Pyloric atresia: an attempt at anatomic pyloric sphincter reconstruction.

BACKGROUND: The standard method of surgical correction of pyloric atresia is gastro-duodenostomy. The authors report a case of pyloric atresia associated with junctional epidermolysis bullosa, treated with a new technique of pyloric sphincter reconstruction by gastric and duodenal mucosa cul-de-sacs advancement and end-to-end anastomosis. METHODS: The patient was a premature 2,100-g baby girl. X-ray showed gastric dilatation suggesting a congenital gastric obstruction. At surgery a pyloric atresia was found, with the appearance of a well-vascularized solid cord about 1.5 cm long. By longitudinal pyloromyotomy the cul-de-sacs of gastric and duodenal mucosa were reached and then isolated in the respective gastric and duodenal sides to obtain better mobilization. The mucosal cul-de-sacs, thus mobilized, were advanced easily into the pyloric canal, opened longitudinally, and were sutured together using end-to-end anastomosis. The longitudinal pyloromyotomy then was closed diagonally above the reconstructed pyloric neocanal. RESULTS: The postoperative course was uneventful: oral feeding was started on the 11th postoperative day. At 4 year follow-up the child was well; no gastrointestinal disorders were present, confirmed by x-ray barium meal and by HIDA technetium Tc 99m hepatic scintiscan, which excluded any bilious duodeno-gastric reflux. CONCLUSION: This technique of pyloric sphincter reconstruction allows preservation of the pyloric sphincter, whose sphincter muscular layer, although hypoplastic, is present in cases of pyloric atresia.

A new approach to the problem of surgical wound infections in clean operations.

A study was made of the risk factors causing a high incidence of surgical wound infections in clean operations. Identification of these factors in the preoperative stage allows the patients to be divided into two categories: a high risk (about 10% of patients for surgery) and low risk. By giving antibiotic prophylaxis only to patients at high risk, the incidence of postoperative infections can be reduced, decreasing the number of extra days in hospital and consequently lowering costs. This is a new approach to the problem of surgical wound infections since not only is it based on the usual classification of operations into clean, clean-contaminated, contaminated and dirty, but it also takes into account the defensive capacity of the target of the infection: the patient.

[Treatment of early colorectal carcinoma: surgery or endoscopy?]. / La terapia del carcinoma iniziale del colon-retto: chirurgia o endoscopia?

This retrospective study analyses the value of endoscopic polypectomy as the operation of choice in cases of early invasive colorectal carcinoma located on the adenomatous polyp. Under these conditions the authors outline their therapeutic strategy, based not only on the histological characteristics of lesions, but also on the evaluation of the risk/benefit ratio established in relation to the characteristics of each individual patient.

[Trans-mesenteric hernia. Presentation of a clinical case and review of the literature]. / L'ernia transmesenterica. Presentazione di un caso clinico e revisione della letteratura.

Trans-mesenteric hernia is a rare case of intestinal obstruction. A peculiar characteristic of this form of hernia is the absence of a sack and recess; in the majority of cases, hernia is due to congenital defects of the mesentery. In clinical terms, hernia is manifested by signs of intestinal occlusion in patients of any age. Occasionally, hernias may be found during surgery or autopsy.

[Early gastric cancer: radiologic, endoscopic or combined diagnosis?]. / Early gastric cancer: diagnosi radiologica, endoscopica o combinata?

Having underlined the importance of an extremely early diagnosis of gastric cancer, the paper focuses on the diagnostic capacities of endoscopy and bone x-ray using a dual-contrast technique. From an analysis of published reports and on the basis of their own experience, the authors prefer, whenever possible, to combine the two methods, since this is the only way of revealing minimum neoplastic stomach lesions in almost 100% of cases.

[Cimetidine in the treatment of peptic esophagitis. Clinical findings and results with 171 patients]. / La cimetidina nel trattamento della esofagite peptica. Rilievi clinici e risultati su 171 pazienti.

After a brief physiopathological introduction, the results obtained with Cimetidine in 171 cases of peptic oesophagitis are described. Given the high percentage of successes even in serious oesophagitis and the minimal incidence of side effects, cimetidine is the therapy of choice in conservative treatment of peptic oesophagitis.

[Cimetidine versus ranitidine in the treatment of peptic esophagitis]. / Cimetidina versus ranitidina nel trattamento dell'esofagite peptica.

A double blind test with cimetidine and ranitidine conducted on 60 patients with acid reflux oesophagitis revealed cimetidine to be the more effective. Its success is felt to lie more in the drug's ability to activate defensive factors than in its inhibition of acid secretion.

[Ranitidine in the treatment of duodenal ulcer. Initial clinical experience with 33 patients]. / La ranitidina nel trattamento dell'ulcera duodenale. Prime esperienze cliniche su 33 pazienti.

The short and medium term results obtained with ranitidine on 33 duodenal ulcer patients are reported. The results obtained indicate that ranitidine is excellent for initial therapy but there are doubts about its efficacity in the prophylaxis of recurring ulceration during maintenance treatment. In addition, about 9% of the patients suffered side effects to the extent that treatment had to be interrupted.