[Perforated diverticulum of the cecum: a difficult preoperative diagnosis]. / Diverticolo perforato del cieco: una diagnosi preoperatoria difficile.

A patient was admitted for a suspected appendicitis; occasionally, a roentgenogram of abdomen, an echography and a tomography: confirmed the suspect. At laparotomy a perforated diverticulum of cecum is suddenly reported: a segmentary resection of ascending colon is performed. Authors remark, according to literature, that preoperative diagnosis of perforated cecal diverticulum is difficult even today, in spite of diagnostic procedures.

[Biomechanical and clinical interpretation of firearm wounds. General problems. VII. Propedeutic ABC of terminal ballistics]. / Lettura biomeccanico-clinica della ferita d'arma da fuoco. Problematica generale (Parte VII). Abbecedario di propedeutica alla balistica terminale.

The parallelism breaks down, and the bullet, which is now the subject, speeds towards the object, the body, its target. The ideal vantage point for capturing the moment of impact is the nose. We set up our station here, imaging that were are a kind of TV camera recording with cold objectivity, in slow motion, instant by instant, the marks and the impact made by the hard body on its soft target.

[Biomechanical-clinical interpretation of firearm wounds. General problems. IX. Propedeutic ABC of terminal ballistics]. / Lettura biomeccanico-clinica della ferita d'arma da fuoco. Problematica generale (Parte IX). Abbecedario di propedeutica alla balistica terminale.

In this chapter, the leading role is played by the mechanical-thermal-ballistic device, issued as a long-barrelled regulation firearm to modern armies. The most accurate description of this type of firearm and its present and possible future development seeks to be in line with the objective comparison between the biological matter and the mechanical material, which constitutes the essential basis for any optimal nosological, aetiological, or pathogenetic classification of bullet wounds. We should not forget that the advent of the M 16 A 1 has aroused great technical interest, particularly--though not only--as regards the hydroshock aspect, and that the technological developments in future can hardly fail to increasingly confirm the singular nature of bullet wounds, which refuse to be encompassed merely within the somewhat limited sphere of their strictly local effects, but carry a broader significance in a critical context open to further verification in the future. There can be no denying that this unique nature of modern bullet wounds makes them ideal candidates bearing witness to a new interpretation of traumatism, which at present is only in its infancy.

[Terminal ballistics. 1]. / Balistica terminale. 1a parte.

We have chosen to conceive of terminal ballistics as a violent and extremely rapid confrontation between two forms of resistance before the final state of rest is reached. This definition, which cannot help but don the admittedly loud and outlandish garb of physics, is the most promising for the purposes of biological interpretation. The main characters on this stage are two, but only one of these really plays the lead, namely the human target, which acts out the basic roles inherent in its physical make-up; the other, the bullet, remains a background figure, frozen in its walk-on part, and ready for the next performance. This modus operandi, which is no simplification, but rather an academic necessity, enables us to focus on images which stand out more clearly as a result of an intensive macroscopic spotlight which brings out the features of the individual phenomena, broken down into a succession of close-ups, and subtracts them from the cold physical nature of this or that form of inert matter, which here is merely an occasional, disagreeable witness, or even more, a standing from time to time for but one of the infinite facets of the biological composite being. Here, then, faced with a kind of exploded macrophotograph of a complex kaleidoscope, we see the animal universe, of which we capture so far the plasticity, the subdivisibility, the anisotropy and the cavitation.

[Terminal ballistics. 3]. / Balistica terminale. 3a parte.

This brief chapter, focusing essentially on a single topic, has been written in homage to Emile Theodor Kocker, a masterful exponent of the art of surgery and founder of the culture of terminal ballistics. For most of the literature we are indebted to Fackler and Dougherty, who, with the particular grasp, and fair of historians, act as guides on a trial which is only apparently retrograde, but which actually bears eloquent witness to the fact that even in the most physically tangible of arts, namely the art of surgery, inspired curiosity may help us to go well beyond the limits of our day and age. This chapter is also dedicated to the memory of another great surgeon, Vittorio Pettinari, who for one of the authors was an incomparable mentor and past-master of such curiosity.

