[Emergency gastro-duodeno-cephalo-pancreatectomy for gastroduodenal necrosis caused by ingestion of caustics]. / Gastro-duodeno-cefalo-pancreasectomia d'urgenza per necrosi gastro-duodenale da ingestione di caustici.

Successful treatment of a case of gastroduodenal necrosis caused by the massive ingestion of muriatic acid is described. Total gastrectomy and resection of the duodenum and head of the pancreas were followed by oesophagocolonjejunoplasty. It is suggested that surgery should be as radical and as early as possible in cases where strong acids have been ingested.

[Metabolic preparation for surgical operations and the problem of chronic shock]. / La preparazione metabolica all'intervento chirurgico e il problema dello shock cronico.

Surgical patients with a chronic energy deficit display a particulare metabolic situation known as chronic shock, marked by deficient utilisation of energy. The picture is related to functional disorders of the cell enzymes, following incomplete resynthesis due to the lack of substrates. The main features are: a) lactic metabolic acidosis due to anaerobic oxidation, usually with insufficiency of the Krebs cycle; b) exaggerated protein catabolism, due to utilisation of amino acids as the energy substrate; c) incomplete utilisation of the (mostly endogenous) substrates available, with lactacidaemia, aminoacidaemia, and increased lipidaemia. A rational form of treatment is proposed after careful analysis of these features and their corresponding clinical phenomena.

Focal nodular hyperplasia of the liver and contraceptive steroids.

A case of Focal Nodular Hyperplasia of the liver in a young woman taking oral contraceptives is described. The parenteral administration of an elevated dosage of progesterone in a concentrated period of time is a remarkable feature of this case. The vascular alterations, which consisted of a marked increase of arterial and venous formations, intimal proliferation, diffused thrombosis, and the presence of large blood spaces recalling "peliosis hepatis" are the most salient microscopic findings. We should not exclude the possibility that these peculiar vascular alterations be the real effect of steroid hormones on a pre-existent hepatic lesion.

PIP: A case of focal nodular hyperplasia (FNH) of the liver in a 25-year-old woman taking oral contraceptives is reported. The patient had taken Lyndiol for 6 months (1975) and had received 6 injections of 5 mg benzoate estradiol plus 50 mg progesterone at intervals of about 2 months (January 1974-February 1976). An isolated mass was found in the right hepatic lobe. The microscopic findings corresponded to FNH. The vascular alterations consisted of a marked increase of arterial and venous formations, intimal proliferation, diffused thrombosis, and the presence of large blood spaces. The possibility that these vascular alterations be the real effect of steroid hormones on a preexistent hepatic lesion should not be excluded.