[Anatomo-clinical considerations on intrahepatic calculosis]. / Considerazioni anatomo-cliniche sulla calcolosi intraepatica.

After reviewing the anatomoclinical classification of intrahepatic lithiasis, the authors underline the need to perform hepatic resections in selected cases. The case reported is an example of the indications for this type of surgery.

[Continuous suture in laparotomy using an absorbable eyelet thread according to the Smead Jones technique]. / Sutura continua di laparotomie con l'impiego di filo assorbibile ad asola secondo la tecnica di Smead Jones.

In 78 patients undergoing laparotomy suturing was carried out using absorbable thread (polyglyconate - Maxon) with eyelet to obtain a continuous knot-free suture according to Smead Jones' technique. A prospective study was made of all surgical wounds three months after the operation to evaluate the reliability of this technique. On examination, wounds were fully healed in 98% of patients. Less than 2% of patients revealed infections, dehiscence or anomalous granulations of the wound. No laparocele were observed at the time of control using this method. Continuous suture using a trimethylene polyglyconate (Maxon) thread with eyelet according to the Smead Jones technique was found to be safe and effective. A follow-up after a longer interval will be performed in this group of patients in order to confirm these conclusions.

[Diagnostic-operative laparoscopy. Our experience]. / La laparoscopia diagnostica-operativa. Nostra esperienza.

Diagnostic laparoscopy has been an integral part of our surgical practice for over 4 years. Between 1988-1992, 100 diagnostic laparoscopies have been performed in this institution without mortality. We have found the procedure to be particularly useful in the following situation: 1) Hepatobiliary disease where it is used in conjunction with targeted liver biopsy. 2) Acute emergency cases. These include the diagnosis of acute peritonitis, abdominal trauma and in patients with suspected mesenteric ischaemia. 3) In the staging of intra-abdominal malignancy especially gastric, oesophageal, colonic, peritoneal and pancreatic neoplasms.

[The functional and manometric results of 2 surgical methods of posterior abdominal rectopexy]. / Risultati funzionali e manometrici di due metodi chirurgici di rettopessi addominale posteriore.

Functional changes after posterior abdominal rectopexy for the treatment of rectal prolapse are not fully understood. We studied the effects of Wells' or Ripstein's rectopexy on functional characteristics as related to anal sphincter function, rectal volume and sensory function in 31 patients with complete or internal rectal prolapse. We have observed an improvement of continence over 70% in both groups. However, an absent or a decreased call to stool, constipation and evacuation difficulties are the aftermath of Wells' rectopexy, while these complaints appear basically unaffected by Ripstein's technique. Maximal squeeze pressure was slightly increased after Ripstein's rectopexy, whereas no significant effects were found on anal pressures. Postoperatively the rectal capacity was reduced by Well's procedure (p < 0.05), while no significant changes were observed with Ripstein's operation. After the Wells procedure patients developed at the threshold for the relaxation of the internal sphincter progressively lower rectal volumes, reaching one year after rectopexy the statistical significance. Sensory thresholds for sense of filling and urge were significantly raised after Wells' rectopexy even one year after operation, whereas after Ripstein's operation sense of filling was not significantly affected and while sense of urge was increased early postoperatively, it was not significantly changed at one hear postoperative control. In conclusion, when fecal incontinence appears associated to a rectal prolapse has good chances to improve postoperatively. Preoperative evacuation difficulties seem to be unaffected by a posterior abdominal rectopexy, Wells or Ripstein, but an extensive dissection of the rectum with the division of the lateral stalks, as it is performed in Wells' operation, seems to be a procedure that can create a further burden of problems the the patient and it seems coupled to a manovolumetric elevation of rectal sensory thresholds.

[2 cases of deep fibromatosis]. / Due casi di fibromatosi profonda.

The authors make clear the importance of extrabdominal fibromatosis as a rare pathology that interests many people in Italy. The pathology is of relatively easy diagnosis with the common investigations, required a radical surgical removed to avoid the frequent local recidivists.

