[Dislocation into the cardial lumen of a PTFE prosthesis used in the treatment of voluminous hiatal sliding hernia, A case report]. / Dislocazione nel lume cardiale di protesi in PTFE utilizzata per il trattamento di voluminosa ernia jatale da scivolamento. Descrizione di un caso clinico.

The authors report a case in which a PTFE prosthesis, used to treat a voluminous hiatal sliding hernia, dislocated inside the cardial lumen. Within two months the prosthesis had become decubitant and penetrated the cardial lumen, causing dysphagia, inappetence and weight loss. The use of radiological and tomographic imaging failed to provide a clear diagnosis; endoscopy alone was conclusive. Surgery was required to remove the prosthesis by resecting the distal esophagus and reconstructing the continuity of the digestive tract using terminolateral esophagogastric anastomosis (front wall of the stomach) in CEEA 21. The absence of a clear etiopathogenetic sequence of the migration of the prosthesis prompted the authors to stop using this type of surgery.

Evolución de 157 pacientes con gliomas de diferente grado de malignidad sometidos a tratamiento multidisciplinario / Evolution of 157 patients whith gliomas of different degree malignity with multidisplinary treatment

Se analiza la evolución de 157 pacientes (97 varones) con diagnóstico histológico de astrocito-ma anaplásico (AA, N=53), astrocitoma de bajo grado (ABG, N=31) y glioblastoma (GB, N=73) sometidos a tratamiento multidisciplinario. Los pacientes con AA, GB y ABG con resecciones parciales (RP) o recidiva realizaron cirugía, radioterapia y/o quirnioterapia (lomustina, vincristina y procarbazina). Los ABG con resec-ción completa (RC) efectuaron solo cirugia. La edad X ñ ES fue 49,71 ñ 1,9 para AA, 39,19 ñ 2,4 para ABG y 59,13 +- 1,3 para GB (p < 0,0001). Un Karnofsky > 70 por ciento se observó en el 84,90 por ciento, AA, 90,32 por ciento ABG y 38,35 por ciento GB. El número de RC fue: 64,15 por ciento para AA; 61,29 por ciento ABG y 23,28 por ciento GB. Se encontraron diferencias significativas entre la edad, Karnofsky y tipos de cirugía de los distintos tipos histológicos. La sobrevida media para AA fue 30,02 meses (IC 95 por ciento 25,99 - 34,05); 43,32 meses (IC 95 por ciento, 36.82 - 49,83) para ABG y 10,20 meses (IC 95 por ciento, 9,28 - 11,12) para GB. La sobrevida se correlacionó con edad, Karnofsky y tipo de cirugía (p<0.0001) en pacientes AA y con Karnofsky en pacientes GB (p<0,000 l). Cuando se analizó la sobrevida de los diferentes tipos histológicos en función de la cirugia y Karnofsky se observó rnayor sobrevida en los pacientes con RC y Karnofskv > 70 por ciento (p<0,0001, Log rank test). Sólo en 10 pacientes la toxicidad correspondió al grado 3 de la OMS y ninguin caso requirió modificación de la dosis. En concordancia con otras comunicaciones la evolución de los AA fue mejor que la de los GB. La mayor frecuencia de resecciones completas, el mejor Karnofsky y la menor edad pueden contribuir con estos resultados. La mejor evolución de los pacientes con ABG dependería más del tipo histológico que de las otras variables consideradas.

Evolución de 157 pacientes con gliomas de diferente grado de malignidad sometidos a tratamiento multidisciplinario / Evolution of 157 patients whith gliomas of different degree malignity with multidisplinary treatment

Se analiza la evolución de 157 pacientes (97 varones) con diagnóstico histológico de astrocito-ma anaplásico (AA, N=53), astrocitoma de bajo grado (ABG, N=31) y glioblastoma (GB, N=73) sometidos a tratamiento multidisciplinario. Los pacientes con AA, GB y ABG con resecciones parciales (RP) o recidiva realizaron cirugía, radioterapia y/o quirnioterapia (lomustina, vincristina y procarbazina). Los ABG con resec-ción completa (RC) efectuaron solo cirugia. La edad X ñ ES fue 49,71 ñ 1,9 para AA, 39,19 ñ 2,4 para ABG y 59,13 +- 1,3 para GB (p < 0,0001). Un Karnofsky > 70 por ciento se observó en el 84,90 por ciento, AA, 90,32 por ciento ABG y 38,35 por ciento GB. El número de RC fue: 64,15 por ciento para AA; 61,29 por ciento ABG y 23,28 por ciento GB. Se encontraron diferencias significativas entre la edad, Karnofsky y tipos de cirugía de los distintos tipos histológicos. La sobrevida media para AA fue 30,02 meses (IC 95 por ciento 25,99 - 34,05); 43,32 meses (IC 95 por ciento, 36.82 - 49,83) para ABG y 10,20 meses (IC 95 por ciento, 9,28 - 11,12) para GB. La sobrevida se correlacionó con edad, Karnofsky y tipo de cirugía (p<0.0001) en pacientes AA y con Karnofsky en pacientes GB (p<0,000 l). Cuando se analizó la sobrevida de los diferentes tipos histológicos en función de la cirugia y Karnofsky se observó rnayor sobrevida en los pacientes con RC y Karnofskv > 70 por ciento (p<0,0001, Log rank test). Sólo en 10 pacientes la toxicidad correspondió al grado 3 de la OMS y ninguin caso requirió modificación de la dosis. En concordancia con otras comunicaciones la evolución de los AA fue mejor que la de los GB. La mayor frecuencia de resecciones completas, el mejor Karnofsky y la menor edad pueden contribuir con estos resultados. La mejor evolución de los pacientes con ABG dependería más del tipo histológico que de las otras variables consideradas. (AU)

[Lymphatic cyst of the mesentery]. / Cisti linfatica del mesentere.

