[Bochdaleck diaphragmatic hernia in adults. Case report]. / Ernia diaframmatica di Bochdaleck nell'adulto. Storia di un caso clinico.

The case of a 27-year-old woman, admitted to our surgical ward with symptoms of epigastric-ache, postmeal vomiting and significant weight loss, is reported. Clinical and radiographic suspicion of mesenterium commune, with duodenal compression due to bands, requested an explorative laparatomy that confirmed the mesenterium commune presence with left caecum and colon adhesion and left Bochdaleck hernia, which is rare in adult age.

[A retrospective study on the efficacy of the treatment of functional dyspepsia. An evaluation of 166 cases]. / Studio retrospettivo sull'efficacia del trattamento della dispepsia funzionale. Valutazione di 166 casi.

A retrospective study is reported carried out on a group of 166 patients affected by dyspeptic syndrome who presented at least 3 of the 9 symptoms which characterise this pathology. One hundred and twenty-eight patients underwent prokinetic drug therapy and 38 received placebo. Clinical parameters were evaluated following one month of therapy all patients in order to compare them to basal values. The results obtained confirm a satisfactory efficacy of the prokinetic treatment in improving dyspeptic symptoms. Although administered to a smaller number of patients, placebo was also found to play an important role in the multifactorial etiopathogenesis of the dyspeptic syndrome on a functional basis.

[Computerized dynamic endothermography of the gastrointestinal mucosa as an indirect index of the state of vascularization of the abdominal organs. A preliminary note]. / L'endotermografia dinamica computerizzata della mucosa gastrointestinale quale indice indiretto dello stato di vascolarizzazione degli organi addominali. Nota preliminare.

Computerized Dynamic Endothermy (CDE) has been applied to the evaluation of the gastroenteric microcirculation. This new method enables mucosal temperature changes to be detected in a dynamic and functional way. With preventive induction of a temperature change (cold stimulus), the instrument measures the time required for the establishment of previous mucosal temperature. Computerized data are displayed in the form of a time/temperature curve. Results obtained on rabbits showed, during ischaemic conditions, a greater reduction of gastric layer temperature during cold stimulus than in basal conditions, followed by a slower return to basal temperature during the recovery time.

Biofeedback conditioning for fecal incontinence.

Twenty-one subjects suffering daily from fecal incontinence were treated with biofeedback training as a rehabilitative trial. Fifteen of these patients had incontinence following surgical interventions; the other six had senile incontinence. A device was employed to record the pressure existing at the level of the anal canal and to stimulate the rectal ampulla to control the performance of the external anal sphincter and the sensibility of the rectum. Of the 31 treated patients, eighteen (86%) presented good results with satisfactory recovery of anal incontinence, and three subjects (14%) showed unsatisfactory results (more than one episode of incontinence monthly). Although both groups of patients showed improvement in external anal sphincter contraction, the sensibility of the rectum to endoluminal distention improved more in good responders. The employment of biofeedback training to obtain improvement of the threshold of rectal sensibility (minimal volume of endoluminal distention to produce the sensation of imminent defecation and external anal sphincter contraction) has proved useful in the rehabilitation of incontinent patients.

[Evaluation of the delayed hypersensitivity response by the Multitest-IMC. Multicenter study for the definition of reference values in a sample population]. / Valutazione della risposta di ipersensibilità ritardata mediante Multitest-IMC. Studio multicentrico per la definizione di valori di riferimento in una popolazione campione.

The latest investigations in the field of clinical immunology have proposed ways of assessing immunological efficiency that have also been used to identify patients most susceptible to infectious complications. The assessment of delayed hypersensitivity response (DHR) using anamnestic antigens is currently the most common method. The results of a polycentric study are presented. The study was conducted on a group of healthy subjects from various Italian regions divided into three age classes. Positive responses to the MT were noted in 96.4% of the population studied. The incidence of energy was statistically higher among females than males, while the mean response to the MT expressed in millimetres was statistically higher in males. Though 7 antigens were administered, the responsive population reacted on average to 3. The highest incidence of positive responses was to Candida, with Trichophyton responsible for the fewest.

Use of a thymic factor in the prevention of postoperative infections.

A controlled study was carried out on 60 patients undergoing laparotomy to assess the role of a thymic factor (TP-1 Serono) in the prevention of postoperative infections. All patients entering the study were preoperatively shown to be at risk of sepsis on the basis of the response to skin multitest system for assay of delayed hypersensitivity (Multitest C.M.I. System). The patients were also postoperatively monitored with the same system. The lower incidence of infections in patients treated with the thymic factor with respect to untreated patients (p less than 0.05) and the postoperative response to skin tests have confirmed the efficacy of the thymic factor under study in the prevention of postoperative infections.

Colon motility and colo-anal reflexes in chronic idiopathic constipation. Effects of a novel enterokinetic agent cisapride.

