[Biliodigestive anastomosis: case series and technical notes]. / Anastomosi bilio-digestive. Casistica e note di tecnica.

AIM: Biliodigestive anastomoses are widely used in the treatment of biliary obstruction. METHODS: A survey is presented of the personal case series treated during the last 5 years. Thirty biliodigestive anastomose have been performed both for neoplastic disease and for benign lesions. RESULTS: The biliodigestive anastomosis has been performed with the Blumgart's technique both for benign and malignant tumors. CONCLUSIONS: The authors point out that experience is of the utmost importance for the operation success. Major attention is paid to the surgical technique used for the biliodigestive anastomosis and a retrospective analysis is made.

[Upper gastrointestinal hemorrhage of unusual etiology: clinical case and technical note]. / Emorragia digestiva alta da causa rara: caso clinico e note di tecnica.

The Authors report a case of upper digestive tract haemorrhage at atypical side, the diagnosis being often difficult as well as therapeutical options, particularly referent to the surgical solutions adopted.

[Liver rupture in HELLP syndrome. Report of a case]. / Rottura epatica in corso di HELLP sindrome. Descrizione di un caso.

Liver rupture and hemorrhage, are the most unusual and serious complications of HELLP syndrome (hemolysis--elevated liver enzymes--low platelet count). The management should be aggressive by treating coagulopathy and favouring a prompt delivery. Liver rupture remains a surgical emergency with control of bleeding based on trauma surgery. The aggressive approach to the management of these patients led to a remarkable decrease of mortality rates.

[Traumatic liver injuries: advances in diagnostic and therapeutic methods]. / Lesioni traumatiche del fegato: evoluzione delle strategie diagnostico-terapeutiche.

One hundred five patients affected by traumatic rupture of the liver were admitted in the Emergency Surgical Unit at Ospedale "A. Cardarelli" in Napoli over a period of five years. In 40 patients a conservative treatment was applied, monitoring red blood count, and haemoglobin values as well as abdominal ultrasound and CT scans. The remaining 65 patients underwent surgery for liver trauma. Twelve out of 65 patients presented with an hepatic injury alone whereas in 53 liver injury was associated with other lesions, as splenic rupture, kidney hematoma, bone fracture, chest trauma, diaphragmatic or cranial injury. Eleven out of 65 patients underwent postoperative complications such as bile collection (nine) and biliary fistula (two); however, none of these complicated patients died or underwent further surgery. On the basis of their data the Authors conclude that a careful preoperative assessment and the monitoring of haemodynamic pattern are advisable in patients with liver trauma, allowing the choice of a conservative treatment whenever possible. In the patients undergoing surgical treatment, a more conservative approach should be advocated, with a wider use of intraparenchymal haemostasis and packing, both to improve the haemodynamic status and to refer the patient to specialized units.

[Cholangiocarcinoma of the main biliary tract. Judging its resectability by imaging procedures]. / Il colangiocarcinoma della via biliare principale. Giudizio di resecabilità con procedure di imaging.

Eighteen patients with main biliary tract cholangiocarcinomas and no spread to the gallbladder and to the papilla of Vater underwent a combined US, ERCP/PTC and CT study. Angiography was performed on a selected group of 12 patients. We divided the infiltrating, polypoid or stenosing lesions in three groups: upper portion tumors, involving the confluence and the common hepatic duct (8 patients); middle portion tumors, originating from the common bile duct between the confluence of the cystic duct and the upper duodenal profile (6 patients); and finally lower third tumors, originating from the common bile duct between the upper rim of the duodenum and the papilla of Vater (4 patients). According to ERCP and/or PTC, US, CT and angiographic findings, only 9 of 18 cholangiocarcinomas were judged as resectable. The authors stress the need to optimize the use of imaging methods: US can locate the biliary obstruction; ERCP and/or PTC can show the tumor and its spread out of the duct, and finally angiography can exclude or confirm the vascular involvement of the hepatic hilum.

[Postoperative hyperbaric oxygen therapy in the rat jejuno-ileal bypass. Preliminary note]. / la terapia ossiperbarica post-operatoria nel by-pass digiuno ileale del ratto. Nota preliminare.

Experimental investigation of complications following jejunoileal by-pass in Wistar rats, treated with doxycycline, metronidazole, special diets and hyperbaric oxygen is reported. Hyperbaric management may even lead to worse liver function, contrary to what is observed in rats subjected to hyperbaric oxygen after a hyperlipidic diet.

[Local treatment of tumors of the rectum]. / Il trattamento locale dei tumori del retto.

Local treatment of tumours of the rectum currently rests on clear-cut indications, restricted to cases in which psychological reasons, the extremely poor condition of the patient, or an over-high element of risk militate against destructive surgery. An account is given of the main techniques employed and their advantages, and a critical assessment of their merits is attempted.