[New abdominal wall reconstruction technique with a plastic-rehabilitative intent (back pain improvement)].

Many abdominal wall reconstruction techniques have generally failed to pay attention to a number of anatomical considerations concerning the continuity of the thoraco-lumboabdominal fascia that envelops the dorsal and ventral muscles. We have introduced a new surgical technique (round mesh) developed to improve the abdominal wall weakness or pathology (hernia, laparocele) with the aim of restoring the muscular synergy between the anterior and posterior trunk compartments, thus improving sacroiliac stability, posture, and standing effort endurance. One hundred patients of both sexes were enrolled in this investigation.

[Sequential endoscopic and laparoscopic and one-step treatment of cholecysto-choledochal calculosis. New perspectives for the surgeon].

The Authors describe 132 cases of sequential treatment of cholecysto-choledochal lithiasis by videolaparoscopic cholecystectomy after endoscopic Common Bile Duct (CBD) clearance and 3 endoscopic sphincterectomy and CBD stone extraction during laparoscopic cholecystectomy. No complications occurred during the procedure. Even though the second one is not a routine method undoubtedly represents the best solution when the surgeon meets an unexpected choledocholithiasis.

[Resection surgery in malignant neoplasms of the exocrine pancreas: our experience, 1987-1994].

From 1987 to 1994, 24 patients underwent resection for pancreatic cancer; they represented 24% of all patients observed in that period. Surgical procedures were a pancreatoduodenectomy (PD) in 20 cases, a distal pancreatectomy in 4 cases, a palliative intervention in 61 cases, an exploratory laparotomy in 13 cases and a video laparoscopy in 2 cases. Adjuvant treatments were given in addition to resection in 20 patients.

Surgical strategy in primary retroperitoneal tumours.

Sixty-nine patients with primary retroperitoneal tumours (17 benign, 52 malignant including 4 malignant tumours of uncertain origin) were reviewed to determine the best form of surgical strategy. Total resection was performed in 88 per cent of benign cases and in 65 per cent of malignant cases. In 62 per cent of the total resections for malignant tumours, en bloc excision included adjacent organs or anatomical structures.

[Reinterpretation of the hepatic abscess, a new dimension in abdominal digestive surgery].

Pyogenic abscess of the liver is viewed here as a surgical disease, which appears to raise doubts as to its actual identity. Though located in a given abdominal organ, such abscesses find it hard to recognize this as their exclusive setting and attempt to shrug off these traditional confines. They aspire, rightly or wrongly perhaps, to symbolize a splanchnic context, though, in actual fact, the latter--at least for contingent, doctrinal reasons--is confined to the bipolar liver-bowel system.

[Biomechanico-clinical interpretation of firearm wounds. General problems (III). A propedeutic ABC on terminal ballistics].

The surgeon should have a comprehensive knowledge of firearms as thermochemico-ballistic machines in order to come to grips in an adequate manner with the wounds they inflict on the human body. The traces left on the body to all intents and purposes embrace a cultural "cul de sac" which risks being defrauded of most of its content by a lack of those propedeutics elements which painstaking reflection is capable of affording us. Only the interpretation of each individual ballistic phase, both as a complete phenomenon in itself and as a component in a single articulated complex, can offer such elements: credit is due at least for a wholehearted commitment in this direction, while never losing sight at any time of the clinical perspective of such wounds.

Emergency surgical management of retrosternal goiter causing tracheal compression.

Acute tracheal compression caused by mediastinal masses is a rare event. Dyspnea is the most frequent symptom and the treatment of choice is intubation followed by surgical operation. Four cases of acute tracheal compression due to retrosternal goiter are described.

[Biomechanico-clinical study of gunshot wounds (general problems--II)].

