Mesenteric cystic neoformations: report of two cases.

The authors present two case reports of mesenteric cystic neoformations which they themselves observed and, with the help of the literature regarding this pathology, discuss the problems of both diagnosis and treatment.

[Evaluation of costs in surgery of inguinal hernia. Day surgery and one day surgery versus ordinary admission]. / Valutazione dei costi nella chirurgia dell'ernia inguinale. Day surgery e one day surgery versus ricovero ordinario.

The authors have completed an analytic research about costs of hospitalization and treatment for inguinal hernioplasty and costs of anesthesiologic and surgical techniques and hospitalization regimen. The authors consider possible in about 50% of cases the tension-free hernioplasty carried out with local anesthesia and day or one day surgery regimen and they have estimated that it is very less costly then traditional herniorraphy carried out with general anesthesia and hospitalization: L. 1.056.075 versus L. 2.252.650. In Emilia-Romagna we could have a considerable cost-saving, even if only the 50% of patients treated for uncomplicated inguinal hernia every year (7.133 patients with mean hospital stay = 5,8 days and total hospitalization = 41.731 days during 1993) could benefit by treatment in one day surgery regimen. In fact, leaving out of account the advantage of the rapid return the patient to work, the costs of hospital stay, esteemed in L. 25.038.600.000, would be L. 8.558.700.000. A considerable increase of one day surgery hernioplasties should be expected by the hospital administration in budget planning.

[Costs of cholecystectomy after the arrival of video-laparoscopic surgery]. / Costi della colecistectomia dopo l'avvento della chirurgia video-laparoscopica.

The authors proceeded to point out the hospital stay costs and the operating-room costs of the cholecystectomy after the introduction of the laparoscopic technique, underlining the higher economic advantages. The total unit cost for laparoscopic cholecystectomy, even if there are higher costs due to the surgical equipment, thanks to the mini-invasive approach and to the reduced hospital stay, results lower (17%) then the total unit cost for laparotomic cholecystectomy (L. 3.982.489 vs. L. 4.825.300). Let us suppose that in the Emilia Romagna Region an 80% of patients underwent to laparoscopic cholecystectomy and only a 20% underwent to laparotomic cholecystectomy: in this case there could be the economic savings of L. 3.777.478.902 and concerning the hospital stay there could be the savings of 17.928 days too. This cost estimation is important if we consider that the rate of cholecystectomy procedures, in our local area, per 1000 inhabitants, increased from 2.29 in 1990 to 3.99 in 1992 (rate of increase: 74%).

[Costs of video-laparoscopic surgery in the treatment of ovarian cysts]. / Costi della chirurgia video-laparoscopica nel trattamento delle cisti ovariche.

The authors proceeded to point out the hospital stay costs and the operating-room costs of the operations for benign adnexal pathologies, especially concerning the ovarian cysts, after having introduced the laparoscopic technique. The highly costs, due to the laparoscopic surgical equipment, are compensated by the reduced hospital stay. The total unit cost for laparoscopic approach results lower then the total unit cost for laparotomic approach (L. 3.253.923 versus L. 4.662.892). If we consider that, in our local area, in 1993, 1212 operations were performed, with 5454 days of postoperative hospital stay, we could suppose that the laparoscopic approach affords higher savings. This cost estimation is important if we consider the diffusion of the mini-invasive procedures.

[Pulmonary hamartoma]. / L'amartoma polmonare.

Pulmonary hamartoma is a rare benign tumor often found by chance. Only in 10% of cases are some calcifications like "pop corn". Fibrobroncho-scopy is help only in endobronchial forms; they don't reach 10% of cases. Computed Tomography and transparietal biopsy can be diagnostic. In the uncertain cases and in presence of symptoms, thoracotomy with exeresis of tumor is justified.

[Meckel's diverticulum. Case contributions]. / Il diverticolo di Meckel. Contributo casistico.

Eight cases of Meckel's diverticulum observed by the authors are reported. Different investigative methods, clinical and surgical aspects are discussed. Even asymptomatic Meckel's diverticulum discovered incidentally at surgery should usually be removed.

[Carcinoid tumors of the appendix. Review of the literature and two case reports]. / I tumori carcinoidi dell'appendice. Analisi della letteratura e presentazione di due casi.

Gastrointestinal carcinoids are infrequent but at the same time hardly rare tumours. They are often chance findings but, as is clearly reported in the literature, their potential malignancy should not be overlooked. They are most commonly localised in the appendix. The authors describe two case reports of carcinoid tumours of the appendix, one of which was diagnosed during left hemicolectomy due to Crohn's disease and the other during acute appendicitis. Prognostic and therapeutic problems are discussed in the light of the most recent literature.

[Duplication of the small intestine. A case diagnosed prenatally]. / Duplicazione intestinale del tenue. Su di un caso diagnosticato in epoca prenatale.