[Biomechanical-clinical interpretation of firearm wounds. General problems. VIII. Propedeutic ABC of terminal ballistics]. / Lettura biomeccanico-clinica della ferita d'arma da fuoco. Problematica generale (Parte VIII). Abbecedario di propedeutica alla balistica terminale.

The Authors, consistent with their aim to compare and contrast the two protagonists of bullet wounds, namely the bullet and its soft human target, delineating their respective profiles, strengths and weaknesses, feel obliged to dwell at some length on the most frequently pathogenetic regulation firearms. Up until the early twentieth century bullet wounds could be generically classified among the forms of open traumatism, but with the advent of high-speed bullets they have come to take on a unique profile of their own, setting against the old permanent cavity due to mechanical insult a new type of transitory ghost, the definition of which as a cavity would merely be an oversimplification in theoretical terms. Can we really attribute this somewhat privileged dimension to bullet wounds today or must we relegate them once again to the sphere of mechanical traumatisms, albeit with a new inflammatory key to their interpretation, making the most in this sense of the contribution provided by the speed of the bullet? The literature is abundant, but uncertain; we intend to attempt an answer to this tricky question in the following pages, devoted more properly to terminal ballistics. Undoubtedly, the new speeds have had a substantial impact on the wounds inflicted upon the soft target, but the streamlining of the jacket has modified and even offset the results, giving rise to the unexpectedly humanitarian bullet, later subject to reappraisal in military quarters as tactically more efficient, because it obliges the enemy to employ greater resources for recovering, assisting and healing the wounded. We can safely claim that ballistic science in the field of light or portable firearms is experiencing a contradiction between the speed of the bullet and the streamlining of the jacket which makes this speed possible, but which undermines the efficacy of the often unconfessable results. Short-barrelled firearms, which on account of their defensive role, the alibi of their problematic access to speed, and their characteristic use as "last-chance" weapons, are less subject to international constraints and enjoy an extensive civilian market with specific claims to stopping power, thus become the true witnesses to a reality no different to the one Dum-Dum interpreted: the field of modern regulation firearms is shrouded in similar doubts, strengthened by the increasingly short barrels of the weapons, remedies and temptations, with, in addition, the increasingly precarious nature of the human element behind the firearm.(ABSTRACT TRUNCATED AT 400 WORDS)

[Biomechanical-clinical interpretation of firearm wounds. General problems. X. Propedeutic ABC of terminal ballistics]. / Lettura biomeccanico-clinica della ferita d'arma da fuoco. Problematica generale (Parte X). Abbecedario di propedeutica alla balistica terminale.

Any discussion of firearms which failed to take due account of the complex interaction between the weapon and its user would be missing the point. This interaction takes on a major role, particularly in the case of military ordinance weapons; their "optimal" use demands the maximum control of this interaction, which is of the utmost importance for the tactical role of the soldier-weapon system. The use of the latest long-barrelled ordinance firearms is more acceptable precisely because of their smaller calibre (which also means reduced interaction with the user). Today the traditional primacy of the long-barrelled weapon (now getting progressively shorter) is threatened by the short-barrelled gun cartridge, which we have seen used on an extensively scale in recent militia warfare. Paradoxically, it is precisely this cartridge, whose main shortcoming is its low propellant content (and thus reduced kinetic energy) which is expected to provide the kind of killing performance capable of snuffing out even "the dead man's last five seconds".

[Biomechanical-clinical interpretation of firearm wounds. General problems. XI. Propedeutic ABC of terminal ballistics]. / Lettura biomeccanico-clinica della ferita d'arma da fuoco. Problematica generale (Parte XI). Abbecedario di propedeutica alla balistica terminale.

The pathogenetic potentiality of firearms differs in relation to whether we are dealing with rifled long-barrelled weapons, handguns, or smooth-bore long-barrelled guns. Up until a few years ago, the tissue-damaging effect, at least in the modern warfare context, of short-barrelled or smooth-bore long-barrelled firearms, was thoroughly negligible; today, however, their impact, as causes of wounds and death, is steadily increasing, and for the first time small bullets designed for low-cost military training are also coming to play a primary role on the battlefield. At the same time short-gun bullets are appearing which, which in the name of "stopping power" seem to contradict the very definition of a handgun. The smooth-bore long-barrelled gun, in turn, is casting off the anti-humanitarian image of the trench gun to play the more suggestive ordinance role of the grenadiercumhunter.

