Purpura fulminans in meningococcal septicaemia in an adult: a case report.

Purpura fulminans is a rare and severe complication of meningococcal septicaemia. It presents as a petechial rash spreading rapidly in extent and depth, evolving into full-thickness skin necrosis. The condition is extremely uncommon in the adult population. We report the case of a 28-yr-old man with extensive meningococcal-related skin necrosis. The initial diagnosis was made and first treatment given in the emergency department of a local hospital, from where after 12 days he was transferred to our hospital. Our approach was based on the continuation of intensive treatment and on staged aggressive debridement. Temporary alloplastic skin grafts were used to prepare the wound bed and the wounds were closed with autologous skin grafts. The patient survived but subsequently, owing to chronic skin ulceration and scar instability, he underwent late bilateral below-the-knee amputation.The patient returned to normal deambulation with an orthopaedic prosthesis 18 months after the onset of meningococcal septicaemia.

[Observations in sclerosing cholangitis]. / Alcune osservazioni sulla colangite sclerosante.

Sclerosing cholangitis is a rare liver disease of unknown etiology with a slow but progressive course. The authors report their experience and illustrate some surgical procedures to preserve bile duct patency in view of a liver transplantation program.

[Double-blind evaluation of the effectiveness of cimetidine in the arrest of hemorrhages due to gastroduodenal peptic lesions]. / Valutazione in doppio cieco dell'efficacia della cimetidina nell'arresto delle emorragie da lesioni peptiche gastro-duodenali.

40 patients with an endoscopic diagnosis of bleeding gastric or duodenal lesions have been examined in a double blind study. The haemorrhages were subdivided into slight and serious on the basis of objective parameters. Cimetidine (1.2 g/die i.v.) or placebo in a preparation indistinguishable from the drug were administered to patients. Arrest of the haemorrhage was evaluated on the basis of clinical and endoscopic criteria, and the study was pursued up to 96 hours from the start of bleeding. The effect of cimetidine proved greater than that of the placebo in serious haemorrhage, particularly where due to gastric lesions, but no differences were seen between drug and placebo in the slight haemorrhages.

[Catheterization of the subclavian vein by the supra- and subclavicular routes. Retrospective study in 105 patients]. / Cateterizzazione della vena succlavia per via sovra e sottoclaveare. Studio retrospettivo di 105 pazienti.

Central venous catheterisation via the supraclavicular and subclavicular route was performed in 61 and 44 cases respectively at the department's intensive therapy unit. A statistical assessment was made of the modalities of application, complications, time of indwelling, and reasons for removal. A large number of more serious complications (pneumothorax, haemothorax, arterial puncture) were noted with the supraclavicular technique, whereas subclavian catheterisation permitted longer residence times and was rarely responsible for serious disturbances, even though there were more instances of poor positioning. A preference is expressed for the second method. Mention is also made of employment of the internal jugular in recent cases, though these are not yet sufficiently numerous to enable any conclusions to be drawn.

[Long-term results of gastric resection with reconstruction, using the Billroth I method]. / Risultati a distanza della resezione gastrica con ricostruzione secondo Billroth I.

Clinical, radiological and endoscopic results at follow-up about 1-5 yr after surgery in a series of 62 patients subjected to Billroth I resection are compared with those in the literature. Recurrence of ulcers was observed in 8% (as opposed to 5% with the Billroth II). In addition, there was a marked reduction in the incidence of post-resection diseases, with less serious forms of dumping, sounder digestion, and smaller weight losses.

[Problems in the emergency surgical treatment of bleeding esophageal varices]. / Problemi nel trattamento chirurgico d'urgenza delle varici esofagee sanguinanti.

An examination is made of a series of emergency operations carried out in the period 1974-78 to arrest haemorrhage due to the rupture of oesophageal varices. An account is given of the personal criteria employed in the choice of candidates and the type of surgical management. Stress is laid on the need for greater aggressivity. In addition, support is expressed for the porto-systemic shunts, especially shunts of the porto-cava and meso-cava type. These are superior to other forms on account of their easy and rapid execution.

[Pancreaticogastrostomy in duodenocephalopancreatectomy. Operative technical note]. / La pancreaticogastrostomia nella duodenocefalopancreatectomia. Note di tecnica operatoria.

The technique used to carry out pancreaticogastrostomy after duodenocephalopancreatectomy in 4 cases is described. The technique is better than pancreaticojejunostomy, which is associated with a high incidence of postoperative complications, such as abscesses, fistulae, haemorrhage, and autodigestion at the site of anastomosis.

[Intestinal occlusion caused by endometriosis]. / Occlusione intestinale da endometriosi.

Three cases of intestinal occlusion due to endometriosis, presenting as surgical emergencies, are reported. After a review of the literature on the incidence of endometriosis, the mechanisms underlying the occlusive process and the various anatomopathological pictures are presented. The reasons why no correct preoperative diagnosis was possible and the problems encountered in differential diagnosis, particularly with respect to carcinoma of the colon and the sigma-rectum, are discussed. It is considered that correct preoperative diagnosis is very important to avoid subjecting the non-cancer patient to destructive surgery. The therapy recommended for intestinal occlusion due to suspected endometriosis is presented.