[Gastric carcinoma. Our experience]. / Il carcinoma gastrico. Nostra esperienza.

This study analysed 66 cases of gastric cancer from 1985 to 1992. Twenty-seven patients (41%) has been treated with anti-H2 drug, either medical care or Jerkily "a la demande": 12 patients have been treated several years. Of the 66 patients: 52 (89%) were operated on while the other 16 received medical treatment because of the extension disease and their precarious condition. Long-term 35 (67%) patients (of the 52 operated) died four years later, independently of the stage and PKT of the first and the second level. The 27 patients treated with anti-H2 drug showed the most undifferentiated grading and 88% belong to the third and the fourth stage; moreover 81% underwent first diagnostic endoscopy notwithstanding a clinical and surgical history of gastric ulcer. Is it possible, therefore, that anti-H2 drug delay the diagnosis.

[Diagnostic and prognostic value of the carcinoembryonic antigen in colonic cancer]. / Valore diagnostico e prognostico del CEA nel carcinoma del colon.

A group of 50 patients operated for carcinoma of the colon in June 1980-December 1981 with a follow-up period of min. 2 months-max. 15 months is presented. C.E.A. measurements were taken in all patients pre and post-operatively and then every 2 months in an attempt to establish its diagnostic and prognostic value. In immediate diagnostic and prognostic terms, pre-operative C.E.A. appears to be insignificant. However both pre-operative C.E.A. and C.E.A. at a distance of 6 months were found to be reliable for long term (max. 15 months) prognosis.

Rupture of thoracic aorta resulting from blunt trauma.

BACKGROUND: Traumatic rupture of thoracic aorta caused by blunt trauma has been observed more frequently in recent years. The aim of this study was to evaluate the state of the art of diagnostic methods used to identify this injury and the surgical techniques used to repair it. METHODS: The study was performed in 29 patients undergoing surgery for traumatic rupture of thoracic aorta from November 1979 to July 1995. RESULTS: All patients presented multiple blunt traumatic injuries. The suspicion of traumatic aortic rupture always arose when evidence of an enlarged mediastinal shadow was found on the chest X-ray, subsequently confirmed in 27 cases using aortography. During the period 1993-1995 11 patients underwent CT scan before aortography, which resulted false negative in 3 cases (27.2%). The decision to perform surgery was based on well defined priorities: abdominal injuries took priority over the aortic injury, and in stable patients with intracerebral injuries, head CT scan and neurosurgery were performed first. Eight patients died (overall mortality was 27.5%). CONCLUSIONS: CT scan should not be used for the diagnosis of aortic traumatic rupture because it is a waste of time (all patients have to undergo aortography before surgery) and the false negative rate is too high.

[Peripheral nerve injuries during carotid endarterectomy]. / Lesioni nervose periferiche durante l'endoarteriectomia della carotide.

Our experience with patients undergoing carotid endoarteriectomy over a 10 year period has been retrospectively reviewed. Nerve injuries were detected by reviewing postoperative progress and clinical notes. One hundred thirty-four procedures were performed on 120 patients, to 15 of whom (9%) occurred major nerve injuries. These included seven vagal nerve injuries causing ipsilateral vocal cord paralysis and hoarseness, five injuries of the marginal mandibular nerve and three injuries of the hypoglossal nerve. None of the patients with nerve injury had a stroke as a result of carotid operation. Vocal cord paralysis was documented by laryngoscopy. The incidence of cranial nerve injury during carotid endoarteriectomy appears to be higher than expected, particularly if asymptomatic patients are controlled.

[Follow-up in femoral artery embolectomy]. / Risultati a distanza nell'embolectomia dell'arteria femorale.

The results of 112 femoral embolectomies performed on 100 patients were reviewed. Operative mortality rate was 15% and early amputation (within 30 day-after the procedure) 18%. The role of early amputation was closely related to the time of leg ischemia. Current follow-up as established for 86 patients. 5 years and 10 years survival rates for the group were 49% and 40%. Although early survival is decreased after femoral embolectomy long term survivors can be expected to live independently with excellent limb salvage and function.

