Organ procurement: experience from a southern Italian region.

The authors report their experience of organ procurement during the last 5 years to evaluate a program that began in 1988 to improve organ retrieval in Calabria. In this region only two donations were reported up to 1988, one each in 1980 and 1985. Because of the large population on dialysis and the willingness of a group of surgeons and anesthesiologists, this program was undertaken in 1988 under the supervision of C.C.S.T. (Co-ordination of Centre and South Italy for Transplantation). This program was designed to act on two levels: to create a large group of people directly involved in health care (physicians and nurses) motivated in organ procurement and transplantation, and to diffuse the "culture" of organ donation among lay people. This was achieved by means of scientific meetings inside the hospital and with conventions and TV programs, supported by an Association of Volunteers, where ethical and scientific problems of organ donation and transplantation were discussed in simple language. Various meetings were also held with high school students. During these meetings a questionnaire was distributed among students. Results of this questionnaire show that the main obstacles to organ donation are the "unclear" concept of "brain death" and religious feelings, but after the concept of brain death was explained, a significant number of students showed a different attitude toward organ procurement and transplantation. Results of this program are extremely encouraging (23 organ donations during the last 3 years). We hope to improve our results in the near future, and we do believe that a further and significant increase to our preliminary good results could be achieved by the possibility of performing at least kidney transplantation in our institution.

[Use of the duodenum in demolition surgery of the stomach. Reconversion gastroduodenostomy in post-resection syndromes following Billroth II operations]. / L'utilizzazione del duodeno nella chirurgia demolitiva dello stomaco. La gastro-duodenostomia di riconversione nelle sindromi post-resezione tipo Billroth II.

Stress is laid on the importance in digestive and absorptive physiology. The methods used for the re-insertion of the duodenum in the digestive circuit in the surgical correction of servious post-Billroth II syndromes are explained. Direct duodenal reconversion by means of the transformation of gastrojejunostomy into gastroduodenostomy is recommended in the light of results obtained in 25 cases of p.o.p.u., dumping syndrome, inflammation of the anastomosis, and ALS. It is suggested that jejunal interposition should be kept for cases in which the particular shortness of the gastric stump makes simple re-insertion of the duodenum into the stomach impracticable.

[Postoperative complications in the Billroth I gastrectomy]. / Complicanze post-operatorie nella resezione gastrica sec. Billroth I.

A series of 234 patients who underwent Billroth I gastric resection for gastric and duodenal ulcerous lesions is reported. Special attention is paid to the immediate postoperative complications whose incidence was 5.5%. Particularly serious is the dehiscence of gastroduodenal anastomosis which requires emergency reconversion intervention, namely gastrojejunostomy with sinking of the duodenal stump.

[Intralobar pulmonary sequestration in lymphoid and vascular hamartia]. / Sequestrazione polmonare intralobare in quadro di amartia linfoide e vascolare

A case of intralobar pulmonary sequestration observed in a young women subjected to right lower lobectomy is described. Reference to the relevant literature is made in outlining the anatomical and clinical picture of this form. Emphasis is laid on certain particular features: rarity, congenital origin, difficulty of interpreting the clinical picture, the need for careful angiographic examination to ensure positive diagnosis, and the indispensability of surgical management.

[Results of the multicenter study (A.C.O.I. Stapler Study Group) on 420 cases of esophagojejunal and 544 cases of colorectal anastomoses]. / Risultati dello studio multicentrico (A.C.O.I. Stapler Study Group) su 420 anastomosi esofago-digiunali e 544 colorettali.

The introduction of staplers in general surgery allowed to perform gastrointestinal anastomoses easier and with better results. Because many series report an important incidence of complications even using stapling instruments, the A.C.O.I. (Italian Association of General Hospital Surgeons), with the support of Auto Suture Italy, promoted a collaborative trial in Italy to evaluate the real incidence of complications after stapled colorectal or esophago-jejunal anastomoses. The study has been carried out during the period April 1990-December 1991 and 58 Centres throughout Italy participated with 420 esophagojejunostomies after Total Gastrectomy and 544 Colorectal anastomoses after Anterior Resection of the Rectum. Many variables were evaluated such as patients general conditions, the pathology and the site of anastomosis, the instrument used, the technique of reconstruction, if it was an urgent or an elective procedure, the incidence of intraoperative problems and the surgical experience. The most frequent complications were bleeding, leakage and stenosis. The incidence of bleeding was low in both groups, it was an occasional event not related with any of the variables previously described. Furthermore it was never important and never required reoperation or caused death of the patient. Leakage was the most frequent and serious complication (12.4% in colorectal anastomoses and 5.5% in esophagojejunostomies) and was mainly related to the incidence of intraoperative technical problems (tearing of the stump or purse string failure), to urgent procedures, to low and ultra low colorectal anastomoses and to centres with less experience, particularly with an experience of less than 50 mechanical anastomoses. Late complications such stenoses, were particularly frequent (8.4%) after a leakage and in very low colorectal anastomoses. Perioperative Mortality was very low in birth groups (1.1% for colorectal anastomoses and 2.6% for esophagojejunostomies) one of the lowest described in the Literature. This study seem to confirm that staplers are effective, safe and easy to use, showing a low incidence of complications and they make possible anastomoses otherwise technically impossible.

[Treatment of secondary intrahepatic calculosis]. / Il trattamento della calcolosi intraepatica secondaria.

The secondary intrahepatic stone is generally associated with an extrahepatic stone and depends on it. Since April 1979 to April 1988 10 cases of secondary I.S. have been treated by the authors. Four cases were treated by papillo-sphincterectomy and the stones were removed i.o. by choledochoscopy. Five cases were treated by a B-D anastomosis and the following extraction of the other stones were done by means of transhepatic choledochoscopy. Another case was treated by a B-D anastomosis while the remaining stones were removed by using both transhepatic choledochoscopy and the ESWL, treatment. The I.S. treatment has not been codified yet. The aim is to remove not just the stones but also to eliminate the responsible cause of stenosis. If surgery has been not able to solve the problem, other methodologies might be used in presence of big stones or stones of the fifth or the third segment.