[Bladder hernia]. / Le ernie della vescica.

A case of bladder hernia in a 61 years old patient affected by benign prostatic hypertrophy is presented. Pre-operative diagnosis was made by cystography. After an adenomiomectomy of the prostate, the patient underwent the resection of the herniated bladder which gave the bladder its normal shape with only a slight reduction of its capacity. Inguino-scrotal bladder hernias are very rare; recognized predisponing factors are weakening of muscular and connective structures of the inguinal canal, and bladder hypotonia secondary to urethro-prostatic obstruction. These hernias, according to the anatomical position of the hernial sac, bladder and peritoneum, are classified in paraperitoneal (most frequent), intraperitoneal and extraperitoneal. The typical symptom of this disease is the two-stage micturition: the patient after a first spontaneous voiding, presses the mass and voids again. Other than cystography, useful diagnostic means are urography and cystoscopy which may confirm the diagnosis and rule out associated urinary disease. The treatment consists of either simple reduction of the bladder hernia, if the hernia is small, or resection of the herniated portion of the bladder, if the hernia is large or is associated with other diseases (e.g. tumors). Bladder resection is then followed by closure of the bladder wall in two layers and by inguinal hernia repair.

[Comparison of ketorolac/buprenorphine in the treatment of post-cholecystectomy pain]. / Confronto ketorolac/buprenorfina nel trattamento del dolore post-colecistectomia.

The authors compared the efficacy of ketorolac trometamin (30 mg i.m. every 6 hours) and buprenorphine (0.3 mg i.m. every 12 hours) in the treatment of pain following cholecystectomy. Ketorolac was found to be equally efficacious in comparison to buprenorphine and caused fewer side effects.

[Current trends in the treatment of reflux esophagitis in childhood]. / Attuali orientamenti nella terapia dell'esofagite da reflusso nell'infanzia.

A problem of some complexity is the management of pathological gastro-esophageal reflux due to the presence of cardio-hiatal malformation, malposition of the cardia and gastric tuberosity, a congenitally short esophagus, and the like. Sometimes, however, there is no demonstrable morphological aleration and the condition, characterized by primitive hypotonia of the LES, goes under the name of infant chalasia of the esophagus. The general policy is to try first a conservative treatment consisting of dietary and postural measures and the administration of metoclopramide and d;ugs that protect the esophageal mucosa; this stage, however, should not be prolonged beyond 6 weeks. The presence of gastro-esophageal reflux associated with hiatal hernia; the presence of severe esophagitis or peptic stenosis of the esophagus and the persistence of symptoms after an adequate period of conservative therapy constitute as many indications for surgical correction. Good results can be obtained by restoring or strengthening the failing function of the LES, as is done quite successfully with funduplication after Nissen or with method of Belsey-Mark IV.

[Emergency surgical treatment of diverticular disease of the colon (personal cases and review)]. / La terapia chirurgiea d'urgenza della malattia diverticolare del colon.

After a critical review of the indications, techniques and results recorded in literature, there is a description of experiences in emergency surgical treatment of 24 cases of diverticulum disease of the colon. In the light of personal results and in agreement with the majority of cases reported in literature, the conviction is expressed that in this surgery the processes graduated in stages (Mickulicz, Hartman, colostomy on transverse - resection) may frequently be indicated, especially in serious and weak patients.

[Congenital stenosis of the esophagus (personal case and review)]. / Le stenosi congenite dell'esofago (caso personale e revisione della letteratura).

Starting from personal observation of a case of congenital stenosis of the oesophagus, the Authors proceed to a review of the scanty literature on the subject. After a discussion of the most outstanding aspects of differential diagnosis, the frequent necessity of histological verification, especially in adolescence and adult age, in order to obtain a correct understanding of the nature of the case, is stressed. On the basis of an essentially favourable prognosis, the Authors maintain that, where medical and dilating treatment is insufficient, surgery is indicated and evidence the straight-forward nature of the process of exeresis in stenosis of valvular type.

[Pseudocysts of the pancreas. (Personal cases)]. / Le pseudocisti del pancreas (contributo personale)

After reviewing all the various procedures for surgical treatment of pseudocysts of the pancreas, the Authors, analysing the advantages and disadvantages of each method, present a set of nineteen personal cases treated by simple cystogastrostomy, simple cystojejunostomy and cystojejunostomy combined with entero-entero-anastomosis according to Braun, or cystojejunostomy on defunctionalised loop according to Roux. After stading the overall criteria for selection of the technique to be applied individually, the Authors conclude by stressing the advantages that cystojejunostomy on defunctionalised loop according to Roux offers as compared with all the other procedures.

[Anatomo-surgical aspects of peroperative cholangiography in biliary lithiasis]. / Aspetti anatomo-chirurgici della colangiografia peroperatoria nella litiasi biliare

Biliary anomalies and volumetric changes in the ductal system often make it difficult to identify individual structures during the course of operations for biliary lithiasis. The Authors reviewed 406 peroperative cholangiographies during the course of 1250 operations, evidencing some statistical data regarding the anomalies of greatest interest for surgical practice and stressing the significance and limits of dilation of the V.B.P. On the basis of their personal experience and the relevant literature the Authors conclude that peroperative cholangiography constitutes a useful method not only for diagnostic purposes, but also for correct definition of certain aspects of the extrahepatic biliary ducts.