[Occult rectal prolapse: functional results after rectopexy]. / Prolasso occulto del retto: risultati funzionali dopo rettopessia.

In the present work the Authors have studied 19 patients with occult rectal prolapse evaluating symptoms and functional results after posterior abdominal rectopexy. Symptoms of internal rectal procidentia appear as a definite syndrome. In our patients pain upon defecation, this being often localized to the perineal and sacral region, was observed in 14 on 19 cases, while fecal incontinence was present in 5 cases (29%) and rectal bleeding in 8 (44%). These compliances are relieved by the anatomical correction of the rectal intussusception, but the preexisting functional disorders in the mechanism of defecation appear to be unaffected by rectopexy. (Sensation of obstruction 11 cases (58%) preop. e 9 cases (53%) postop.).

[Variations in rectal capacity and compliance after abdominal rectopexy]. / Variazione della capacità e della compliance rettale dopo rettopessia addominale.

The aim of this study was to attempt to gain insight in to the pathophysiologic characteristics of rectal prolapse by evaluating rectal compliance in patients with complete or incomplete rectal prolapse, before and after rectopexy. 21 subjects with complete rectal prolapse and 10 subjects with internal procidentia of rectum were treated with one of two abdominal rectopexies, according to Wells or according to a modified Ripstein's technique. For comparison, measurements were also carried out in 17 age and sex control subjects who had no bowel disturbances or anal symptoms. On distension with 40 cm H2O rectal volume amounted to 218 (175-255) ml for controls, 225 (178-256) ml for complete prolapses and 200 (125-225) ml for invaginations. Compliance amounted respectively to 9.5 (5-11,4), 8.5 (5-12,6), 7.5 (4-10,6) ml/cm H2O in the pressure interval 0-10 cm H2O with a decrease in compliance at higher pressure intervals. There was no correlation between rectal volume and compliance and gas or faecal incontinence, evacuation difficulties, feeling of blockade upon defecation and constipation. The effect of rectopexy has been separately evaluated according to the diagnosis. In complete prolapse significant changes of rectal capacity were observed for lower distending pressures (from 10 to 30), but not for higher (40-50). The compliance was significantly different for even lower distending pressures (0-10 cm H2O). In internal rectal procidentia rectopexy did not significantly changed capacity compliance. This work confirms the observations that the rectal compliance in rectal prolapse, complete and incomplete, do not differ from healthy controls.(ABSTRACT TRUNCATED AT 250 WORDS)

[Evaluation of the sphincter function and rectal sensitivity in rectal prolapse associated with fecal incontinence]. / Valutazione della funzione sfinterica e della sensibilità rettale nel prolasso del retto associato ad incontinenza fecale.

It has been suggested that incontinent patients with rectal prolapse develop a relaxation of the internal sphincter at a lower filling volume than those with the same disorder who were continent. A constant relaxation of the internal sphincter during filling before the individual experiences a need to defecate could be a contributory cause of the incontinence in these patients. Aiming to evaluate the former observations we have investigated continent and incontinent patients, with complete and internal rectal prolapse, by mean of the recto-anal manovolumetry. 31 patients were studied, 21 had a complete rectal prolapse and 10 had internal rectal prolapse and 28 sex and age matched controls were selected among volunteers. No difference has been found between the continent and incontinent patients with rectal prolapse, in term of sensory function studied by graded isobaric distention. Moreover, no difference has been found between the rectal volume at which perception of filling and relaxation of the internal sphincter during filling occurs. Therefore, in this respect, the present data are not in agreement with the theory proposed.

[Rectal prolapse and fecal incontinence. A prospective manometric study]. / Prolasso rettale ed incontinenza fecale: studio prospettico manometrico.

In the present work we have studied two consecutive series of patients who underwent a posterior abdominal rectopexy according to Wells or Ripstein. During the year of follow up no recurrences were observed. Functional results, evaluated according to a protocol, by history of the patient and manovolumetry, shoved an improvement of fecal continence in more than half of the incontinents in both series. However, constipation increased after Wells' rectopexy, while no major changes were observed after Ripstein's rectopexy. We conclude that the first surgical technique may offers worse functional results.

