[Right abdominal colonic masses. Recent diagnostic and therapeutic advances: personal experience]. / Masse addominali destre di appartenenza colica. Recenti acquisizioni diagnostiche e terapeutiche: esperienza personale.

The authors, referring to their experience, make a review of colic pathological features presenting as right abdominal mass. Despite of modern diagnostic means--specially radiological investigations: ultrasonographic and CT scanning--accurate clinical examination still plays a role in the initial assessment and to address diagnostic procedures. Diagnosis may be difficult as the right colon is hardly accessible even to present investigative means. US scanning has proved to be useful, in the surgeon's hands, for timely detection of the lesion and in monitoring its evolution. Many diseases must be considered in the diagnosis of a right colon mass and a few rare too: Meckel diverticolitis, carcinoid, vermiform appendix pseudomyxoma, amebic granuloma, Kaposi's sarcoma. Treatment is still an intriguing question, depending on many factors: site, kind and variety of the diseases showing as right abdomen mass, difficulty in early diagnosis, risk of misdiagnosing, shortage of series reported in literature and the absence of multicenter studies.

[Traumatic retroperitoneal lesions]. / Lesioni traumatiche retroperitoneali.

The presence of lesions on the retroperitoneum generally worsens the prognosis in traumatic pathology; it implies more attention and skills from both the medical and surgical aspect. All type of trauma, blunt or open, may involve retroperitoneal structures and organs; specifically there may be lesions on the great vessels, pancreas, duodenum, oesophagus and genitourinary apparatus. Mortality is high, compared to abdominal traumatic lesions confined within the peritoneal sac. Treatment of single or associated lesions requires a multidisciplinary approach, as the surgical repair implies a specific knowledge and experience on different organs, whose habitual pathology lies on the hands of more surgical specialists. Lesions of great vessels are immediately life-threatening; moreover the choice to "open" a patient for a retroperitoneal hematoma has to be taken upon a careful estimation. It could be better in more than a situation leave such hematoma in its place, specially in the iliac region, waiting for the spontaneous resolution of the hemorrhagic source and of the hematoma itself. The involvement of oesophagus, duodenum or pancreas determines instead a poorer prognosis at a distance. In conclusion retroperitoneal traumatic lesions are among the most challenging and serious emergencies, and necessitate a maximum of attention and expertise by the surgical team involved. Only with a careful judgement about the tactics and the procedures to carry on it is possible to obtain valid results, which often means to safe the patients life.

Surgery of abdominal aorta in octogenarians. Can indications be extended?

BACKGROUND: This paper describes the authors' experience with the management of the abdominal aorta in patients aged over 80 years. METHODS: Ten urgent procedures were performed on patients older than 80 years during a 2 year period. In 4 cases surgery was performed because of a ruptured aneurysm of the subrenal abdominal aorta, in 2 cases for active symptomatic aneurysms, in 3 cases for severe lower limb ischemia (occlusion of the iliac and femoral arteries) and in 1 case for a secondary aortoenteric fistula. RESULTS: The operative mortality rate was 20% (2 cases with a ruptured aneurysm). Five patients are still alive in good health conditions (one of them had been operated twice for two different diseases). Even if our findings refer to a small number of patients, although similar series on emergency operations found in the literature are not substantially larger, the results do not advise against operative treatment of the abdominal aorta in cases requiring a direct approach, even in patients over 80 years of age. CONCLUSIONS: If this treatment strategy is obviously adopted in emergency conditions, as with the patients we are reporting on, since the alternative to operation is usually death, it should also be carefully considered in elective circumstances, where alternative treatments such as endovascular stents did not to date obtain better results. In the elective scenario all the necessary biological and physical parameters as well as the patient's age should be taken into proper account in deciding whether to operate. This is specially true now that the average life spans of an individual is longer so that patients, who may incur serious problems if left untreated, may be offered a better quality of life.

[Splenic trauma: splenectomy in every case?]. / I traumi splenici: splenectomia in ogni caso?

The authors report their experience in the conservative treatment of splenic traumas observed in the period 1987-1997. They point out the difference in the incidence of splenectomy in comparison with conservative treatment (p < 0.001) and nonoperative management (p < 0.05) in the two periods examined (1987-92 and 1993-97). They stress the manifold functions of the spleen and his role in the immunitary defense above all in pediatric age, and emphasize, on the base of their experience, the conservative treatment of traumatic splenic injuries in patient carefully selected. This curative strategy is supported by the notable contribution offered by sophisticated methods of radiological imaging (echography, CT, angiography) and by the commercialization of substances at high stick capacity (Tissucol). The lack of complications at short and middle term (reoperation for restart of the hemorrhage and ischemic necrosis after ligature of the splenic artery) induces the authors to consider the conservative treatment of the splenic traumas, in the cases in which it is pursuable, an ideal therapeutic solution.