The authors present a case of neonatal intestinal duplication. Etiopathogenic view and the diagnostic and therapeutic problems are discussed. Echotomographic examination can provide useful diagnostic input, as in this case, even at a prenatal stage.

[Role of magnetic resonance in the diagnosis of cryptorchidism]. / Il ruolo della risonanza magnetica nella diagnostica del criptorchidismo.

The paper reports the authors' personal experience regarding the use of magnetic resonance imaging in the diagnosis of cryptorchidism. The result of the study of 13 patients with non-palpable gonads, who all underwent surgical confirmation (with positive outcome in 66% of cases), encourage the use of this non-invasive method with a high anatomic resolution, which can be used to diagnose both the site, dimensions and possible structural alterations of the gonad.

[Trans-suture mechanical colorectal anastomosis using a double stapler in the anterior resection of the rectum. Technical note]. / Anastomosi colo-rettale meccanica trans-suturale mediante duplice suturatrice nella resezione anteriore del retto. Nota di tecnica.

The spread of mechanical staplers now makes it possible to perform anastomoses in anterior resections of the rectum that are easier and safer than manual ones. Certain related problems are well known, particularly in patients with narrow pelvis and, in low anastomoses, the fashioning of the tobacco pouch on the distal rectal stump. The technique of transutural mechanical colorectal anastomosis with circular stapler after closure of the rectal stump with linear stapler is described in detail. Advantages of the technique are: anastomoses that are technically easier and safer because making of the tobacco pouch on the distal rectal stump is avoided; pollution of the operating field is reduced to the minimum; there are no problems related to differences in lumen of the colorectal stumps.

[New approaches in the diagnosis of pelvic recurrence after the Miles intervention]. / Considerazioni sui nuovi indirizzi nella diagnosi di recidiva pelvica dopo intervento di Miles.

The Authors refer some diagnostic and therapeutic observations about pelvic-perineal recurrence after abdominal-perineal excision of rectum (AAP). They analyze new possibilities of diagnostic instrumentation, in particularly TC and RM scanner, comparing the results and valuing the sensibility and specificity in a selected group of patients.

[Inguinal hernia in childhood]. / L'ernia inguinale in età pediatrica.

The paper reviews the current methods of surgery for inguinal hernia in children. This is a relatively common pathology but there is still no consensus regarding the most important aspects, namely "who" should be operated, "why", "when", "what methods should be used", and "what results are achieved" The excellent outcome in addition to the rarity of relapse in cases of uncomplicated hernia, opposed to emergency operations due to strangulation which are accompanied by a significant rate of mortality, justify, with rare exceptions, early intervention once the diagnosis has been confirmed.

[Costs and benefits in the follow-up of abdomino-perineal amputation of the rectum for cancer]. / Costi e benefici nel follow-up dopo amputazione addomino-perineale del retto per cancro.

A cost/benefit analysis has been carried out of the follow-up of abdomino-perineal amputation of the rectum for cancer in the light of the objectives pursuable with this practice and the diagnostic techniques available today. As regards early diagnosis of a return of the disease, it is necessary to distinguish between long-term recurrence, hepatic or pulmonary for example, in relation to their greater potential capacity for surgical exeresis and local pelviperineal recurrences which are more rarely susceptible to radical exeresis in spite of the introduction of computed tomography and nuclear magnetic resonance in the diagnostic/therapeutic routine. As for diagnosis and management of metachronous polyps as a prevention of metachronous cancer, the importance of periodic trans-stomal pancolonoscopic control of the residual colon in all patients emerges. Finally, in cost/benefit terms, the objective of a psychophysical rehabilitation of the colostomized patient is advantageous with a marked reduction in welfare expenditure for the community.

[Current principles in surgical therapy of rectal cancer]. / Principi attuali della terapia chirurgica del cancro del retto.

The Author critically analyzes the aims of curative surgery for rectal cancer, i.e. radical colonic resection, lymphoadenectomy, conservation of adequate post-surgical functionality of the remaining colon. Nowadays, therapy does not end with the exeresis of the primary cancer as an isolated stage but rather includes adequate follow-up to prevent metachronous cancer by detecting and removing recurrent adenomas. But it also includes early diagnosis of any recurrence of the primary cancer to facilitate adequate treatment.

[Multiple choice questions in educational assessment: proposal of a computerized program]. / Le DSM (domande a scelta multipla) nella verifica dell'apprendimento: proposta di un programma computerizzato.

After a description of the basic criteria for the correct formulation of Multiple Choice Questions (MCQ) for use in the assessment of different levels in the intellectual process (memorising, data interpretation, problem solving) a package of computer programs for the use of MCQ in the assessment of what has been learned in a General Surgery course in the Faculty of Medicine and Surgery are presented. The MCQ is a valuable didactic tool that can well supplement though not replace oral examination for assessment at all stages of a course.