[Phlebographic study of venous incontinence in varicose veins]. / La ricerca flebografica delle incontinenze venose nella malattia varicosa.

Phlebography is a test known for a long time: although by this time it is supported and, in a way, substituted by some substantial and not surgical methods like the doppler test, doppler echography, plethysmography and the duplex scanner. This test makes it possible for us to achieve precise diagnosis rapidly and in an unequivocal way, especially in those cases in which the mentioned methods don't give final results. Nowadays phlebography has to be optimized and adapted to clinical request, in order to provide a through diagnostic result. The purpose of this work is to evaluate the effectiveness of this methodology using a group of selected patients for the test.

[Malignant peritoneal mesothelioma: its evolution and outlook]. / Mesotelioma peritoneale maligno: evoluzione e prospettive.

Mesotheliomas are mesenchymal neoplasms which originate in the lining membrane of various serous cavities: pleural, pericardial and peritoneal. Peritoneal mesotheliomas are extremely rare. They are usually seen to middle to old age, predominate in men. We report a case and show the most recent concepts about histology, pathology, diagnosis and medical-surgical therapy of these diseases.

[Total thyroidectomy in recurrent goiters (anatomicosurgical observations with the operating microscope)]. / La tiroidectomia totale nelle recidive di gozzo (osservazioni anatomo-chirurgiche con l'ausilio del microscopio operatorio).

The relapses of the multinodular goitre, often linked with an insufficient surgical treatment of primitive lesions, make serious problems about the operating technique. The current guidance of surgeons is directed towards the complete thyroidectomy which profits, during the operating time, by the use of microscope to identify and to protect the recurrent nerves. This equipment has to be used by those equipped which know how to use it. In our work we report the results obtained with this technique and it's underlined how the complete thyroidectomy for the benign relapsing goitre could be considered curative towards those cases which present hidden microcarcinoma.

[The functional and manometric-volumetric results following abdominal rectopexy for total rectal prolapse]. / Risultato funzionale e manovolumetrico dopo rettopessia addominale posteriore per prolasso totale di retto.

Functional changes after the posterior abdominal rectopexy for the treatment of rectal prolapse are not fully understood. We studied the effects of Wells' or Ripstein's rectopexy on functional characteristics as related to anal sphincter function, rectal volume and sensory function in 21 patients with complete rectal prolapse. We have observed an improvement of continence over 70 per cent in both groups. However, an absent or a decreased call to stool, constipation and evacuation difficulties are the aftermath of Wells' rectopexy, while these complaints appear basically unaffected by Ripstein's technique. Sensory thresholds for sense of filling and urge were significantly raised after Wells' rectopexy even one year after operation, whereas after Ripstein's operation sense of filling was not significantly affected and while sense of urge was increased early postoperatively, it was not significantly changed at one year postoperative control. In conclusion, when fecal incontinence appears associated to a complete rectal prolapse has good chances to improve postoperatively. Preoperative evacuation difficulties seems to be unaffected by a posterior abdominal rectopexy, Wells or Ripstein, but an extensive dissection of the rectum with the division of the lateral stalks, as it is performed in Wells' operation, seems to be a procedure that can create a further burden of problems to the patient and it seems coupled to a manovolumetric elevation of rectal sensory thresholds.

[Use of an aldosterone antagonist in abdominal surgery]. / Utilizzazione di un antagonista dell'aldosterone in chirurgia addominale.

Clinical and humoral signs of postoperative stress ore partly related to temporary hyperaldosteronism. The action of an aldosterone-antagonist was therefore studied on 24 abdominal surgical patients. The aldosterone-inhibitor has shown a consistent pharmacological and clinical effect. The drug seems then to be useful and safe-with close clinical and humoral follow-ups for the treatment of the postoperative secondary hyperaldosteronism.