[Complications of thyroidectomy: hemorrhage]. / Complicanze della tiroidectomia: l'emorragia.

The authors report their experience in haemorrhage after thyroid surgery. Haemorrhagic complications occurred in 5 cases in a series of 1803 sequential thyroidectomies (incidence: 0.27%). In particular, incidence was 1.9% after interventions for thyroid neoplasias (adenoma and carcinoma) and 0.18% after interventions for non-neoplastic thyroid pathology. Haemorrhage occurred always after "total" operations, even if monolateral. Causative and contributing factors, precautions and measures helpful in reducing the incidence and the potential dangerousness of haemorrhagic complications are discussed.

[Biomechanical-clinical interpretation of firearm wounds. General problems. IX. Propedeutic ABC of terminal ballistics]. / Lettura biomeccanico-clinica della ferita d'arma da fuoco. Problematica generale (Parte IX). Abbecedario di propedeutica alla balistica terminale.

In this chapter, the leading role is played by the mechanical-thermal-ballistic device, issued as a long-barrelled regulation firearm to modern armies. The most accurate description of this type of firearm and its present and possible future development seeks to be in line with the objective comparison between the biological matter and the mechanical material, which constitutes the essential basis for any optimal nosological, aetiological, or pathogenetic classification of bullet wounds. We should not forget that the advent of the M 16 A 1 has aroused great technical interest, particularly--though not only--as regards the hydroshock aspect, and that the technological developments in future can hardly fail to increasingly confirm the singular nature of bullet wounds, which refuse to be encompassed merely within the somewhat limited sphere of their strictly local effects, but carry a broader significance in a critical context open to further verification in the future. There can be no denying that this unique nature of modern bullet wounds makes them ideal candidates bearing witness to a new interpretation of traumatism, which at present is only in its infancy.

[Terminal ballistics. 1]. / Balistica terminale. 1a parte.

We have chosen to conceive of terminal ballistics as a violent and extremely rapid confrontation between two forms of resistance before the final state of rest is reached. This definition, which cannot help but don the admittedly loud and outlandish garb of physics, is the most promising for the purposes of biological interpretation. The main characters on this stage are two, but only one of these really plays the lead, namely the human target, which acts out the basic roles inherent in its physical make-up; the other, the bullet, remains a background figure, frozen in its walk-on part, and ready for the next performance. This modus operandi, which is no simplification, but rather an academic necessity, enables us to focus on images which stand out more clearly as a result of an intensive macroscopic spotlight which brings out the features of the individual phenomena, broken down into a succession of close-ups, and subtracts them from the cold physical nature of this or that form of inert matter, which here is merely an occasional, disagreeable witness, or even more, a standing from time to time for but one of the infinite facets of the biological composite being. Here, then, faced with a kind of exploded macrophotograph of a complex kaleidoscope, we see the animal universe, of which we capture so far the plasticity, the subdivisibility, the anisotropy and the cavitation.

[Terminal ballistics. 3]. / Balistica terminale. 3a parte.

This brief chapter, focusing essentially on a single topic, has been written in homage to Emile Theodor Kocker, a masterful exponent of the art of surgery and founder of the culture of terminal ballistics. For most of the literature we are indebted to Fackler and Dougherty, who, with the particular grasp, and fair of historians, act as guides on a trial which is only apparently retrograde, but which actually bears eloquent witness to the fact that even in the most physically tangible of arts, namely the art of surgery, inspired curiosity may help us to go well beyond the limits of our day and age. This chapter is also dedicated to the memory of another great surgeon, Vittorio Pettinari, who for one of the authors was an incomparable mentor and past-master of such curiosity.

[Biomechanical-clinical interpretation of firearm wounds. General problems. VIII. Propedeutic ABC of terminal ballistics]. / Lettura biomeccanico-clinica della ferita d'arma da fuoco. Problematica generale (Parte VIII). Abbecedario di propedeutica alla balistica terminale.

The Authors, consistent with their aim to compare and contrast the two protagonists of bullet wounds, namely the bullet and its soft human target, delineating their respective profiles, strengths and weaknesses, feel obliged to dwell at some length on the most frequently pathogenetic regulation firearms. Up until the early twentieth century bullet wounds could be generically classified among the forms of open traumatism, but with the advent of high-speed bullets they have come to take on a unique profile of their own, setting against the old permanent cavity due to mechanical insult a new type of transitory ghost, the definition of which as a cavity would merely be an oversimplification in theoretical terms. Can we really attribute this somewhat privileged dimension to bullet wounds today or must we relegate them once again to the sphere of mechanical traumatisms, albeit with a new inflammatory key to their interpretation, making the most in this sense of the contribution provided by the speed of the bullet? The literature is abundant, but uncertain; we intend to attempt an answer to this tricky question in the following pages, devoted more properly to terminal ballistics. Undoubtedly, the new speeds have had a substantial impact on the wounds inflicted upon the soft target, but the streamlining of the jacket has modified and even offset the results, giving rise to the unexpectedly humanitarian bullet, later subject to reappraisal in military quarters as tactically more efficient, because it obliges the enemy to employ greater resources for recovering, assisting and healing the wounded. We can safely claim that ballistic science in the field of light or portable firearms is experiencing a contradiction between the speed of the bullet and the streamlining of the jacket which makes this speed possible, but which undermines the efficacy of the often unconfessable results. Short-barrelled firearms, which on account of their defensive role, the alibi of their problematic access to speed, and their characteristic use as "last-chance" weapons, are less subject to international constraints and enjoy an extensive civilian market with specific claims to stopping power, thus become the true witnesses to a reality no different to the one Dum-Dum interpreted: the field of modern regulation firearms is shrouded in similar doubts, strengthened by the increasingly short barrels of the weapons, remedies and temptations, with, in addition, the increasingly precarious nature of the human element behind the firearm.(ABSTRACT TRUNCATED AT 400 WORDS)

