[Conservative treatment using mesalazine in ischemic colitis]. / La terapia conservativa con mesalazina nella colite ischemica.

The authors propose the conservative treatment of ischemic colitis using slow-release mesalazine and enema. The excellent tolerability of the treatment and the good level of therapeutic efficacy was confirmed in 13 cases treated without signs of recurrence of disease.

[Prosthetic repair of inguinal and crural hernias]. / La riparazione con protesi delle ernie inguinali e crurali.

335 inguino-femoral hernias were repaired with polypropylene mesh from December 1991 through December 1995. Eleven patients underwent mesh reinforced Bassini, 167 modified Lichtenstein's technique and 108 Trabucco's repair. Forty-three patients were treated under regional anesthesia. Bilateral hernia was diagnosed in 33 patients and in 20 out of 33 the surgical procedure was entirely performed under regional anesthesia. Early complications referred were 32 scrotal hematomas which spontaneously healed. Two patients showed a recidive hernia and were retreated with and additional mesh; plug rejection (early experience) was referred in one patient who was reoperated on employing a mesh. The indications for the more suitable technique were directly deducted from Nyhus' hernia classification. The authors finally point out the: 1) importance of regional inguinal anesthesia; 2) correct cutting and application of the mesh in the inguinal canal; 3) internal inguinal ring repair; 4) bilateral hernia repair under regional anesthesia.

Comparison between therapeutic regimes in erosive chronic gastritis associated with Helicobacter pylori.

Following numerous reports confirming the role of erosive chronic gastritis and ulcer, several treatment protocols have been used with the aim of eradicating this microorganism. Elimination was initially achieved using polychemotherapeutic associationsbismuth salts+metronidazole+amoxycillin and/or tetracyclineswhich proved relatively efficacious in therapeutic terms, but often led to side effects, the onset of bacterial resistance and scarse patient compliance. The authors consider that these limits can be overcome by using a new association of homeprazole+azithromycin, whose effica-cy in the eradication of Helicobacter pylo-ri has been shown to be of about 85% of cases treated for a relatively short period (4 weeks).

[Hemorrhage of the upper digestive tract in the elderly patient: is the limit of 60 years of age still biologically valid? Statistical study]. / Emorragie del tratto digestivo superiore nel paziente anziano: sono i 60 anni un limite ancora biologicamente valido? Studio statistico.

The authors examine 192 consecutive cases of upper gastrointestinal hemorrhage; the series included 133 males and 59 females with a mean age of 55.78 years (SD +/- 17.88) and range of 18-97. All patients underwent emergency esophagogastroduodenoscopy within 6-12 hours of hospitalisation. Adequate infusion and; when necessary, transfusion therapy associated with protection using anti H2 (ranitidine 200 mg/24 h) and octreotide (0.2 mg x 3/day sc), proportionately scaled over the following 72 hours, were used in all patients. Nasogastric aspiration (nasogastric probe or Sengstaken-Blakemore probe) were used for at most 48 h after endoscopy. Patients were then subdivided into 2 age groups: under (104 cases) and over (88 cases) 60 years. Statistical relations were studied (Chi-square test), assuming the reference value to be p = 5%, between age and diagnosis, sex, symptoms on presentation, hemotransfusion, Forrest's classification, the onset of renewed bleeding and lastly the evolution of each case. Hemorrhage was more frequent in males aged < 60 years and in females aged > 60 (p < 0.004), hemorrhagic shock, the presence of Forrest 1a and 1b and death were significant in elderly subjects (p < 0.004; p < 0.01; p < 0.01). The latter finding included patients with esophageal varices, group which was significantly correlated with mortality independent of age. The overlap of statistical results in hemorrhage not related to varices suggests, on the one hand, that appropriate early treatment has a greater influence on the prognosis rather than the type of pathology, and on the other that being aged over 60 does not correspond to an increased biological risk.

[Ogilvie's syndrome: does it have to be redefined? An analysis of 8 cases and contribution to the discussion]. / La sindrome di Ogilvie: è da ridefinire? Analisi di 8 casi e contributo alla discussione.

The authors examine eight cases of acute pseudo-obstruction of the colon and point out that these may be inserted in the wider context of intestinal pseudo-obstructions. These comments raise questions concerning Ogilvie's syndrome since the dilatations observed do not only affect the colon, according to the classic definition, but also the ileo-jejunal tract, in spite of the fact that the main target continues to be the colon. The term Ogilvie's syndrome is still significant in the clinical identification of colic dilatation, in particular the right colon in which possible complications are more severe. The authors identify colonoscopy as the best instrumental test owing to the possibilities its offers, including therapeutic, and also underline that there does not appear to be a real risk of iatrogenic lesions if an appropriate technique is used.

[Omentitis and mesenteric lymphadenitis: is there a relationship? Apropos of 3 cases]. / Omentite ed adenomesenterite: c'è relazione? A proposito di tre osservazioni.

The authors report three cases of acute epiploitis diagnosed intraoperatively and discuss the etiopathogenetic hypotheses. They suggest a relationship between acute epiploitis and mesenteric lymphadenitis, as well as their common origin.

[Acute intestinal ischemia. Our experience]. / L'ischemia intestinale acuta. Nostra esperienza.

Acute intestinal ischemia is a pathology which is relatively often encountered in elderly patients where the concomitance of other diseases make its prognosis more severe, especially since diagnosis is usually late. Laboratory tests and imaging techniques are not of great value to diagnosis since they do not provide pathognomonic data, but together with a careful anamnesis they contribute a series of findings which, taken as a whole, lead to the diagnosis of intestinal ischemia. The sole therapy is surgery--when still possible and the best results are obtained when surgery is performed at an early stage. The authors report a series of 12 cases of acute intestinal ischemia and underline the difficulty of diagnosing this subtle pathology and the advantages of aggressive surgical techniques.

[The management of head trauma in a general surgery department. a contribution to an epidemiological analysis]. / La gestione del trauma cranico in un reparto di chirurgia generale. Contributo per un'analisi epidemiologica.

Personal experience in the management of head injury in a General Surgery Department is reported and a series of 352 patients analysed with a view to identifying variations in the epidemiological profile of this pathology over the last decade and in order to establish indications for admission and the transfer of the patient to specialist departments.