[Popliteal aneurysm. Our experience in 65 cases]. / Gli aneurismi poplitei. La nostra esperienza in 65 casi.

Fifty patients with 65 popliteal aneurysms underwent reconstructive procedures (mean age 64). Atherosclerosis is almost the exclusive cause of popliteal aneurysms. Most of the cases showed an acute ischemia, while he others were asymptomatic or presented a complication of venous occlusion or neural compression. Numerous cases were found incidentally at amputations (these were not included). The best operational method is ligation of the aneurysm sometimes with partial resection and autologous venous graft bypass. The immediate results were excellent in all cases, loss of limb was observed in only three.

[Aneurysms of the abdominal aorta in patients 80 and over years of age. Long term results]. / Aneurismi dell'aorta addominale in pazienti ottantenni ed ultraottantenni. Risultati a distanza.

During a thirteen years period 29 patients 80 years of age and older, underwent surgical procedure for abdominal aortic aneurysm. There were 9 elective aortic reconstructions and 20 ruptured abdominal aortic aneurysms (AAA) repairs. Perioperative mortality after elective AAA resection was 33% vs 50% after ruptured AAA (a postoperative period of 30 days was considered). Comparison of survival following aortic reconstruction in 14 patients with survival of general population matched for age, sex and race, is not significant.

[Intramural hematoma of the duodenum. Diagnosis and therapy]. / Ematoma intramurale del duodeno. Diagnosi e terapia.

Two cases of intramural haematoma of the duodenum caused by injury are examined. The clinical signs were non-specific: vomiting and epigastric pain. The salient features of laboratory tests were leucocytosis and hyperamylasaemia. Radiography of the digestive tract revealed classic bunching of the mucous plicae in the second section of the duodenum in one case and a mark on the gastric antrum together with a clear stretch in the third duodenal section in the other. Surgical examination and drainage of the haematoma was performed in one case while the other was given conservative treatment. Both patients were clinically cured on release from hospital.

[Treatment of esophageal reflux by insertion of Angelchik prosthesis: analysis of the follow-up in 26 patients]. / Trattamento del reflusso esofageo mediante posizionamento di protesi di Angelchik: analisi del follow-up in 26 pazienti.

The authors report a retrospective analysis of the immediate and long-term results of treatment of gastroesophageal reflux refractory to medical therapy using the insertion of Angelchik's prosthesis in a group of 26 patients operated at the Institute of Emergency Surgery of Turin University from January 1980 to December 1993. All patients underwent pre- and postoperative endoscopy and were then controlled using esophagogastric X-ray, esophagogastroscopy, esophageal manometry and pH-metry in the event of disorders of esophageal motility. Operative mortality was nil and no major surgical complications were reported. Postoperative endoscopy showed the resolution of esophagitis in 23 patients (88.4%); symptoms of slight esophagitis persisted in 2 cases, and moderate esophagitis in another. Eighteen patients were monitored over time with a minimum follow-up of more than 2 years: persistent dysphagia appeared in 3 cases (16.6%), and in one patient this led to the need for endoscopic dilatations. Two patients (11.1%) presented "gas bloat syndrome" which gradually improved. It was never necessary to remove the device. No cases were observed of erosion, migration or destruction of the prosthesis. Follow-up exceeded 10 years in 7 patients, at present asymptomatic. Angelchik's prosthesis proved to be efficacious, rapid and simple to insert, and characterised by a lower morbidity rate and shorter postoperative course. The incidence of postoperative dysphagia makes only it is use indicated only in patients with a high operative risk, obese subjects and in case of recidivation of reflux after fundoplication.

[Emergency surgery problems: selective decompression of esophagogastric varices]. / Problemi in chirurgia d'urgenza: la decompressione selettiva delle varici esofago-gastriche.

The physiopathological premisses of portosystemic anastomosis and the modern approach to this question are explained. Stress is laid on the general and haemodynamic advantages offered by selective shunts and 6 cases (4 distal splenorenal and 2 coronarocava shunts) are presented. As yet the postoperative period is not long enough to enable a final judgement to be formed. However, it can be stated that the success of this form of management is primarily determined by the proper choice of candidates, i.e. patients with non-decompensated initial cirrhosis and unimpaired portal hepatic flow.

