[Angiodysplasia of the right colon]. / Angiodisplasia del colon destro.

Ascending colon angiodysplasia is a frequent cause of colorrhagia or chronic blood loss in old patients, but also possible under the age of 55. Angiodysplasia diagnosis is often underestimated. For a long time colorrhagia or lower intestinal bleeding were generally diagnosed like diverticular bleeding. This conclusion was the result of several conditions: the conservative management of distal gastrointestinal bleeding is in most cases successful; the double dye clysma was the first and the main diagnostic procedure for many years and the result was a not correct diagnosis of diverticular bleeding since large bowel diverticulosis is always present in the elderly. The authors report on three cases of low intestinal bleeding where the diagnosis of angiodysplasia in the first patient was performed by upper mesenteric artery arteriography, in the second by preoperative colonoscopy and after confirmed by the histology of the specimen and in the last one by colonoscopy performed in emergency and after intestinal irrigation. The first patients refused the operation; the second had right hemicolectomy and the third one had a spontaneous stop of bleeding. According to their clinical experience the authors suggest that colonoscopy performed in emergency or intraoperative is the first choice diagnostic procedure: it can detect the source of bleeding between right or left colon. Arteriography often shows vascular images characteristic for angiodysplasia or other vascular malformations but, in our experience, it may be absolutely not diagnostic. Colonoscopy performed in emergency during bleeding or per-operative is the best procedure in order to diagnose the source of bleeding. Emergency colonoscopy can distinguish if the blood is coming from the right or left colon and in our experience, colonoscopy during bleeding is always possible because blood has a cathartic effect. In case of emergency operation pre-operative colonoscopy can usually detect the source of bleeding. A double dye clysma, whether barium or hydrosoluble doesn't give a diagnostic support in low intestinal bleeding; on the contrary it can prevent a correct arteriographic and endoscopic evaluation. At last histopathological findings on the specimen are conclusive for the diagnosis.

[Congenital duodenal stenosis. A case treated in adulthood]. / Stenosi duodenale congenita. Su di un caso trattato in età adulta.

The authors report their experience the diagnosis and management of congenital duodenal malformation in adults. They emphasize problems and difficulties in this disease of pediatric age and the physiopathological adaptation in these years. They point out that surgery can modify important metabolic functions and sub-clinical pathological conditions that the malformation made up.

[Surgical treatment of liver metastases of colorectal carcinoma. Our experience and review of the literature]. / Il trattamento chirurgico delle metastasi epatiche da ca. colo-rettale. Nostra esperienza e revisione della letteratura.

The authors describe their personal experience of the surgical treatment of hepatic MTS caused by colon-rectum ca. Following a review of the literature, including therapeutic protocols which do not always agreed, the problems inherent to the number, site, size and appearance of MTS themselves are discussed. Different approaches are compared in an attempt to clarify this pathology about which still very little is known. There is often uncertainty regarding the cases which should be treated surgically, and there is certainly a need for a greater number of case studies so as to avoid relying on the sensitivity and experience of the individual surgeon.

[Reimplantation of the inferior mesenteric artery during surgery of abdominal aortic aneurysm. Current trends]. / Il reimpianto dell'arteria mesenterica inferiore nella chirurgia dell'aneurisma aortico addominale. Moderni orientamenti.

After a review of world literature and on the basis of personal experience, the problem of ischaemic colitis following abdominal aortic aneurysmectomy is examined. After remarks on the aetiopathogenesis and clinical picture of the condition the paper stresses the need for early detection of patients at high risk, to prevent a clinical picture that is insidious but serious and tends to develop rapidly. The use of preoperative angiography to study the SMA and IMA as well as intraoperative stump-pressure measurement is considered essential. The paper concludes that ischaemic colitis following abdominal aortic reconstruction can be avoided in a large percentage of cases by IMA implantation on the Dacron prosthesis, a surgical technique that is easy and not time-consuming.

[Surgical therapy of the kinking of the internal carotid artery. Indications and limitations]. / La terapia chirurgica del kinking della carotide interna. Indicazioni e limiti.

Surgical treatment of a case of symptomatic kinking of the internal carotid suggested a review of the problem on the basis of the national and international literature. Opinions are not only extremely distant but not infrequently antithetical. In such a heterogeneous subjects that is often difficult to interpret, the most interesting approaches are examined in the light of new experimental and clinical findings.

[Second look yes, second look no, in the surgical therapy of intestinal infarct]. / "Second look sì", "second look no" nella terapia chirurgica dell'infarto intestinale.

The thorny second-look problem is examined on the basis of personal experience of 65 cases of intestinal infarction over a period of 10 years. The medical literature is particularly lacking in indications on this point and only from careful assessment of reported experience and personal experience itself has it been possible to find indications and limitations. Data are reported which do not pretend to be absolute but do provide a useful aid for those faced with doubtful anatomopathological pictures during operation for acute intestinal ischaemia.