Autoimmune pancreatitis: a case of difficult diagnosis.

Autoimmune pancreatitis (AIP) is an insidious disease of non-specific symptomatology. To make correct diagnosis three different findings must correlate: radiological imaging, serological markers, and histology. This is not easy, and furthermore an incorrect diagnosis can lead to incorrect management and even patient death.

Upper gastrointestinal massive bleeding successfully treated intra-operatively with a collagen and thrombin-based high-viscosity gel for haemostasis. Case report.

A 57-year-old male patient was admitted in our Department for a non-variceal upper gastrointestinal massive bleeding. In accordance with the clinical guidelines, the patient underwent an early endoscopy (within 24 hours from admission), which showed the source of bleeding in the second portion of the duodenum. An endoscopic haemostatic injection with dilute adrenalin (epinephrine, 1:10.

Gastric adenocarcinoma cutaneous metastasis arising at a previous surgical drain site: a case report.

Introduction: Skin metastasis from internal carcinoma rarely occurs. It has an incidence of 0.7 to 9% and it may be the first sign of an unknown malignancy.

Laparoscopic anterior gastropexy for chronic recurrent gastric volvulus: a case report.

Introduction: Gastric volvulus is an uncommon clinical entity, first described by Berti in 1866. It is a rotation of all or part of the stomach through more than 180 degrees . This rotation can occur on the longitudinal (organo-axial) or transverse (mesentero-axial) axis.

Helicobacter pylori eradication as a surrogate marker for the reduction of duodenal ulcer recurrence.

Objectives: An abundance of data exists documenting the association of H. pylori eradication with the reduction in duodenal ulcer recurrence.

Aim: To evaluate the validity of using H.

US double-blind, controlled trials of omeprazole and amoxycillin for treatment of Helicobacter pylori.

Background: Widely variable Helicobacter pylori eradication rates have been reported with omeprazole/amoxycillin dual therapy. We present the first US double-blind, controlled trials of this dual therapy.

Methods: Three separate studies were performed: Studies 1 and 2 included patients with an active duodenal ulcer and Study 3 included patients with a documented history of duodenal ulcer.

[The role of video-laparoscopy in the management of ovarian swellings].

Methods: Personal experience in videolaparoscopic treatment of 42 ovarian masses during the period September 1991-December 1995 is reported. Seven patients have been operated in emergency, 35 in election. Resection of the masses has been performed by two methods: dissection and electrocoagulation, generally preferred in benign functional cysts; resection by stapler (endo GIA).

Accuracy of CLOtest after Helicobacter pylori therapy.

Background: The accuracy of rapid urease testing after Helicobacter pylori therapy has not been widely studied and might be diminished because of decreased numbers of organisms. We assessed CLOtest results after therapy in two randomized, double-blind trials.

Methods: A total of 233 patients (in two separate studies) with true-positive baseline CLOtests (by histology or culture) received 2 weeks of omeprazole/amoxicillin, omeprazole, or amoxicillin.

Time of Helicobacter pylori eradication assessment following treatment.

Background: The most appropriate time to assess accurately Helicobacter pylori eradication following treatment has been debated, with recommendations ranging from 1 to 3 months. The purpose of this study was to validate the assessment of H. pylori eradication 1 month following treatment.

[Torsion of uterine fibroma associated with incarcerated inguinal hernia in pregnancy. Case report].

The incidence of inguinal hernias in pregnancy is 1:1000 about. Much more frequent are uterine leiomyomas, reported in 0.5-2.

[Varicocele and infertility: clinical framework and therapeutic approach].

A diagnostic-therapeutic protocol which can be used in patients affected with varicocele, in order to obtain a complete clinical study of them and try to improve functional results of therapy, is described. The aims of this protocol are: precise diagnosis of venous refluxes, examination of testicular functionality, detection of possible associated pathologies which can cause infertility, establishment of correct indication to hormonal postoperative therapy. The rapid surgical correction of venous stasis, the treatment of prostatic phlogosis, often concomitant, and, in selected patients, the use of hormonal therapy, can improve functional results in the treatment of this pathology.

[Locoregional complications of stomas. Therapeutic approach].

Principal local complications of ostomies are examined. Etiologic factors and possibilities of treatment are analyzed. These pathologies are often extremely troublesome and their resolution very difficult, unless appropriate therapy is established and, when possible, causal factors removed.

[Functional and esthetic results of surgery of leg varices].

An experience of 1240 patients suffering from varicose veins of the lower limbs and operated from December 1987 to October 1992, is reported. In order to obtain an objective valuation of functional and aesthetic results, a table with subjective symptoms and clinical and instrumental signs was filled in, before the surgical operation. The correction of anatomic and functional defects and the results so obtained were evaluated by filling in another table after the operation and comparing the postoperative to the preoperative situation.

[Systems of cerebral monitoring and protection in extracranial carotid surgery].

