[Gastric antral vascular ectasia (GAVE or watermelon stomach): a case report]

Gastric antral vascular ectasia (GAVE), recently described in literature, is an important cause of gastric bleeding. A case of great gastrectasia with vascular ectasia in an elderly male patient is reported. The lesion was characterized by great linear and brush folds along the antrum and body of the stomach, Endoscopically, this folds seems like the watermelon streakings. It could be an acquired lesion probably linked to traumatism on gastric mucosa.

Intraoperative H/R echography for carotid surgery

BACKGROUND

Intraoperative duplex examination can be used during carotid surgery to identify small technical defects (like anastomotic stenosis, intimal flaps or subintimal wall dissections) that cannot be easily found by palpatory manoeuvres. The objective of this clinical study is to correlate intraoperative duplex findings with early postoperative complications and with duplex data obtained during follow-up.

METHODS

From January 1993 to January 1996 we compared early and late postoperative complications that occurred after carotid surgery in two groups of patients: a group of 120 patients undergone intraoperative duplex compared with a group of 100 patients not undergone intraoperative ultrasound.

RESULTS

The percentages of early and late postoperative complications which occurred in the first group were respectively 7.5% and 4.2% contrary to 10% and 7% occurred in the control group.

CONCLUSIONS

Duplex constitutes a selective intraoperative method for carotid surgery, easy to use, enable to identify and immediately correct technical defects.

Symptomatic abdominal aortic aneurysm and "situs viscerum inversus." Diagnostic and therapeutic approach

BACKGROUND

We report one case of symptomatic aneurysm of infrarenal abdominal aorta in a patient symptomatic for acute abdomen.

METHODS

The patient was accepted at the Emergency Care Unit and the routine admission tests were taken. US of the abdomen revealed a <<Situs Viscerum Inversus Totalis>> (SVI) disposition of the organs and an aneurysm of the abdominal aorta below the renal arteries. Patient underwent an aorto-aortic straight graft

CONCLUSIONS

In this case-report we show SVI cannot be considered a problem in the surgical treatment of symptomatic abdominal aortic aneurysms.

Intestinal occlusion secondary to Morgagni-Larrey's herniation in an adult. Case report and analysis of the literature

Morgagni-Larrey's hernias are congenital diaphragmatic hernias, rarely observed and generally identified accidentally due to the lack of symptoms. The authors report a case of intestinal occlusion secondary to Morgagni-Larrey herniation in an adult recently observed and underline the aetiopathogenic aspects, the diagnostic tools and the clinical pattern. They suggest to consider surgical repair as a choice of treatment, also for asymptomatic patients.

[Laparoscopy in iatrogenic lesions of the colon during operative endoscopy]

Colonscopy is a standard diagnostic and therapeutic procedure that has its own morbidity. Colonic perforation is the dangerous complication of this procedure. Successful management of perforation by conservative or surgical treatment remains controversial. We report two cases, recently observed, of patients with colonic perforation occurring during therapeutic colonscopy treated with minimally invasive technique.

Reversal of Hartmann's procedure. Our experience

Hartmann's procedure has progressively changed its indications in the last years; nowadays they are reduced by the increasing of anesthesiology and the introduction of stapler devices. The introduction of staplers makes reconstructive operation easier and it contributes to a sensible increasing of reversal percentage after Hartmann's procedure. Video-assisted techniques make Hartmann's procedure possible for older patients with high-risk of post-operative general complications. The authors describe the results obtained with traditional and video-assisted reversal Hartmann's procedure, comparing with data from Literature.

[Cutaneous mechanical staplers. Our experience]

This paper reports the results of a trial, comparing the use of disposable skin staplers with conventional nylon or silk sutures in skin closure. This study began in 1986; 7274 patients undergoing elective and emergency operations were controlled during the postoperative period, 3 and 6 months after surgery. It was shown that skin clips instead of sutures decrease the operative time, produce wound healing with a good cosmetic results, and above all a significant lowering of the wound infection rate.

[Adenomyomatosis of the gallbladder. Our experience]

Adenomyomatosis is a rare affection of the gallbladder and it's infrequently reported in the Literature. Having observed eighteen cases of adenomyomatosis of the gallbladder in the last five years and considering the difficulties in making an early diagnosis of gallbladder cancer, the authors suggest the importance of cholecystectomy in this pathology.