Lymphatic cyst of the mesentery is a rare lesion; one case per 100,000 hospital admissions is reported. A case of lymphatic cyst in a sixty-one-year-old woman is presented. The symptoms are extremely variable, not characteristic and correlated to the location and size of the cyst. Abdominal ultrasonography and computed tomography may lead to a correct diagnosis, which is regularly made at the time of abdominal exploration. In this case the cyst was enucleated from the mesentery with open surgery.

[Retroperitoneal tumors. Observations on 8 cases]. / I tumori retroperitoneali. Osservazioni su 8 casi.

The incidence of retroperitoneal tumours is extremely low (0.01-0.2% of all neoplasias). Their onset is atypical and a palpable mass is often clinically evident, together with abdominal pain and fever. A major impetus has been given to diagnosis by instrumental techniques, and in particular CT. Surgical treatment is required for these tumours. The prognosis does not improve following radio and chemotherapy. The authors describe 8 cases referred to their attention between 1980 and 1995.

[Proposal for the use of preoperative pneumoperitoneum in the treatment of large bilateral inguinal-scrotal hernias]. / Proposta di utilizzazione del pneumoperitoneo preoperatorio nel trattamento delle ernie inguino-scrotali permagne.

The authors bring again their therapeutic behavior effected with the technique of the pneumoperitoneum preoperative for the resolution or a case of bilateral inguinal hernia. Having used a catheter of Tenckoff with external link to Y, in use beside the nephrologist, for peritoneal dialysis and has stayed positioned for percutaneous way into the peritoneal cavity. Has stayed insufflated increasing quantity of air in abdomen from 100 cc after the first day of treatment, to 1500 cc after the 15th day, to allow a sufficient increase of the ability or the peritoneal cavity and allow the reduction of the intestinal loops in abdomen. The patient has stayed subjected to F.K. Respiratory T. and constant control of the EGA for permitting the patient to have a hernioplasty with median navel-pubic access and positioning of preperitoneal prosthesis according to Stoppa in the best possible conditions.

[Dieulafoy ulcer associated with acute drug-induced gastritis: a rare case]. / Ulcera di Dieulafoy associata a gastrite acuta da farmaci: un raro caso.

The lesion in Dieulafoy's disease consists of an unusually large and tortuous artery in the base of an ulcer. The disease is underdiagnosed rather than truly rare and often presents with a massive and potentially fatal, usually repeated, haematemesis. The authors describe a case of Dieulafoy's disease associated with acute drug-induced gastritis whose gravity required, in the case reported, a very serious emergency treatment.

[Pancreatic encephalopathy. Description of an unusual case]. / Encefalopatia pancreatica. Descrizione di un raro caso.

The authors describe a case of pancreatic encephalopathy. This uncommon condition, rarely described in the literature, occurs with neuropsychiatric signs 3-4 days after the onset of acute pancreatitis. Diagnosis is due to clinical and biochemical findings and to post mortem examinations revealing also amylase in CSF.

[Use of atracurium in continuous intravenous infusion]. / Impiego dell'atracurium in infusione endovenosa continua.

In this study the use of atracurium was evaluated for use in continuous endovenous infusion by controlling infusion levels using the simple technique of TOF monitoring during general surgical operations. In conclusion, continuous infusion of blocking agents is the preferential technique for controlling and maintaining a neuromuscular block; moreover, the use of besylate of atracurium is advised to ensure a reduced rate of individual variation.

[Comparative evaluation of several muscle relaxants]. / Valutazione comparativa di differenti miorilassanti.

The use of different muscle relaxants have been studied in two homogeneous groups of patients, in the first group atracurium and in the second succinylcholine-pancuronium. The utility of atracurium in short-medium abdominal surgery has been demonstrated.

[Proposal for a new technic for surgical treatment of essential varicocele]. / Proposta di una nuova tecnica per il trattamento chirurgico del varicocele essenziale.

An original technique for the surgical treatment of essential varicocele called "Transposition of the pampiniform plexus" is proposed. The operation does not cause trauma and does not involve damage to or removal of any structure. Its purpose is essentially to limit damage to the testicle consequent on venous stasis and the weight of the column of blood which in the erect position weighs on the gland. Transposition of the pampiniform plexus permits the placing of what is tantamount to a filter, interrupting a column. The results obtained in six years of activity on 163 cases have been very satisfactory. Recurrences were never observed.

[The use of atracurium in subjects with chronic renal insufficiency]. / L'uso dell'atracurium in soggetti con insufficienza renale cronica.

Atracurium has been studied in 16 patients divided into two groups, the first of which suffering from chronic renal failure. The two groups were made standard for age, weight, type of intervention and duration of intervention. Arterial pressure, heart frequency, oesophageal temperature and blood gas were monitored. A neuromuscular stimulator was used to study the neuromuscular block. No difference was found in the treatment of two groups of patients and it is concluded that no contraindication emerges for the use of atracurium in patients with chronic renal failure.

[A new method in the diagnosis of joint pathology: arthroscopy]. / Considerazioni su una recente metodica per la diagnosi della patologia articolare: l'artroscopia.

A simple new symptomatological technique is described with the emphasis on its great value in the diagnosis of joint pathologies.