[Aspects of the complications after restorative proctocolectomy in the treatment of ulcerative colitis. Review of the literature and personal experience]. / Aspetti delle complicanze dopo proctocolectomia restaurativa nel trattamento della colite ulcerosa. Revisione della letteratura ed esperienza personale.

PURPOSE: Analysis of complications and causes of failure after stapled restorative proctocolectomy with ileal J pouchanal anastomosis in patients with ulcerative colitis is presented. PATIENTS AND METHODS: The procedure was performed in 28 patients, 19 males (68%) and 9 females (32%); diverting ileostomy was always performed. RESULTS: There was no perioperative mortality. The overall morbidity rate was 31%. Six patients (21%) had pelvic abscess, 2 (7%) pelvic hematoma, 4 patients (14%) presented ileo-anal anastomotic stricture, 1 patient (3.6%) had pouch-vaginal fistula, three patients (11%) presented intestinal obstruction and 7 (25%) pouchitis. Reoperation was necessary in patients with small bowel obstruction and with pouch-vaginal fistula. Septic complications and pouchitis were resolved with medical treatment. Stenosis of the anastomosis required anal dilation. No patient underwent pouch excision for pouch failure. CONCLUSION: The main significant complications of ileal pouch-anal anastomosis for ulcerative colitis were pelvic sepsis, intestinal obstruction and pouchitis. Our results suggest that the use of stapling technique is safer and has fewer early septic complications and sepsis-related pouch removals. Success in ileo-anal construction increases with experience. The selection of patients with exclusion of Crohn disease, a correct surgical timing, a carefully technique, a delayed ileostomy closure and a low pre and postoperative regimen of steroids are important factors of success.

[The spontaneous rupture of a pyogenic liver abscess. A clinical case]. / Rottura spontanea di ascesso epatico piogenico. Caso clinico.

The authors report a case of a large monolocular liver abscess in a patient with gallbladder and choledocic stones and biliary stent, complicated by rupture into the peritoneal cavity, that required surgical treatment. Surgical exploration versus other approach results the choice treatment, as shown by resolution of the pathology.

Esophageal achalasia. Diagnostic and therapeutic implications.

Over an 11-year period, 15 patients underwent surgery for achalasia (Heller's operation with added antireflux procedure). Thereafter due to the use of manometry 25 other achalasic patients were diagnosed and 17 of them underwent the same surgical procedure. Manometry was done by means of a triple-lumen catheter as described by Arndorfer. Surgical results in the first group were good in 80% and moderate in 20% with no recurrence or organic complications due to acid reflux, while in the second group good results were 95%. In 16 cases of the second group, diagnosis was based on manometric recordings, since the radiological findings were lacking. Early diagnosis enabled to operate on selected patients according to the motor findings of the esophageal body. Follow-up by manometry revealed in some cases an increase in post-deglutitory motor activity and in two cases a return of a coordinated peristalsis. Clinical and functional results are discussed and the role of manometric studies is stressed in order to improve the knowledge of the pathophysiology of functional diseases of the esophagus.

[Clinical and endoscopic follow-up of gastrectomized patients Billroth II technic for benign pathology]. / Verifica clinica ed endoscopica di gastroresecati secondo Billroth II per patologia benigna.

A follow up was performed in 109 patients primarily undergone Billroth II resection for benign gastric or duodenal diseases to analyze mucosal changes, possibility of premalignant lesions and importance of causal factors in aetiology of gastric stump cancer. Moreover, clinical status and haematological parameters for nutritional assessment are examined to identify indicators of postgastrectomy sequelas.

[Candida esophagitis simulating a neoplasm]. / Esofagite da candida simulante la neoplasia.

The authors report a case of Candida esophagitis developed like a malignant neoplasm. They explain the severe lesions according to the last physiopathological findings and emphasize the role of roentgenographic and endoscopic (biopsies and brushing) examinations in the differential diagnosis.

[Benign obstructive choledochal pathology. I. A comparison between alternative technics of surgical treatment]. / La patologia benigna ostruttiva coledocica. I. Confronto tra le tecniche alternative del trattamento chirurgico.

The authors, on the basis of personal experience, as well as mentioned in the literature, discuss indications and complications concerning alternative surgical choice in the treatment of benign obstructive lesions of the biliary tract.

[Benign obstructive choledochal pathology. II. Immediate and late results of surgical treatment. 294 cases]. / La patologia benigna ostruttiva coledocica. II. Risultati immediati e a distanza del trattamento chirurgico. 294 casi.

Personal experience in 294 cases of surgical management of common bile duct is described. Results are obtained by a computerized data analysis.

[External duodeno-pancreatic fistulas. Proposal of an associated treatment: aspiration with a nutripump and infusion of lactic acid]. / Le fistole duodeno-pancreatiche esterne. Proposta di trattamento associato: aspirazione con nutripompa ed infusione di acido lattico.

A technique is proposed for a conservative treatment of the duodenal-pancreatic fistula. The use of a two-way peristaltic pump; with normal flux for the enteric route and inverted flux for aspiration with terminal in external fistula allowing for in the meantime a constant infusion of lactic acid.

[Critical evaluation of the protracted use of somatostatin in the conservative treatment of complex pancreatico-duodenal fistulas]. / Valutazione critica dell'impiego protratto della somatostatina nella terapia conservativa delle fistole complesse pancreatico-duodenali.

The authors refer to their experience in dealing with prolonged intravenous infusion of Somatostatin in treating two cases of complicated duodenal-pancreatic fistula. The results confirm the therapeutic efficiency in accelerating the healing process without any side effects of the drug.

[Short-term effects of cimetidine in patients with bleeding duodenal ulcer. Presentation of cases]. / Effetto a breve termine della cimetidina in pazienti affetti da ulcera duodenale sanguinante. Presentazione della casistica.

The authors here present a work dealing pith two groups of subjects, both groups having the diagnose of bleeding duodenal ulcer; one group using therapy antacid alone, the other using cimetidine and antacid. This last is more affected in controlling bleeding then just using antacids alone. Moreover the use of cimetidine reduces the period of bleeding, increases the number of subject who stop bleeding and reduces the amount of blood transfused in these subjects. We are also convenced that the use of cimetidine even prolong in time, does not protect these subjects from having other relapse. Therefore propose the Billroth II and from own experience this is a good therapy to prevent other bleeding.

[Wilkie's syndrome: etiopathogenetic, clinical and therapeutic aspects of some cases we have seen]. / La sindrome di Wilchie: considerazioni eziopathogenetiche, cliniche e terapeutiche su alcuni casi giunti alla nostra osservazione.

The Authors hold that for the onset of the clinical manifestations of the Wilchie's syndrome the contemporary appearance of 2 causes is necessary: the first is an anatomical variance of the organs comprising that particular anatomical location and the second being a pathological alteration taking place in one or more of these set organs. Moreover they suggest appropriate surgical procedure art at removing both causes that produced the disease.