[Biliary peritonitis caused hy hydatid disease]. / Peritonite biliare da malattia idatidea.

After specifying that rupture of a hydatid cyst in the peritoneal cavity is one of the most serious and rarest complications of hepatic hydatidosis, attention is paid to the peritoneal hydatid (o chole-hydatid). The aetiopathogenetic mechanisms and the anatomo-pathological features of this type of lesion are described in brief. Finally, the personally employed diagnostic protocol and therapeutic strategy in the face of this feared complication are reported.

[Trans-anal resection of low rectal neoplasms]. / Exeresi transanale delle neoplasie del retto basso.

BACKGROUND: The rising incidence of colorectal neoplasms, and in particular those localised in the lower rectum is stressed and the therapeutic opportunities offered by the trans-anal resection technique are underlined. METHODS: The indispensable conditions for adopting a surgical approach are pointed out. These are identified as the size of the neoplasm, which should not exceed 4 cm, the fixity, site, the polypoid and non-ulcerated nature of the lesion, and the involvement of not more than 1/4 of the circumference of the bowel. Using these inclusion criteria, the authors operated on five patients in the 4th Division of General Surgery at G. Martino Polyclinic in Messina, using trans-anal resection of low rectal neoplasm. RESULTS: No hemorrhagic complications or lesions in the visceral wall occurred. All patients underwent a follow-up of up to 36 months and to date no patient has presented long-term metastasis; local recidivation was observed in one patient after 14 months and this was treated using the trans-anal method. CONCLUSIONS: The authors affirm that trans-anal resection may be regarded as the elective treatment of patients with neoplasms confined to the visceral wall and without dissemination; it is palliative in cases where the tumour is larger than 4 cm, with lymph node involvement. But even in this case, and in more advanced situations, this method allows mortality due to occlusive complications to be reduced and ensures a better quality of residual life.

[Carcinoma of the gastric stump]. / Il carcinoma del monocone gastrico.

After having emphasized that carcinoma of the gastric stump represents a "major" risk in patients undergoing gastric resection, the authors describe the physiopathology of the new anatomical and functional status of the gastroenteric apparatus and underline the probable etiopathogenetic stages attributable to carcinogenesis. They then describe the treatment of this neoplasia with a marked aggressive character and conclude with the affirmation that the surgeon's efforts must be focused on the correct execution of gastroresection and the follow-up of gastro-resected patients in order to allow the early identification of precancerous conditions and therefore the commencement rational oncological prophylaxis.

[Use of monofilament prosthesis in inguinal hernia treatment: cost-benefit ratio]. / L'impiego delle protesi in monofilamento nella terapia dell'ernia inguinale: rapporto costo-beneficio.

BACKGROUND: The authors aimed to demonstrate the real advantages in terms of cost and patient comfort of inguinal hernia surgery using monofilament prostheses. METHODS: A retrospective survey was carried out on two groups of patients: the first group, consisting of 1032 patients who underwent inguinal hernia surgery under general anesthetic between 1985 and 1995 at the Institute of General Surgery at the University Polyclinic of Messina, included cases of both emergency and elective surgery that did not use monofilament prosthesis. The second group, consisting of 348 patients operated under local anesthesia between 1996 and 1999 at the IV Division of General Surgery at the University Polyclinic of Messina, included cases of both emergency and elective surgery using tension-free techniques and polypropylene mesh. The numbers of recidivations and complications were compared, together with the relative costs of the methods used in both groups. CONCLUSIONS: In the light of these experimental results, it is clear that the use of biocompatible alloplastic materials in monofilament considerably reduces the risks of recidivation, without no significant increase in the number of dehiscences, infections or postoperative complications. Moreover, there was a striking reduction in costs linked not only to the shorter hospitalisation of patients and the reduced use of painkillers, but also a fall in the number of future hospital admissions owing to recidivation.

[Barrett esophagus. The diagnostic and therapeutic aspects]. / Esofago di Barrett. Aspetti diagnostici e terapeutici.

The authors, after a dissertation on the aetiopathogenesis of "Barrett's oesophagus", dwell on the precancerous nature of this pathology involving the oesophageal-gastric junction. Its frequent association with cancer explains the necessity for an accurate follow-up in these patients: many investigations can be useful, the radiological study of oesophagus and stomach, manometry, pH-metry, but an irrefutable diagnosis can only be achieved through endoscopy, which makes possible a histological examination of the bioptic fragments. The authors also deal with the ideal therapeutic strategy and differentiate the cases in which the pharmacological therapy is more appropriate from those that need a surgical approach.

[Laparoscopic cholecystectomy: the complications]. / La colecistectomia per via laparoscopica: le complicanze.

