Intestinal perforation as a long-term complication of plug and mesh inguinal hernioplasty: case report.

Tension-free and sutureless hernioplasty by plug and mesh of nonreabsorbable material is one of the most common techniques for inguinal hernia repair. It's a simple and quick procedure with a low cost and allows for a short hospital stay. It shows a low reoccurrence rate, but it can result, in very few cases, in complications strictly related to prosthetic material. The literature describes some cases of plug migration from its proper position, for example, to the scrotum, preperitoneal adipose tissue, and abdominal cavity. We report on a case of sigmoid colon perforation due to a plug of Trabucco hernioplasty performed 2 years previously.

[Portal hypertension and enterostomy: a dangerous combination. Colostomy-induced varices as a rare cause of gastrointestinal hemorrhage. Report of a case and review of the literature]. / Ipertensione portale ed enterostomia: un binomio a rischio. Le varici colostomiche come causa rara di enterorragia. Descrizione di un caso e revisione della letteratura.

Variceal bleeding from enterostomy in an unusual complication of portal hypertension. The hemorrhage can be managed in most patients with local measures, but if these manouvres fail, surgical procedures may be required. Treatment options include pressure dressings, stomal revision or disconnection, suture or ligation of stomal varices, bowel resection, and porto-systemic shunting. Recently sclerotherapy and percutaneous transhepatic embolization have been reported. A case of ectopic varices in the site of colostomy complicated by recurrent hemorrhage is described and the therapeutic option utilized is discussed with review of Literature to assess the efficacy of the various treatment options.

Functional evidence of atypical beta 3-adrenoceptors in the human colon using the beta 3-selective adrenoceptor antagonist, SR 59230A.

The role of beta 3-adrenoceptors in human colonic circular smooth muscle was assessed in vitro by use of the beta 3-selective antagonist SR 59230A. Isoprenaline, in the presence of the selective beta-adrenoceptor antagonists CGP 20712A (beta 1) and ICI 118551 (beta 2), both at 0.1 microM, concentration-dependently relaxed the preparation (pEC50 = 5.22). This effect was potently and competitively antagonized by SR 59230A with a pA2 of 8.31, while its R,R enantiomer SR 59483A gave an apparent pKB of 6.21. Relaxation was likewise produced by CGP 12177A (pEC50 = 6.05), but not by BRL 37344. Although only one of these beta 3-selective agonists was effective, the remarkably high potency of SR 59230A as a stereospecific antagonist of non-beta 1 non-beta 2 relaxation of human colonic muscle by isoprenaline provides strong functional evidence of beta 3-adrenoceptors in that tissue.

[Malignant tumors of the small intestine. Clinical and therapeutic considerations on 23 observed cases]. / I tumori maligni del piccolo intestino. Considerazioni cliniche e terapeutiche su 23 casi osservati.

Small bowel tumours observed by the Authors at the IInd Surgical pathology of Pavia University between 1974 and 1992 were reviewed. There were found 23 cases; istopathologic findings, clinical presentation, diagnostic aspects and therapeutic options are discussed. The primary role of surgery in the treatment of these cancers is emphasized, but this can be curative only if diagnosis has been timely.

[Manometric findings after sclerotherapy for esophageal varices]. / Rilievi manometrici dopo scleroterapia per varici esofagee.

To study the effect of sclerotherapy of varices on esophageal function, the motility of the tubular esophagus and L5S was recorded in 12 cirrhotic patients. The following results were obtained: abnormal wave patterns in the lower esophagus were frequently present after sclerotherapy; no impact on L5I pressure and function was found; the motility changes induced by the treatment have a tendency to decrease as time goes by except for the amplitude of the wave whose decrease persist long.

[Deposits with anti-globulin activity in dermatitis herpetiformis]. / Depositi con attività antiglobulinica nella dermatite erpetiforme.

Skin biopsy specimens from 2 patients with dermatitis herpetiformis were examined by means of direct immunofluorescence with fluoresceinated aggregated human IgG (FAIgG) for the presence of tissue antiglobulin activity. Positive FAIgG staining was seen in both skin biopsy specimens yielding a fluorescence pattern similar to that of immunoglobulin and complement deposits. Tissue antiglobulin activity was no more detectable in a second skin biopsy obtained from one patient whose rash was controlled by Dapsone. These findings suggest an involvement of tissue antiglobulin activity in the pathogenesis of dermatitis herpetiformis. In fact, tissue antiglobulin activity is capable of acting as an immunoabsorbent and binding immunocomplexes from the circulation.

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.

[Validity of ano-rectal manometry in the diagnosis of cathartic colon as a cause of chronic pseudo-obstruction of the colon. Considerations on a case]. / Validità della manometria ano rettale nella diagnosi di colon catartico causa di pseudo ostruzione cronica del colon. Considerazioni su di un caso.

