[Staging of gastric carcinoma]. / La stadiazione del carcinoma gastrico.

The controversies over the patterns of gastric cancer staging in western countries (UICC-AJCC), Japan (JRSGC) and more recently Hawaii (1984) are analysed with reference to the problems of definition and assignment of values to the single elements: T,N,M, location and stage grouping that were not homogeneously established in the patterns mentioned. Problems about T mainly regard T1 and T4. T1 incorporates tumours (T1m and T1sm) with quite different prognosis and therefore represents, in spite of several changes made, a dyshomogeneous group. The same can be said about T4 where prognoses are considerably different according to contiguous structures involved in the tumour and they are not held in due consideration by the various staging systems. In all these, the different lymph nodes are gathered into homogeneous groups (N1,N2,N3) progressively numbered according to the prognostic value. These groups are based, however, on inadequate information and in fact constitute heterogenous umbrellas. The greatest problems about parameter M concern subclinical M1 that, missed at the time of the tumours staging before or during operations, reveal themselves shortly after operations considered radical. Finally new views about the relationship between cancer biology and prognosis (cytofluorometry, immunohistochemistry, etc.) are examined.

[Rubber-band ligation of hemorrhoids]. / La legatura elastica delle emorroidi.

In the last few years there has been a considerable reduction in surgical treatment of piles; on the other hand a series of therapeutic outpatient treatments has developed aiming at a conservative management of piles. This new approach is mainly due to high costs in surgical treatment. In accordance also with the experience of the most important proctologic centres, nowadays only 26% of our patients suffering from piles undergo operation, since we regard rubber band ligation as a more rational and economical method for the treatment of hemorrhoids. The instruments and the technique related to band ligation have been described together with some modifications suggested by our personal experience. Indications and contraindications for rubber band ligation have been analyzed pointing out that, in our opinion, such an approach is advised also in the management of stage 3 and 4 hemorrhoids; on the other hand the surgical treatment has its role when band ligation is contraindicated. We have then reported about the good results obtained with 162 patients suffering from stage 2, 3 and 4 hemorrhoids, by using band ligation. Our experience, in accordance with international literature, enables us to emphasize the almost complete absence of complications and the satisfactory results of band ligation, even if compared to other methods.

[Use of anal dilators in the conservative therapy of anal rhagades]. / L'uso dei dilatatori anali nella terapia conservativa della ragade anale.

The AA. refer their results in the treatment of anal fissure, using surgical and conservative methods. In their experience, internal lateral sphincterotomy, according to the literature, is the best treatment. The use of anal dilators is effective, but it always needs the patient's compliance.