30%) with sepsis accounting for the majority of deaths.

[Large abdominal incisional hernias, use of prosthesis. Our experience]. / Considerazioni sui grandi laparoceli addominali, l'utilizzo di protesi. La nostra esperienza.

Retrospective analysis of risk-factors in 241 patients with large abdominal incisional hernia collected in a 16-year period at the Department of Surgery, University of Pavia, allows the Authors to identify the aetiological mechanism of herniation and to discuss the fundamental technical skills in wall reconstruction. The recurrence rate after primary repair was 30% (63/209 patients). In 32 patients (13.3%) plastic prosthesis was used. The side of recurrent herniation was upper midline in 12 patients (37.5%), lower midline in 6 patients (19%), right lower quadrant in 8 patients (25%), right and left flank in 4 (12.5%) and in 2 patients (6.25%) respectively. Plastic repair was performed with a polytetrafluoroethylene graft (PTFE) in 19 patients (59%), with a polypropylene mesh in 7 patients (22%); woven polyethylene mesh was used in 6 patients (19%). Recurrence after prosthetic repair was seen in 5/32 patients (15.6%) and was correlated to local sepsis in patients with poor nutritional status. The PTFE mesh was considered useful to reduce the recurrence rate of hernias and the postoperative disability. It was associated with good elasticity, adequate strength, satisfactory tissue acceptance and minimal risk of infection. However the best results need a careful preoperative evaluation, no tension on the suture line, the prevention and properly treatment of postoperative complications.

[Primary malignant neoplasms of the liver. Contribution of echography to the preoperative diagnosis]. / Neoplasie maligne primitive del fegato. Contributo dell'ecografia alla diagnosi preoperatoria.

Primary malignant hepatic tumors are relatively common and the possibility of radical surgical treatment in the initial stages has modified our clinical approach therefore stressing the validity of a correct screening and follow-up of this pathology. The Authors present their clinical experience in the field enriched by the use of ultrasonography and conclude that this represents a highly effective diagnostic technique whereas it is less reliable in the determination of the nature of the lesion.

[Postoperative external biliary fistulas: personal case series]. / Fistole biliari esterne post-operatorie: casistica personale.

Over the period 1974-1986, five patients with external biliary fistulas were admitted to our clinic. The fistulas set in as complications of surgical operations due in 3 cases to a Kehr drainage of the common bile duct, in 1 case to drainage of a subhepatic abscess and in 1 case to pancreatic hydatid cyst. The causes of onset of the fistulas are reported as well as the therapy adopted in each case.

Efficacy and tolerance of ceftazidime in the treatment of post-operative respiratory tract infections.

Ceftazidime proved particularly effective in the treatment of acute respiratory tract infections arising in the immediate post-operative period, affording complete clinical cures in 88.8% of cases and a substantial improvement in the pathological picture in the other 11.2% of cases treated. The authors also draw attention to the excellent tolerance of the antibiotic, as evaluated on the basis of liver and kidney function and blood chemistry parameters and the total absence of adverse reactions.

Study on the ATPasic lymphocytic activity during menstrual cycle.

We previously studied ATPasic activity in the lymphocyte according to sex, age and in pregnant women. Now we considered it is interesting to go on with out study with the dosage of ATPasic lymphocytic activity during menstrual cycle, monitored with basal temperature method. The methodology we followed is Ellegaard and Dimitrov one of 1972, with modifications and simplifications while the proteins dosage in the supernatant has been effected with biuret method. Our data showed a decrease of the ATPasic lymphocytic activity at the middle of cycle for ovulatory cycles, while there is no difference between data at the middle of the cycle and in menstruation for cycle without ovulation. We suppose a connection between ATPasic lymphocytic activity and the hormones which stimulate ovulation.

Study of the ATPasic lymphocytic activity in the woman at the end of fertile age.

The object we propose to ourselves is to define mean values of ATPasic lymphocytic activity in different physiological conditions. This study considers the ATPasic lymphocytic activity in the woman at the end of prolific age. The methodology we followed is Ellegaard and Dimitrov one of 1972 with some modifications and simplifications; the proteins dosage in the overfloating has been effected with biuret method. No correlation between the number of months from last reported menstruation and the ATPasic lymphocytic activity has come out. Furthermore, the data woman at the end od fertile age similar to the ones of the young woman in menstrual cycle or at the middle of a cycle without ovulation. Data of aged woman, on the contrary, draw away from the data of young woman at the middle of an ovulatory cycle. Our present intention is, at this point, to turn attention to peculiar hormonal situations, for instance in presence of an estroprogestinic therapy.