[Primitive adenocarcinoma of the duodenum. Description of two clinical cases]. / Adenocarcinoma primitivo del duodeno. Descrizione di due casi clinici.

Two cases of a primitive adenocarcinoma of the duodenum are presented. Both cancers were localized near the papilla. Duodenocephalopancreatectomy was the surgical treatment for each patient. One patient died of myocardial infarction eight months after surgery, without any sign of recurrence of the cancer; the other is in good health three months after surgery. The rarity of such a tumor is underlined: in 44 papers published in various journals from 1971 to 1993, 88 cases of primitive adenocarcinoma of the duodenum were examined; the average number of cases per author was two. Between 1980 and 1993, an Italian multicenter study carried out in 36 hospital and university centers, showed only 89 cases of primitive duodenal adenocarcinoma.

[Laser therapy of esophageal tumors. Technical notes and personal experience]. / Il trattamento dei tumori esofagei con laser. Note di tecnica ed esperienza personale.

In Italy the incidence of oesophageal cancer is very low: 4 cases every 100,000. More than 60% of patients are observed with dysphagia and oesophageal stenosis. For these patients their is no surgical indication and prognosis is less than 1 year. We have applied the recanalization of oesophagus with laser in 137 patients (range 47-88 years). One year survival was 53.1%, three years 5.8%. The aim of this paper is to describe our techniques and analyze 5 years of activity.

Diaphragmatic hernias due to blunt thoracoabdominal trauma.

This nineteen-year retrospective review was designed to evaluate diaphragmatic hernias due to blunt thoracoabdominal trauma in a series of 50 patients. Motor-vehicle accidents were the most frequent cause. The diagnosis was made immediately after injury in 34 patients (acute hernias), but delayed from two months to 30 years in 16 (chronic hernias). Two patients, with multiple associated injuries, died soon after admission and diagnosis was made at necropsy. The nature of injury, the physical findings and the plain chest roentgenograms suggested a traumatic diaphragmatic hernia in most of the remaining acutely injured patients. All patients with chronic hernias had suggestive or suspicious abnormalities on chest roentgenograms; however, appropriate upper gastrointestinal tract and barium enema studies were of utmost importance for the correct diagnosis. Reduction of herniated viscera and repair of diaphragmatic defect were generally accomplished through a laparotomy in acute hernias, whereas thoracotomy was the preferred approach in delayed instances. There were four postoperative deaths, three with severe multiple associated injuries and one with respiratory failure.

[Retrosternal gastric bypass in the palliative treatment of advanced carcinoma of the thoracic esophagus]. / Il bypass gastrico retrosternale nel trattamento palliativo del carcinoma avanzato dell'esofago toracico.

Palliative substernal gastric bypass was performed in 20 patients with far-advanced, obstructing carcinoma of the thoracic esophagus between the years 1978 and 1982. In 18 patients the thoracic esophagus was bypassed using the stomach brought to the neck by substernal route for anastomosis to the proximal end of the divided cervical esophagus. The thoracic esophagus was completely excluded in 10 patients; the tumor-bearing segment of the esophagus excluded formed a small and asymptomatic mucocele with time. The Kirschner-Ong technique with the additional step of Roux-en-Y jejunal anastomosis to the intra-abdominal esophagus was used to provide drainage of esophageal secretions in 8 patients with tracheoesophageal invasion or impingement, for fear of imminent esophagorespiratory fistula; in three of these patients a radiation therapy was subsequently administered. In two patients an isoperistaltic gastric tube formed from the greater curvature and brought to the neck substernally was used for esophageal bypass. Anastomotic leakage occurred in 3 patients (15%). The thirty day operative mortality was 10 per cent (2/20) and the mean survival time was 10 months. The palliation afforded was excellent in all survivors with restoration of the ability to swallow a normal diet until the time of death. The authors believe that a simple one-stage bypass of the esophagus using the stomach substernally is an effective alternative to esophageal intubation, prolonged radiation therapy or colon bypass in achieving palliation with an acceptable morbidity and mortality in a high risk patient group.

[Bilateral splanchnicectomy according to the Dubois method in pain caused by chronic pancreatitis and by inoperable neoplasms of the pancreas]. / La splancnicectomia bilaterale second Dubois nelle algie da pancreatite cronica e da neoplasie inoperabili del pancreas.

The authors report a personal series of 12 p. undergoing splanchnicectomy through Dubois' transhiatal approach because of abdominal pain of pancreatic origin. They underline this technique produces immediately a total, lasting pain relief, improving quality of life of these patients.

[Treatment of esophagotracheal and esophagobronchial fistulas secondary to carcinoma of the esophagus]. / Il trattamento delle fistole esofago-tracheali ed esofago-bronchiali secondarie a carcinoma dell'esofago.

An experience with 16 patients with respiratory tract fistula (RTF) related to carcinoma of the esophagus is presented. The malignant fistula was present at the time of initial presentation and/or before any therapeutic intervention in 11 patients, and developed either during or following a course of radiation therapy in 5 patients. Bronchoscopy examination in 8 patients prior to RTF development showed tracheobronchial invasion or impingement in all. The patients were divided in five groups according to the treatment received. One patient received no specific therapy although was fed via nasogastric tube. Three patients had a feeding gastrostomy. Four patients underwent insertion of a Celestin tube. Three patients were submitted to esophageal exclusion with combinations of cervical esophagostomy, feeding gastrostomy and ligation or complete division of the gastroesophageal junction; drainage of the excluded esophagus was provided by a red rubber catheter. Five patients received by-pass operation: four had Kirschner-Ong operation with gastric by-pass placed substernally and distal esophagus anastomosed to a Roux-en-Y jejunal loop; in one patient an isoperistaltic gastric tube brought to the neck substernally was used for esophageal by-pass. These patients had, by far, the best palliative results with complete relief of their respiratory tract symptoms and restoration of the ability to eat and drink. Substernal gastric by-pass of the RTF is therefore advocated if the general conditions of the patient are improved with the institution of parenteral hyperalimentation and antibiotic therapy.

[Current role of surgery in the treatment of pulmonary metastasis]. / Il ruolo attuale della chirurgia nel trattamento delle metastasi polmonari.

During the period between november 1964 and december 1982, 48 patients were operated upon for metastatic lesions of lung from previous or actual carcinomas and sarcomas elsewhere in the body. The most frequent sites of origin of the primary malignancy were colon, testis and breast. The usual approach was through a thoracotomy; bilateral lung metastases were removed with one-stage procedure through a median sternotomy in two patients. The operative mortality was 2%. Overall five-year survival was 26%, which was not influenced by tumor histology, disease-free interval, or extent of pulmonary excision. In view of these findings, conservative pulmonary resection of metastatic lesions is advocated, regardless of the tumor histology or the disease-free interval, when the following criteria are adhered to: primary site controlled or controllable; no extrapulmonary metastases demonstrable; good operative risk; no other effective means of treatment available.

[Long-term results of the surgical treatment of ileo-colonic Crohn disease]. / Risultati a distanza del trattamento chirurgico della malattia di Crohn ileo-colica.

18 patients with Crohn's disease primarily treated with excisional surgery were studied. The crude recurrence and reoperation rate were analyzed. The influence of sex, age and length of history prior to operation was in this respect also studied.