[Evaluation of costs in surgery of inguinal hernia. Day surgery and one day surgery versus ordinary admission]. / Valutazione dei costi nella chirurgia dell'ernia inguinale. Day surgery e one day surgery versus ricovero ordinario.

The authors have completed an analytic research about costs of hospitalization and treatment for inguinal hernioplasty and costs of anesthesiologic and surgical techniques and hospitalization regimen. The authors consider possible in about 50% of cases the tension-free hernioplasty carried out with local anesthesia and day or one day surgery regimen and they have estimated that it is very less costly then traditional herniorraphy carried out with general anesthesia and hospitalization: L. 1.056.075 versus L. 2.252.650. In Emilia-Romagna we could have a considerable cost-saving, even if only the 50% of patients treated for uncomplicated inguinal hernia every year (7.133 patients with mean hospital stay = 5,8 days and total hospitalization = 41.731 days during 1993) could benefit by treatment in one day surgery regimen. In fact, leaving out of account the advantage of the rapid return the patient to work, the costs of hospital stay, esteemed in L. 25.038.600.000, would be L. 8.558.700.000. A considerable increase of one day surgery hernioplasties should be expected by the hospital administration in budget planning.

[Costs of cholecystectomy after the arrival of video-laparoscopic surgery]. / Costi della colecistectomia dopo l'avvento della chirurgia video-laparoscopica.

The authors proceeded to point out the hospital stay costs and the operating-room costs of the cholecystectomy after the introduction of the laparoscopic technique, underlining the higher economic advantages. The total unit cost for laparoscopic cholecystectomy, even if there are higher costs due to the surgical equipment, thanks to the mini-invasive approach and to the reduced hospital stay, results lower (17%) then the total unit cost for laparotomic cholecystectomy (L. 3.982.489 vs. L. 4.825.300). Let us suppose that in the Emilia Romagna Region an 80% of patients underwent to laparoscopic cholecystectomy and only a 20% underwent to laparotomic cholecystectomy: in this case there could be the economic savings of L. 3.777.478.902 and concerning the hospital stay there could be the savings of 17.928 days too. This cost estimation is important if we consider that the rate of cholecystectomy procedures, in our local area, per 1000 inhabitants, increased from 2.29 in 1990 to 3.99 in 1992 (rate of increase: 74%).

[Meckel's diverticulum. Case contributions]. / Il diverticolo di Meckel. Contributo casistico.

Eight cases of Meckel's diverticulum observed by the authors are reported. Different investigative methods, clinical and surgical aspects are discussed. Even asymptomatic Meckel's diverticulum discovered incidentally at surgery should usually be removed.

[Duplication of the small intestine. A case diagnosed prenatally]. / Duplicazione intestinale del tenue. Su di un caso diagnosticato in epoca prenatale.

The authors present a case of neonatal intestinal duplication. Etiopathogenic view and the diagnostic and therapeutic problems are discussed. Echotomographic examination can provide useful diagnostic input, as in this case, even at a prenatal stage.

[Congenital duodenal obstruction, Malrotation of the intestine associated with annular pancreas (author's transl)]. / Occlusione duodenale neonatale. Considerazioni su di un caso di malrotazione intestinale associata a pancreas anulare.

A newborn presenting duodenal stenosis by small bowel malrotation and annular pancreas is reported. Major diagnostic problems in duodenal obstruction of newborn are considered in keeping with literature review and personal experience. In this presentation clinical appearance has been long aspecific (apnea and bradycardia spells) in spite of a rather typical radiological picture. Really, the true diagnostic nature of midgut obstruction is often intraoperative. Face to any duodenal obstruction in a newborn the possibility of many malformations of the gut should be raised and consequently looked for accurately by the surgeon for a good postoperative prognosis. The surgical procedure of choice is frequently a duodeno-jejunostomy or a duodeno-duodenostomy; the annular pancreas should, on the contrary, never be sectioned.

[Diagnostic and therapeutic reflections on polyps and polyposis of the large intestine]. / Riflessioni diagnostico-terapeutiche sui polipi e poliposi del grosso intestino.

The systematic employment of pancolonoscopy in patients with diseases of the large intestine has shown that histological typing is essential when a polyp or polyposis is observed, since this is the only way prognosis can determined, and is only possible through endoscopic polypectomy. Familial investigation is also mandatory. If its findings are positive, every "polyp", irrespective of its number, site, and distribution, is a possible sign of polyposis. In this context, rectum preservation techniques are justified in relation to factors associated with both the polyp itself and its host.

[Stomach polyps. Clinical and therapeutic considerations]. / Polipi dello stomaco. Considerazioni cliniche e terapeutiche.

The main clinical and therapeutic problems of gastric polyps are examined on the basis of 7 personal cases and the literature on the subject. 5 of the cases were adenomatous polyps proper, one of them in malignant degeneration and associated with polyposis of the large intestine. In 2 other cases, the histopathological picture revealed Peutz-Jeghers type hamartomatosis polyps confined to the gastric region without the typical cutaneo-mucous stigmata or familial character. Classification of polyps must allow not only for aetiopathogenetic or clinical criteria but for histopathological and histogenetic criteria also. A clear-cut distinction must be made between adenomatous polyps, of definite malignant potential, and pseudoneoplastic polypoid lesions that are essentially benign. The main diagnostic techniques available to handle a symptomatology that is often oligosymptomatic and aspecific, or associated with complications (such as ulcers, haemorrhage, stenosis or, not least, malignant transformation) are reviewed and stress laid on the importance of endoscopy prior to histopathological study which is of value only if carried out on a totally removed polypous lesion. The guidelines for indicating and selecting the radial surgical technique are presented.

[Treatment of cancer of the breast with Patey's modified radical mastectomy]. / Trattamento del cancro della mammella con mastectomia radicale modificata secondo Patey.

Patey's operation was used to treat breast cancer in 658 cases between 1956 and 1976 at the Bologna University Surgical Clinic. Follow-up in 562 cases revealed 5-yr and 10-yr survival rates substantially similar to those obtained by Halsted and others. It is felt that the type of operation used is of relative importance for survival, since breast cancer is dependent on other factors that require careful appraisal in each case.

[Specific cytoplasmic receptors for steroid homones in benign and malignant breast diseases, in normal glandular tissue and pectoral muscle]. / Recettori citoplasmatici specifici per ormoni steroidi in affezioni mammarie benigne e maligne, in tessuto ghiandolare normale e muscolo pettorale.

An improvement to the DCC (destran-coated charcoal) method for determining receptors for 17-beta-oestradiol, 5-alpha-dihydrotestosterone and progesterone in benign and malignant breast conditions, normal glandular tissue and muscular tissue is reported. Preliminary results on 16 malignant cancers and 4 fibrocystic mastopathies are discussed together with a critical review of the technique employed and the results obtained in hormone competition.