[Foreign bodies in the gastrointestinal tract. Our cases and a review of the literature]. / I corpi estranei nell'apparato gastroenterico. Nostra casistica e revisione della letteratura.

The ingestion or introduction of foreign bodies is a common situation in emergency surgery. The patients who usually ingest foreign bodies for different reasons are children, psychotics, alcoholics, prisoners and old people. The authors analyzed 65 cases observed in the I Institute of Surgery of the University of Rome "La Sapienza": 45 males and 20 females. Both the anal introduction and ingestion may be accidental or voluntary. The incidence of complications is estimated about 5 to 7%. The authors underline the opportunity of a conservative removal through endoscopic procedures especially for intraesophageal corps. This procedure is recommended to reduce morbidity and mortality rates, as well as hospitalization and social costs.

[Septic complications in emergency surgery: our experience and a review of the literature]. / Le complicanze settiche in chirurgia d'urgenza: nostra esperienza e revisione della letteratura.

Surgical infections represent one of the main causes of postoperative morbidity and mortality, especially in emergency surgery, with negative consequences on health costs. The Authors examined 2002 cases of emergency admission for surgical pathologies at the I Surgical Department of the University of Rome ¿La Sapienza¿ from 1987 to 1992. Overall septic complications were 13,7%, with a mortality rate of 1,2%. The Authors underline the lack in Italy of either an accurate system for monitoring septic complications or a useful method for data collection. At last the attention is focused on the main causes of septic complications, their diagnosis and treatment.

[Aneurysm of the celiac trunk: review of the literature and report of a clinical case]. / Aneurismi del tronco celiaco: revisione della letteratura e descrizione di un caso clinico.

After reviewing current and past medical Literature regarding celiac axis aneurysms the case of a 70 year-old emphysematous patient with an aneurysm of the celiac axis measuring 6 cm in diameter is reported. The patient's pulmonary function testing status strongly precluded a surgical option. Angiographic embolization of the aneurysm was then performed. The Authors observed that embolization with immediate occlusion of all afferent vessels of the celiac axis leads to no serious short or long-term consequences as long as an adequate collateral hepatic circulation is maintained through the gastroduodenal and inferior pancreaticoduodenal arteries. This case would appear to be the first described in the Literature and the Authors hold this technique to be a valid alternative whenever a surgical procedure would be difficult or impossible to perform.

[The diagnostic-therapeutic picture in liver injuries: a review of the literature and clinical cases]. / Inquadramento diagnostico-terapeutico nei traumi epatici: revisione della letteratura e casistica clinica.

Approximately 80% of liver trauma cases have a good prognosis and do not create decision-making problems for the surgeon, while in the remaining 20% the correct choice still represents a problem. Recently there has been a trend toward more conservative surgical management with emphasis on hemostasis and debridement, as well as a move toward a non-surgical alternative (surgical abstention) where feasible, relying in such cases on first-line CT scans for trauma evaluation. We report 51 cases of liver trauma observed in the period 1985-1993 graded according to the AAST Liver Injury Scale as follows: 12 grade I lesions (23.5%), 7 grade II lesions (13.7%), 19 grade III lesions (37.3%), 7 grade IV lesions (13.7%), and 6 grade V lesions (11.8%). In managing these cases we relied on two first-line diagnostic procedures: diagnostic peritoneal lavage (DPL) and CT scans. DPL, performed on 10 blunt trauma victims with unstable vital signs, was positive in 7 who thus underwent immediate surgery, and negative in 3 who subsequently underwent CT scan. Another 14 blunt trauma victims with stable vital signs underwent first-line CT scanning. In the event of a CT grade III or IV lesion patients underwent surgery, while patients with a CT grade I or II lesion were followed expectantly. Deaths (14) occurred only among patients with grade III or IV lesions (including 9 multiple trauma victims) who underwent surgery.

[Comparative study of the effectiveness of imipenem versus ceftazidime and ceftriaxone in the prevention of postoperative infections]. / Studio comparativo sull'efficacia dell'imipenem versus ceftazidime e ceftriaxone nella profilassi delle infezioni postoperatorie.

A comparative study was performed on the efficacy, safety and tolerability of three different antibiotics (imipenem, ceftazidime, ceftriaxone) in the prevention of postoperative infection. Evaluations were made on the basis of the results obtained in a group of 90 patients subdivided into three matched groups each of which was treated with one of the three compounds. The trend of cutaneous temperature showed differences at the limit of significance (p congruent to 0.05). Variations in leucocyte concentrations showed an analogous pattern in all patients, although there were fewer and with a shorter duration in subjects treated with imipenem. The wound healing process was improved in patients receiving prophylactic antibiotic treatment in the form of imipenem (0.01 < p < 0.05) who also showed a greater respect for therapeutic protocols (80%), a higher percentage of remission of fever and a shorter mean hospital stay (9 days). In the light of these preliminary results the authors express their favourable judgement regarding the choice of imipenem for the prophylaxis of postoperative infection; however, each of the three protocols showed a considerable prophylactic capacity as well as good tolerability and ease of use.