[Use of Valtrac in digestive surgery. Initial clinical experience]. / L'uso del Valtrac in chirurgia digestiva. Iniziale esperienza clinica.

Stapling instruments are being currently used for digestive or colorectal anastomoses with definite advantages. The authors report their initial clinical experience about BAR utilization to restore intestinal continuity after upper digestive and colorectal resections. The authors have been carried out 20 anastomoses on 18 patients: 11 males and 7 females. Eleven (61.1%) of them were affected with malignant neoplasms and in 9 cases were performed an urgency procedure. The colorectal and jejunal-jejunal anastomoses were performed, respectively, in 8 cases; gastric-jejunal and ileo-colic anastomoses, respectively, in 2. The satisfactory results obtained seem to demonstrate that the biofragmentable anastomotic ring constitutes a "safe" method of bowel junction of the whole digestive apparatus.

[Renal angiolipoma associated with bilateral double ureter. A clinical case]. / Angiomiolipoma renale in doppio distretto bilaterale. Caso clinico.

Renal angiomyolipoma is a rare renal tumor usually associated with tuberous sclerosis, a syndrome characterized by adenoma sebaceum, mental insufficiency and epilepsy. The authors present a rare case of renal angio-myolipoma associated with bilateral double ureter, in a young male patient not affected by tuberous sclerosis. Histologically, the angiomyolipoma is defined by the presence of smooth muscular cells, new formed vessels and fat. Clinical diagnosis requires the utilization of various imaging techniques, like intravenous pyelogram, ultrasonic scan, CT scan, and FNA (Fine Needle Aspiration). In the histopathologic diagnosis of angiomyolipoma the use of immunohistochemical techniques with different antibodies has been helpful, for the necessity to differentiate angiomyolipoma from other epithelial tumors, as renal cell carcinoma and sarcomatous neoplasms. As for as treatment is concerned, the indication for surgery is still maintained by two factors not affected by these diagnostic improvements: tumor size and presence of symptoms. Tumor size is an important predictive growth factor of the tumor. In the absence of symptoms a close follow-up with ultrasonographic scan may be indicated, keeping in mind the possible presence of a synchronous renal cell carcinoma. Hemorrhage can be a fatal complication of renal angiomyolipoma, requiring emergency surgery or embolization.

[Computerized archives in surgery. Our experience]. / Archiviazione computerizzata in chirurgia. Nostra esperienza.

In recent years, the necessity for a surgical department to obtain a wide range of clinical data in a short period is greatly increased. This necessity has been almost satisfied with widespread use of information systems in medicine using database programs and the integration of these database with other programs has allowed graphic representation of data. Anyhow, some difficulties are still present, such as low knowledge in using personal computers and lacking of a common program for all surgical departments. In the article the authors present a computerized program for the filing of medical records in a surgical department. Starting from January 1992, clinical data of all patients admitted in our department have been recorded in the described program. After three years of use, the system has shown to be easy to use, and able to give useful information for data analysis regarding the population observed, the clinical activity performed and the level of quality obtained. For these reasons, it can represent an attempt to diffuse and uniform computerized data recording in surgical departments.

[Emergency abdominal surgery in the aged]. / L'urgenza addominale chirurgica nell'anziano.

The results of 93 elderly patients, subdivided in two age groups (> 65 < 80 years; > 80 years), undergoing abdominal surgery in immediate or delayed emergency over the past five years are reported. The overall morbility was 47.3% (48 complications in 44 patients); among the complications, sepsis was the first factor in frequency in either group (group I: 28.1%, group II: 17.2%), and was reported mostly in patients with associated diseases (group I: 61.1%, group II: 60%). Overall mortality was 16.2% (group I: 15.6%, group II: 17.2) related to 15 patients; among them, 10 had associated diseases (66.6%). The authors try to identify risk factors and their influence in prognosis and propose a multidisciplinary approach in the pre and postoperative period.

Testicular feminization syndrome diagnosed in an elderly patient at surgery. A case report.

A case of Morris' syndrome in which the diagnosis has been realized only in old age is reported. A 69 year-old patient, with female external genitalia and secondary sexual characteristics, was referred to us with a diagnosis of a mass in the right inguinal region. Her personal history was based on a primary amenorrhoea, which was unsuccessfully investigated since she was adolescent. At the age of 63, during surgery for a left inguinal hernia realized in another hospital, a testis-like mass with the spermatic cord was casually found. During our hospitalization, a surgical removal of the right inguinal mass was performed, and the histologic examination showed the presence of a dominant sclerohyalin testicular tissue without evidence of seminal epithelium and sparse focuses of Leydig cells hyperplasia. Besides, the determination of gonadotropins and sex hormones yielded an increased production of LH, FSH, estradiol, testosterone and androstenedione. A cytogenetic analysis showed a 46, XY karyotype. The diagnosis realized only in old age has compelled the patient to live all her life, from sexual maturity, with indecision and doubt, and without a clinical explanation of fundamental utility even from the psychological point of view. Finally, in our patient the absence of cytologic aspect of malignant transformation in the removed testes in a six years period, seem fortuitous. It is always necessary to consider Morris' syndrome among the possible diseases causing primary amenorrhoea in the clinical evaluation of young phenotypic female patients.