The authors report their experience of 48 consecutive cases of colecystectomy performed using a videolaparoscopic technique. Laparoscopic surgery was not successful in only two patients in whom it was necessary to resort to laparotomy; bile duct injury occurred in one patient. On the basis of their experience the authors conclude by affirming that this videolaparoscopic technique may be applied to almost all patients requiring cholecystectomy since it offers considerable advantages over traditional techniques.

[Treatment of occlusions caused by carcinoma of the left colon in the aged]. / Il trattamento delle occlusioni da carcinoma del colon sinistro in età geriatrica.

The Authors, after pointing out that, in geriatric age, the incidence of left colon carcinoma has significantly increased, and this, in a high quantity of cases, goes unnoticed in precocious stage, but appears "d'emblée" pith an occlusive situation, state their experience concerning the surgical treatment of occlusions due to left colon carcinoma in patients aged over sixty. From the evaluation of the results they obtained, the Authors assert that, if the operation is performed after a correct appraisal of the patient's general conditions and after an adequate counterbalancing of the metabolic and functional alterations, often present in old people, the operative mortality, the postoperative complications and the indices of survival are not so significantly different from those remarked in the young subjects.

[Use of cytologic examination based on needle aspiration biopsy in the diagnosis of breast pathology]. / L'impiego dell'esame citologico su agoaspirato nella diagnostica della patologia mammaria.

The authors point out the cytologic test on needle-aspiration report is a method phich, although complementary to clinical examination and mammography, results to be extremely valid and useful for diagnostical purposes and a correct therapeutical programming; they describe the set of instruments and technique they adopted, and point out its easy execution and complete absence of risks. Then, they illustrate the cases they studied, including 86 patient women with both benign and malignant breast pathology, in whom an aspiration biopsy was performed. On the basis of the results obtained, they, as a conclusion, assert the cytologic test with needle-aspiration, although burdened by a fair quantity of false negatives, deserves, for its quick and simple execution, to be included in the breast diagnostical routine, yet without replacing the classic interoperative biopsy for doubtful cases.

[Use of the CO2 laser in the treatment of cutaneous malignant melanoma: lymphoadenectomy]. / L'impiego del laser al CO2 nel trattamento del melanoma maligno cutaneo: la linfoadenectomia.

The Authors, after pointing out the incidence of complications subsequent to lymphoadenectomy performed with the traditional means (lymphorrhea, dehiscence of the pound, etc.), report their experience concerning the removal of inguinal or aqillary lymphnodes of patients suffering from cutaneous malignant melanoma (N+), performed pith laser lancet. After a short description of the peculiar features of the Laser Surgical Unit they used, the Authors emphasize that, thanks to the peculiar power for the laser lancet to close the lymphatic vessels during the lancing itself, surgeons can prevent the postoperative lymphorrhea, which is the main cause of dehiscence of such surgical wounds.

[Immunologic profile of patients with carcinoma of the colorectum in the aged]. / Studio del profilo immunologico in pazienti con carcinoma del colon-retto in età geriatrica.

The authors, after explaining why they were persuaded to effect a study about the immunological outline of patients in geriatric age, suffering from colorectal carcinoma in different stages, state the methods they adopted for the in vivo and in vitro study of the cellular and humoral immunity. In order to better characterize these subjects, the authors also dosed tumoral markers, specific enough for the large intestine carcinoma, such as CEA and AFP. After reporting the results of their research, the authors, as a conclusion, assert there is certainly a straight correlation between immunity faults, bound to ageing, and neoplastic disease; therefore, the study of the immunological outline in aged patients is very useful, not only for prognostic purposes, but also to monitoring the immunitary state, mot inclined to meet depression in such patients as a consequence of the different therapies performed.

[Clinico-statistical features of breast pathology in old age]. / Rilievi clinico-statistici sulla patologia mammaria in età geriatrica.

The authors, after discussing the incidence and etiopathogenesis of displastic and neoplastic diseases of breast in geriatric age, state their experience in the treatment of such illnesses. They emphasize the necessity for a treatment suitable for aged people, based on the selection of the patients, their preparation and the constant pre- and postoperative monitoring, and, as a conclusion, affirm the necessity for a strict interdisciplinary cooperation, pith the purpose to ecectively treat such pathology, showing a more and more increasing incidence in the population of the most advanced nations.

[Use of the indirect hemoagglutination test in the diagnosis of the hydatid disease]. / L'impiego del test di emoagglutinazione indiretta nella diagnosi della malattia idatidea.

The authors state their experienle about the use of the maemagglutination reahtion test for the diagnosis of human hydatid disease, and point out this is a sensitive and highly specific technique, and, moreover, its execution is rapid and easy.

[Clinico-statistical features on the operative risk in old age]. / Rilievi clinico-statistici sul rischio operatorio in età geriatrica.