[Propedeutic to general problems of the hypothesis of a new "open" interpretation of firearm wounds of soft tissues]. / Propedeutica alla problematica generale sulla ipotesi di nuova lettura "aperta" della ferita d'arma da fuoco delle parti molli.

On the basis of a review of the literature and their own personal knowledge and experience, the authors define the state of the art regarding a point of considerable importance, namely the leaky gut hypothesis. Taking gunshot wounds in soft tissues as their starting point, they believe that such lesions are among the most suitable for illustrating the chain of events which translates an entirely local pathology--admittedly serious--into a systemic pathology carrying a very severe prognosis, if the physician is unable to interrupt this clinical course.

[Terminal ballistics. 2. (The skin)]. / Balistica terminale. 2a parte (la cute).

It goes without saying that, at first glance, it is the velocity with which the fired bullet pierces the solid target and perhaps even penetrates it that bears witness to the efficiency of a firearm. Prior to the advent of ceramic and composite materials, iron and its clone, steel, provided the most satisfactory and most coveted evidence as a test material in both the positive and negative senses. It the biological field, wood and deal in particular were for decades the only witnesses, alongside tests in cadavers, which, despite obvious reservations, provided us with a wealth of data, much of which is still regarded today as among the mainstays of forensic didactics. Prominent among these, in terms of clinical importance, in that they mark the start of the bullet wound, are the velocity and energy thresholds per presentation area. The bullet, after overcoming the barrier of the skin, continues on its course through the soft tissues, and there leaves its most authentic and singular mark as a bullet wound.

[Biomechanical and clinical interpretation of firearm wounds. General problems. VI. Propedeutic ABC of terminal ballistics]. / Lettura biomeccanico-clinica della ferita d'arma da fuoco. Problematica generale (Parte VI). Abbecedario di propedeutica alla balistica terminale.

Any lengthy and properly structured propedeutic ABC of terminal ballistics must necessarily embrace a comparison between the two main protagonists of gunshot wounds. It is almost a specular, yet distorted image of the ritual act consumed by the larger mammals, not proud of their mutual aggression, but the conformation between mechanics and biology, or between kilogram-metres and life. The two types of physical entity brought together through the unique agency of a new language--both biological and mechanical, but necessarily halting and inadequate--stand out like two parallel lines opposite one another, displaying their respective profiles and most intimate structures. One can take this as far as the biological paradox of the clash between the dimension of power and the chance quality of life.

[Biomechanical and clinical interpretation of firearm wounds. General problems. V. The propaedeutic ABC of terminal ballistics]. / Lettura biomeccanico-clinica della ferita d'arma da fuoco. Problematica Generale (Parte V). Abbecedario di propedeutica alla balistica terminale.

Modern portable firearms, whether for military or civilian use, present substantially different features as instruments for striking, wounding and killing compared to those used in the past on account both of their intrinsic characteristics as thermo-chemico-ballistic machines, guaranteeing extra, more easily achievable performance and of the characteristics of the bullets used. The factors responsible for this difference, which consists essentially in an unprecedented wounding capability, are, in the military field, the enormous amount of research which only now is beginning to yield a bare minimum of concrete results in terms of futuristic forms and devastating performance, amongst other things because it is easier to achieve, and, in the "civilian" field, the maniacal search for an unlikely definitive wound, based on the unusual nature of the cartridge and on sophisticated training.

[Mesenchymoma of the mediastinum (a case report)]. / Il mesenchimoma del mediastino (presentazione di un caso).

A 44-year-old male affected by mesenchymoma of the mediastinum was treated surgically. The neoplasm, localized in the postero-inferior mediastinum with prevalent development to the left, was found to consist of adipose, leiomuscular and myxoid tissue. The patient was asymptomatic. Complete removal of the neoplasm proved possible, and one year after surgery no signs of recurrence were present. Few cases of mediastinal mesenchymoma have been reported.

[The clinical biomechanical interpretation of gunshot wounds. The general problems (IV). The propedeutic ABCs of the terminal ballistics]. / Lettura biomeccanico-clinica della ferita d'arma da fuoco. Problematica generale (Parte IV). Abbecedario di propedeutica alla balistica terminale.