[Esophagogastroplasty in upper esophageal lesions. Apropos of 4 cases]. / L'esofagogastroplastica nelle lesioni esofagee alte. A proposito di 4 casi.

Oesophagogastroplasty has been performed in 4 patients in the Turin Department of Emergency Surgery. Three of them presented high neoplastic lesion of the oesophagus, while the fourth was suffering from mediastinic compression due to sclerosing mediastinitis. The technique and results are reported in detail. Indications for surgery for both malignant and benign lesions are presented. The real advantages of the operation with respect to stomach to chest transposition and oesophagocolonplasty which have in the personal series created considerable inconvenience, are discussed. The reasons making it necessary to carry out the operation in two stages, with different modalities, are also discussed. Complications are indicated and postoperative treatment discussed. This plays a notable part in the success of the operation, as does correct technique.

[Long-term results of gastric resection with reconstruction, using the Billroth I method]. / Risultati a distanza della resezione gastrica con ricostruzione secondo Billroth I.

Clinical, radiological and endoscopic results at follow-up about 1-5 yr after surgery in a series of 62 patients subjected to Billroth I resection are compared with those in the literature. Recurrence of ulcers was observed in 8% (as opposed to 5% with the Billroth II). In addition, there was a marked reduction in the incidence of post-resection diseases, with less serious forms of dumping, sounder digestion, and smaller weight losses.

The integration of vascular surgical techniques with oncological surgical protocols in the treatment of soft tissue sarcomas of the limbs.

Soft tissue tumors, involving the vascular bundle, require a particular surgical approach: oncological and vascular surgical techniques must be integrated in order to perform a limb-saving surgery with adequate margins. Thirty-six soft tissue sarcomas of the thigh and popliteal region were treated from June 1999 to September 2002. Nineteen cases involving the vascular bundle were analysed and placed in two groups according to imaging and clinical information: Group A, 14 patients, with tumors close to femoral vessels without adventitial infiltration, and Group B, 5 patients, with vascular infiltration. Group A was treated with vascular blunt dissection performing adventitial excision. Group B was treated with vascular "en-bloc" resection and reconstruction. Imaging and clinical information together with surgical techniques, strategies and complications were analysed in order to plan the surgical approach in neoplastic vascular bundle involvement.

Echocolor Power Doppler with contrast medium to evaluate vascularization in lesions of the soft tissues of the limbs.

PURPOSE: Echocolor Power Doppler with contrast medium forms a non-invasive vascular image; the purpose of the study is to evaluate the effectiveness in differentiating benign and malignant tumors in the soft tissues of the limbs. MATERIAL AND METHOD: Echocolor Power Doppler with contrast medium was used to study 80 patients with swelling in the soft tissues of the limbs: there were 54 benign lesions, 22 sarcomas, and 4 aggressive desmoid fibromatoses. RESULTS: Were identified 4 patterns of wash-in and wash-out curves that could be correlated to the histological diagnosis: type I was present in 85% of benign lesions, type III in 91% of malignant lesions and in 3.7% of the benign ones, type II in aggressive fibromatoses, anomalous type in 4 benign lesions and 2 sarcomas; the curve was absent in 2 benign lesions. CONCLUSIONS: Power Doppler Echocolor with contrast medium can become a useful method to be associated with traditional imaging methods in the differential diagnosis of swelling of the soft tissues of the limbs.

Two-stage treatment of a secondary aortoesophageal fistula after thoracic endovascular aneurysm repair.

Secondary aortoesophageal fistula is a relatively rare but very often lethal complication that may develop after thoracic endovascular aneurysm repair (TEVAR). The clinical syndrome is well explained by the Chiari triad: midthoracic pain and/or dysphagia, and sentinel minor hematemesis followed by massive hematemesis. The incidence of this serious complication has increased with the growing number of patients undergoing TEVAR. This case report describes a patient who was seen in the emergency department at this hospital because of fever, sepsis and thoracic pain radiating to the back and unresponsive to drug therapy, diagnosed with a secondary aortoesophageal fistula and subsequently treated with a two stage surgical procedure.