Retroperitoneal fibrosis: unusual localization.

Six cases of retroperitoneal fibrosis, each with a different pathogenesis and unusual localization were observed from 1980 to 1996. Four patients had had previous surgery for a neoplasm, one patient had idiopathic retroperitoneal fibrosis, and the last patient was hardly classifiable due to the complexity of the clinical pattern. The mean survival in 3 patients with malignant retroperitoneal fibrosis was 7 months. Two patients treated with medical therapy are still alive and in good clinical condition. The aspecificity of the symptoms makes early diagnosis difficult. CT and NMR are essential procedures for differential diagnosis of abdominal masses. Histology differentiates benign from malignant retroperitoneal fibrosis. The choice between medical or surgical therapy depends on the general condition of each patient.

Instrumental treatment of recurrent lithiasis of biliary tract with stenosis of hepatico-jejunal anastomosis.

The optimal treatment for recurrent stones of the biliary tract in patients previously treated by hepatic-jejunal anastomosis with Roux en Y loop is debated and the criteria are not fully defined. Age, cardiopulmonary diseases, diabetes, multiple previous surgery of the biliary tract, size, number, and type of stones are some of the factors to evaluate before choosing the most convenient approach. We present two high surgical risk patients with recurrent biliary tract stones previously treated with hepatic-jejunal anastomosis and Roux en Y loop, and treated successfully. Percutaneous lithotripsy was used and in one extracorporeal lithotripsy was associated. These techniques offered a good treatment for these patients, but we must consider the high cost of these procedures. The criteria to choose the best option should consider the risk factors and the cost effectiveness of the various possibilities.

[Diagnosis of the nature of biliary stenoses: role of exfoliative cytology by external biliary drainage]. / Diagnostic de nature des sténoses biliaires: rôle de la cytologie exfoliative par drainage biliaire externe.

The use of percutaneous transhepatic biliary drainage (PTBD) has allowed the development of new diagnostic examinations, such as biliary exfoliative cytology. This is extremely important in patients with biliary tract strictures, in order to obtain a diagnosis about the real nature of the stricture. Forty-nine patients underwent exfoliative biliary tract cytology from bile samples. Exfoliative cytology was performed on bile samples taken at different times for each patient. The results of our study proved this examination to be highly specific (there were no false positive samples), although the diagnostic sensitivity was not as high (63.9%). It is important to underline that whenever the epithelium of the biliary tract is involved by neoplasm, the result of examination is always positive. These data may be useful to choose an appropriate surgical procedure.

Relationship of the carcinoma of bile ducts to cholelithiasis.

Thirty-eight patients with carcinoma of the bile ducts were studied by PTC and ERCP. These instrumental procedures permit at present a precise and complete diagnosis. In 22 cases (57.9%) the association of a lithiasis was evidenced. The application of a percutaneous transhepatic drainage after PTC in cases of stricture furtherly supports the diagnostic accuracy by the cytologic examination and culture of the bile collected from drainages.

[Esophageal pH-manometry in the evaluation of pathologic gastroesophageal reflux]. / La pH-manometria esofagea nella valutazione del reflusso gastroesofageo patologico.

Combined pressure and pH measurement of distal esophagus is very important for an accurate diagnostic approach and a correct therapeutic course of gastro-esophageal reflux disease. Sixty-eight patients with suspected gastroesophageal reflux disease have been examined by combined pressure and pH-measurement. Collected data confirm the method worth, that allows to study gastro-esophageal reflux and the esophageal motor dysfunction related.

[Clinical use of percutaneous transhepatic biliary decompression]. / Applicazioni cliniche della decompressione biliare transepatica percutanea.

Several interesting applications of P.T.C. with biliary drainage are described out of several years' experience with the technique. It was found to be extremely useful for precise preoperative diagnosis of biliary calculus and any associated pathologies. The information provided by biliary drainage is also obviously helpful in selecting the correct surgical approach to this condition.