[Our experience with the use of Absolok polydioxanone resorbable clips in laparoscopic surgery]. / Nostra esperienza sull'utilizzo delle clips riassorbibili in polidiossanone Absolok in chirurgia laparoscopica.

BACKGROUND: The study aims to evaluate the efficacy of resorbable clips in polydioxanone in laparoscopic surgery. METHODS: The authors report their personal experience regarding the use of Absolok (ABL) resorbable clips in laparoscopic surgery. Out of a total of 745 laparoscopic operations performed from September 1992 to February 1997, 438 included the use of resorbable clips in place of metal clips, both for cystic duct section during cholecystectomy and vascular structures, or to lock continuous sutures. ABL clips were also used for major vessels (e.g. mesenteric artery) during laparoscopic colic resections. RESULTS: In all cases when they were used, ABL never gave rise to complications, such as biliary outflow or hemorrhage caused by the dislocation of the clips themselves. CONCLUSIONS: The authors conclude by affirming the value and safety of this type of clip.

Conservative laparoscopy in the treatment of posttraumatic splenic laceration using microfiber hemostatic collagen: three case histories.

Three cases of posttraumatic splenic laceration in young patients are reported. In each case, hemostasis of the lesion was obtained by the use of microfiber collagen in emergency laparoscopy. In two cases, complete hemostasis was achieved and the entire organ was saved. In the third case, splenectomy proved necessary after renewed bleeding occurred.

Ileal volvulus on internal hernia following left laparoscopic-assisted hemicolectomy.

Described here is a case of constriction of the ileal loop caused by a volvulus forming on an internal hernia through the mesenteric opening in the anastomotic colonic stumps, following left laparoscopic-assisted hemicolectomy. This experience indicates the need for closure of mesenteric gaps with a continuous suture after laparoscopic-assisted left hemicolectomy.

[The Shouldice plastic surgery: our clinical experience]. / Plastica secondo Shouldice: nostra esperienza clinica.

The Authors present cases of groin hernioplasty using the Shouldice method; the method used for more than six years, such as elective technique to treat groin hernia, is evaluated on the basis of results of complications and recurrences. A careful clinical check of patients operated on over one year at least, allows confirmation of the efficiency of the method, because it results in a low percentage of recurrence and complications, plus a low social and economical cost. For these reasons it is proposed that the method is applied in day surgery.

Palliative treatment of carcinoma of the rectum by endoscopic injection of polidocanol.

Between January 1987 and December 1988, at the Surgical Department of Chiarenzi Hospital, five patients underwent endoscopic intratumoral injection of polidocanol for palliative treatment of inoperable carcinoma of the rectum. Histological evaluation was performed in all cases. The patients comprised two males and three females aged 78 to 88 years (mean 83.4). One of them refused surgery for recurrent rectal cancer, four consulted us with impending intestinal obstruction; three were inoperable due to local spread of the tumor and poor general condition, the other was in a poor general condition due to massive metastatic hepatic disease. In all the patients, we observed remission of the obstructive symptoms with no major complications; none of them has required a colostomy. The follow-up period has covered a period of two months to two years. The technique of injection is simple, inexpensive and, properly performed, safe. All these advantages make this type of palliative treatment for rectal cancer interesting, even when compared with laser treatment, urological resectoscope or electric snare resection, and electrocoagulation.

Continuous peritoneal dialysis in acute experimental pancreatitis in dogs. Effect of aprotinin in the dialysate medium.

In 27 beagle dogs, acute necrotizing pancreatitis was induced by retrograde injection of autologous bile and trypsin into the main pancreatic duct. Animals were randomly assigned to the following treatments: group 1--(9 dogs) aprotinin 600,000 KIU/d by i.v. route; group 2--(9 dogs) peritoneal dialysis for 6 d plus 500,000 KIU/L of aprotinin in the dialysate fluid; group 3--(9 dogs) peritoneal dialysis without aprotinin in the dialysate fluid. All dogs of the group 1 died within 16 h following the induction of pancreatitis and extensive necrotizing and hemorrhagic changes were seen in the pancreatic and peripancreatic areas. Six dogs of the group 2 survived and no necrotizing changes were observed 30 or 50 d after the induction of pancreatitis. Three dogs of the group 3 survived, but slight necrotizing lesions were found at the autopsy. The survival rate was higher in dogs with peritoneal lavage (p = 0.0129) or with peritoneal lavage plus aprotinin (p less than 0.0001) than in those receiving i.v. aprotinin, indicating that the latter treatment has no beneficiary effect on the course of acute pancreatitis.

