Prognostic evaluation of pT1 and pT2 colorectal cancer.

Authors analyze the characteristics of the stage pT1 and pT2 colorectal cancer and carry their experience on 68 patients operated. The survival of the colon carcinoma has been of 91% to 2 years and 88% to 5 years, while for the rectum has been of 90% to 2 years and 84% to 5 years. The attitude of the Authors has been to perform radical surgery. Lymph node metastases has been taken like only survival predictive factor while the CEA has diagnostic value of recurrence.

[Pseudoaneurysm of the gastroduodenal artery: clinical case]. / Pseudoaneurisma dell'arteria gastroduodenale: caso clinico.

The Author report a case of massive digestive hemorrhage from fistulization into the duodenum of a pseudoaneurysm of the gastroduodenal artery consequent upon pancreatic pseudocyst. The surgical treatment consisted in intracyst artery ligation and led to complete reabsorption of the pseudocyst formation and healing of the patient. Bleeding from pseudoaneurysm has a high mortality rate and requires a surgery that may be very difficult to perform in emergency conditions. In this type of surgery it's important an anterior approach of pancreas, to do a good preoperatory diagnosis, and a good knowledge of surgical anatomy.

[Hemorrhoid ligation: a new technique]. / Legatura delle emorroidi: una nuova tecnica.

The Author describes an old technique of hemorrhoids' treatment with a new disposable instrument: the canadian Patrick O'Regan's Ligator. On a series of 342 patients, from December 1998 to March 2000, the Author, treating this pathology with good results in percentage, stresses on the manageability and practicality of this instrument both in the hospital regimen and in the Day Hospital.

Bassini vs Lichtenstein: two basic techniques for inguinal hernia treatment.

Two techniques for inguinal hernia treatment are compared: the plastic repair of Bassini and that of Lichtenstein. The authors stress the differences between these two techniques by reporting and comparing the results obtained during four years of operating on 381 patients with the Bassini technique and 357 with the Lichtenstein technique.

[Accidents in laparoscopic surgery: Mirizzi's syndrome]. / Incidenti in chirurgia laparoscopica: la sindrome di Mirizzi.

It's still much discussed if Mirizzi syndrome must be operated in laparoscopy. Many authors stress the importance to make laparoscopy but others refuse absolutely such possibility and they only work in the classic manner. Nobody has still described the injury of right hepatic duct for Mirizzi syndrome Csendes type I during laparoscopic cholecystectomy. The authors report such a case that has been converted in the classic manner due to the importance of the injury for unknown Mirizzi syndrome.

[Osteosynthesis with the Gamma nail of fractures of the proximal third of the femur in elderly patients. The immediate results in 181 cases]. / Osteosintesi con il chiodo Gamma delle fratture del terzo prossimale del femore in pazienti anziani. Risultati immediati in 181 casi.

Treatment of the fractures of the proximal third of femur is a traumatology chapter, for elderly patients, in progression and evolution. Authors examined 205 patients operated in 5 years for fractures of proximal third of femur (excluding fractures of the neck) with the Gamma nail finding, in this endomedullar nail, a valid instrument for primary stability, fewer surgical aggressiveness and less morbidity, in a new optics of savings of hospital costs.

[Acute postoperative acalculous cholecystitis: case report and review of the literature]. / Colecistite acuta postoperatoria alitiasica: caso clinico e revisione della letteratura.

Postoperative acute acalculous cholecystitis is condition observed after gastrointestinal operations, traumatism or long assisted ventilation periods. The Author report the case of a patient operated for gastric carcinoma with the evolution of an acute cholecystitis on 5th postoperative day. The clinic and the diagnostic findings weren't able to remove the doubts and the patient is reoperated: there was not anastomotic leak, but the evidence of an acute acalculous cholecystitis, with thickened walls. The review of the literature show that few cases of the acute acalculous postoperative cholecystitis are reported.

Short-term vs long-term dexamethasone treatment: effects on rat diaphragm structure and function.

The effects of dexamethasone treatment duration (2.5 vs 10 weeks) on diaphragm myosin heavy chain isoforms, fiber types, and contractile characteristics were studied in male rats. Compared with ad libitum-fed and pair-fed controls, dexamethasone significantly decreased body weight, costal diaphragm weight, and the relative expression of myosin heavy chain isoform MHC-2B. Compared with pair-fed controls, the effect on MHC-2B expression was greater after 10 weeks than after 2.5 weeks. Type I and type II costal diaphragm fiber atrophy occurred, and type II fiber atrophy was greater after 10 weeks. Costal diaphragm-specific forces were not affected significantly by dexamethasone, regardless of the treatment duration or control group comparison. Fatigue resistance indexes were increased significantly after long term treatment compared with pair-fed controls and after both short-term and long-term treatment compared with ad libitum-fed controls. In conclusion, the effects of dexamethasone on MHC isoform phenotype expression, fiber type costal diaphragm atrophy, and fatigue resistance were dependent on treatment duration, with greater effects after long-term (10 weeks) treatment.

[Primary cysts of the spleen: apropos 3 cases with a review of the literature]. / Le cisti primitive della milza: a proposito di 3 casi con revisione della letteratura.

The splenic cyst occurs rarely, is benign and often asymptomatic. Surgery is the therapy of choice as soon as the size reaches 2 centimeters. Following the exclusion of an echinococcus infection, the cyst can be treated either by complete resection or by fenestration. Recently laparoscopy has been demonstrated to be a useful alternative to open surgery in the treatment of selected splenic cysts. We report 3 cases successfully operated with conventional surgical procedures and, based on the literature, we review the history, the physical signs, the investigations and the surgical procedures.

