[Dynamic ultrasonography in the assessment of candidates to laparoscopic cholecystectomy]. / L'ultrasonografia dinamica nella valutazione del candidato alla colecistectomia laparoscopica.

Laparoscopic surgery has opened a new era in the management of surgical diseases. But, on the other hand, has created problems relating to the technological and to the technico-surgical aspects. In the preoperative evaluation of laparoscopic cholecystectomy candidates it is very important to know about the pathological state of the gallbladder, which may become the cause of very difficult or impossible laparoscopic operation, and the convert in an open procedure will be forced. Recurrent gallbladder inflammations provoke alterations of the normal structure of the wall (oedema, fibrosis) and normal elasticity and contraction after stimulation is last. Adhesion with neighbouring organs hinder contraction as well, and surgical difficulties increase. Choledocholithiasis must be known before operation, to plan surgical strategy. The presence of choledochus disease does that allow us to modify its calibre after stimulation. 100 patients who underwent laparoscopic cholecystectomy, in our Department, were evaluated before with dynamic ultrasonography (DUS), and the results were compared with operating finds. In this paper are exposed the used method of evaluation and the results of this work. These results allow as to state that the method is effective and trustworthy.

[Pneumoperitoneum without perforation]. / Pneumoperitoneo senza perforazione.

Usually, pneumoperitoneum is due to perforation of a hollow abdominal organ. In the absence of peritoneal symptoms, pneumoperitoneum may be due to other causes. Two patients with pneumoperitoneum without perforation were treated in our department. A 41-year-old female patient was admitted to our hospital with abdominal pain for 12 hours, without vomiting. On abdominal examination fullness of the liver was absent, the abdomen was not distended and there were no signs of peritoneal irritation. The roentgenogram showed free air under the diaphragm. Laparotomy was performed because of the abdominal complaints. No perforation could be found. A 70-year-old female patient was admitted to the hospital because of mild abdominal pain. For a week she had a severe attack of coughing due to bronchitis. Big capacity of air had been blown in the stomach without abnormalities in the roentgenologic examination. The treatment was conservative. Both patients left the hospital in good health. More knowledge of the less frequent causes of pneumoperitoneun without perforation can possibly contribute to to refraining from exploratory laparotomy in these cases.

Relief of pain from pancreatic carcinoma.

Several methods for relieving pain from pancreatic cancer are described and the particular place of pancreaticojejunostomy is discussed.

An experimental evaluation of the types of material used for bile duct drainage tubes.

A comparison has been carried out of the properties of latex, silicone, red rubber and polyvinyl chloride (PVC) T tubes draining the common bile duct in dogs. The tubes remained in the animals for 15-98 days. Bile cultures, liver function tests, cholangiograms and the histology of the common bile ducts were studied, and the changes in the physical properties of tubes implanted in the experimental animals, and of those after 1 month's incubation in human bile, were assessed. The elasticity of the tubes was also measured and the tissue reaction around them observed. Finally, the tissue reaction following implantation in mice of tubes which had been incubated in human bile for 1 month was investigated, and compared with that when new tubes were used. Polyvinyl chloride tubes caused the least reaction in both the common bile duct and the peritoneal cavity. However, the lack of tissue tract formation around them, owing to their inertness, and their rapid development of rigidity make them unsuitable for use in biliary surgery. Red rubber tubes were found to be the most irritant. While silicone tubes proved to have desirable physical properties compared with latex tubes, they did, however, disintegrate easily with improper handling on suturing and were slow to produce a satisfactory tract, the latter fact suggesting that they would be unsuitable for short term biliary drainage. It appears that the latex tube is the tube of choice for drainage periods of up to 3 months, while silicone tubes are preferable when intubation for longer periods is necessary. Red rubber tubes may be the alternative for routine short term drainage if a latex tube is not available.