Motor activity of the colon and reflex behaviour of the anal sphincters in normal subjects and in patients with idiopathic constipation were studied using a novel probe with 5 open-end tips to measure pressures, and 3 balloons for stimulation of the distal colon. Constipation appeared to be associated with an increased threshold of the inhibitory relaxation reflex of the internal anal sphincter (41.7 in normals and 65.7 in patients), and in particular with a blunted sensation of the defaecation urge (51.0 in normals and 112.8 in patients). Single-blind comparison with a placebo showed that cisapride, a new gastrointestinal prokinetic substance, had a significant effect on the sensation threshold, which normalized or improved in 15 out of the 16 patients studied.

Immunosuppressive effect of surgery evaluated by the multitest cell-mediated immunity system.

The immunosuppressive effect of surgery in a series of 100 elective laparotomies was determined by analysing the delayed skin hypersensitivity, the most sensitive in-vivo reflection of cell-mediated immunity. For this purpose, a new method (Multitest cell-mediated immunity system) for simultaneous, multiple, intradermal skin tests was used. This system uses a plastic disposable device for simultaneous intradermal injection of seven immunologically standardized recall antigens, offering the possibility of assessing a patient's immunologic capability in a manner that is painless, rapid, safe, reproducible and quantifiable. Patients were tested preoperatively and on days 1, 3 and 7 after operation. Twenty healthy volunteers, the control group, were similarly tested. Immunosuppression was observed in all patients, reaching a peak on postoperative day 3. Recovery occurred between 7 and 10 days after operation. Immunosuppression was more severe and prolonged in patients with neoplastic disease. By continued immunologic monitoring using the Multitest system, the authors could confirm the suggested immunosuppressive effect of operation and establish that the phenomenon is temporary.

Colorectal cancer: relationship of histologic grading to disease prognosis.

Ninety patients underwent curative surgery for colorectal adenocarcinoma and they were followed for a period of 3 years. The aim of this retrospective study was to relate the cell differentiation (grading) and TNM classification of the UICC (1978) with the disease evaluation and patient survival. The results showed a consistent relation between grading and lymph node metastasis in patients with moderately and poorly differentiated adenocarcinoma, whereas no relationship was found between grading and local invasion of the tumor. Therefore, histocytologic grading of colorectal cancer appears to significantly influence survival grading parameters, and it may be a good method for monitoring the disease and follow-up of the patients.

[Evaluation of the functional modifications of the lower esophageal sphincter after use of the Angelchik prosthesis]. / Valutazione delle modificazioni funzionali dello sfintere esofageo inferiore (LES) dopo applicazione della protesi di Angelchik.

The manometric recording of Lower Esophageal Sphincter (LES) has been made in 8 patients who have undergone surgical apposition of Angelchik prosthesis for hiatal hernia. The patients underwent an esophageal manometric study in the preoperative period, one month and one year after the intervention. In the preoperative patients, the mean LES pressure was 10,3 +/- 0,5 mmHg and there was sphincterial incoordination to peristaltic waves after swallow. In one month postoperative patients the LESP was 20,1 +/- 1,0 mmHg (p less than 0,001), and one year after the LESP was 17,0 +/- 0,3 (p less than 0,001) with an ameliorated coordination of the LES activity in response to swallow. Therefore, during postoperative manometric controls the Authors identified a high pressure subdiaphragmatic zone unmodified by deglutitory acts which was not present in the preoperative investigation. Probably the presence of this zone would been explained as a consequence of mechanical action of the prosthesis and the postsurgical fibrino-reaction around the prosthesis. The Authors discussed the results obtained and their importance to Angelchik prosthesis employment for surgical correction of hiatal hernia.

[The role of segmental transit time in the large intestine in the diagnosis of severe constipation]. / Il ruolo dei tempi di transito settoriale del crasso nella diagnosi della stipsi grave.

Segmental small and large bowel transit time of 25 healthy volunteers have been studied, as a control group, by means of radio-opaque markers prepared and administered according to an original method. The same study has been subsequently carried out on 37 patients suffering for chronic non organic constipation. The resulting data, though poorly homogeneous, may however, be plotted in 8 classes; each class groups subjects presenting very similar segmental transit time whose changes are less than 4 hours. The first class gathers the 8.1% of the cases, presenting in increased small bowel transit time; the patients of the second class (5.4%) has resulted affected by "right colon constipation syndrome"; another 5.4% of patients, plotted in the third class have shown a permanence time of the markers in the transverse colon of about 190 hours, while the 10.8% fourth class and the 16.2% fifth class have presented a 97 and 150 hours' one respectively. The patients of the sixth class (21.6%) have shown long lasting permanence of markers in the left colon and in the rectum. The 13.5% of cases, gathered in seventh class, has shown an increased transit time through the whole colon, while at last the eight class (19.0% of patients) has resulted affected by dischezia. The described method has thus revealed useful in the study of bowel segmental transit time from a topographic diagnostic point of view.