[Use of mechanical staplers for the solution of proctological problems. Our experience with 122 patients]. / Uso della suturatrice meccanica nella risoluzione di problematiche proctologiche. Nostra esperienza relativa a 122 pazienti.

The Longo technique using a circular stapler has changed haemorrhoid therapy. Thanks to the advent of this technique for treating haemorrhoids without excision, we can now successfully eliminate the mechanism responsible for their pathogenesis. The aims of circumferential stapled anoplasty are to correct the anodermal prolapse and restore the haemorrhoidal cushions to their anatomical position. Furthermore, with a few variants the technique can be utilised for other proctological problems, such as obstructed defecation in rectocele and incomplete internal prolapse (or rectal intussusception). The authors report on their experience in a consecutive series of 122 cases undergoing circular stapled anoplasty for haemorrhoids, associated in 10 cases with rectocele or rectal intussuscep-tion, analysing early and late complications after an accurate follow-up. The procedure can be performed with local or spinal anaesthesia. The operation lasted on average 19 minutes. There were few complications: early bleeding (4.9%), late bleeding (0.8%), mild stricture (2.5%) and thrombosis of external piles (8.2%). This new surgical technique is effective and rapid, causes only minimal postoperative pain and could be proposed as an alternative to traditional surgery also in the day surgery setting.

[Abdominal tuberculous lymphadenitis simulating pancreatis cancer]. / Linfoadenite tubercolare addominale simulante un carcinoma pancreatico.

The Authors report the case of a patient symptomatic for fever, weight loss and abdominal pain submitted to abdominal sonography and CT which identified a mass of the pancreatic head. The patient underwent laparotomy plus biopsy; the istologic and bacteriological diagnosis demonstrated a tuberculous lymphoadenitis in spite of a normal cutaneous tuberculin test. Abdominal localization of TBC infection therefore is increasing in epidemiological studies, and thus it must be included in the differential diagnosis of subdiaphragmatic disease.

[Vascular bench surgery in renal transplant]. / Chirurgia di banco vascolare nel trapianto di rene.

The development in the number of patients for renal transplants has not been matched to the kidneys supplied. On this subject the authors think that this chronic deficit could be improved by making use of all the organs by using a series of technical means during bench surgery; which enable optimisation of use of kidneys with vascular abnormalities or those injured upon removal. The authors report their experience of 450 renal transplants operated between January 1981 and December 1985 and of the evolution vascular bench surgical techniques which enable use of a considerable number of kidneys which would otherwise have been discarded. Moreover, it helped the implant, shortened surgery time without prolonging hot ischemia, and did not increase the number of complications.

[Renal transplantation in patients over 60 years of age. An increasing clinical reality]. / Il trapianto renale nei pazienti ultrasessantenni. Una realtà clinica in aumento.

The elevation of the uremic population age, the longer survival of dialysis, the increasing number of elderly donors, together with the safer surgical, anesthesiological and immunological procedures have led all over the word to an improvement of over 60s patients transplantation program, with very good results. The authors present their own experience of renal transplantation in elderly recipients and a review of what is reported in the literature on the question.

[Retrorectal hamartomatous cysts or "tail gut syndrome": a case report and review of the literature]. / Cisti amartomatosa retrorettale o "tail gut syndrome": caso clinico e revisione della letteratura.

Retrorectal cyst hamartomas or so called tail gut syndrome are dystopic lesions, rarely reported in Literature, characterized by the presence of cysts lined by mucous-producing ciliated epithelium. The Authors report a case, recently observed and surgically treated, in a 55 year old male, hospitalized because of an abscess and fistula in the right buttock diagnosed to be a cyst hamartoma. The Literature is reviewed as well.

[Pregnancy in women undergoing a kidney transplant. Our experience and a review of the literature]. / Gravidanza in donne sottoposte a trapianto renale. Nostra esperienza e review della letteratura.

