[Identification of an objective reference parameter for the reconstruction of a large incisional hernia following physiological principles]. / Identificazione di un parametro obiettivo di riferimento per la ricostruzione secondo criteri fisiologici del grande laparocele.

Repairing a parietal defect of a large incisional hernia should not be limited to the closure of the breach by means of the modern biocompatible prosthetic sheets, but must also be able to restore a correct intra abdominal pressure, otherwise the derangement from the normal respiratory dynamics and the circulatory stasis in the abdominal veins and in those of the lower limbs remain unaltered. Over-correcting the parietal abdominal tension on the contrary can cause a dangerous compartmental syndrome. The attempts of an intraoperative measurement of the correct intra abdominal pressure restoration has been generally hampered from the condition of curarization of the patient during the operation. Using the automatic mechanical ventilator fixed at volume and not at pressure priority, as usual, can offer the possibility to calibrate, following objective parameters, the propriety of the surgical repair still during the final phases of the reparative operation. The simplicity and ingenuity of the here proposed method and the normal availability in every operative theatre of the necessary means for this measurements described, requires attention among the surgeons and a large diffusions of its simple use.

[Complicated colon cancer: the experience at an Operative Surgery Unit]. / Il cancro del colon complicato: esperienza di una Unità Operativa Chirurgica.

INTRODUCTION: Prognosis of colon cancer is worse if complications are present at the moment of diagnosis. The high mortality rate with surgery in emergency in such cases needs a careful reflection about the best suitable operation to perform. MATERIALS AND METHODS: 107 consecutive patients observed along a 9 year-period for colon-rectal cancer are retrospectively analysed. 27 of them were complicated at the presentation for obstruction (19 patients), colon perforation (6 patients) or rectal hemorrhage (2 patients). In the whole experience 5 patients underwent primary resection of the tumour and direct anastomosis; 5 only a decompressive colostomy; 6 were primarily resected and anastomized under the protection of a cecostomy; 6 other patients underwent a Hartmann procedure; 2 were treated with only an intestinal by-pass; 1 was treated with Miles procedure; 1 with an anterior rectal section and the last one was resected-anastomosed in two steps, after a temporary decompressive colostomy. RESULTS: Intraoperative mortality was of 11.1% (3 patients) and morbidity 18.5% (5 patients). General 5 years survival was 62.1% among the cases complicated at presentation. The recurrence rate was 8.45%. Both these figures are below a statistical significance (p = 0.57). CONCLUSIONS: The necessity to treat in emergency the colon cancers reduces the possibility to adopt the best rules of modern programmed oncologic surgery giving up the chemotherapy w/o neoadjuvant radiotherapy with which a preoperative down-staging of the tumour were possible. For these reasons in emergency not only mortality and morbidity are higher than in case of elective surgery, but also metastasization and recurrence are worse because of a more difficult radicality in surgery.

[Digestive system neoplasms originating from the autonomic nervous system. Diagnostic, therapeutic and prognostic issues]. / Tumori del canale digerente derivati dal sistema nervoso autonomo. Problematiche diagnostiche terapeutiche e prognostiche.

The gastrointestinal autonomic nerve tumors (GAN tumor) are uncommon stromal tumors of the intestinal tract and retroperitoneum. The distinction of GAN tumors from other gastrointestinal stromal tumors is based on electron microscopic findings. However further study of additional cases is needed to fully characterize both their gross and microscopic features and to further characterize the natural history of such tumors. In the present study we report two cases of GAN tumor that arose from the stomach and small intestinal with different prognostic evolution in two patients of 73 and 65 years old. They were both treated by surgery, but only one case was successful. In addition patient 1 aged 73, died 11 months after surgical treatment with liver metastases on CT. scan. Patient 2, is clinically well five years after surgical treatment.