[Biomechanical-clinical interpretation of firearm wounds. General problems. X. Propedeutic ABC of terminal ballistics]. / Lettura biomeccanico-clinica della ferita d'arma da fuoco. Problematica generale (Parte X). Abbecedario di propedeutica alla balistica terminale.

Any discussion of firearms which failed to take due account of the complex interaction between the weapon and its user would be missing the point. This interaction takes on a major role, particularly in the case of military ordinance weapons; their "optimal" use demands the maximum control of this interaction, which is of the utmost importance for the tactical role of the soldier-weapon system. The use of the latest long-barrelled ordinance firearms is more acceptable precisely because of their smaller calibre (which also means reduced interaction with the user). Today the traditional primacy of the long-barrelled weapon (now getting progressively shorter) is threatened by the short-barrelled gun cartridge, which we have seen used on an extensively scale in recent militia warfare. Paradoxically, it is precisely this cartridge, whose main shortcoming is its low propellant content (and thus reduced kinetic energy) which is expected to provide the kind of killing performance capable of snuffing out even "the dead man's last five seconds".

[Biomechanical-clinical interpretation of firearm wounds. General problems. XI. Propedeutic ABC of terminal ballistics]. / Lettura biomeccanico-clinica della ferita d'arma da fuoco. Problematica generale (Parte XI). Abbecedario di propedeutica alla balistica terminale.

The pathogenetic potentiality of firearms differs in relation to whether we are dealing with rifled long-barrelled weapons, handguns, or smooth-bore long-barrelled guns. Up until a few years ago, the tissue-damaging effect, at least in the modern warfare context, of short-barrelled or smooth-bore long-barrelled firearms, was thoroughly negligible; today, however, their impact, as causes of wounds and death, is steadily increasing, and for the first time small bullets designed for low-cost military training are also coming to play a primary role on the battlefield. At the same time short-gun bullets are appearing which, which in the name of "stopping power" seem to contradict the very definition of a handgun. The smooth-bore long-barrelled gun, in turn, is casting off the anti-humanitarian image of the trench gun to play the more suggestive ordinance role of the grenadiercumhunter.

[Terminal ballistics. 2. (The skin)]. / Balistica terminale. 2a parte (la cute).

It goes without saying that, at first glance, it is the velocity with which the fired bullet pierces the solid target and perhaps even penetrates it that bears witness to the efficiency of a firearm. Prior to the advent of ceramic and composite materials, iron and its clone, steel, provided the most satisfactory and most coveted evidence as a test material in both the positive and negative senses. It the biological field, wood and deal in particular were for decades the only witnesses, alongside tests in cadavers, which, despite obvious reservations, provided us with a wealth of data, much of which is still regarded today as among the mainstays of forensic didactics. Prominent among these, in terms of clinical importance, in that they mark the start of the bullet wound, are the velocity and energy thresholds per presentation area. The bullet, after overcoming the barrier of the skin, continues on its course through the soft tissues, and there leaves its most authentic and singular mark as a bullet wound.

[Anastomotic complications in the surgical treatment of rectal neoplasms]. / Le complicanze anastomotiche nel trattamento chirurgico delle neoplasie rettali.

The authors review the problems relating to the healing of colorectal anastomotic complications following anterior resection. They report on their own experience with 328 anastomoses, 281 of which constructed manually and 47 using a mechanical suturing gun. Following manual anastomosis, the reported incidence of clinical dehiscence was 1%, as against a 10.3% incidence of radiologically detectable dehiscence. In the cases of mechanically produced anastomoses the incidence of clinical dehiscence was 6.4%. In 2 cases stenosis developed as a result of the clinically manifest dehiscence following manual anastomosis. In the patients undergoing mechanical anastomosis, occlusion occurred in one case and stenosis in another, without any concomitant peri-anastomotic inflammatory processes; these complications were caused by a membrane extending between the margins of the anastomosis. The authors ascribe the greater incidence of clinically important dehiscence following mechanical anastomosis to a greater sensitivity of the mechanical suture to colonic contamination compared to the manual suture. According to the authors, the stenosis is attributable to inflammatory processes resulting from the dehiscence in the manual anastomosis cases and from the anastomotic structure in the mechanical-suture case.