[An unusual case of intramuscular hemangioma]

A case of cavernous-capillary intramuscular haemangioma is reported. The tumour was characterized histologically by a proliferation of capillaries, cavernous blood spaces, along with arterial and venous blood vessels, intermingled with striated muscle fibres and fat tissue. The complex mixture of vessels and the circumscribed margins of the tumour could support a congenital origin.

[Surgical treatment of cervical fistula after esophagogastroplasty (EGP)]

The authors report their experience on cervical anastomosis dehiscence in patients who had total esophagectomy and esophagogastroplasty for esophageal neoplasms. They describe, accurately and step by step, the plastic reconstructive technique (by using a vascularized transposed cutaneous flap), used to treat a symptomatic cervical fistula which occurred in 3 of the 24 patients who had esophagectomy and cervical-esophagogastroplasty. This kind of treatment led to complete healing of the fistulas, without clinical and radiological signs of fistula recurrence in all the patients treated.

[Primary torsion of the greater omentum. A case report and review of the literature]

The Authors report a case of acute abdominal syndrome, caused by primary torsion of the greater omentum. They describe the still unknown aetiopathogenetic factors, pointing out the problems of preoperative diagnosis.

[Deep venous thrombosis and surgery. Assessment of the main risk factors]

Deep venous thrombosis is a quite frequent pathology with a high degree of morbidity and death-rate. Two are the main problems of this disease: the risk of pulmonary embolism and outcome of a post-thrombotic syndrome, leading patients to infirmity. The patients max exposed to the risk of deep venous thrombosis are the surgical ones: the authors, with a retrospective study on 480 surgical patients, examine the risk factors mostly related with the onset of deep venous thrombosis. At the end they refer about connection between the risk factors studied and the clinical display of in surgical patients.

[Chemo-antibiotic prophylaxis in general surgery. A study of 1722 cases]

Up until now the problem of surgical infections has been one of the most important which surgeons must confront daily. In 1989 our Institute began programs for control and surveillance of surgical infections; these include, among others, the use of chemo-antibiotic prophylaxis protocols applied to all of the patients hospitalized for surgery. The authors report two years application of three protocols of chemo-antibiotic prophylaxis related to 1722 patients, in which we pointed out the passage from 27.6% of infected cases in the control group to 10.2% infected cases in one of the groups subject to prophylaxis. In these cases the antibiotic prophylaxis also acted reducing in a spectacular manner the incidence of clinically not significant infections.

[Subrenal coarctation of the aorta. Presentation of a clinical case]

Coarctation of abdominal aorta constitutes a rare group of vascular abnormalities, including segmental stenoses and extended hypoplasia below the restriction. Usually hypertension is the only clinical evidence. The natural history of the surgically untreated disease foresees a decline of life expectancy; while surgical operation permit an almost complete "restitutio ad integrum". The Authors report a case of coarctation of the abdominal aorta come to their observation whose particularly was determined by the absence of high blood pressure, the aortic stenoses being located under the renal arteries.

[Vascular microsutures with resorbable and nonresorbable sutures. A comparative study]

Modern technology has recently provided us with new resorbable suture material for use also in vascular surgery. Clinical use of these sutures has been impeded however by not little mistrust and by old dogmas without a rational experimental basis. We have therefore begun studies of two slowly resorbable materials, polyglactin 910 and polyglycolic acid, in comparison with two classic nonreabsorbable materials, nylon and polypropylene, used in experimental model of end-to-end anastomosis rats'infrarenal aorta, following up the healing process and its evolution after an interval. The results are discussed in relation to data collected from current literature.

Coagulation disorders and tumor markers in the diagnosis of pancreatic cancer

Twenty patients (42-80 years old of whom 9 women) affected by instrumentally ascertained pancreatic cancer (7 cases were operated on) were studied. In all of them the following coagulation indices (fibrinopeptide A, FpA; beta-thromboglobulin, BTG; platelet factor IV, PF4; fibrinogen degradation products, XDP) and tumor markers (gastrointestinal cancer associated antigen, GICA; tissue polypeptide antigen, TPA; carcinoembryonic antigen, CEA; alpha-fetoprotein, or AFP) were assessed at the time of diagnosis, and 10 and 30 days after diagnosis, to test whether and which of the above parameters are more sensitive for entertaining the underlying affection. In both operated and nonoperated patients FpA was shown to be the most sensitive index. Lesser sensitivity was shown by XDP, GICA, and BTG. AFP proved to be quite useless as its serum levels constantly fell within the normal range.