The main methods for cerebral monitoring and protection during surgical operations of extracranial carotid are examined, analyzing for everyone advantages and limits. Particularly, the authors discuss benefits and disadvantages of cerebral monitoring using somato-sensorial evoked potentials (EP) associated with the measurement of the stump pressure in patients in which general anaesthesia was performed, comparing this method to the monitoring of patients operated using locoregional anaesthesia. The results obtained allow us to say that EP are a very good method for cerebral monitoring and that, if they are not pathological, also with stump pressure values lower than 40 mmHg, a shunt is not necessary.

[Varicose veins in pregnancy: physiopathology and therapeutic approach].

The Authors examine the endocrinological, mechanical and constitutional factors which are involved in the pathogenesis of varicose veins in pregnancy. Discussing the results of their experience (328 pregnant patients observed, 158 of which affected with various degrees of varicose veins) they suggest a protocol of treatment in the different situations in order to obtain an improvement of the clinical conditions and, if necessary, postpone a surgical operation after delivery, so avoiding useless risks during the pregnancy.

[Giant ovarian dermoid cyst in prepubertal age. Report of a case].

We report a case of a very large (size cm 33 x 41) dermoid cyst in the right ovary in a 11 year old child, causing a complete atrophy of the remaining right ovarian parenchyma and ipsilateral salpinx. Sonography and CT allowed us to diagnose this disease and also showed an associated ureterohydronephrosis. The patient underwent a surgical operation during which a right ovarosalpingectomy was performed.

[Surgical staplers in surgical emergencies. Our experience].

This study describes the use of staplers during surgical treatment performed in emergency from January 1980 to December 1991. For the different, possible operations, some technical notes are examined and results reported. The advantages and risks related to the use of these devices are analysed.

[Surgical alternatives in the treatment of perforated duodenal ulcer].

The therapy of perforated gastroduodenal ulcer is still discussed, especially today that good drugs and new surgical devices are available for the treatment of this disease. The authors try to establish a valid protocol for the diagnosis and the therapy of patients affected with this disease.

[Acute cholecystitis in videolaparoscopy].

The authors describe their experience in 15 cases of acute cholecystitis treated with laparoscopic cholecystectomy in emergency. Only in one patient, affected with an abscess of the upper right abdominal space, a laparotomy was performed. The results were excellent.

Therapeutic strategies in the surgical management of pancreatic neoplasms in the elderly.

The clinical records of all consecutive patients aged 65 and older undergoing surgical treatment for pancreatic neoplasms between January 1980 and January 1992 were reviewed in order to establish a clinical trial based on the morbidity and mortality rates related to the different surgical procedures. In early diagnosed neoplasms, in patients in good general condition, even in the geriatric age a radical surgical procedure is preferred. In other cases, a palliative surgical procedure has to be performed if possible, namely a bilio-digestive anastomosis, associated if necessary with a gastro-enteric anastomosis.

[Role of the second look in ovarian neoplasia].

The indications for the execution of a second look in patients affected with ovarian cancers and the possible benefits of this procedure, related to the stage of the neoplastic disease, are examined. The second look, at first largely used in patients in which had been performed adjuvant chemotherapy with drugs containing platinum and with no evidence of residual disease, has been later strongly criticized and the effective usefulness of this invasive procedure discussed. At the moment, we think that the indications for its execution are still large because with the second look it is also possible to put into the abdomen a catheter which can be used for locoregional chemotherapy and there is now the opportunity to perform this procedure also in video-laparoscopy.

[Surgery vs PTA in sub-inguinal atherosclerosis].

The authors describe their experience in the treatment of arterial occlusive disease of the lower limbs in the femoro-popliteal and tibioperoneal districts, by surgery (proximal or distal femoro-popliteal by-pass or segment by-pass) and Percutaneous Transluminal Angioplasty (PTA), analyzing indications, advantages, limits and complications of the two methods. Immediate and after one and three year results of surgical by-pass and PTA are compared. On the whole, in the patients in which we performed a surgical by-pass, we obtained slightly better results.

The anastomotic aneurysms.

The authors describe their experience of anastomotic aneurysm diagnosis and treatment. They are classed into two groups: slowly growing anastomotic aneurysms, which are the most common; and rapidly growing anastomotic aneurysms, which are more infrequent. A follow-up is proposed in order to detect this involvement early, in election.

[Saphenous vein stripping in an outpatient service. 800 cases].

During the period from January to June 1991, 800 patients with varicose veins of the legs underwent, without hospitalisation, stripping of the saphenous vein, multiple phlebectomies by micro-incisions using the Muller technique and elastic compression. Careful patient selection, thorough pre-operative evaluation and perfect surgical technique made it possible to perform the procedure on an out-patient basis and in addition to obtain a good functional result and a very good esthetic result.

Effects of lovastatin in diabetic patients treated with chlorpropamide.

Patients with non-insulin dependent diabetes mellitus (NIDDM) have a higher risk of atherosclerotic cardiovascular disease than nondiabetic subjects. In seven patients with both hypercholesterolemia and NIDDM controlled by chlorpropamide, lovastatin (20 mg b.i.