[A rare case of colonic invagination due to leiomyosarcoma]. / Su di un raro caso di invaginazione colica da leiomiosarcoma.

The authors report on a case of leiomyosarcoma with intussusception of the large bowel. They stress the importance of the clinical suspicion in targeting preoperative instrumental instrumental investigations.

[Extended surgical resections of locally diffuse colorectal carcinoma (clinical cases)]. / La demolizione chirurgica allargata nel carcinoma colo-rettale localmente diffuso (casistica clinica).

The authors report on a study population of extended operations for locally spread colon-rectum cancer in the Verona Surgical Clinic over the period from 1971 to 1987 (114 surgical demolitions for colon-rectum cancer out of a total of 1294 operations). They report an overall 5-year survival rate of 41% and a 3-year survival rate of 59% with a perioperative mortality rate of 1.75%. A number of aspects of such extended operations are discussed, and, in accord with most other reports in the literature, the authors confirm the validity of the choice of this type of surgery.

[Behavior of TBII (TSH receptor binding immunoglobulins) in multinodular struma]. / Sul comportamento delle TBII (TSH receptor binding inhibitory immunoglobulins) nello struma multinodulare.

The authors consider the behaviour of TBII (TSH receptor binding inhibitory immunoglobulins) in multinodular goiter, in relation to the functional status of the thyroid classified on the basis of T3, FT4, TSH IRMA. The samples were collected from 53 patients with normal T3, FT4 and TSH; 14 patients with T3 and FT4 in normal range and TSH less than 0.15 milli U/l; 8 patients with T3 and/or FT4 above the superior limits of normal range and TSH less than 0.15 milli U/l and from a control group of 10 patients with Grave's disease. TBII was measured by radioreceptor assay and the index resulted less than 15% in all the patients with eufunctioning or hyperfunctioning multinodular goiter. Mean value in biochemically hyperthyroid patients was 6.25% and in euthyroid patients was 5.69%. The difference was statistically not significant. Moreover, significantly elevated levels of TBII were found in 60% of patients with Grave's disease.

[Treatment of perineal breach in radical surgery of the rectum: notes on the surgical technic]. / Il trattamento della breccia perineale nella chirurgia demolitiva del retto: note di tecnica chirurgica.

The Authors review the various techniques used in closing and draining the pelvic basin after total resection of the rectum due to neoplastic and/or inflammatory disease. The examine their experience with 248 cases of total resection of the rectum and propose closure of the perineal breach as the first step in through closure of the pelvic peritoneum.

[Surgical treatment of malignant colorectal neoplasms in the population over (our experience)]. / Il trattamento chirurgico delle neoplasie maligne del colon-retto nella popolazione al di sopra dei 75 anni.

The Authors examine a series of 95 operations in the Verona Surgical Clinic for colorectal carcinoma in patients aged above 75 and discuss the results obtained. The low mortality rate (2.95% for resections) and the acceptable incidence of morbidity confirm the validity of performing radical surgery for malignancies in very elderly patients, as is stressed in most of the relevant literature.

[Our experience with the surgical treatment of the solitary ulcer syndrome of the rectum]. / La nostra esperienza nel trattamento chirurgico della sindrome dell'ulcera solitaria del retto.

The authors examine the question of the pathogenesis of solitary rectal ulcer syndrome (S.R.U.S), illustrating the importance of a correct differential diagnosis versus other relevant forms of disease affecting this region, particularly rectal cancer. They describe their experience with both the medical and surgical treatment of the syndrome.

[Malignant schwannoma of the ileum: an extremely rare disease entity (presentation of a case and review of the literature)]. / Lo schwannoma ileale maligno: una entità morbosa estremamente rare (presentazione di un caso e revisione della letteratura).

The authors examine a case of malignant ileal schwannoma successfully treated in the Verona Surgical Clinic. They compare their experience with the data reported in the literature, confirming the extreme difficulty encountered in diagnosing the disease. Therapy is discussed, and the authors stress that, in the presence of an intestinal haemorrhage the origin of which traditional diagnostic investigations are unable to establish, one should always bear in mind the possibility of schwannoma despite its rarity.

[Our experience in the surgical treatment of diverticular disease (I: Election)]. / La nostra esperienza nel trattamento chirurgico della malattia diverticolare (Nota I: L'elezione).

The authors review their patient population with regard to the surgical treatment of diverticular disease. This population consists of 76 cases, 30 of which were subjected to elective surgery. They conclude by stating that, in the light of their experience, the most effective elective operation is resection of the tract affected by diverticuli followed by and end-to-end anastomosis with the protection of a decompressive transversostomy.

[Our experience in the surgical treatment of Arbuthnot Lane disease]. / La nostra esperienza nel trattamento chirurgico della malattia di Arbuthnot Lane.

In the light of their experience, the authors review the data reported in the literature regarding Arbuthnot Lane Disease. The therapeutic indications are examined, and the results of the various types of surgery proposed are compared.