Fecal neutral steroids in normal conditions and in patients with polyps or cancer of the large bowel.

There is evidence suggesting that the excretion and conversion of neutral sterols in the human large bowel might be somewhat related to the development of colorectal cancer. Therefore, our objectives were: to characterize the excretion and the major pattern of sterol degradation in normal conditions, both in children and in adults; and to investigate if abnormalities of these parameters are frequent in patients with colorectal cancer or polyps. The study has been carried out in: 38 adult volunteers; 29 children divided into 4 age groups; 22 patients with colorectal cancer; 16 members of 6 families with adenomatosis coli; 15 members of 2 families with a high prevalence of multiple polyps or cancer of the large bowel; 12 subjects with colorectal polyps without familiality. With the subjects kept under metabolic control, fecal samples were collected for at least 3 days and analyzed by thin layer chromatography and gas-liquid chromatography. Total neutral steroid excretion was lower in children than in adult volunteers; in contrast, there was no significant difference between the latter and the other investigated group of patients with cancer or polyps, with values ranging between 230 and 680 mg/day. All the adult volunteers were "high converters" of cholesterol to its intestinal metabolites coprostanol and coprostanone [89 +/- 10% (SE) of degradation]. Children less than 1 year old degraded little or no cholesterol (10.4 +/- 6% of total neutral sterols), whereas with increasing age the fraction of conversion became more similar to that of adults. In patients with colorectal tumors 2 populations could be defined, one characterized by a large degradation of cholesterol and the other by little or no conversion. Low degradation of cholesterol was found in 3 of 6 families with adenomatosis coli. In conclusion, we did not find any significant difference in total neutral sterol excretion among controls, colorectal cancer patients, or subjects at risk. In adult volunteers the normal pattern of cholesterol degradation is characterized by a large conversion of cholesterol to its intestinal metabolites. In children this process changes with increasing age from an absolute "nonconverter" state (after birth) to the pattern typical of adults. Finally, in a minority of patients with either polyps or cancer of the large bowel and of their first-degree relatives, cholesterol is poorly degraded and represents the most abundant fecal sterol.

[Clinical and lymphographic findings in miliary tuberculosis with tuberculin anergy. Considerations on a case]. / Rilievi clinici e linfografici in corso di tbc miliare con anergia alla tubercolina. Considerazioni su un caso.

Abdominopelvic lymphadenography conducted with due care in a patient with miliary TB and anergy to tuberculin ruled out alterations attributable to retroperitoneal lymphomatosis, and revealed a picture of miliary lymphadenitis. Splenectomy induced positivisation of the reaction to tuberculin and paved the way for a favourable response to anti-TB chemotherapy.

[New approaches in the diagnosis of pelvic recurrence after the Miles intervention]. / Considerazioni sui nuovi indirizzi nella diagnosi di recidiva pelvica dopo intervento di Miles.

The Authors refer some diagnostic and therapeutic observations about pelvic-perineal recurrence after abdominal-perineal excision of rectum (AAP). They analyze new possibilities of diagnostic instrumentation, in particularly TC and RM scanner, comparing the results and valuing the sensibility and specificity in a selected group of patients.

[Rubber band ligation of hemorrhoids. Our experience]. / La legatura elastica delle emorroidi. Nostra esperienza.

The authors present their series of rubber band ligation of hemorrhoids performed from 1991 to 1994 in the Unità di Colon Proctologia of Modena, that is located in the Second Division of Surgery of the Surgical Department of Modena University. In that period 158 patients were treated. Age range was between 17 and 93 years old, and patients were affected by II and III degree of hemorrhoids. The complications verified were: 14 cases of recurrence (8.8%), 2 cases of severe bleeding, no case of perineal sepsis or urinary retention. Other complications of less importance were 89 cases of pain (56.3%), not severe bleeding in 23.41% of patients. Results show that this method of treatment of hemorrhoids, used by experts, is the first choice treatment of this pathology.

[Diagnostic and therapeutic reflections on polyps and polyposis of the large intestine]. / Riflessioni diagnostico-terapeutiche sui polipi e poliposi del grosso intestino.

The systematic employment of pancolonoscopy in patients with diseases of the large intestine has shown that histological typing is essential when a polyp or polyposis is observed, since this is the only way prognosis can determined, and is only possible through endoscopic polypectomy. Familial investigation is also mandatory. If its findings are positive, every "polyp", irrespective of its number, site, and distribution, is a possible sign of polyposis. In this context, rectum preservation techniques are justified in relation to factors associated with both the polyp itself and its host.

[Stomach polyps. Clinical and therapeutic considerations]. / Polipi dello stomaco. Considerazioni cliniche e terapeutiche.

The main clinical and therapeutic problems of gastric polyps are examined on the basis of 7 personal cases and the literature on the subject. 5 of the cases were adenomatous polyps proper, one of them in malignant degeneration and associated with polyposis of the large intestine. In 2 other cases, the histopathological picture revealed Peutz-Jeghers type hamartomatosis polyps confined to the gastric region without the typical cutaneo-mucous stigmata or familial character. Classification of polyps must allow not only for aetiopathogenetic or clinical criteria but for histopathological and histogenetic criteria also. A clear-cut distinction must be made between adenomatous polyps, of definite malignant potential, and pseudoneoplastic polypoid lesions that are essentially benign. The main diagnostic techniques available to handle a symptomatology that is often oligosymptomatic and aspecific, or associated with complications (such as ulcers, haemorrhage, stenosis or, not least, malignant transformation) are reviewed and stress laid on the importance of endoscopy prior to histopathological study which is of value only if carried out on a totally removed polypous lesion. The guidelines for indicating and selecting the radial surgical technique are presented.

