[The use of prostheses in recurrent hernias]. / L'uso delle protesi nelle ernie recidive.

The use of inert plastic (Prolene mesh, 0,027 inches in thickness fournited by Ethicon) as preperitoneal prosthesis in repair of incisional hernias and inguinal hernia recurrencies has been investigated in 28 patients operated upon then 1977 to 1984. In 9 patients the inguinal approach was used with one recurrence (11%). In 9 patients the posterior approach through a midline incision has been used with two recurrences (22%). In 10 patients with incisional hernias there was only one recurrence (10%). Total recurrences rate was 14%. Most recurrences occur in patients operated from 1977 to 1980 (40%). Patients operated in the last period from 1980 to 1984 had no recurrences.

[Anal sphincter function following colorectal anastomosis with a stapler by transperineal-sphincter approach]. / La funzionalita' sfinterica anale dopo anastomosi colo-rettale con stapler per via trans-perineo sfinterica.

In 4 patients who under went low anterior resection for cancer of mid and lower 1/3 of the rectum, with colo-rectal anastomosis by posterior transphinteric approach, anorectal pressure profiles have been studied by open tip technique 30 d. 6 months following operation. Bowel movements, gas and feces discrimination and anal continence were also controlled. Resting pressure, delta % pressure changes during recto-anal reflex, pressure in voluntary contraction, altered in the first post-operative period, become normal in 6 months. Although volume and pressure at urgent rectal sensation, volume and rectal sensation and compliance altered after surgery did not change after 6 months, suggesting that the reservoir function of the rectum is lost, patients achieved a good control of bowel movements, and a good gas and feces discrimination and anal continence within the first 6 months of operation.

[The use of mechanical suturing in colorectal anastomoses]. / L'uso delle suturatrici meccaniche nelle anastomosi colo-rettali.

In 16 patients affected by cancer of the mild or lower 3 of the rectum, has been performed a colorectal anastomosis by EEA Stapler, with abdomino-transanal approach. In the postoperative period no case of anastomotic bleeding or stenosis has been observed. 3 patients (18%) presented minor anastomotic dehiscence detected by radiologic examination, without clinical symptomatology. The EEA Stapler anastomosis seem sure almost as the traditional hand sutures, and allow the execution of anterior resection instead of abdominal perineal amputation of rectum.

[The use of mechanical suturing in esophago-jejunal anastomoses]. / L'uso della suturatrice meccanica nelle anastomosi esofago-digiunali.

10 esophagojejunostomies by EEA Stapler were performed on adult patients (8 males and 2 females, mean age 54 years), after total gastrectomy for gastric cancer. No postoperative bleeding or stricture were observed. 2 anastomotic leaks occurred (20%). The major cause of anastomotic failure is probably technical (incorrect assembly or lubrication of the instrument). According to the our experience and to literary data, the use of stapling devices for performance of esophagojejunostomies is recommended.

[Strain-gauge plethysmography in the evaluation of the evolution of deep vein thrombosis of the legs]. / La pletismografia a strain-gauge nella valutazione della evoluzione della trombosi profonda degli arti inferiori.

Previous research has shown that MVO (Maximum Venous Outflow), VR (Venous Reflux), VE (Venous Emptying) and the respiratory waves recording are useful in differentiating occlusion and recanalization in postphlebitic syndrome. In the present work strain-gauge plethysmography was employed to quantitate the venous function after deep venous thrombosis of the legs. The studies were performed in a vascular laboratory with controlled temperature (23 to 25 C); records were obtained by a plethysmograph Parks mod. 270 connected to a Hewlett-Packard multi-channel mod. 7700. 17 patients (12 males, 5 females), mean age 55 years (range 24-75) that presented femoropopliteal thrombophlebitis documented by phlebography at the admission to the hospital were examined. MVO with and without superficial veins occlusion was measured by a mercury in silastic strain-gauge placed circumferentially about the calf. A pneumatic cuff thigh was inflated to 60 mm Hg. VE was measured in patients lying in inclined bed with the lower extremities 100 cm below the heart level compressing the calf with a pneumatic cuff 10 times for 5 seconds; the strain-gauge was placed on the foot level. VR after Valsalva's maneuver and the respiratory waves were recorded by a strain-gauge positioned at the maximum girth about the calf in patients lying on inclinated bed with the lower extremities 50 cm below the heart level. The result are here indicated: (Table: see text) There was differences in the evolution of venous function after deep venous thrombosis of the legs for each patient. Strain-gauge plethysmography may become evaluable non invasive technique in the evaluation of deep venous thrombosis evolution in the legs. The therapeutic assessment of postphlebitic syndrome.

[Sexual impotence of vascular etiology in arterial obstructive disease of the legs]. / L'impotenza sessuale da causa vascolare nelle arteriopatie obliteranti degli arti inferiori.

In order to demonstrate the relationship between sexual impotence and penile-brachial index 142 patients with arteriosclerotic disease of the legs and 15 control patients have been studied. Penile-brachial index has been evaluated by Doppler ultrasound, while sexual impotence has been graded on the basis of clinical history. Patients with arteriosclerotic disease have been further divided into 2 groups: patients with normal sexual potence and patients with sexual impotence. Penile-brachial index resulted 0,87 +/- S.D. 0,16 in the former group, while it resulted 0,59 +/- S.D. 0,22 in the latter. The present data seem to suggest that in patients with arteriosclerotic disease of the legs a positive relationship exists between penile-brachial index greater than 0,80 and a normal sexual potence, while a penile-brachial index less than 0,60 strongly indicates the possibility that the main factor responsible for sexual impotence is vascular insufficiency.