[The quality of life of the elderly after a surgical intervention. II. Gastric carcinoma].

Having reviewed the literature on this topic, the authors examined the "quality of life" of elderly patients undergoing surgery for gastric carcinoma over the past 5 years. From the results obtained it was seen that the most frequent operation was total gastrectomy (51.1%), followed by gastric resection (48.

[The quality of life of the elderly patient after a surgical intervention. I. Interventions on the colon].

Following a brief review of the literature on this topic, the paper analyses a series of geriatric undergoing surgery for cancer of the large intestine and controlled during follow-up over the past years. From the results obtained, the authors assessed the quality of life of these patients according to Masera and Esposito's classification, as a state of well-being, intermediate or illness: it was found that 78.7% were in a state of well-being, 10.

[Thyroid pathology in the aged].

Following a review of the literature on this topic, the authors examine all patients with thyroid pathologies who were admitted to the 1st Institute of Surgical Pathology of the University of Pavia between 1-1-1974 and 31-12-1990. Only patients aged over 65 were included in the study and were subdivided into two groups, namely those aged between 65-74 (3rd age) and those over 75 (4th age). Particular attention was focused on the type of pathology (benign or malignant), other pathologies associated to the basic pathology, the type of operation performed and, in the case of malignant diseases, the histological type of tumour and any metastasis.

[Intestinal occlusions in the elderly patient].

After reviewing the literature on this topic, the authors examine all patients admitted to the Institute of Surgical Pathology in Pavia with a diagnosis of intestinal occlusion from 1-1-1974 to 31-12-1990. Of these, only those aged over 65 were included in the study and were in turn subdivided into 3rd and 4th age groups. The etiopathogenesis of this disorder is also discussed, stressing that it may be non-neoplastic (Group I) or neoplastic (Group II).

[Acute disorders of the biliary tract in geriatric patients].

Acute pathologies of the biliary tract in geriatric patients were examined in this study taking into account the major causes, treatment used and results obtained. All patients aged over 65 who had been hospitalised during the past 17 years for acute pathologies of the biliary tract (564 cases, equivalent to 34.2% of all in-patients suffering from acute biliary pathologies) were included in the study.

[Hiatal hernia in old age].

Following a review of the literature on the topic, the Authors examined all patients admitted to the Institute of Surgical Pathology 1st at the University of Pavia between 1-1-1974 and 31-12-1988 for hiatus hernia, paying special attention to those aged over 65. From an analysis of the results, it was possible to evaluate the influence of collateral pathologies and age-dependent biological changes on the basic disease and the outcome of the operation in elderly patients. In conclusion, this pathology, although not strictly confined to old age, affects a large number of elderly patients, particularly females.

[Hernias of the abdominal wall in old age].

Following a review of the literature on the topic, the authors examined all patients admitted to the Institute of Surgical Pathology 1st at the University of Pavia between 1-1-1974 and 31-12-1988 affected by hernias of the abdominal wall or surgical laparoceles, paying special attention to those patients aged over 65. Attention was focused on concomitant diseases, the acuteness of the basic pathology and possible recurrence. From the results obtained it was concluded that the associated pathology and the acute state of the basic diseases condition the successful outcome of the operation more than age itself.

[A diagnostic protocol for gastric cancer in old age].

After examining the various diagnostic methods used for gastric cancer, the paper analyses all geriatric patients affected by this disease and hospitalised in the Institute of Pathological Surgery at the University of Pavia between 1/1/1974 and 31/12/1986. The results obtained confirmed that: the subjective symptoms of the elderly patient affected by gastric cancer differ in a large number of cases from those in adults; in some cases, in fact, the disease is silent for long periods of time, whereas it is only slight in others; tests performed revealed neoplasia and possible metastases. In conclusion, although the symptomatology in elderly patients is not clear, some symptoms (weight loss, anemia, etc.

[Acute abdomen in the elderly].

After a review of the literature on the subject, all IIIrd and IVth age patients admitted for acute abdomen to the Department of Surgical Pathology I of the University of Pavia between 1-1-1974 and 31-12-1988 were studied. The various pathologies encountered in acute abdomen are considered on the basis of the results obtained, stress being laid on the clinical and diagnostic problems observed in these patients in relation to those of adult age. It is concluded that the study method used in the elderly gave good results with a mortality rate lower than that encountered in other studies on the subject.

[Cancer of the esophagus in the elderly].

After a review of the literature a study was conducted into oesophageal cancers among elderly patients in Pavia University's Institute of Surgical Pathology in 1974-1985. The results led to the following conclusions: this disease occurs most often among the elderly especially those in their sixties; symptoms (dysphagia, weight loss, regurgitation with epigastric and retrosternal pain are initially unclear which makes early diagnosis difficult; most cases require surgery. It is concluded that the appropriate tests should be performed at the first warning signs and that, once the condition is diagnosed, the elderly patient should be prepared for surgery which should be as radical as possible.

[Gastric carcinoma in the aged].

After examining the literature on the subject, all patients aged over 60 and admitted to the Surgical Pathology Department of Pavia University from 1-1-1974 to 31-12-1985, suffering from gastric carcinoma have been considered. From the results obtained it is concluded that stomach cancer is a disease that preferentially affects the IIIrd age, usually occurring with atypical symptomatology that leads the patient to underestimate the seriousness of the disease, and impeding early diagnosis that would be effective for therapeutic purposes. It is therefore essential for the necessary examination to be carried out at the first warning symptoms.

[Non-neoplastic pathology of the pancreas in the elderly].

After examining the literature on the subject, all patients of the IIIrd age suffering from non-neoplastic pathology of the pancreas are considered. The results show that this pathology contains more acute pancreatitis and fewer chronic pancreatitis (at times a consequence of the acute) cases. Pancreatic cyst was also noted.

[Peptic ulcer in the elderly].

The Authors, after having reviewed all the literature on this topic, have studied all patients over 60 which were admitted with a diagnosis of peptic ulcer disease at the Institute of Surgical Pathology of the University of Pavia from January 1, 1974 until December 31, 1985. They noted, from their results, that this disease shows a predilection for adults, but is also frequently found in the elderly. In fact, in the latter, during this period of life, the complications which are most frequently observed (especially gastric) are hemorrhage and perforation; according to the Authors the former is due to arteriosclerosis which hinders vascular contraction, while the latter to a reduction of blood flow due to endarteritis, which causes necrosis of the ulcer's base, creating therefore a "locus minoris resistentiae".

[A case of lipoma of the small intestine].

A case of small bowel lipoma with few evident symptoms is reported. Radiological diagnosis was confirmed at surgery. The comparative rarity of this type of benign intestinal neoformation is pointed out.

[A rare clinical manifestation of intestinal carcinoid conditioning mesenteric vascular insufficiency (author's transl)].

The Authors after having paid considerable attention on the contemporary existence of numerous carcinoid tumours of the intestine and of other abdominal organs, as well as on the frequent multicentricity exhibited by the very same at the level of the last tract of the ileum, explain this by considering the recent research performed on the APUD cells and on the cells of the diffuse endocrine system (DES) of the intestine. They present a carcinoid case, where it is understood that the product of secretion of the same, still not completely identified in its structure and mode of action, produces an arterial vascular alteration even at considerable distance from the tumour, hence bringing about an intestinal ischemic symptomatology which they hypothesize is the case for all the cells of the intestinal diffuse endocrine system, a type of self-regulatory feed-back hormonal system.