The authors, after reporting the data concerning the increase of the average length of life and the increment of the population in geriatric age, studied the different aspects of the surgical risk. They consider the age, the existence or absence of associated diseases, the situation of the different organs or apparatuses, and the possibility to correct, in preoperative stage, the different functional unbalances remarked. At last, after confirming the conception whereby age for itself does not represent a specific factor of risk, they emphasize the importance of a multidisciplinary cooperation in the assistance to old patients, both during intervention and in the postoperative course.

[Colo-rectal precancerous conditions: anatomo-pathologic and clinical aspects]. / Le precancerosi colo-rettali: rilievi anatomo-patologici e clinici.

The authors, after emphasizing the value presently ascribed to the conception of "epithelial displasia" as initial histologic and cytologic alteration, common to all groups of patients with high risk of development of colorectal cancer, review the mani precancer lesions of large intestine. As a conclusion, they affirm the main target one presently aims at for the screening in groups with high risk is to precociously identify the stage of transformation of epithelial displasia into carcinoma, so as to be able to set up a timely treatment.

[Principles of rehabilitation of colostomy patients]. / Princípi di riabilitazione nel colostomizzato.

The authors, after pointing out the number of enterostomized patients in the last years was more and more increasing, study all the repercussions of metabolic, functional and psychologic nature which are arising in the patients subjected to ultimate colostomy. Then, they describe the principles of a correct rehabilitative program for such patients, consisting in performing a correct colostimy and rigidly following hygienicodietetic rules. At last the authors, as a conclusion, affirm the rehabilitation, through the creation of proper centers with specialized staff, should also aim at the resolution of the remarkable psychologic problems affecting such patients, so as to have them reinserted in the social context they are coming from.

[Sequential therapy with antiestrogens and progestational drugs in carcinoma of the breast in an advanced stage]. / La terapia sequenziale con antiestrogeni e progestinici nel carcinoma della mammella in fase avanzata.

After discussing the mechanism of action of antioestrogens and medroxy-progesterone-acetate, the authors report on their experience with the sequential use of these two hormones in a group of patients with advanced cancer of the breast. After illustrating the results of their study, the authors conclude by stressing that the sequential use of these drugs appears to improve the quality of life of the patients with a significant increase in rates of complete or partial remission of the neoplastic disease.

[Malignant melanoma of the skin: current diagnostic and therapeutic approaches]. / Il melanoma maligno cutaneo: attuali orientamenti diagnostici e terapeutici.

The Authors claim that the treatment of malignant melanosis of the skin is a problem of undiminished topical interest owing to its highly aggressive characteristics. Risk factors and pre-neoplastic lesions are reviewed, and the signs of malignant transformation are described along with the appropriate treatment. The Authors stress the importance, for therapeutic and prognostic purposes, of accurate clinical staging and macro- and microscopic study of the primary tumour. They also describe their own therapeutic approach, which involves the use of a CO2 laser for resecting the primary tumour. They present their patient population and conclude by observing that the progress achieved over the past decade is due both to earlier diagnosis and to improvements in the various therapeutic means available.

[Importance and limitations of the immunological monitoring of patients with malignant tumors]. / Importanza e limiti del monitoraggio immunologico nei pazienti affetti da tumori maligni.

The authors, after considering the incidence of neoplastic diseases is particularly high in subjects suffering from congenital or acquired immunologic lacks, assert the importance to perform an immunologic monitoring in the patients bearing malignant neoplasms, with the purpose to identify and calculate the direrent deficits of the sheltering organism. Then, they state the method adopted for the study of the cellulo-mediate immunity (in vivo and in vitro) and the humoral one. At last, on the basis of the results they obtained, the Authors, as a conclusion, affirm there is always in neoplastic patients a certain degree of depression of tumour immunity (especially if cellulo-mediate), and it can be put in relation to the evolutive stage of neoplasm.

[Role of suture materials in the treatment of inguinal hernia]. / Il ruolo dei materiali di sutura nel trattamento dell'ernia inguinale.

The Authors evaluated the role suture materials have in recurrent groin hernia. According to the Literature and to their experience, it is concluded that suture materials seem not to have a significant influence on relapse.

[Conservative surgical treatment of acute hemorrhagic necrotizing pancreatitis]. / II trattamento chirurgico conservativo della pancreatite acuta necrotico-emorrgica.

The Authors though in theirs' opinion medical treatment is the primary therapeutical approach to Acute Necrotizing Haemorrhagic Pancreatitis (A.N.H.P.), state that the surgical treatment is indicated as soon as the necrotizing haemorrhagic evolution of the disease is strongly suspected. It should be conservative in type acting on the evolution of the disease and saving the anatomic integrity of the pancreas. The surgical technique adopted is described which consists in removing cellular debris as well as highly toxic necrotic pancreatic apparatus and it is completed by the endo-retroperitoneal perfusion for a continuous washing of the peritoneal cavity. In conclusion, they report their personal experience with 16 patients affected with A.N.H.P.