If we want to enunciate the damaging potential of a bullet fired from a gun we have to express ourselves right from the outset in terms of destructive work, that is to say not only destruction of the structures the bullet passes through, but also, above all, destruction of the homeostatic condition. In modern terms, this is particularly true of the abdomen, which, in perspective, above and beyond any direct involvement, is a candidate for an interesting role. As regards the translation of this destructive force in mathematical language, formulae are proposed in kilogram-meters, feet per second and Joules. A basic factor in external ballistics, quite apart from the actual forces involved, is the trajectory in space, the hyperbola, though we should also reflect on the problem of resistance, which has such a considerable effect on the behaviour of the "ideal" bullet in the atmosphere (the smallest calibre for a given mass, with the attempt to rid itself of its forced subordination to the calibre of the barrel). This leads us on to the subsequent concept of the "ballistic coefficient" and, in itself definitively established the basic assumptions of terminal ballistics.

[Extended surgical resections of locally diffuse colorectal carcinoma (clinical cases)]. / La demolizione chirurgica allargata nel carcinoma colo-rettale localmente diffuso (casistica clinica).

The authors report on a study population of extended operations for locally spread colon-rectum cancer in the Verona Surgical Clinic over the period from 1971 to 1987 (114 surgical demolitions for colon-rectum cancer out of a total of 1294 operations). They report an overall 5-year survival rate of 41% and a 3-year survival rate of 59% with a perioperative mortality rate of 1.75%. A number of aspects of such extended operations are discussed, and, in accord with most other reports in the literature, the authors confirm the validity of the choice of this type of surgery.

[Spontaneous rupture of the esophagus (presentation of a case)]. / Rottura spontanea dell'esofago (presentazione di un caso).

The authors describe the case of a 67-year-old patient with spontaneous rupture of the middle third of the oesophagus, occurring apparently without any involvement of intraluminal hypertension. The surgical treatment consisted in the execution of an aspiration drainage of the left pleural cavity, followed by a right thoracotomy with exploration of the mediastinum. A gastrostomy according to Witzel was also performed. Total parenteral nutrition was instituted in the post-operative period. Healing of the oesophageal lesion was confirmed radiologically 2 months after admission to our department.

[Treatment of perineal breach in radical surgery of the rectum: notes on the surgical technic]. / Il trattamento della breccia perineale nella chirurgia demolitiva del retto: note di tecnica chirurgica.

The Authors review the various techniques used in closing and draining the pelvic basin after total resection of the rectum due to neoplastic and/or inflammatory disease. The examine their experience with 248 cases of total resection of the rectum and propose closure of the perineal breach as the first step in through closure of the pelvic peritoneum.

[Surgical treatment of malignant colorectal neoplasms in the population over (our experience)]. / Il trattamento chirurgico delle neoplasie maligne del colon-retto nella popolazione al di sopra dei 75 anni.

The Authors examine a series of 95 operations in the Verona Surgical Clinic for colorectal carcinoma in patients aged above 75 and discuss the results obtained. The low mortality rate (2.95% for resections) and the acceptable incidence of morbidity confirm the validity of performing radical surgery for malignancies in very elderly patients, as is stressed in most of the relevant literature.

[Our experience with the surgical treatment of the solitary ulcer syndrome of the rectum]. / La nostra esperienza nel trattamento chirurgico della sindrome dell'ulcera solitaria del retto.

The authors examine the question of the pathogenesis of solitary rectal ulcer syndrome (S.R.U.S), illustrating the importance of a correct differential diagnosis versus other relevant forms of disease affecting this region, particularly rectal cancer. They describe their experience with both the medical and surgical treatment of the syndrome.

[Malignant schwannoma of the ileum: an extremely rare disease entity (presentation of a case and review of the literature)]. / Lo schwannoma ileale maligno: una entità morbosa estremamente rare (presentazione di un caso e revisione della letteratura).

The authors examine a case of malignant ileal schwannoma successfully treated in the Verona Surgical Clinic. They compare their experience with the data reported in the literature, confirming the extreme difficulty encountered in diagnosing the disease. Therapy is discussed, and the authors stress that, in the presence of an intestinal haemorrhage the origin of which traditional diagnostic investigations are unable to establish, one should always bear in mind the possibility of schwannoma despite its rarity.