[Endoscopic surgery of the digestive system: state of the art. Opinion of an endoscopic surgeon]. / Chirurgia endoscopica dell'apparato digerente: stato dell'arte. L'opinione di un endoscopista chirurgo.

The Authors review the possible applications of surgical endoscopy in oesophageal, gastric, biliary, pancreatic and colic diseases. This critical assessment, performed under the abdominal endoscopic surgeon's point of view, is based on the overall experience of about 20 years of surgery, with particular regard to the sclerosis of oesophageal varices, neoplastic obstructions of oesophagus, biliary tract, colon and localized Laser treatment of neoplasms. Based on the results achieved, thanks to selective indications and monitoring by conventional surgical experience, the Authors conclude by staging a better reliability of the surgeon who performs surgical endoscopy to obtain good results after an accurate selection of those cases which can really benefit from endoscopic management.

[Endoscopic sclerotherapy of esophageal varices]. / La sclerosi endoscopica delle varici esofagee.

Magnetic tape recordings of endoscopic images relating to pathologies with it is extremely important to follow morphological changes after treatment offer unquestionable advantages especially in the field of sclerosing endoscopic therapy for esophageal varices. This study--which was carried out using a 3/4 inch U-Matic videotape lasting 10 minutes--confirm the above statement. The criteria of selection for sclerosing techniques are illustrated according to the authors' personal evaluations made on the basis of experience accumulated during more than 10 years' activity; the results of modulated treatment are compared as both emergency and elective treatment, used as the single therapy or following deconnection or portosystemic derivation operations. The choices are confirmed by the number of successful outcomes, with only minimal and almost always easily controlled complications. This has led to the method's inclusion in clinical practice as yet another means of controlling hemorrhages due to portal hypertension, in addition to permitting a marked increase in the percentage of success following deconnecting and derivative operations performed in patients in better conditions of clinical compensation.

[Endoscopic biliary surgery today: current aspects and prospects]. / La chirurgia biliare endoscopica oggi: attualità e prospettive.

Over the past twenty years endoscopic surgery has reached a level of use which was unthinkable when it was first introduced. The practical experience of practitioners is now able to offer a wide-ranging guarantee for the complementary and alternative resolution of even severe clinical conditions. From the start its use appeared to be particularly available in the context of biliary diseases, especially for the treatment of lithiasis and sepsis, as well as in the treatment of both benign and malignant conditions of obstructed biliary flow. Special attention has been paid to the cost/benefit ratio which is increasingly the main goal of the medical activity today. The paper illustrates the different methods which can be used with specific reference to techniques and other devices able to reduce risks and improve results. The Author's personal experience is compared with that reported in the literature in the different sectors of application. There is increasing consent regarding the results achieved to data as well as technological progress.

[Criteria of diagnostic evaluation and results of surgical treatment in chronic pancreatitis]. / Criteri di valutazione diagnostica e risultati del trattamento chirurgico della pancreatite cronica.

Correct diagnostic evaluation of chronic pancreatitis pictures must of necessity be directed to recognition of recurrent and stable forms and identification of the pathogenetic cause of the clinical forms. This objective seems to be achieved more than satisfactions by the diagnostic protocol employed personally, the first stages of which include X-ray of the abdomen for the identification of possible pancreatic calcification, ultrasonography and computed axial tomography for the analysis of organ's morphology and structure, intestinal absorption and pharmacodynamic tests of the papillary excretory complex for the evaluation of functional state of the pancreas. At a second time, this diagnostic protocol includes endoscopic pancreatography for the analysis of the excretory duct and identification of possible calcareous concretions in its lumen, and district angiography, for information on the extreme viscero-vascular implications and the possibility of coexistence of district portal hypertension pictures. The resulting information dominates therapeutic choices by indicating the usefulness of performing a papillo-sphincteroplasty to handle the biliary aetiology in recurrent forms and Wirsung septoplasty for ductal ostial stenoses. The choice of shunts and resections is confirmed to the stable forms, with the use of the former in the event of ductal dilatation and of the latter in the absence of this and in the presence of more or less marked gland fibrosis. Derivative procedures also control treatment of chronic post-pancreatitis pseudocyst, with a clear-cut prevalence of cysto-gastric shunts over all the other possibilities.(ABSTRACT TRUNCATED AT 250 WORDS)

[Endoscopic papillotomy today. Indications and results]. / La papillotomia endoscopia oggi. Indicazioni e risultati.

The therapeutic possibilities offered by endoscopic papillotomy have improved in comparison with the recent past by virtue of mounting experience and increasingly satisfactory results. The position of the surgeon in the face of this procedure is more serene and objective than those who concern themselves with the endoscopic method as such. In long-term personal experience, endoscopic papillotomy was indicated in 162 cases of biliary lithiasic pathology--associated and otherwise with Odditis--and angiocolitis, with and without the gall-bladder. The reference to endoscopic treatment was mainly confined to patients with associated pathologies, dependent and otherwise, that involved general or specific surgical risk, while evaluations of the lumen of the biliary excretory way, of the coexistence of more or less incisive biliary inflammation, of the age of the patient--all parameters to which are attributed special importance for the choice between derivative intervention and open papillotomy--do not possess particular significance for the endoscopic method. Results obtained and the low incidence of short and long-term morbility support the claim to absolute usefulness of the method when it is proposed on correct indications and carried out with expert technique.

Hemangioma of the small bowel. Case report.

Cavernous hemangioma is a very rare disease if located in the ileum, but not an uncommon lesion if it occurs in the large bowel. The Authors report a case of small bowel cavernous hemangioma, and consider clinical, diagnostic and therapeutic aspects for an exact evaluation of the lesion.

[Prognostic, clinical and anatomo-pathological aspects of gastric lymphoma]. / Aspetti prognostici, clinici ed anatomopatologici del linfoma gastrico.

The authors refer about the results of a study made on 15 cases of gastric lymphoma with a mean follow-up of 6 years. Among the examined features they underlie the clinical appearance of each case according to histologic cell-type, stage of disease and performed treatment with relation to the survival rate. According to the Rappaport classification, diffuse histiocytic lymphoma was the most frequent histologic type of disease: the prognosis turned out to be significantly favorable in case of stage I, while no correlation was observed between different surgical procedures and cell-type. The overall 5 years survival rate was 33.3% with a strong suggestion of better survival in case of early diagnosis.