[Our experience in vascular trauma of the limbs]

Progress in the management of complex vascular injuries of the limbs has not eliminated the necessity for amputations. Physicians' failure to suspect vascular injury on admission in traumatized patients causes delay in the diagnosis and management of arterial injury that ultimately leads to limb loss. High index of suspicion, early recognition by clinical evaluation, routine use of Doppler flowmeter and broad indication of preoperative angiography result in prompt repair of these lesions in the majority of cases. In managing the lower popliteal or trifurcation vessels, distal radial and ulnar artery as well as nerve injuries, the Authors believe microsurgical techniques should always be employed.

[Total gastrectomy for cancer: personal experience with reconstruction of the alimentary tract]

Nineteen patients with total gastrectomy for neoplastic diseases were followed up from twelve to thirty months. Three different surgical reconstructive procedures were employed. Results are discussed and compared with those of the recent literature.

[Comparative diagnostic value of echography and oral radiologic examination of the gallbladder in relation to surgical findings]

For nearly 60 years, since it was introduced by Graham and Cole (1924), oral cholecystography (OCG) has been used as the imaging technique of choice in investigation of gallbladder disorders. Recently, the future of OCG has come into doubt, principally as a result of ultrasonography, with the advent of high-resolution real-time scanning. Stones are seen as echoes within the lumen of the gallbladder and are associated with an acoustic shadow, findings which are highly specific. On this basis, to evaluate the accuracy of ultrasonography in detecting cholelithiasis, the A. have performed by real-time cholecystosonography 60 patients with not diagnostic OCG in a group of 546 patients affected by gallbladder diseases. Our results have confirmed that sonography revealed 4 normal gallbladders, 51 gallstones and 1 primary gallbladder cancer, with 5 cases of false positive. The true false negative rate has been difficult to determine, as surgery is usually not performed after a negative study. The accuracy of cholecystosonography for gallstone diagnosis was found to be 88,1% for all three Crade's categories.

[Simultaneous and independent multifocal neoplasms of the large intestine]

The Authors report the presence of two simultaneous neoplasms of the large bowel which are independent of each other from the histological point of view. The Authors point out the more interesting aspects of this particular neoplastic pathology, which creates different clinical syndromes; diagnosis and therapeutic possibilities were investigated. The frequency of these neoplasms is not exceptional, and, therefore, the possible existence even in subjects having a single tumor of the colon or rectum should not be neglected.

[So-called cystic stump syndrome]

After outlining and discussing the etiology and pathophysiology of the postcholecystectomy syndrome, the authors describe their own series of 35 cases, therapeutic policies, and results obtained. In the discussion they suggest that the so-called cystic stump syndrome has probably been overplayed, since in the authors' own series of cases there was a high incidence of associated pathology.

[Anti-edema activity of injectable Venoruton in abdominal surgery]

The anti-oedema activity of an injectable drug (HR; active principle: 0-(beta-hydroxyethyl)-rutoside) was assessed in 60 gastric extrahepatic bile duct, and large intestine surgery patients (30 being used as controls). Gastroscopy (with biopsy), gastroduodenoscopy, colonoscopy (with biopsy) and radiological examination were usually performed on the 5th and 10th post-operative days. The drug showed significant therapeutic effects: rapid resolution of oedema, especially at the sutures, leading to early cicatrisation, canalisation and the prevention of dehiscence. Finally, duration of hospitalisation was less than in the untreated cases. The gastroscopic, radiographic and biopsy findings are considered to have shown clear evidence of the drug's action against oedema formation.

[Clinical study of a new preparation in the treatment of anorectal varices]

Sterectal is a new antihemorrhoidal drug which contains prednacinolone, lidocaine hidrochloride and ephedrine hidrochloride. The results of the double blind, between patient, clinical study carried out in order to detect effectiveness of Sterectal compared with placebo show that the new drug owns a more rapid onset of therapeutic activity and exhibits a greater reduction in symptom severity than placebo. Both treatments were well tolerated.

[Internal drainage of the thoracic duct in the surgical treatment of cirrhotic ascites. 3-year follow-up]

The results of reimplantation of the thoracic duct carried out in 22 patients suffering from cirrhotic ascites refractory to medical therapy are presented and analysed. 3-year survival was 54,5% with disappearance of the ascites in 83% of cases. Other conditions being equal, these results are superior to those obtained with porto-systemic shunt.