[Laparoscopic cholecystectomy. Our experience]. / La colecistectomia laparoscopica. Nostra esperienza.

BACKGROUND AND AIMS: The authors analyse their first two years of experience regarding the use of laparoscopic cholecystectomy and report the results of this series and their observations. METHODS: A total of approximately 200 cholecystectomies have been performed using a laparoscopic technique at S. Paolo Hospital in Naples (Department of Surgery; Head: Prof. R.A. Caliendo) since October 1996. Initially patients were rigorously selected in accordance with international criteria. At present, after the good results obtained, the real contraindications to laparoscopic cholecystectomy are considered to be: a) the patient's refusal; b) general conditions that do not allow the use of general anesthesia in surgery. RESULTS: None of these 200 patients was converted to open surgery, although six complications occurred: four of these were cases of bleeding in which it was decided to choose a carefully monitored wait-and-see approach. Mean postoperative hospitalisation was two days. No major postoperative complications were observed and it was not necessary to keep any patient for more than five days. CONCLUSIONS: On the basis of this experience, the authors underline the value of laparoscopic surgery versus open cholecystectomy (reduced morbidity, shorter hospitalisation with marked social and economic advantages). Furthermore, the authors emphasise that, when laparoscopy is first introduced, it is important for the same operating team always to be present in order to ensure a good learning curve and increasing familiarity with the technique.

[Colonic angiodysplasia: an important cause of digestive hemorrhage]. / Le angiodisplasie del colon: un'importante causa di emorragia digestiva.

Angiodysplasia of the colon is one of the most common causes of lower gastrointestinal bleeding in elderly patients. The diagnosis can be made by colonscopy or angiography. The best treatment, endoscopic coagulation or surgical resection, is still being debated. Over a period of nearly seven years, 5 patients with angiodysplasia of the colon were treated in our Department. The treatment was right hemicolectomy for all patients with localization at the caecum or ascending colon; in the only patients with segmoid localization a segmentary resection was performed. During a mean follow-up of 22.8 months no patient had any further bleeding. In our opinion surgery is a satisfactory treatment, even if for localization on the left colon a conservative treatment should be preferred.

Postoperative gastric complications in vascular patients.

Although there is no etiopathogenetic correlation between arterial diseases and gastroduodenal ulcer, a chronic gastric disease can increase postoperative morbidity and mortality, in patients with arterial diseases. Furthermore, postoperative complications due to the development of acute hemorrhagic gastritis are frequent and dangerous, even in patients without any pre-existing gastric pathology. The experience of our Department in this field is reported here, and the risk and severity of hemorrhagic complications after administration of prophylaxis in patients with arterial diseases and gastroduodenal ulcer are evaluated.

[Effects of parenteral nutrition on gastric secretion in patients in cerebral coma]. / Effetti della nutrizione parenterale sulla secrezione gastrica in pazienti in coma cerebrale.

Total parenteral feeding reduced gastric secretions, but patients sometimes complain of pyrosis and acidity. The gastric secretion, gastrinaemia and insulinaemia of 96 patients subjected to TPN were measured. Results showed a nonpathological increase in gastrinaemia and acidity which might be related to the high levels of insulinaemia.

[Metabolic imbalance during total parenteral nutrition. Experience in subjects with degenerative neurological diseases]. / Squilibri metabolici in corso di N.P.T. Nostra esperienza in soggetti con malattie neurologiche defedanti.

Various metabolic disturbances (hydroelectrolytic and basic acid imbalances, hypo- and hyper- glycaemia etc.) are among the possible complications of N.P.T. A comparative statistical study of similar patients undergoing N.P.T. and others not so treated demonstrates that far from stimulating metabolic disturbances, N.P.T. is able to reduce the incidence of such conditions.

[Biohumoral variations during total parenteral nutrition with lipids. Effects on plasma lipoproteins in patients in cerebral coma in regression]. / Variazioni bioumorali in corso di N.P.T. con lipidi. Effetti sulle lipoproteine plasmatiche di pazienti in coma cerebrale in regressione.

An assessment was made of the blood lipid pattern in a group of patients in critical situations subjected to T.P.N. with a mixed calorie intake (sugars, lipids, amino acids). It was found that the pronounced previous deficiency was corrected in a significantly shorter period, and that despite the large load on calories in the form of fats there were no changes worthy of note in the body fluids. Serial determination of lipoproteins before, during and after T.P.N. substantiated the clinical findings. Lab checks, within the limits set by intuitive variations, did not reveal alterations with a pathological meaning, for the very reason that they were not linked to organic enzyme and hormone deficiencies, but were positive changes attributable to the temporary exogenous input.