Evolution of surgery for liver hydatidosis from 1950 to today: analysis of a personal experience.

Hydatid disease (echinococcosis) remains a complex worldwide problem in rural areas. Medical treatment does not definitively cure hydatid cysts, and surgical management aims to eliminate the parasite, favoring rapid disappearance of the residual cavity, preventing complications and recurrence, and shortening the hospital stay. In this consecutive series, 298 patients with liver hydatidosis were treated surgically by the authors from 1950 to 1987 in various hospitals in Rome, Italy. Surgery comprised conservative methods (marsupialization and partial cystopericystectomy) and radical methods (total pericystectomy and liver resection). Liver resection was used only if unavoidable. Complications were exudate from the residual cystic cavity, cholerrhagia, and nonspecific incisional fistula. In the entire series, morbidity was 8.7% of which 12.6% was seen with conservative methods and 5.5% with radical methods (p < 0.05); mortality was 3.6%, of which 5.9% was seen with conservative methods and 1.8% with radical methods (p = NS). Over the 37 years, as medical science and complementary therapies progressed, the use of conservative operations diminished and radical treatments increased. Long-term follow-up showed that hydatid disease relapsed more frequently in patients who underwent conservative or subtotally radical treatment than in those who underwent radical surgery: eight patients (11.2%) versus one (0.9%) (p < 0.01). Hence surgical treatment that removes all of the pericyst and preservation of the nonpathologic liver are important.

Histopathology, clinical findings and treatment of renal hydatidosis.

Renal hydatidosis, although not frequent, is the third location of the echinococcus granulosus in the man, after the liver and lungs. Its clinical importance is remarkable as the natural history of the process (if left untreated) usually results in the opening of the parasitic focus into the excretory ducts and the complete destruction of the kidney. In spite of that, insufficient attention is usually dedicated to the topic. So in the lecture the major aspects of the problem have been considered, also on the basis of histological, clinical and radiological personal studies. The site localisation is essential, and at present is possible on combined modality studies, in particular on diagnostic imaging: plain radiography, conventional urography and new imaging procedures, US, CT and MR, give typical images that definitively prove the specific diagnosis. With regard to treatment, the problem at present is still basically surgical: but nephrectomy (as excessively performed in the past) must be if possible avoided and reserved for cases of parenchymal destruction or of untreatable infection). On the contrary, when it is still possible, one must consider conservative techniques, limited to the removal of the parasite and of permanently damaged parenchymal areas. Cystectomy with resection of the exuberant pericystium or (when possible) segmental resection of the kidney offer a good solution, sometimes also in cases of recurrence.

[Lymphadenectomies in the surgery of stomach cancer]. / Observations sur les lymphadénectomies dans la chirurgie du cancer de l'estomac.

This paper describes the author's personal experience (363 cases: 1950-1982) in gastric cancer surgery, with a lymphadenectomy closely resembling the one currently in use. The first results were published in 1970. The final results confirm that enlarged lymphadenectomy is beneficial not only in total but also in subtotal gastrectomies performed to remove tumours in the lower half of the stomach. Lymphonodal invasion influences final outcome.

[Considerations on lymph node excision in the surgery of stomach cancers]. / Observations sur les lymphadénectomies dans la chirurgie du cancer de l'estomac.

The use of extensive lymphadenectomy is based on a historical comparison of results before 1950, when only subtotal gastrectomy was used, and after 1950 when variably extensive lymphadenectomy was associated to visceral exeresis. At the beginning, we involved neither the retroduodenopancreatic lymph nodes nor the juxtahilar nodes of the hepatic pedicle in this lymphadenectomy, and we actually performed only type R2 lymphadenectomy. After 1965, exeresis was extended to said lymph nodes, thus becoming a type R2-R3 operation. As far as viscéral exeresis is concerned, our indication to extend exeresis has been defined according to the site of the tumor, to the degree of infiltration of the gastric wall and to the histological type, rather than to a principle. Thus we have after used subtotal gastrectomy, with 33.3% survival after five years, 30% after ten years and 29% after 12-15 years for the cases of the first period (R2 lymphadenectomy). With type R2-R3 lymphadenectomy, survival is 35.5% at five years and 32.5% at ten years. Total gastrectomy (always with splenectomy) has been performed in all cases of proximal extension, of juxtacardial and fundal location, of multifocal lesions and of poorly differentiated histological types (86 cases). During the period or R2 lymphadenectomy, we had 33.3% survival at five years and 25% at ten years, vs. 36.2% at five years and 32% at ten years in the second period. In properly indicated subtotal resection, R2 lymphadenectomy extending to some third-level areas provides better survival, with acceptable morbidity and mortality.(ABSTRACT TRUNCATED AT 250 WORDS)

[Pericystic pathology and surgery of hepatic hydatidosis. Studies and personal experiences]. / La pathologie du périkyste et la chirurgie de l'hydatidose hépatique. Etudes et expériences personnelles.

In the general study of the consequences of hydatid cysts on the parenchyma of the organ involved, particular interest was given to the conditions of the pericyst. Thus a genuine pericystic pathology was systematized for most evolved pericysts. The signs vary according to the various conditions, sometimes including simple fibrosis, sometimes calcifications with specific and different appearances, almost always chronic inflammation. Fissuration was rare and, more importantly, exogenous vesiculation, a frequent cause of recurrence, was more often noted. The treatment is chosen on these bases, and determined by the local situation, hepatobiliary complications and the general condition of the patient. The author demonstrates the surgical evolution he followed in relation with the progress made in liver surgery, from plain drainage methods to radical pericystectomy and hepatic resection procedures. The conclusions he has drawn as a Symposium moderator during the World Congress of Hydatology held in Madrid in 1985, which will be summed up in the report, still seem to be perfectly valid.

[Pirenzepine parenterally administered in high doses in the treatment of upper digestive hemorrhage]. / La pirenzepina per via parenterale ad alto dosaggio nel trattamento delle emorragie digestive alte.

22 patients with moderate and severe haemorrhages of the UAC were given endovenous doses of Pirenzepine (100 mg/48 hrs). The drug was effective in 86% of the cases and its effect on pH values was demonstrated by testing before and after administration (p less than 0.01). Better results were observed in the treatment of patients with moderate and severe DUS.