[Anal carcinoma].

The authors, want to demonstrate the operation of abdominal perianal rectum amputation, and it is considered absolute, even 80 years, in the treatment of the anal neoplasia, it is superseded by alternative methods represented by protocols radio-chemo-therapeutic associated or less to the surgery treatment. They make then a retrospective valuation since 1963 till our days on 54 patients. In the 6 patients (stadium I-II) treated after 1982 with protocols of freemall, it is was obtained disappearance of the neoplasia about 50% the cases.

[Use of monofilament prosthesis in inguinal hernia treatment: cost-benefit ratio].

Background: The authors aimed to demonstrate the real advantages in terms of cost and patient comfort of inguinal hernia surgery using monofilament prostheses.

Methods: A retrospective survey was carried out on two groups of patients: the first group, consisting of 1032 patients who underwent inguinal hernia surgery under general anesthetic between 1985 and 1995 at the Institute of General Surgery at the University Polyclinic of Messina, included cases of both emergency and elective surgery that did not use monofilament prosthesis. The second group, consisting of 348 patients operated under local anesthesia between 1996 and 1999 at the IV Division of General Surgery at the University Polyclinic of Messina, included cases of both emergency and elective surgery using tension-free techniques and polypropylene mesh.

[Trans-anal resection of low rectal neoplasms].

Background: The rising incidence of colorectal neoplasms, and in particular those localised in the lower rectum is stressed and the therapeutic opportunities offered by the trans-anal resection technique are underlined.

Methods: The indispensable conditions for adopting a surgical approach are pointed out. These are identified as the size of the neoplasm, which should not exceed 4 cm, the fixity, site, the polypoid and non-ulcerated nature of the lesion, and the involvement of not more than 1/4 of the circumference of the bowel.

[Carcinoma of the gastric stump].

After having emphasized that carcinoma of the gastric stump represents a "major" risk in patients undergoing gastric resection, the authors describe the physiopathology of the new anatomical and functional status of the gastroenteric apparatus and underline the probable etiopathogenetic stages attributable to carcinogenesis. They then describe the treatment of this neoplasia with a marked aggressive character and conclude with the affirmation that the surgeon's efforts must be focused on the correct execution of gastroresection and the follow-up of gastro-resected patients in order to allow the early identification of precancerous conditions and therefore the commencement rational oncological prophylaxis.

[Laparoscopic cholecystectomy: the complications].

The authors report their experience of 48 consecutive cases of colecystectomy performed using a videolaparoscopic technique. Laparoscopic surgery was not successful in only two patients in whom it was necessary to resort to laparotomy; bile duct injury occurred in one patient. On the basis of their experience the authors conclude by affirming that this videolaparoscopic technique may be applied to almost all patients requiring cholecystectomy since it offers considerable advantages over traditional techniques.

[Barrett esophagus. The diagnostic and therapeutic aspects].

The authors, after a dissertation on the aetiopathogenesis of "Barrett's oesophagus", dwell on the precancerous nature of this pathology involving the oesophageal-gastric junction. Its frequent association with cancer explains the necessity for an accurate follow-up in these patients: many investigations can be useful, the radiological study of oesophagus and stomach, manometry, pH-metry, but an irrefutable diagnosis can only be achieved through endoscopy, which makes possible a histological examination of the bioptic fragments. The authors also deal with the ideal therapeutic strategy and differentiate the cases in which the pharmacological therapy is more appropriate from those that need a surgical approach.

[Role of suture materials in the treatment of inguinal hernia].

The Authors evaluated the role suture materials have in recurrent groin hernia. According to the Literature and to their experience, it is concluded that suture materials seem not to have a significant influence on relapse.

[Biliary peritonitis caused hy hydatid disease].

After specifying that rupture of a hydatid cyst in the peritoneal cavity is one of the most serious and rarest complications of hepatic hydatidosis, attention is paid to the peritoneal hydatid (o chole-hydatid). The aetiopathogenetic mechanisms and the anatomo-pathological features of this type of lesion are described in brief. Finally, the personally employed diagnostic protocol and therapeutic strategy in the face of this feared complication are reported.

[Malignant melanoma of the skin: current diagnostic and therapeutic approaches].

The Authors claim that the treatment of malignant melanosis of the skin is a problem of undiminished topical interest owing to its highly aggressive characteristics. Risk factors and pre-neoplastic lesions are reviewed, and the signs of malignant transformation are described along with the appropriate treatment. The Authors stress the importance, for therapeutic and prognostic purposes, of accurate clinical staging and macro- and microscopic study of the primary tumour.

[Conservative surgical treatment of acute hemorrhagic necrotizing pancreatitis].

The Authors though in theirs' opinion medical treatment is the primary therapeutical approach to Acute Necrotizing Haemorrhagic Pancreatitis (A.N.H.

[Aminoglutethimide in the treatment of metastasizing breast carcinoma in old age].

