[High resolution vascular ultrasonography. Personal experience]. / L'ecotomografia vascolare ad alta risoluzione. La nostra esperienza.

Personal experience in the use of two-dimensional echography (B-scan) in vascular diagnosis is reported, stress being laid on its advantages with respect to other non-invasive investigations (rheography, photoplethysmography, Doppler measurement) and conventional arteriography. The importance of the technique is considered and special attention paid to the system of Biosound for defining small and initial parietal changes whose consequences, particularly if located in the carotid district, can be very serious. The result of an 18-month study using real-time Doppler ultrasonography is reported. 147 carotids and 88 lower extremities were involved and percentages were matched against conventional arteriography where the latter was carried out.

Proximal gastric vagotomy or truncal vagotomy and drainage for chronic duodenal ulcer?

A comparison has been made between truncal vagotomy and drainage (TVD) and proximal gastric vagotomy (PGV) performed electively for chronic duodenal ulceration from 1968 to 1981 in 209 and 272 patients respectively. The morbidity was 23 per cent after TVD and 19.8 per cent after PGV, with a mortality of 0.5 per cent and 0.4 per cent respectively. Of 163 patients in the former group and 253 patients in the latter group the follow-up was an average of 5.7 and 6.2 years respectively; 128 patients (78.5 per cent) and 198 (78.3 per cent) respectively had a good functional result, graded as Visick I and II, but 35 (21.7 per cent) and 55 (21.7 per cent), respectively, had a poor result owing to recurrent ulceration in 23 (14.1 per cent) after TVD and 44 (17.4 per cent) after PGV. These results were not statistically different. The frequency of diarrhoea was 23 per cent and dumping 6.8 per cent after TVD which was significantly reduced to 2.0 per cent (P less than 0.005) and 1.2 per cent (P less than 0.025), respectively, after PGV. However, only five patients (3.0 per cent) had severe symptoms from diarrhoea and two (1.2 per cent) from dumping after TVD. Both operations seem to carry an equal incidence of unsatisfactory results, though for slightly different reasons it might be concluded that both procedures have an equal degree of acceptability.

Truncal vagotomy and drainage: a comparison of elective and emergency operations.

A comparison has been made between truncal vagotomy and drainage (TV + D) performed from 1968 to 1981 in 209 patients electively and in 68 patients as an emergency. The male:female distribution was 167:42 and 59:9 with a significant difference (P less than 0.001) in the mean ages of 49 years and 55 years respectively. Major postoperative complications following emergency TV + D (22 per cent) were significantly more common (P less than 0.001) than following elective TV + D (6.7 per cent) with seven (10.3 per cent) and one (0.5 per cent) deaths respectively. Of 163 patients in the elective and 54 in the emergency group followed up for an average of 5.7 and 5.9 years respectively, 132 patients (81 per cent) and 46 (82.5 per cent) had a good functional result graded as Visick I and II, but 31 (19 per cent) and 8 (14.8 per cent) patients respectively had a poor result due to recurrent ulceration in 23 (14.1 per cent) after elective TV + D and in all 8 (14.8 per cent) after emergency TV + D. These results are not statistically different. Thus emergency TV + D carries a higher mortality and morbidity than elective TV + D, but the long term results are similar. This conclusion substantiates the equivalent effectiveness of emergency and of elective TV + D.

Effects of CO2 laser on the healing of experimental colon anastomoses.

Anastomotic leakage after colonic resection still remains a troublesome complication of major clinical significance. Systemic (nutritional status, blood viscosity) or local factors (contamination by local germs, suture technique) seems to be implicated in the healing process of the suture line. The CO2 laser as a cutting procedure in colonic resection should provide a useful tool for its accuracy and the bactericidal properties. We have tested the strength of an end-to-end anastomosis of rat colon resected by CO2 laser, scalpel and diathermy, respectively, by measuring the bursting pressures at different postoperative days. The present study shows that the use of CO2 laser resulted in a significant increase of colonic bursting pressure at the anastomotic site.

Liver regeneration after atypical hepatectomy in the rat. A comparison of CO2 laser with scalpel and electrical diathermy.

Rats were subjected to partial hepatic lobectomy with removal of about two thirds of the liver either by scalpel, by CO2 laser, or by electrical diathermy. Macroscopic examinations of livers at various days after surgery indicated that CO2 laser surgery results in minor tissue damage, reduced complications from inflammation and infections, and faster healing compared to electrical diathermy, but it is less satisfactory than the scalpel with respect to all these parameters. Rat liver regeneration was followed at the molecular level by measuring the changes of protein biosynthesis activity in the liver, as monitored by modifications of ribosome organization. Activation of the protein biosynthesis process started 1 day after surgery when hepatectomy was performed by scalpel, while 2 days were required when CO2 laser or electrical diathermy were used instead.

[Sequential hepato-biliary scintigraphy and percutaneous cholangiography in the diagnosis of benign diseases of the biliary tract Indications and limits]. / La scintigrafia sequenziale epato-biliare e la colangiografia percutanea nella diagnosi delle affezioni benigne della via biliare. Indicazioni e limiti.

Attention is drawn to the results of a study of 45 patients with bile duct calculosis designed to assess the soundness and the limits of two diagnostic examinations (HIDA and PTC) in determining the morphological and functional characteristics of the hepatoenteric tract. The results indicated that HIDA is a useful first step in average to serious cases of icterus as a means of evaluating the functional state of liver cells and the bile ducts by determination of activity-time curves for preselected areas, whereas PTC is more important in cases of serious icterus, since it also enables the patient to be suitably prepared for surgery.

[Hyperthyroidism as a rare cause of "false acute abdomen"]. / L'ipertiroidismo quale causa rara di "falso addome acuto".

4 patients affected by hyperthyroidism presenting a feature of "false acute abdomen" as main clinical sign are presented. The low incidence of that association, according to the literature, and the difficulties of a correct diagnosis, which could lead to a useless laparotomy is pointed out. The conclusion is drawn that tests of thyroid functions should be done whenever the feature of acute abdomen presents without any past history of gastro-enteric lesions.