[Study of the facial nerve in parotid surgery]. / La ricerca del nervo facciale nella chirurgia della parotide.

The Authors, basing on cadaveric dissections and 40 parotidectomies performed, accurately describe relations between facial nerve and surrounding tissues in its extracranial tract, with particular reference to parotid surgery. They underline Schwalbe's apophysis as the sole safe and constant anatomic landmark in the dissection of the facial nerve trunk.

Long-term efficacy of interferon alpha-2b and lamivudine in combination compared to lamivudine monotherapy in patients with chronic hepatitis B. An Italian multicenter, randomized trial.

BACKGROUND/AIMS: To evaluate the therapeutic efficacy of interferon alpha-2b and lamivudine in combination compared to lamivudine monotherapy in patients with chronic hepatitis B. METHODS: One hundred and fifty-one patients were randomly assigned to receive either recombinant interferon alpha-2b (nine million units three times per week) and lamivudine (100 mg/daily per os) for 24 weeks or lamivudine alone (100 mg/daily per os) for 52 weeks. Patients were followed up for a further 48 weeks. RESULTS: Sustained HBeAg seroconversion with undetectable serum levels of HBV DNA was observed in 25 of 76 patients (33%) treated with the combination therapy and in 11 of 75 patients (15%) treated with monotherapy (P=0.014). Histological improvement defined as a reduction of at least two points in the inflammation score as compared with pretreatment score was observed in 35 of 76 patients (46%) treated with combination therapy and in 20 of 75 patients (27%) treated with monotherapy (P=0.021). Both therapeutic regimens were well tolerated. CONCLUSIONS: Six-month treatment with interferon alpha-2b and lamivudine in combination appeared to increase the rate of sustained HBeAg seroconversion compared to 1-year lamivudine monotherapy. However, the potential benefit of combining lamivudine and interferon should be investigated further in studies with different regimens of combination therapy.

[Surgical treatment of total rectal prolapse: Delorme's technique]. / Terapia chirurgica del prolasso totale del retto: l'intervento di Delorme.

Rectal total prolapsus is a cause of a permanent disablement more founded in old women. Many pathogenetic hypotheses are made up to date time, many surgical treatments were proposed for the treatments of this disease: through perineal, abdominal or combined way. The results are different, of course, in a short and a long time, whether in the matter of relapse of the prolapse, or in morbidity in connection to surgical treatment and his sequences. After a review of the most frequent techniques now in use, the Authors report their experience on 6 patients operated from 6 January 1988 to June 1993, giving reasons for their preference to Delorme's operation through perineal way.

[Amebic liver abscess: review of 9 cases]. / Ascesso amebico epatico: revisione di una casistica relativa a 9 casi.

Amoebiasis is an infection of the large intestine produced by the protozoan Entamoeba histolytica. More than 10% of the world population is estimated to be infected. The italian pattern of this infection is similar to the EEC trend: the prevalence is approximately 0.012% during the years '88 and '89. Hepatic abscesses usually present with moderate fever, weight loss and abdominal pain. During the last ten years nine patients with amoebic liver abscesses were admitted to our hospital, six males and three females (all had acquired the infection in tropical countries). After ultrasonographic and computed tomography scanning evaluation, all patients were treated with metronidazole at the dosage of 750 mg three times a day for a period ranging from 30 to 60 days. In five patients Chloroquine was added at the dosage of 1.2 g a day for fourteen days. In five patients became necessary a surgical drainage under ultrasonographic control.

[Omeprazole and misoprostol in acute gastroduodenal pathology. Physiopathological and therapeutic considerations in a surgical study]. / L'omeprazolo e il misoprostol nella patologia acuta gastroduodenale. Considerazioni fisiopatologiche e terapeutiche da uno studio in ambiente chirurgico.

In a clinical study on acute gastroduodenal pathology, the authors checked the therapeutical efficacy of Omeprazole and Misoprostol in comparison with H2-Antagonists. The study shows how Omeprazole could reduce to a half the treatment period necessary for H2-Antagonists to determine duodenal ulcer healing. Compared with these drugs, Omeprazole represents a real therapeutical progress. However, Omeprazole did not change the actual indications for surgical treatment in gastroduodenal ulcer. In drug-induced erosive gastritis treatment, Misoprostol proved to be unable to replace H2-Antagonists advantageously.

Biliary pseudocyst. A rare consequence of an iatrogenic lesion of the bile ducts.

A patient with a biliary pseudocyst due to an iatrogenic lesion of the hepatic duct is reported. The pseudocyst caused compression of the bile duct with progressive jaundice. Diagnostic problems and the utility of ERCP and PTC in determining the exact site of the lesion for surgical treatment are reported.

Management of liver trauma.

A ten-year experience with the management of liver trauma is reported. The diagnostic approach is examined, stressing the role of selective arteriography. The management of the 78 observed cases is described. The need for biliary drainage to prevent postoperative leakages, is supported. Overall mortality in this series was 16.6%.

[Neoplastic occlusions of the large intestine (clinical study)]. / Le occlusioni neoplastiche del grosso intestino (contributo clinico).

The authors do a clinico-epidemiologic reviewing of 24 cases of neoplastic obstruction of large intestine, they had the opportunity to observe. Such patients represent 12.9% of all cases of mechanic intestinal obstruction. The obstructive complication, which in 70% of the observations involved sigma and rectosigmoid junction, was the clinical beginning of 9,6% of colonic and rectal carcinomata. Such disease arose preferably in old patients and in those suffering from one or more concomitant diseases. Some reflections about the surgical treatment, which, in this casuistry, determined a mortality of 25%, lead the Authors to think the requirements of the treatment of high risk patients and the rigid observance of the rules of colonic surgery should be put before the requirements of oncological radicalness.

Mesenteric artery embolectomy: a case report.

A case of successful superior mesenteric artery embolectomy with bowel resection is reported. Superior mesenteric artery embolization must be strongly suspected in a patient with atrial fibrillation, presenting sudden abdominal pain and an unremarkable examination. Extensive use of abdominal angiography is strongly recommended, since successful results depend on early diagnosis. This "second look" procedure may be limited, on the basis of careful clinical observation. Should any doubt persist regarding bowel viability, a duodenoenteric anastomosis is recommended.