Whenever the surgeon finds himself face to face with a wound (probably this is the only opportunity for a meeting between physician and pathology which seems to be able to leave the "illness" on one side, almost forgotten, as it were), even when immersed in routine, he can hardly help making a number of considerations of a general nature, to which the sentence above in brackets is not entirely extraneous. In practice, we cannot help asking ourselves an apparently simple, almost banal, question: what exactly is trauma? This triggers off a whole series of secondary queries, such as, for instance, what the relationship is between trauma and classical pathology? In the first place, it should be pointed out that "traumatic" pathology is undoubtedly the only instance of pathology in which, as a rule, at least at the outset, one can justifiably talk about the "isolated" role of what can certainly be regarded as an out-of-body factor. If, then, we consider the specifically morphological and pathophysiological aspects of the period subsequent to the traumatic insult, we find ourselves in an even more embarrassing position: we are faced with irreparably devastated organ and body structures, or with a situation which is already on the way to convalescence.

[Biomechanical and clinical study of gunshot wounds (general problems). I].

Above and beyond their effective epidemiological incidence, which is perhaps somewhat greater than is commonly imagined even outside the war context, gunshot wounds constitute a unique cultural opportunity for the traumatologist and for surgeons in general. The actual morphological and clinical features of such wounds, which bear precise, localized witness to, and reflect in a virtually mathematical manner, a programmed, and thus readily quantifiable, dimension of kinetic energy (rich in experimental implications), stand out against the backcloth of an extremely extensive involvement of the body in which, amongst other things, the intervention of a whole host of mediators may be seen to play a decisive role. Lastly, it should not be forgotten that it is precisely in field hospitals or their equivalents that surgery has found a precious opportunity to escape the environmental or "cultural" conditioning of the moment and play a leading role not only in terms of technological solutions but also in terms of reflection on the main leitmotive of pathophysiology, from shock to ARDS.

[Treatment of perineal breach in radical surgery of the rectum: notes on the surgical technic].

The Authors review the various techniques used in closing and draining the pelvic basin after total resection of the rectum due to neoplastic and/or inflammatory disease. The examine their experience with 248 cases of total resection of the rectum and propose closure of the perineal breach as the first step in through closure of the pelvic peritoneum.

[Hypothesis of mediation pathology in surgery (4)].

The mediation pathology concept takes account to a large extent, though by no means exhaustively, of that horizontal language between peripheral cells, based on locally produced hormone-like substances and aimed at covering extremely short distances. This brings us well and truly into the paracrine domain of intercellular communication, whereby an exchange of messages takes place between adjacent cells via the interstitial spaces. Alongside this short-range communication network, there also exists a long-range network, involving above all the blood stream both as an intermediary and as mediation terrain.

[Hypothesis of the pathology of mediation in surgery (3)].

There are three aspects to mediation: the first of these is purely physiological, or rather is concerned with performance of service functions such as ovulation, sexual activity, sleep, etc.; the second, strictly speaking, may be defined as pathophysiological, as its starting point is considered to be an aggressive event, even when a routine occurrence (in the stomach, for instance, aggression is a constant feature, even when of only slight intensity, as produced by the physical characteristics of the enormous quantities of food transiting the stomach and by particular environmental conditions; the third aspect is distinctly pathological, in that it constitutes the basis for the aggravation of a pathological situation already in progress, sometimes according to the logic of plain addition, but more often according to a more catastrophic process of multiplication (less frequently it takes the form of induction of a prevalent or independent disease condition). This break-down of mediation into distinct types, though necessary from the point of view of academic classification, proves extremely difficult to apply in practice.

[Hypothesis of the pathology of mediation in surgery (2)].

There are clearly numerous examples of mediation pathology in surgery. They go far beyond what may be defined as severe forms, in which the entire body is involved in the precipitating disease process and in which the mediation appears more easily recognizable, in that it evokes a resonance which wipes out all specificity and becomes the true protagonist of the critical situation. Forms which can be traced to a well defined pathogenesis, and others to a more debatable pathogenesis, afford great scope for mediation.

[Hypothesis of the pathology of mediation in surgery (1)].

The mediation pathology hypothesis is not new. As early as 1955, Laborit hinted at something of the kind in his phrase "N'est malade que l'organisme qui le vent bien". Today, however, in the light of free oxygen radicals, which together with other mediators may possibly represent only the tip of an enormous iceberg, we may venture a number of admittedly cautious theoretical considerations.