Gender-specific effects of dexamethasone treatment on rat diaphragm structure and function.

The effects of long-term dexamethasone treatment on diaphragm muscle were studied in female and male rats. Compared with pair-fed control animals, dexamethasone treatment did not significantly affect estrous cycling or peak serum estradiol levels; however, testosterone levels were significantly increased in females and decreased in males. Dexamethasone significantly reduced body and costal diaphragm weights, but to a lesser extent in females than in males. Reductions in diaphragm weight were proportional to reductions in body weight. In females and males, dexamethasone treatment significantly decreased diaphragm fiber (types I and II) cross-sectional area and the relative expression of myosin heavy chain isoform 2B. With the exception of type I fiber atrophy, these changes occurred to a lesser extent in females. Dexamethasone did not significantly affect specific forces. Dexamethasone significantly increased twitch one-half relaxation time and fatigue resistance indexes in males but not in females. In conclusion, the effects of long-term dexamethasone treatment were gender specific, with significantly fewer effects in females, and changes in serum testosterone levels were associated with these findings.

Short- and long-term effects of testosterone on diaphragm in castrated and normal male rats.

The effects of short- and long-term testosterone absence or treatment on the diaphragm were studied in castrated and sexually normal male rats. Compared with control rats (untreated normal males), testosterone absence or treatment did not significantly affect costal weight. In untreated castrated males, there were significant decreases in specific forces, type II fiber cross-sectional area, and myosin heavy chain (MHC) isoform 2B after 2.5 wk. In castrated males that received testosterone, there were significant increases in specific forces, type II total fiber proportional area, and relative expression of all adult diaphragm fast MHC isoforms (MHC-2all) after 2.5 wk. In normal males that received testosterone, the only significant finding was an increase in MHC-2B after 2.5 wk. Across all groups, there was close correlation between increases in maximum tetanic forces and MHC-2all. Changes in diaphragm function and composition were closely related to changes in serum testosterone levels at 2.5 wk. The lack of significant change in diaphragm function at 10 wk occurred despite changes in serum testosterone levels and diaphragm composition similar to those at 2.5 wk. These findings support our hypothesis that the effects of testosterone are dependent on basal circulating androgen levels and study duration.

[Cystic dilatation of the biliary tract]. / La dilatazione cistica della via biliare.

Cystic dilatation of the biliary tract is a rare disorder, more common in children, with a high morbidity and mortality rate. Death may follow one of the possible complications (recurrent cholangitis, biliary cirrhosis, cholangiocarcinoma). The Authors report the case of an asymptomatic adult woman. According to CT scan and ERCP the lesion found was classified as type IVb of Todani's classification. The cyst was removed and a Roux en-Y reconstruction was performed. This procedure is currently associated to a low mortality rate and the best long term results.

[Spontaneous rupture of the esophagus]. / La rottura spontanea dell'esofago.

Spontaneous rupture of the esophagus is a rare emergency that requires immediate diagnosis and superior surgical treatment. Delay in diagnosis is common and is caused mostly by lack of consciousness of the disease and consequent tendency to diagnose a cases as perforated peptic ulcer, pancreatitis, acute coronary disease etc. Mortality and morbidity increase proportionally to the time between esophageal perforation and adequate treatment. In this paper the Authors present a case of Boerhaave's syndrome in a patient who underwent two surgical repairs followed by leakages of the esophageal sutures. The definitive successful treatment has been obtained with a third operation performed after complete sterilization of the mediastinum.

Effect of cefodizime (HR 221) on immunological defects induced by surgical stress.

Cefodizime, a new aminothiazolylcephalosporin, has been shown to possess immunomodulating activity in many experimental models in vivo and in vitro. The in-vivo effect of the drug was evaluated in a model represented by the surgical patient, being surgical practices usually associated with an immunological impairment involving many aspects of the immune response. Two groups of ten subjects were treated respectively with cefodizime (2 g i.v. daily) and another cephalosporin (ceftriaxone) at the same dosage. Aspecific immunity (complement activity, neutrophil phagocytosis, chemiluminescence and superoxide anion production) and cell-mediated reactivity (lymphocyte subpopulations and E-rosette-forming cells) were evaluated before, and at predetermined intervals after, surgery and antibiotic treatment. In the control group an important immunological derangement is observed, involving both lymphocytes and neutrophil functions and complement system. The treatment with cefodizime displays a positive effect with a significant improvement of impaired functions. The effect of the drug particularly influences neutrophil phagocytosis, explored with both the NBT test and determinations of chemiluminescence, and the complement system, through both the classic and the alternative pathways. A slight effect is observed on lymphocyte functions.

[Collagenous colitis: a disease difficult to define]. / La colite collagena: una patologia di difficile definizione.

The Authors report a case with watery chronic diarrhoea not related to malabsorption or to inflammatory bowel disease or to intestinal neoplasm. Colonic biopsy, performed during colonoscopy, with the histologic finding of collagenous material in the subepithelial space associated to epithelial alterations and to the presence of inflammatory cells, confirmed the diagnosis of this rare pathologic condition. The pathogenesis of the syndrome, however, is still unknown.

[Cavernous hemangioma of the small intestine]. / Emangioma cavernoso del tenue.

The Authors report an uncommon cavernous hemangioma of the small bowel. Pathological and clinical features are compared with those of the literature. Considering the difficulty of diagnosis, they remark the importance of histological exam as the only reliable diagnostic tool and surgery as the only therapy.