The chances of pregnancy for uremic women are usually very low, because of hormonal balance changes which determine a strong reduction in fertility. Epidemiological studies reveal that pregnancy in hemodialyzed women in fertile patients 4.6-6 months after a well functioning kidney transplant, one fertile transplanted woman over 50 can become pregnant. In the first transplant era, pregnancy after kidney transplant was considered "a big hazard", especially because of the possible side-effects of immunosuppression drugs on foetus development, and the risk of a worsening in the mother's renal function. Therefore, women were strongly recommended to avoid pregnancy. More recently, several reported papers have shown that pregnancy can be safely carried on also by transplanted women, under careful criteria and monitoring. Our experience too, even if limited in number (4 patients) reported in this article confirms this conviction.

[Technique of vascular reconstructive bench surgery in pancreas transplantation]. / Tecnica di chirurgia ricostruttiva "su banco" degli assi vascolari nel trapianto di pancreas.

Vascular reconstructive bench surgery has become a basic step in pancreas transplantation, in order to prevent vascular thrombosis. The Authors describe their experience, also reporting literature results.

[Interstitial radiotherapy with 125I in non-resectable pancreatic carcinoma]. / Radioterapia interstiziale con 125I nel carcinoma pancreatico non resecabile.

The authors analyze results of 220 patients suffering from pancreatic cancer treated in their department from 1982 to 1992. Among these patients 24 of them underwent surgical operation for positioning of radioactive pills. The discussion is on indication and results of this technique, considering also what's reported in scientific literature on the argument.

[Malignant neoplasms arising "de novo" after a kidney transplant. Our experience and a review of the literature]. / Neoplasie maligne "de novo" insorgenti dopo trapianto renale. Nostra esperienza e revisione della letteratura.

The incidence of "de novo" cancers in kidney transplanted patients, especially because of immunosuppressive treatment, seems to be increased. The authors analyse their experience and review the literature.

[Diverticulitis of the appendix: a rare cause of acute abdomen]. / La diverticolite dell'appendice vermiforme: rara causa di addome acuto chirurgico.

Diverticulosis of the vermiform appendix, either single or multiple, congenital or acquired, is rather infrequent and usually asymptomatic. However, it may be complicated by flogosis configuring an acute abdomen hardly recognizable from an acute appendicitis not related to the diverticular disease. The Authors report a case of acute appendicular diverticulitis surgically treated. A brief review of the literature is also reported.

[Isolated unilocular hydatidosis of the kidney: a rare clinical event]. / Echinococcosi granulosa isolata del rene: evenienza clinica rara.

The authors report a case of granulomatous hydatid disease of the kidney recently observed in a 47-year-old female patient with a preoperative diagnosis of nephrolithiasis. The rarity of the location and the likely asymptomatic nature of the disease are, in the authors opinion, of clinical and scientific interest.

[Extensive resections in rectal carcinoma. Our experiences]. / Resezioni allargate del carcinoma rettale. Nostre esperienze.

The authors review their experience in the surgical management of rectal cancer. They analyze rectal malignancies and their recurrences from natural history to surgical strategies and survival rates. In particular, the need to perform extended operations in order to offer patients a better prognosis is discussed.

[Multiple hamartomas of the bile ducts (MBDH) or von Meyenburg's complex]. / Amartomi multipli dei dotti biliari (MDH) o complesso di Von Meyemburg.

Multiple bile duct hamartomatosis of the liver or so-called von Meyenburg's syndrome, is an infrequent disease related to a dysembryogenic error. The authors discuss clinical features, diagnostic methods and possible related pathologies. Data reported in the literature are also received.

[Aneurysms of the visceral arteries: the diagnostic problems and therapeutic strategies]. / Gli aneurismi delle arterie viscerali: problematiche diagnostiche e strategie terapeutiche.

Intestinal artery aneurysms are a rare clinical condition, usually asymptomatic. However, sometimes they occur as vascular emergency, with a mortality rate of about 75%. Therefore, their occasional diagnosis should be carefully considered as an indication for elective surgery. The authors report their experience in the surgical management of 3 cases of intestinal artery aneurysms respectively involving the splenic, the gastroduodenal and the inferior mesenteric artery. A review of the literature is also presented.