After first analyzing the basic pathophysiological aspects and the mechanism of action of aminoglutethimide, the authors report on their experience with the use of this steroid biosynthesis inhibitor in a group of geriatric patients with advanced cancer of the breast. After illustrating the results of their study, the authors conclude by stressing that the use of this drug appears to improve the quality of life of the patients with a significant increase in rates of complete or partial remission of the neoplastic disease.

[Sequential therapy with antiestrogens and progestational drugs in carcinoma of the breast in an advanced stage].

After discussing the mechanism of action of antioestrogens and medroxy-progesterone-acetate, the authors report on their experience with the sequential use of these two hormones in a group of patients with advanced cancer of the breast. After illustrating the results of their study, the authors conclude by stressing that the sequential use of these drugs appears to improve the quality of life of the patients with a significant increase in rates of complete or partial remission of the neoplastic disease.

[Use of tumor markers in monitoring thyroid carcinoma].

The authors report on their experience regarding the use of tumours markers for the pre-operative monitoring and subsequent follow-up of patients suffering from thyroid carcinoma. All patients were subjected to radio-immuno-assay for circulating thyroglobulin, a valuable indicator of residual and metastatic thyroid tissue. The patients suffering from medullary carcinoma of the thyroid and their immediate families were also monitored by periodic thyrocalcitonin assay.

[Clinico-statistical features on the operative risk in old age].

The authors, after reporting the data concerning the increase of the average length of life and the increment of the population in geriatric age, studied the different aspects of the surgical risk. They consider the age, the existence or absence of associated diseases, the situation of the different organs or apparatuses, and the possibility to correct, in preoperative stage, the different functional unbalances remarked. At last, after confirming the conception whereby age for itself does not represent a specific factor of risk, they emphasize the importance of a multidisciplinary cooperation in the assistance to old patients, both during intervention and in the postoperative course.

[Use of the indirect hemoagglutination test in the diagnosis of the hydatid disease].

The authors state their experienle about the use of the maemagglutination reahtion test for the diagnosis of human hydatid disease, and point out this is a sensitive and highly specific technique, and, moreover, its execution is rapid and easy.

[Clinico-statistical features of breast pathology in old age].

The authors, after discussing the incidence and etiopathogenesis of displastic and neoplastic diseases of breast in geriatric age, state their experience in the treatment of such illnesses. They emphasize the necessity for a treatment suitable for aged people, based on the selection of the patients, their preparation and the constant pre- and postoperative monitoring, and, as a conclusion, affirm the necessity for a strict interdisciplinary cooperation, pith the purpose to ecectively treat such pathology, showing a more and more increasing incidence in the population of the most advanced nations.

[Importance and limitations of the immunological monitoring of patients with malignant tumors].

The authors, after considering the incidence of neoplastic diseases is particularly high in subjects suffering from congenital or acquired immunologic lacks, assert the importance to perform an immunologic monitoring in the patients bearing malignant neoplasms, with the purpose to identify and calculate the direrent deficits of the sheltering organism. Then, they state the method adopted for the study of the cellulo-mediate immunity (in vivo and in vitro) and the humoral one. At last, on the basis of the results they obtained, the Authors, as a conclusion, affirm there is always in neoplastic patients a certain degree of depression of tumour immunity (especially if cellulo-mediate), and it can be put in relation to the evolutive stage of neoplasm.

[Principles of rehabilitation of colostomy patients].

The authors, after pointing out the number of enterostomized patients in the last years was more and more increasing, study all the repercussions of metabolic, functional and psychologic nature which are arising in the patients subjected to ultimate colostomy. Then, they describe the principles of a correct rehabilitative program for such patients, consisting in performing a correct colostimy and rigidly following hygienicodietetic rules. At last the authors, as a conclusion, affirm the rehabilitation, through the creation of proper centers with specialized staff, should also aim at the resolution of the remarkable psychologic problems affecting such patients, so as to have them reinserted in the social context they are coming from.

[Colo-rectal precancerous conditions: anatomo-pathologic and clinical aspects].

The authors, after emphasizing the value presently ascribed to the conception of "epithelial displasia" as initial histologic and cytologic alteration, common to all groups of patients with high risk of development of colorectal cancer, review the mani precancer lesions of large intestine. As a conclusion, they affirm the main target one presently aims at for the screening in groups with high risk is to precociously identify the stage of transformation of epithelial displasia into carcinoma, so as to be able to set up a timely treatment.

[Use of cytologic examination based on needle aspiration biopsy in the diagnosis of breast pathology].

The authors point out the cytologic test on needle-aspiration report is a method phich, although complementary to clinical examination and mammography, results to be extremely valid and useful for diagnostical purposes and a correct therapeutical programming; they describe the set of instruments and technique they adopted, and point out its easy execution and complete absence of risks. Then, they illustrate the cases they studied, including 86 patient women with both benign and malignant breast pathology, in whom an aspiration biopsy was performed. On the basis of the results obtained, they, as a conclusion, assert the cytologic test with needle-aspiration, although burdened by a fair quantity of false negatives, deserves, for its quick and simple execution, to be included in the breast diagnostical routine, yet without replacing the classic interoperative biopsy for doubtful cases.