[Biology and surgery: a bound pair or merely a couple of disciplines? (3)].

In the following reports two main problems are questioned by the Authors. To start with, a sharp distinction is made between the so-called "theoretical physiology" and the "actual" use of the physiological functions adopted by the single man and woman. The second question is concerned with the biological consistency of the different surgical approaches.

[Biology and surgery: a bound pair or merely a couple of disciplines? (2)].

Carcinoma of the breast, to our way of thinking, appears to be capable of providing what is virtually a master key to the interpretation of surgical oncological pathology. In the wake of the acquisitions made in this field--not always as a result of the initiative of the surgeon - a definite process of revision of the age-old concept of surgical radicality is underway, albeit in a somewhat surreptitious manner. Oncological surgery is clearly passing through a difficult phase, almost a crisis of identity, and, in the authors' opinion, may to some extent come back into its own, albeit only after a great deal of painstaking effort, by adopting a "biological" approach with greater respect for the morpho-functional integrity of the patient, who must no longer be viewed as merely the victim of disease, but rather as the prime mover of the disease itself.

[Nd-YAG laser disobstruction of esophageal endoprostheses occluded by neoplastic development in the palliative treatment of esophageal cancer].

Since August 1984 18 patients suffering from inoperable esophageal cancer have been treated by Nd. Yag Laser therapy under endoscopic control in the Verona University Institute of Clinical Surgery. Three patients, all males ranging in age from 68 to 80 years, had endo-esophageal prostheses which were occluded as a result of the neoplasms.

Leiomyomata of the oesophagus: report of four surgically-treated cases.

Four patients with leiomyoma of the upper or middle third of the oesophagus treated by surgical excision are reported. All operations were performed through a right thoracotomy with simple enucleation of the lesion. Two patients were asymptomatic.

[Biology and surgery: a team of disciplines or merely two disciplines? (1)].

The present work questions itself about the "ideal" relation between biology and surgery, the necessarily bloody arm of medicine, namely, of that science man has been preparing, parallel with his culture, to enrich the wideness of the defensive slope of his biologic curriculum. Does the instructiveness, we were accustomed to by the university route, give a satisfactory answer? Does not the preparation of a biologic basis seem nearly the arrangement of a compulsory stage, from which to subsequently deviate also in name of technology and by means of same? Surgery can draw advantages or disadvantages from such a way? In the oncologic field it represented the introduction to the anatomical and mechanistic principles which inspired Halsted's thought about radical intervention. At the same time, a sort of dam against the biologic questions was built.

[The other face of oxygen (2)].

The authors, in this second part of "The other face of Oxygen", pay attention no more to O2, the "untrustworthy" protagonist of oxidation, but to the opposite side, namely the "physiologic" antioxidative protections. Such antioxidative protections, which were being prepared and improved in cell, in interstices and in organic liquids, during millions of pears, perhaps represent the "most true" witness of the always "traumatic" cohabitation between organisms, although eukaryote, and oxygen. This, after all, in spite of the evolutive push, remained an element "foreign" to life, although, paradoxically, first protagonist of it.

[Pregnancy and enterostomy].

The authors describe the difficulties and possible complications of pregnancy in colonostomized women. In the neoplastic forms, generally appearing in advanced age, the knowledge of the basic disease discourages any possible attempt at pregnancy. In the chronic inflammatory diseases (ulcerous rectocolitis and Crohn's disease), typical of young age, pregnancy, if opportunely followed and programmed, can get an absolutely favourable course.

[Surgical treatment of pulmonary metastases of colorectal cancer].

The pulmonary metastatic locations due to colorectal cancer were considered, in not remote times, not worthy of surgical treatment. At present, according to our experience and some other Authors' one, the surgical removal of metachronal pulmonary metastases should be considered suitable to improve the period of life free from symptoms and the survival. The surgical treatment has improved the survival in the single or double pulmonary locations, whereas the monolaterality of multiple pulmonary lesions, in respect of the bilaterality, was not significantly bettered the prognosis (Hiroshi Takita, Francis Edgerton).