[Clinical results after proximal selective vagotomy (considerations on 42 cases)]. / Risultati clinici dopo vagotomia selettiva prossimale (considerazioni su 42 casi).

The authors report the results of a 6-8 year follow-up of 42 patients treated by selective proximal vagotomy with pyloroplasty for gastric or duodenal ulcer disease. On the basis of Visick's classification, the patients broke down into the following categories: Cat. 1: 66.6%; Cat. 2: 26.1%; Cat. 3: 2.3%; Cat. 4: 4.7%, with 92.7% belonging to the first two categories. These data are in agreement with other data reported in the literature, and show no significant differences as compared to follow-up one year after surgery.

Ciprofloxacin penetration in pancreatic juice.

The penetration of ciprofloxacin in pancreatic juice was investigated in 5 patients with pancreatic fistula. The drug was administered as a single oral dose of 500 mg after which serial samples of pancreatic juice and serum were collected for ciprofloxacin assay. The following pharmacokinetic parameters (mean +/- SD) were estimated from the serum level versus time curves: clearance 11.51 +/- 2.85 (ml/min/kg); Vd area 3.08 +/- 1.20 ml/kg; terminal half-life 3.10 +/- 0.92 h; mean residence time 5.64 +/- 1.40 h. Ciprofloxacin serum levels declined rapidly after the third hour, whereas concentrations in pancreatic juice remained elevated (above 1 mg/1) for nearly 12 h. The pancreatic juice/serum ciprofloxacin concentration ratio increased gradually fom 0.63 +/- 0.45 after 0.5 h to 6.18 +/- 4.59 after 12 h (mean +/- SD). Our data indicate that while the drug elimination half-life from the serum is short, the time-course of ciprofloxacin levels in the pancreatic juice conforms to a much slower disappearance rate. In particular, the ciprofloxacin levels achieved in pancreatic juice are constantly greater than the MICs of the bacteria generally responsible for pancreatic infections.

[Epithelial splenic cysts]. / Cisti splenica epiteliale.

The authors describe a case of an epithelial cyst of the spleen treated successfully by splenectomy. Diagnostic techniques and the principles adopted in treatment this rare disease are discussed.

[Gastric metastasis of melanoma (report of a clinical case)]. / Metastasi gastrica da melanoma (presentazione di un caso clinico).

The Authors report a case of gastric metastasis from melanoma of the skin, occurring 6 years after removal of the primary neoplasm. The metastasis, which was characterized by conspicuous alimentary tract haemorrhage, called for emergency surgery consisting in a total gastrectomy with oesophago-jejunal anastomosis according to Roux. The Authors then go on to review the literature on the subject, stressing the frequency of gastrointestinal metastases in skin melanomas with an incidence affecting up to 60% of cases in autopsy series. After examining the main clinical aspects, endoscopic appearances and r-ray findings, the Authors deal at some length with prognosis, pointing out that isolated metastases may constitute a surgical indication in view of the cases of fairly good long-term survival reported in the literature.

[Pancreas transplant today: review of the literature]. / Il trapianto di pancreas oggi: revisione della letteratura.

The authors, after analysing the world literature concerning the pancreatic transplantation, dwell in considering the problems involved in the indications and techniques of the transplantation itself. Among the several problems expecting an ultimate solution, the improvement of prophylaxis, diagnosis and treatment of rejection seems to heavily affect the future of this surgery.

[Retroperitoneal neurilemmoma (considerations on 4 cases)]. / Il neurilemmoma retroperitoneale (considerazioni su 4 casi).

