Hemangioma of the small bowel. Case report.

Cavernous hemangioma is a very rare disease if located in the ileum, but not an uncommon lesion if it occurs in the large bowel. The Authors report a case of small bowel cavernous hemangioma, and consider clinical, diagnostic and therapeutic aspects for an exact evaluation of the lesion.

[Prognostic, clinical and anatomo-pathological aspects of gastric lymphoma]. / Aspetti prognostici, clinici ed anatomopatologici del linfoma gastrico.

The authors refer about the results of a study made on 15 cases of gastric lymphoma with a mean follow-up of 6 years. Among the examined features they underlie the clinical appearance of each case according to histologic cell-type, stage of disease and performed treatment with relation to the survival rate. According to the Rappaport classification, diffuse histiocytic lymphoma was the most frequent histologic type of disease: the prognosis turned out to be significantly favorable in case of stage I, while no correlation was observed between different surgical procedures and cell-type. The overall 5 years survival rate was 33.3% with a strong suggestion of better survival in case of early diagnosis.

[Endoscopic sclerosing therapy in esophageal varices. Indications and personal technics]. / Sclerosi endoscopica delle varici esofagee.

Variceal bleeding in cirrhotic patients with poor liver function is associated with a high mortality. A non-operative treatment, endoscopic sclerotherapy, was employed in 16 patients. The preliminary results have been encouraging. It has been possible to eradicate esophageal varices in the cronic injection group. A longer follow-up period will be required to assess both the quantitative and the qualitative aspects of survival and to determine how long esophageal varices will remain eradicated as well as how frequently repeated injections will be required.

Endoscopic polypectomy of the large bowel: management of cancer-bearing polyps.

From January 1974 to May 1979, among 2,338 endoscopic examinations of the large bowel, 184 polypectomies were performed. Forty-two cases of familial polyposis coli were excluded from this study. Of the remaining 142 cases, 21 had cancer foci: fourteen were mucosally confined carcinomas, and seven submucosally invading carcinomas. Endoscopic polypectomy was considered a radical treatment for the former and not satisfactory for the latter. Therefore macroscopic type of polyp, location of carcinoma in the polyp, and lymphatic and venous permeation were the main criteria evaluated for the strategy of treatment in cases of submucosally invading carcinoma-bearing polyps. Radical resections are necessary in cases of semipedunculated polyp with carcinoma located near the base, and in cases of pedunculated polyps with carcinoma extending to the stalk. However, as general criteria for the management of submucosally invading carcinoma-bearing polyps have not yet been established, radical resections are indicated in cases which do not fit the generally accepted criteria, in order to attempt a curative treatment. Endoscopic polypectomy therefore seems to be of great value in the early detection of colorectal cancers and their treatment.

[Endoscopic biliary surgery today: current aspects and prospects]. / La chirurgia biliare endoscopica oggi: attualità e prospettive.

Over the past twenty years endoscopic surgery has reached a level of use which was unthinkable when it was first introduced. The practical experience of practitioners is now able to offer a wide-ranging guarantee for the complementary and alternative resolution of even severe clinical conditions. From the start its use appeared to be particularly available in the context of biliary diseases, especially for the treatment of lithiasis and sepsis, as well as in the treatment of both benign and malignant conditions of obstructed biliary flow. Special attention has been paid to the cost/benefit ratio which is increasingly the main goal of the medical activity today. The paper illustrates the different methods which can be used with specific reference to techniques and other devices able to reduce risks and improve results. The Author's personal experience is compared with that reported in the literature in the different sectors of application. There is increasing consent regarding the results achieved to data as well as technological progress.

[Endoscopic retrograde catheterization of Vater's ampulla in the diagnosis of bilio-pancreatic diseases]. / I1 cateterismo retrogrado endoscopico della papilla di Vater nella diagnostica delle affezioni bilio-pancreatiche

The technique, indications and contraindications for endoscopic retrograde cholangiopancreatography are discussed. Some of the most demonstrative cholangiographic and pancreatographic pictures are described and the reasons that have led to a marked reduction in complications immediately after the examination are analysed. Therapeutical aids for limiting any slight disturbances connected with the examination are also presented. Finally, some morphological data useful for differentiating between inflammatory and neoplastic lesions in the juxta- and intrapancreatic biliary excretory way and the pancreas itself are considered.

[Endoscopic sclerotherapy of esophageal varices]. / La sclerosi endoscopica delle varici esofagee.

Magnetic tape recordings of endoscopic images relating to pathologies with it is extremely important to follow morphological changes after treatment offer unquestionable advantages especially in the field of sclerosing endoscopic therapy for esophageal varices. This study--which was carried out using a 3/4 inch U-Matic videotape lasting 10 minutes--confirm the above statement. The criteria of selection for sclerosing techniques are illustrated according to the authors' personal evaluations made on the basis of experience accumulated during more than 10 years' activity; the results of modulated treatment are compared as both emergency and elective treatment, used as the single therapy or following deconnection or portosystemic derivation operations. The choices are confirmed by the number of successful outcomes, with only minimal and almost always easily controlled complications. This has led to the method's inclusion in clinical practice as yet another means of controlling hemorrhages due to portal hypertension, in addition to permitting a marked increase in the percentage of success following deconnecting and derivative operations performed in patients in better conditions of clinical compensation.

[Endoscopic papillotomy today. Indications and results]. / La papillotomia endoscopia oggi. Indicazioni e risultati.

The therapeutic possibilities offered by endoscopic papillotomy have improved in comparison with the recent past by virtue of mounting experience and increasingly satisfactory results. The position of the surgeon in the face of this procedure is more serene and objective than those who concern themselves with the endoscopic method as such. In long-term personal experience, endoscopic papillotomy was indicated in 162 cases of biliary lithiasic pathology--associated and otherwise with Odditis--and angiocolitis, with and without the gall-bladder. The reference to endoscopic treatment was mainly confined to patients with associated pathologies, dependent and otherwise, that involved general or specific surgical risk, while evaluations of the lumen of the biliary excretory way, of the coexistence of more or less incisive biliary inflammation, of the age of the patient--all parameters to which are attributed special importance for the choice between derivative intervention and open papillotomy--do not possess particular significance for the endoscopic method. Results obtained and the low incidence of short and long-term morbility support the claim to absolute usefulness of the method when it is proposed on correct indications and carried out with expert technique.

[Endoscopic surgery of the digestive system: state of the art. Opinion of an endoscopic surgeon]. / Chirurgia endoscopica dell'apparato digerente: stato dell'arte. L'opinione di un endoscopista chirurgo.

The Authors review the possible applications of surgical endoscopy in oesophageal, gastric, biliary, pancreatic and colic diseases. This critical assessment, performed under the abdominal endoscopic surgeon's point of view, is based on the overall experience of about 20 years of surgery, with particular regard to the sclerosis of oesophageal varices, neoplastic obstructions of oesophagus, biliary tract, colon and localized Laser treatment of neoplasms. Based on the results achieved, thanks to selective indications and monitoring by conventional surgical experience, the Authors conclude by staging a better reliability of the surgeon who performs surgical endoscopy to obtain good results after an accurate selection of those cases which can really benefit from endoscopic management.