[Circular myotomy in the reconstructive therapy of esophageal atresia. Experimental study in the rabbit]. / La miotomia circolare nella terapia ricostruttiva delle atresie esofagee. Studio sperimentale nel coniglio.

The authors report their experimental results in 22 rabbits subjected to circular myotomy of the esophagus, with radiological followup and final autopsy verification. This relatively simple surgical procedure may prove valuable for the correction of neonatal atresia of the esophagus; in particular, when done upon the cranial stump, it affords primary anastomosis of the viscus without undue tension even in cases of faulty esophageal continuity involving a length of several centimeters.

[Costs of cholecystectomy after the arrival of video-laparoscopic surgery]. / Costi della colecistectomia dopo l'avvento della chirurgia video-laparoscopica.

The authors proceeded to point out the hospital stay costs and the operating-room costs of the cholecystectomy after the introduction of the laparoscopic technique, underlining the higher economic advantages. The total unit cost for laparoscopic cholecystectomy, even if there are higher costs due to the surgical equipment, thanks to the mini-invasive approach and to the reduced hospital stay, results lower (17%) then the total unit cost for laparotomic cholecystectomy (L. 3.982.489 vs. L. 4.825.300). Let us suppose that in the Emilia Romagna Region an 80% of patients underwent to laparoscopic cholecystectomy and only a 20% underwent to laparotomic cholecystectomy: in this case there could be the economic savings of L. 3.777.478.902 and concerning the hospital stay there could be the savings of 17.928 days too. This cost estimation is important if we consider that the rate of cholecystectomy procedures, in our local area, per 1000 inhabitants, increased from 2.29 in 1990 to 3.99 in 1992 (rate of increase: 74%).

[Evaluation of costs in surgery of inguinal hernia. Day surgery and one day surgery versus ordinary admission]. / Valutazione dei costi nella chirurgia dell'ernia inguinale. Day surgery e one day surgery versus ricovero ordinario.

The authors have completed an analytic research about costs of hospitalization and treatment for inguinal hernioplasty and costs of anesthesiologic and surgical techniques and hospitalization regimen. The authors consider possible in about 50% of cases the tension-free hernioplasty carried out with local anesthesia and day or one day surgery regimen and they have estimated that it is very less costly then traditional herniorraphy carried out with general anesthesia and hospitalization: L. 1.056.075 versus L. 2.252.650. In Emilia-Romagna we could have a considerable cost-saving, even if only the 50% of patients treated for uncomplicated inguinal hernia every year (7.133 patients with mean hospital stay = 5,8 days and total hospitalization = 41.731 days during 1993) could benefit by treatment in one day surgery regimen. In fact, leaving out of account the advantage of the rapid return the patient to work, the costs of hospital stay, esteemed in L. 25.038.600.000, would be L. 8.558.700.000. A considerable increase of one day surgery hernioplasties should be expected by the hospital administration in budget planning.

[Hyperlipemias and obliterating peripheral arteriopathies]. / Iperlipidemie ed arteriopatie obliteranti periferiche

160 patients suffering from radiologically confirmed peripheral obliterating arteriopathy have been studied with respect to frequency of lipid alterations. The resulting data were compared with those observed in a group of clinically healthy subjects. In the arteriopathic series, lipid alterations were encountered in 44% of patients, with a percentage of 12.5% for Fredrikson type II, 7.4% for III and 24% for IV. In women, incidence attained 50% and type classification was 25% for the 2nd, 12.5% for the 3rd and 14.5% for the 4th. An alteration of 18.7% was encountered in the control group. The high frequency of hyperlipidaemia in peripheral vascular diseases reported in the literature and confirmed by the above data, justifies the employement of appropriate dietetic and pharmacological measures for the prevention and treatment of this arteriosclerotic disease risk factor.

Vertical subcutaneous pedicle flaps for posterior perineal reconstruction. Report of three cases.

PURPOSE: Loss of a certain amount of cutaneous tissue of the perineal region may be remedied by first intention with creation of cutaneous flaps, thus preventing second intention healing. METHODS: We present three emblematic cases in which the posterior perineal region was reconstructed by means of vertical subcutaneous pedicle flaps, subsequent to cutaneous tissue loss after surgery for extensive condilomas or neoplastic pathologies. RESULTS: Tissue loss was repaired by means of a V-Y type vertical subcutaneous pedicle flap, constructed laterally of the extirpation zone and advanced in a median direction. In all cases, no ischemia or infection of flaps occurred; sphincteral continence and long-term aesthetic results have proved to be satisfactory. CONCLUSIONS: Vertical pedicle subcutaneous flaps are well vascularized, extremely mobile, and easy to perform and have no serious postoperative complications.