The authors show 4 cases of retroperitoneal neurilemmoma, surgically treated by simple excision of the tumour. From the general observations, as well as from the analysis of the literature, they can remark the rareness of the location in such anatomical region. The clinical symptoms are common to those of the region retroperitoneal tumours, and are due to the compressive effect developed by the tumour on the contiguous structures. As regards the diagnostic procedures, they emphasize the primary value of axial computed tomography in the evaluation of the retroperitoneal pathology. The diagnosis cannot be but histologic, and is based upon the presence of the typical histologic pictures according to Antoni A and B types.

[A case of duodenal duplication in the adult]. / Su di un caso di duplicazione duodenale dell'adulto.

The authors describe a rare case of duodenal duplication presenting in adult life; the complete preoperative investigations did not substantiate. The diagnosis which can be accomplished in most cases only intraoperatively. The diagnosis is mainly based upon knowledge of the condition and upon pathologic examination.

[Our experience in the use of "traction" endoprosthesis as a palliative treatment of cardial carcinoma]. / La nostra esperienza nell'uso delle endoprotesi "a trazione" quale trattamento palliativo del carcinoma cardiale.

The Authors review the methods of palliative treatment of cardial carcinoma, and particularly report some results obtained through the application of oesophageal endoprostheses (by Celestin and by Haring), following the traction method, in 38 patients. The global mortality amounted to 8 cases (21%). In 12 patients (31%), complications such as stoppage or dislocation of the prosthesis were observed. In two cases the perforation of oesophageal wall occurred, with spontaneous resolution in one of the two patients and serious mediastinitis and exitus in the other. The Authors' present trend is toward the use of push type endoprosthesis, because of the lower mortality reported in literature.

[Surgical therapy of gastro-esophageal reflux (clinical contribution)]. / Terapia chirurgica del reflusso gastro-esofageo (contributo clinico).

The Authors, on the basis of 119 cases of gastroesophageal reflux, submitted to intervention at the Surgical Department of Verona from 1970 up to 1983, seize this opportunity for some remarks about the problem: in fact, its physiopathology is still discussed, and numerous were the surgical techniques suggested for its treatment. 56 patients, treated according to Nissen-Rossetti's technique, and 16, in whom the antireflux plastic operation was complemented by a selected proximal vagotomy with pyloroplastics, were remote-checked. The good results got till now mean the SPV + P can be usefully associated to the antireflux plastics for hiatal hernia.

[Surgical therapy of gastric carcinoma in an advanced stage (clinical cases)]. / Terapia chirurgica del carcinoma gastrico in fase avanzata (contributo clinico).

The Authors study the casuistry of the Verona Surgical Clinic concerning the interventions for gastric cancer; they particularly study 35 cases of plurivisceral demolition for neoplasm in advanced phase. After a discussion of the data supplied by the literature; the Authors, as a conclusion, suggest not to consider the overcoming of the gastric barrier in multivisceral sense as a rigid element for the exclusion of these patients from surgery, although they exclude widely demolitive interventions in seriously weakened patients, or in bearers of such spreadings as to involve tremendous operative risks, not rewarded with a satisfactory advantage.

[Bilemia: diagnosis and conservative treatment. Apropos of a case complicated by hepatic abscess]. / Bilemia: diagnosi e trattamento conservativo. A proposito di un caso complicato con ascesso epatico.

The authors report a case of bilemia of their own--with traumatic genesis--complicated by liver abscess, treated through outside biliary drainage and piloted transhepatic percutaneous drainages along the line of the echotomography and computerized axial tomography (T.A.C.). They report the treatment adopted, and emphasize the importance of the instrumental methods followed in the diagnostical and therapeutical approach of both diseases.

[Contribution of computerized axial tomography in the study of splenic injuries]. / Il contributo della T.A.C. nello studio dei traumi splenici.

The splenic traumatic from a retrospective study of splenic traumatic lesions, they had the opportunity to observe in the last 2 years, emphasize the importance of T.A.C. (Computed Axial Tomograph). Such inspection, quick to be executed and non-invading, allows a thorough study of abdomen, and is a guide to a correct surgical option.