[Fournier syndrome: report of a clinical case]. / La sindrome di Fournier: descrizione di un caso clinico.

The case of a Fournier's syndrome in a 58 years old patient is reported from the Authors that describe the ethiopathogenetic and therapeutic aspects. They analyse the importance of an early surgical treatment associated with antibiotic therapy and later a riparation of the lesions with a myocutaneous skin flap of TLF.

[Hemorrhoidectomy with ropivacaine (Naropin) local anesthesia. Preliminary experience]. / L'emorroidectomia in anestesia locale con ropivacaina (Naropina). Esperienza preliminare.

BACKGROUND: The use of local anesthesia in non-septic anal surgery is now well established. Tolerance to local injection, duration of local effect and the risk of local or systemic complications still represent unsolved issues. Ropivacaine, a new local anesthetic, seems particularly indicated for this kind of surgery because of its pharmacologic properties which reduce patient's discomfort during infiltration and provide good antalgic coverage in the first hours following the operation. METHODS: The first 20 consecutive cases operated with local anesthesia by ropivacaine have been prospectively studied. All patients have been given an 11-point box VAS scale which is used for subjective evaluation of pain. RESULTS: Mean pain score resulted 1.1, 1.6 and 1.4 at 1, 2 and 3 postoperative hours, respectively. Thirty percent of patients subsequently required pain medication up to the first bowel movement. No complications related to the use of ropivacaine has been observed. CONCLUSIONS: This new drug can be safely used in the outpatient or Day-Surgery treatment of hemorrhoids.

[Incidental diagnosis of seminoma in male infertility: report of a clinical case]. / Diagnosi incidentale di seminoma nell'infertilità maschile: descrizione di un caso clinico.

The aims of the study were to evaluate the association between male infertility and risk of developing testis cancer and to establish guidelines for the early diagnosis of testis neoplasia in subfertile men. 32-year-old infertile man. The patient underwent random testicular biopsy to establish the exact cause of infertility. An incidental diagnosis of seminoma was made and the patient then underwent right testis excision. Anatomopathologic macroscopic examination revealed two nodules, the sizes of which were 0.8 x 0.4 and 0.3 x 0.2 cm, respectively. Histologic examination confirmed the diagnosis of typical seminoma, pT1, with copious lymphocytic struma infiltration. There appears to be a correlation between male infertility and occurrence of seminoma. Diagnosis of testis cancer is often incidental and sometimes occurs in men undergoing testicular biopsy to investigate infertility. Since the biopsy was not specifically targeted in our case, the diagnosis of seminoma was casual. This suggests the need for a careful follow-up, including testicular ultrasonography as a screening test to achieve an early diagnosis of testis cancer in all infertile men, because of their higher risk of developing testis cancer than the normal population.

[Endolaparoscopic "Rendez-vous" in the treatment of cholecysto-choledochal calculosis]. / Il "Rendez-vous" endolaparoscopico nel trattamento della calcolosi colecisto-coledocica.

Different methods, all of which equally efficacious and safe, can be selected to access the choledochus in patients with cholecysto and choledocholithiasis on the basis of clinical and anatomosurgical parameters. From 1990 we evaluated three groups of patients who underwent surgery at different times and with different methods: sequentially (endoscopic sphincterotomy and laparoscopic cholecystectomy), one step laparoscopy and combined laparo-endoscopy. The results obtained seem to show that the treatment with laparoscopy alone is the most advantageous in terms of cost-benefit, while the endoscopic access of the choledochus during laparoscopic cholecystectomy is the one to prefer in terms of efficacy and safety.

[Gastric resection and subtotal gastrectomy. Principles and updated surgical technique]. / La resezione gastrica e la gastrectomia subtotale. Princìpi ed attualità di tecnica chirurgica.

The Authors describe their last 10 years experience in gastric surgery. They report the results obtained in 12 gastric resections performed for complications following gastric and/or duodenal peptic ulcers, in 33 cases of total gastrectomies (34%), and 48 cases of subtotal gastrectomies (49%) for early and advanced cancer. The results lead to interesting conclusions: first of all achieving a wide jejunojejunostomy between the afferent and the efferent loop the problems related to gastric resection (as postoperative sequelae, dumping syndrome, reflux esophagitis, alkaline gastritis, etc.) are avoided. Problems regarding lymphadenectomy in patients submitted to subtotal gastrectomy (D2-D3) are then reported. After a brief history of gastric reconstruction following gastric resection the evolution in surgical techniques and the results obtained during the last 10 years are described. The good long term results allow to conclude that our strategy in gastric surgery ensures a good quality of life of the patients as well as a radical operation in case of gastric cancer.