[Efficacy of long-term total parenteral nutrition treatment in a case of postoperative fistula of the gastric fundus]. / Considerazioni sull'efficacia del trattamento con NPT di lunga durata in un caso di fistola postchirurgica del fondo gastrico.

The Authors report their experience about an unusual case of gastro fundic fistula arisen after a surgical procedure and successfully treated with long term N.P.T. The Authors describe the modality of the long term treatment, underlining the importance and efficacy of N.P.T. which represents an efficient alternative to surgery.

Cholecystectomy for acute cholecystitis: timing of operation, bacteriologic aspects, and postoperative course.

There is still considerable controversy among surgeons regarding the most opportune moment for surgical intervention in the case of acute cholecystitis. For this reason, 471 patients cholecystectomized for acute cholecystitis from 1970 through 1982 were studied. During the first period, there were two types of surgical intervention: during hospitalization after resolution of the acute episode, and during a second hospitalization 2 to 3 months later. During the second period, early cholecystectomy within 72 hours of the onset of symptoms became the option. Emergency operations did not reflect a surgical choice but rather conditions of necessity. The results of this study demonstrate that early cholecystectomy is preferred for a variety of reasons, the most important of these being a low incidence of positive results of bile culture in this phase, a negligible percentage of postoperative complications and mortality, and a short hospitalization period with resulting cost containment.

[Anastomosis in digestive surgery: results of single layer sutures with absorbable and non-absorbable material]. / Le anastomosi in chirurgia digestiva: risultati delle suture monostrato eseguite con materiale riassorbibile e non riassorbibile.

The authors report the results of a study performed among 280 single layer extramucous interrupted stitches digestive inverting anastomosis, for a total amount of 661 anastomosis made in patients hospitalized for different digestive pathology, from 1975 to 1981. The single layer sutures were performed with absorbable material in 43,35% of cases and with non absorbable in 54,64%. The Authors report the incidence of precocious and retarded complications regarding the type of the some anastomosis and the material used. The Authors conclude, also on the basis of observed cases, that the anastomosis, performed with slowly absorbable materials, afford better results and fewer complications than those performed with non absorbable materials.

[Preliminary observations on the behavior of serum ferritin in female patients with breast cancer at various stages of the disease]. / Osservazioni preliminari sul comportamento della ferritina serica in pazienti affette da neoplasia della mammella in diversi stadi evolutivi.

The Authors have been evaluated the behaviour of serum ferritin in 16 patients with breast cancer. In all of the cases the serum ferritin values were significantly higher, compared with those found in 11 normal control subjects. Of particular interest was the reduction of serum ferritin in most of the patients who had undergone polychemotherapy with CMF. The results agree with the observations of various Authors as far as high levels of serum ferritin in course of breast cancer are concerned. Moreover it can be pointed out that the serum ferritin evaluation can represent a monitoring marker for the evaluation of the evolution of this disease.

[Changes in the principal biohumoral parameters after jejuno-ileal bypass in rats with experimentally induced obesity (preliminary note)]. / Modificazioni dei principali parametri bio-umorali dopo by-pass digiuno-ileale praticato nel ratto con obesità sperimentalmente indotta. (Nota preliminare).

End-to-end jejuno-ileal by-pass is one of the most extensively used surgical procedure in the treatment of morbid obesity. The Authors evaluated hematologic indices in experimentally induced obese Sprague-Dowley rats and their modifications after jejuno-ileal by-pass. This surgical procedure induced a significant weight loss and a considerable improvement of glucidic and lipidic metabolic disorders, presents in experimentally obese rats. The Authors conclude that an intestinal by-pass preserving a jejuno-ileal tract with sufficient absorbtion potential, is able to induce adequate weight loss with regression of glucidic and lipidic metabolic disorders, in absence of heavy alterations of the others hematologic indices.

Hydroxyproline and zinc excretion in patients with neoplastic breast disease.

Hydroxyproline and zinc excretion was evaluated in 87 patients with neoplastic breast disease; 40 of these had carcinoma, without radiological and scintigraphy demonstration of bone metastases. In the group of patients with breast cancer, the mean values of hydroxyproline and zinc excretion were found to be significantly higher than in the group with benign breast disease; only 12 of the patients with histologically detected breast cancer had hydroxyprolinuria levels which were higher than the upper limit of the values obtained in the control group. The authors, therefore, conclude that the patients in this group must be considered as being at greater risk.