Cathartic colon is a rare pathology which hits old people and is radiologically characterized by dolichocolon and megarectum. It is nearly sure that the unusual length of the whole colon might be the first source of the cathartic disease. Rectal ampulla dilatation (megarectum) is due to the extended use of laxatives which induce changes in smooth muscle and in the myenteric nervous plexus. The anatomo-pathological changes of the rectum have been proved so far by histological examination of local and deep biopsy; now, in our opinion, they can be shown by manometry. The authors emphasize the possibility that cathartic colon might give episodes of diarrhoea and also recurrent bowel obstructions limited to the colon and so-called "chronic pseudo-obstruction" of the colon. They describe a case of this rare pathology admitted and treated in their ward. Gastric and esophageal motility in the patient was normal as was the motility of the upper rectum. Therefore they think that changes resulted from extended use of cathartics. In both cases patients show low manometric pressure, disordered peristalsis and in particular lack of internal anal sphincter relaxation in response to high balloon distension. As the occlusive status developed in an old patient (the patient was 81 years old), the authors think that the functional disorders were absent at birth. Cathartic colon is, in the authors experience, a cause of chronic pseudo-obstruction of the colon. Rectal manometry makes it possible to avoid surgical treatment. The therapy of pseudo-occlusion, if correctly diagnosed, consists in endoscopic intubation and decompression of the colon.(ABSTRACT TRUNCATED AT 250 WORDS)

[Manometric findings on esophageal motility in patients with reflux esophagitis]. / Rilevazioni manometriche della motilità esofagea in pazienti con esofagite da reflusso.

The aim of the study was to investigate the incidence of the acid reflux and its relationship to the oesophageal motility and to clinic symptoms. Recording of oesophageal manometry under basal and stimulating conditions obtained from 30 patients GERD and 10 healthy controls were assessed. Manometric results were analyzed for the occurrence of failed primary peristalsis, for the occurrence of peristaltic dysfunctions or for hypotensive LES pressure. Motor abnormalities found in the body of the oesophagus during simulated oesophageal reflux were described. The AA. found that there is not a sure correlation between the occurrence of peristaltic dysfunctions and hypotensive LES such as was not possible to find a direct relationship between peristaltic disorders and oesophagitis degree or symptoms.

[Secretory carcinoma of the breast: clinicotherapeutic considerations and a review of the literature]. / Carcinoma secretorio della mammella: considerazioni clinico terapeutiche e revisione della letteratura.

Prompted by the observation of a case of secretory (juvenile) secretory carcinoma of the breast, the Authors review the literature on this extremely rare disease. In view of the biological characteristics of this type of tumour, the Authors maintain that to ensure radical surgery and correct staging a quadrantectomy operation combined with emptying of the axillary cavity should be performed in those cases complying with the tumour size indication (2 cm). In larger tumours they regard the Helsted operation as the only form of surgery guaranteeing an adequate degree of radicality.

[Synchronous and metachronous carcinoma of the large intestine]. / Carcinomi sincroni e metacroni del grosso intestino.

The Authors report their experience about 20 cases of multiple large bowel adenocarcinomas, 9 of them synchronous and 11 metachronous. After developing a brief reexamination of epidemiology and etiopathogenesis, they explain their diagnostic and therapeutic considerations. The necessity of a real complete and exact radiological and endoscopical preoperative study, being also early, is at last emphasized, as well as an accurate postoperative follow-up.

[Primary malignant lymphomas of the gastrointestinal system]. / Linfomi maligni primitivi del tratto gastrointestinale.

The Authors describe their experience regarding eight cases of primary malignant gastrointestinal lymphomas. After having briefly reexamined the epidemiology and the problems coming from the discordances that still exist on various systems of classification and of staging, they put in evidence that it is not always possible to reach a sure preoperative diagnosis on such pathology, and they explain some considerations about the diagnosis, the therapy and the prognosis.

[Lymphoma of the thyroid (description of 2 cases)]. / Linfoma della tiroide (descrizione di due casi).

Primary lymphoma of the thyroid is a rare disease and it occurs in a low percentage of thyroid tumours. Nevertheless its frequency is increasing. We present two observed cases in this study. One of these is an exceptional extra-nodal localization of Burkitt's lymphoma. The role of surgery in these particular neoplasms and the importance of intraoperative histological examination for the rational therapeutic behaviour are stressed.

[Cervico-mediastinal goiter. Problems of surgical technic and tactics]. / Il gozzo cervico-mediastinico. Problemi di tecnica e di tattica chirurgica.

The Authors, on the basis of their experience, as well as of the data of the literature, discuss the problems of technique and tactics involved in the treatment of retrosternal goiters. As to the way of approach, they think cervicotomy should be primarily preferred, and the complementary sternotomy should be associated to the former only in some limited cases of totally dipped and large-sized goiter. They, moreover, assert that, beyond the diagnostical and therapeutical difficulties, endothoracic goiter, if adequately treated, keeps a favourable diagnosis, not dissimilar from the one of cervical goiters.