[Pleuro-pneumo-phreno-pericardiectomy with pericardial and diaphragmatic plasty]. / Le pleuro-pneumo-freno-pericardiectomie con plastica pericardica e diaframmatica.

Aim of the paper is to evaluate 43 extrapleural pneumonectomy performed from 1988 to May 2000. Criteria for extrapleural pneumonectomy were pleural biopsy by thoracoscopy, potentially completely resectable unilateral disease by computed tomography and predicted postresection forced expiratory volume >1,3 L/sec. The resections regarded 33 pleural mesothelioma, 9 pleural lung-carcinosis and 1 pleural melanoma effusion. The perioperative mortality rate was 2,2% (1 death) and morbidity 21,4%.

[Videolaparoscopic treatment of biliary lithiasis. Evolution of our experience]. / Trattamento videolaparoscopico della litiasi biliare. Evoluzione della nostra esperienza.

Videolaparoscopic cholecystectomy is considered the treatment of choice for simple cholelithiasis. Now many surgeons consider the laparscopic procedure usable also in the complicated biliary lithiasis like acute cholecystitis and choledocholithiasis. The authors report their recent experience of the laparoscopic treatment of biliary lithiasis, regarding 221 non-selected patients (69% symptomatic cholelithiasis, 20% chronic cholecystitis, 4.5% acute cholecystitis, 4.5% coledocolithiasis, 2% hydrops). The diagnostic-therapeutic protocol and the results are described and compared with the beginning of their experience, when they treated only symptomatic gallbladder stone disease, and with the reports of the literature. The authors concluded that the laparoscopic procedure is a good chance for the surgeon in the treatment of all cases of benign biliary disease. But, in particular for patients with choledocholithiasis, he has be able to know all the diagnostic and therapeutic possibilities, to choose the best in every single case.

[Minimally invasive surgery and neoplasms of the inferior third of the rectum: personal technique]. / Chirurgia miniinvasiva e neoplasie del terzo inferiore del retto: tecnica personale.

In the last decade minimally invasive surgery has gained an increasing success and was firstly applied to the treatment of benign pathologies, and recently to the malignant ones. The Authors report two cases of inferior rectal neoplasm treated with Miles operation through a video-laparoscopic-perineal approach. The abdominal phase of the operation was performed only through 5 small laparoscopic incisions. The perineal phase and the stoma were performed using traditional technique. The method appears feasible and oncologically correct; however, further trials are needed to evaluate long-term results.

[Medullar breast cancer, occult papillary carcinoma, pulmonary metastases: a case report]. / Carcinoma midollare della mammella, carcinoma papillifero occulto, metastasi polmonari. Case report.

The authors have carried out their study on a woman who previously underwent QU.A.R.T. because of a medullar breast cancer. She also had pulmonary metastases resistant to chemotherapy which were then resected by mini-invasive video-assisted thoracic surgery: it was so discovered that such lesions came from an occult papillary carcinoma of the thyroid gland originated in a multinodular goitre. This study has allowed the accomplishment of a right aetiologic and therapeutic classification of the patient.

[Laparoscopic cholecystectomy. Our experience]. / La colecistectomia laparoscopica. Nostra esperienza.

This study analysed 90 cases of symptomatic cholelithiasis treated with laparoscopic cholecystectomy. 27% of the cases studied suffered from microlithiasis, 44% from multiple calculosis with calculi measuring 1 to 2 cm in diameter, 25% from single calculi measuring up to 4 cm in diameter, and 4% from a benign proliferative pathology of the cholecystic wall. Calculosis of the main biliary tract was also found in 3 patients and was treated by preoperative endoscopic papillosphincterotomy. In addition to routine tests and ultrasonography, endovenous cholangiography, or retrograde cholangiography (ERCP) in cases of suspected calculosis of the biliary tract, was always performed prior to surgery. Mean operating time was 60 min. Two procedures were converted into laparotomy due to laceration of the cystic artery. In one case laparotomy was performed on day two due to choleperitoneum following a lesion of the cystic duct. Pneumoperitoneum could not be performed in three cases. Mean hospital stay was 48 hours. No other intra- or postoperative complications were reported. These results support the opinion that laparoscopic cholecystectomy is a safe method, with few limitations and represents the treatment of choice in the therapy of symptomatic cholelithiasis.

[Rationale for the use of bile salts after cholecystectomy: results of a controlled clinical study using tauroursodeoxycholic acid (TUDCA)]. / Razionale all'utilizzo dei sali biliari nel paziente colecistectomizzato: risultati di uno studio clinico controllato con l'impiego dell'acido tauroursodesossicolico (TUDCA).

Cholecystectomy causes alterations in bile composition. In particular it rises the proportion of highly detergent bile acids with the possible consequence of the manifestation of dyspepsia in a high percentage of patients: this is the well-known post-cholecystectomy syndrome. In this clinical trial we studied the activity and safety of tauroursodeoxycholic acid--TUDCA--(500 mg/die) in the prevention of dyspepsia in cholecystectomized patients, in comparison with no treated group. We enrolled 203 patients (101 TUDCA--group A--and 102 control-group B). The two groups were comparable for age (47.1 years in group A and 50.7 years in group B), sex (m/f: 28/73 and 37/65 in the two groups) and for other characteristics connected to surgical procedures. After operation all patients suffered from dyspepsia symptoms. In patients treated with TUDCA we registered a prompt regression in severity of symptoms when compared with no treated group: in fact we noted a significant difference only at the first control planned after one month from operation. No difference were registered at the other controls (two and three months after operation). Two patients in A and 3 in group B manifested adverse events. In conclusion, the treatment with TUDCA, a new hydrophilic bile acid, seems to contribute to the improvement of clinical course in cholecystectomized patients.

[Mechanical anastomosis without purse-string suture in esophageal surgery]. / Anastomosi meccaniche senza borsa di tabacco in chirurgia esofagea.

A new surgical procedure for oesophago-enterostomy using staplers without purse-string suture is described. This technique is possible only using the CEEAP stapler, thanks to its new technical features.

[Raynaud's phenomenon: diagnostic and therapeutic aspects]. / Il fenomeno di Raynaud: aspetti diagnostico-terapeutici.

The Authors report their experience concerning 120 patients with Raynaud's Disease (50 pats.) or Syndrome (70 pats.). All patients were studied before and after treatment, by clinical, thermometric, oscillographic and photoplethysmographic observation and by the Doppler examination, in order to evaluate the functional and organic component of the disease. Surgical treatment was reserved to 45 patients with secondary or primitive Raynaud's phenomenon refractory to medical therapy. The treatment of choice was thoracic sympathectomy. The result was excellent in 64% of cases, fair in 26%, and nil in 8%. 75 patients were treated with various drugs for a period of 6 months or 1 year. In 54% of cases the result was excellent, fair in 29%, and nil in 16%. The Authors conclude that diagnosis of Raynaud's Syndrome is above all clinical, that a leading part is played by photoplethysmography and the Doppler examination, and that medical therapy is indicated in the first instance, since it is capable of preventing the rise of those distal trophic disorders that constitute one of the main indications of surgical treatment.