[Complicated diverticular disease of the colon: 5 years' experience in a provincial hospital]. / La malattia diverticolare complicata del colon: esperienza di 5 anni in un ospedale di provincia.

Colon diverticular disease presents in 10%-25% of cases when a complication arises. Helped by Hinchey's classification, the surgeon can choose from among the following therapeutic strategies: a) medical treatment; b) one-stage resection and anastomosis with or without a protective colostomy; and c) resection according to Hartmann. The increasingly widespread use of laparoscopic techniques, though generally improving surgical outcomes, has perhaps made the choice of treatment more difficult, because it has extended the range of indications, both in the elective and emergency setting. From January 1999 to December 2004 411 patients (174 men and 237 women) affected by symptomatic diverticular disease were admitted to our surgical department and 94 of these (22.8%) underwent surgery: 41 of them (43.6%) underwent a true emergency operation, while for 53 of them surgery was delayed (within one week). None of the patients undergoing resection-anastomosis had a protective colostomy. The total morbidity was 3.7% and total perioperative mortality 1% (one patient undergoing surgery with the Hartmann procedure). More than one year after the end of the research there was no need for operation of any of the non-surgical patients and no deaths due to diverticular disease were recorded. On the basis of our experience we may conclude that a one-stage resection, even in the emergency situation, is possible and yields excellent results, while preventive resection would not currently seem justified.

[Merkel cell carcinoma: a report of two cases]. / Carcinoma a cellule di due osservazioni.

The Authors report two cases of Merkel cell carcinoma and describe their diagnostic and therapeutic difficulties in the management of these tumours. The main therapeutic problem consists in establishing the size of the excision margins in relation to the neoplastic aggressiveness. The first case was characterised by major lymphophilia and by a tendency to relapse. Radical excision was achieved by low invasive surgery using a radioguided technique to search for microscopic disease. The radioguided technique takes the place of the intra-operative anatomo-pathological examination. After adjuvant ra- diotherapy and chemotherapy the patienthas remained in remission for three years. The second case is characterized by a rapid haematic diffusion with metastasis and exitus after one year. Radiotherapy and chemotherapy were ineffective. In this case surgery was limited to a bioptic approach since extirpative surgery would have been inappropriate. Our experience shows the wide biological variability of Merkel cell carcinoma and the importance of eclectic treatment to avoid ineffective extirpative surgery.

[Traumatic rupture of the pancreatic isthmus complicated by concomitant rupture of the duodenum and right kidney]. / Rottura traumatica dell'istmo pancreatico complicata da rotture concomitanti del duodeno e del rene destro.

The Authors describe a case of complete traumatic transection of the pancreatic isthmus associated with complete transection of the first portion of the duodenum and the isthmus of a horseshoe kidney. The treatment of the pancreatic lesion was intestinal drainage of the distal portion of the pancreas and closure of the proximal one. The authors stress the advantages and good outcome of the conservative operation, performed at an early stage, with the clinical indications and adequate surgical techniques.