[Preservation of the pectoral nerves in modified radical mastectomy]. / La conservazione dei nervi pettorali nella mastectomia radicale modificata.

Modified radical mastectomy with preservation of one or both pectoral muscles is the surgical treatment of choice in stage I and II breast cancer. A surgical anatomic study has been performed, based on post-mortem and intraoperative findings, to investigate origin and course of lateral and medial pectoral nerves and their relations to pectoral muscles and axillary lymphonodes. The results suggest that Patey-Meier operation can produce, in 80 per cent of cases, atrophy and fibrosis of the costoabdominal portion of the pectoralis major muscle as lateral pectoral nerve is generally dissected. On the contrary, radical mastectomy with both pectoral muscles preservation permit also to preserve the nerves during lymphadenectomy if they are recognized.

[The treatment of acute cholecystitis (author's transl)]. / "Il trattamento delle colecistiti acute".

Authors report own experience on 384 patients operated for acute cholecystitis, from 1970 to 1979, among over 2.100 operations for cholelithiasis performed in that period. Operations have been divided in 3 groups: 1) deferred after 2 months (196 cases); 2) deferred, but during hospitalization, between 8th and 25th day from the onset of acute symptomatology (133 cases); 3) early, within 72 degrees hour from beginning of the disease (55 cases). Many clinical features have been considered and among these bacteriological investigations. Diagnostic acids, especially echotomography in last years, surgical procedures, pathological findings and different rates of mortality and morbidity, for each group of patients, have been studied. The conclusion is that acute cholecystitis have to be operated early, not after degrees day from onset of symptoms, especially if there is no tendency to remission of symptomatology.

[Local recurrences after mastectomy for cancer (author's transl)]. / Le recidive locali dopo mastectomia per cancro.

The Authors, in a review of 162 patients submitted to mastectomy for cancer, have considered the incidence of local recurrences related to the type of operation and to the clinical stage of primitive neoplasia. Particularly, the percentage of local recurrences does not seem to be related to the type of surgical procedure employed but rather to the presence of metastatic lymph nodes at the time of the first treatment of neoplasia. Is also related the treatment of the local recurrences observed and the detained data are compared with that reported in the literature, particularly about the mechanisms of formation, the incidence and the types of treatment.

[CEA and breast neoplasms: application of a personal method for determination of CEA in the clinical study of 242 patients (author's transl)]. / ACE et tumeurs mammaires: application d'une méthode personnelle de détermination de l'ACE à l'étude clinique de 242 malades.

The authors report their experience of the clinical application of monitoring serum CEA levels in breast tumours, obtained by a new direct method of determination. A total of 242 patients were studied: 124 with benign tumours, 75 with primary carcinoma in various stages; and 43 who had previously undergone to surgery for breast carcinoma. The analysis of pre-surgical specimens demonstrate consistently normal values for the benign tumors, whereas patients with malignant tumours had positive values in 40 p. 100 of cases. Significant differences in values were seen between benign tumours and Stage II malignant tumours, and between Stage II and Stage III tumours, whereas there was no significant difference between benign forms and Stage I, and between Stage III and Stage IV. In patients with metastases, followed up after surgery, the CEA was positive in 94 p. 100 of the cases. In the opinion of the authors, CEA levels do not seem to be useful for the early diagnosis of malignant breast tumours but are important, harmless and inexpensive, in the follow-up of patients who have undergone surgery for breast neoplasms.

[Critical considerations on the use in instrumental divulsion of the papilla in surgery of the bile ducts. Long-term results in 103 cases]. / Considerazioni critiche sull'impiego della divulsione strumentale della papilla nella chirurgia delle vie biliari. Esiti a distanza di 103 casi

With a view to carrying out a critical review of the use of instrumental divulsion in surgery of the bile ducts, a long-term follow-up was made, from one to 12 years after performance of this operation, in 103 out of 157 cases. An examination of the immediate results which were favourable, in contrast with those found at long-term, led to the conclusion that this procedure was of little use and it has now been dropped both in diagnostics and, with greater reson, in treatment of benign papillary stenosis.