[Adjuvant radio-chemotherapy in cancer of the rectum treated with radical surgery and with high risk of recurrence. Preliminary results of a prospective study].

Unlabelled: INTRODUCTION MATERIAL AND METHODS: From January, 1990, to December, 1995, 138 consecutive patients with radically resected stage II and III rectal and rectosigmoid cancers were treated with adjuvant radiochemotherapy. Eighty-one patients with 24 months' follow-up were assessable. Low anterior resection (LAR) was performed in 64 (79%) patients and abdominoperineal resection (APR) in 17 (21%).

[Ruggero Oddi and the discovery of the common bile duct sphincter].

The author gives some information about life in Perugia in the years 1883-87, when Ruggero Oddi was a medical student at the "Libera Università" of Perugia. Moreover the author gives notes about the Hospital and the University in those years with special reference to the situation of the Department of Physiology where the discovery of the sphincter of the common bile duct took place. Then, the author reports the most peculiar facts of Ruggero Oddi's life in a chronological way and finally, he deals with the history of Oddi's discovery of the sphincter of the common bile duct, when he was a student in the fourth year at the "Facoltà di Medicina e Chirurgia" in Perugia.

[Pre- and postoperative radiotherapy of operable carcinoma of the rectum].

This was a non-randomized prospective study on the "sandwich" radiosurgical treatment of resectable rectal and rectosigmoid carcinomas. From December 1984 to December 1989, 100 patients were treated 86 of them are now evaluable. Mean follow-up was 38 months (range: 9-69).

[Perforated duodenal ulcer. Personal experience].

Reference is made to personal experience in affirming that the treatment of perforated duodenal ulcer should set out to resolve both the perforation and the ulcer at the same time. Troncular vagotomy combined with pyroloplasty is put forward as an effective way of achieving this, and long-term results on a par with those obtained electively are described.

[Repair of inguinocrural hernias with subperitoneal prostheses].

An original technique for the repair of recurrent inguinocrural hernia destruction of the inguinal ligament is presented. A prosthetic lamina is applied in the subperitoneal space against the deep fascia of the inguinocrural musculature. It is held in place by intra-abdominal pressure and ordinary stitches.

[Current trends in the therapy of bleeding duodenal ulcer].

A distinction is drawn between two main groups of patients with continuous and massive haemorrhage respectively in bleeding duodenal ulcer, and the criteria upon which this distinction is based are described. The two main types of surgery proposed for the treatment of this complication of duodenal ulcer (vagotomy and gastric resection) are examined. The conclusion is drawn that vagotomy (truncular with drainage, or superselective with or without drainage) is to be preferred to gastric resection in the light of personal experience, and with particular reference to operative mortality and the recurrence of haemorrhage and ulcers.

[Internal hernia through an orifice of the broad ligament of the uterus].

A case of hernia-induced occlusion of the small intestine through an orifice of the broad ligament of the uterus is reported. After reviewing the literature, the pathogenetic aspects are considered, with reference to the congenital or acquired origin of the defect. Clinically, the most significant factors for diagnosis are the patient's multipara condition, previous obstetrico-gynaecological operations, signs of mechanical type intestinal occlusion and palpation of a parauterine mass.

[Rupture of the pericardium caused by closed thoracic injuries].

Rupture of the pericardium due to closed thoracic trauma is a very rare event which is hard to diagnose. It occurs in the form of two main clinical pictures: 1) severe chest trauma with massive haematoma requiring surgery and which permits diagnosis, and 2) precordial pain and clinical signs of pericardiac origin. Surgery is essential in view of the risk of lethal complications from cardia luxation.

[The axillo-axillary bypass].

Personal experience with two cases of symptomatic occlusion of the subclavian artery treated with axillo-axillary by-pass is reported. The operating technique, in which the second portion of the axillary artery and a dacron blood conductor are employed, is described and the various transthoracic and extrathoracic operations that have been proposed are reviewed along with the advantages and disadvantages of each. It is concluded that axillo-axillary by-pass is a simple solution for a complex haemodynamic, clinical and therapeutic problem.

[Spontaneous rupture of the subdiaphragmatic esophagus].

Personal experience with an extremely rare clinical picture, spontaneous rupture of the subdiaphragmatic oesophagus is reported. In the case in question, the laceration occurred in a free peritoneum, unlike what occurred in the first reported case, that of Strauch and Lynch in 1965, where the lesion was retroperitoneal. On the basis of this experience, certain pathogenetic and diagnostic factors are discussed, but most attention is paid to the surgical treatment of this exceptional lesion.

[Experience in the treatment of bleeding esophageal varices].

Personal experience with respect to the diagnosis and treatment of bleeding oesophageal varices in patients with cirrhosis is described. Diagnosis is directed both to the establishment of the site of bleeding and the disease responsible and to the evaluation of risk in view of the possibliity of portal decompression. Treatment is aimed at stopping bleeding and at lowering this risk so that as many patients as possible can be operated with an acceptable degree of surgical risk.

[Endoscopic control of patients subjected to vagotomy and drainage for duodenal ulcer. Personal experience].

The usefulness of endoscopic examination of patients subjected to vagotomy and drainage for duodenal ulcer is stressed, since it permits recurrences and ineffective treatment to be detected, along with the control of other parameters, such as the appearance of the mucosa, the performance of gastric drainage, the features of peristalsis and gastric tone, and the performance of the cardial sphincter. Data from a series of 43 endoscopies performed after 192 vagotomy and drainage operations carried out between 4-1973 and 5-1976 are presented.

[Late radiological aspects after vagotomy and gastric drainage].

Personal experience in 87 cases of vagotomy and gastric drainage is presented. Pyloroplasty according to Heinecke-Mikulicz was performed in 50 cases and drainage according to Judd in 9. Three groups were distinguished on the basis of the presence of a "gastroduodenal canal" and "pseudodiverticula".

[Embolisms of the upper extremities].

6 cases of upper extremity embolism observed over the past three years are reported. Fogarty embolectomy was carried out in all patients, favourable revascularization results being obtained in 5. Forearm amputations was necessary in 1 case owing to the presence of ischaemic lesions that were already advanced at admittance, further proof that results depend above all on the vitality of the extremity rather than on the duration of the arterial occlusion.

[Hemobilia caused by rupture of a false aneurysm of the left branch of the hepatic artery].

The pathogenetic and diagnostic features of false aneurysm of the left branch of the hepatic artery are discussed in the light of a personal case. It is felt that ligation of the vessel constitutes the treatment of choice, whereas hepatic resection should be undertaken in the case of very peripheral aneurysms.

[Suture threads in the pathology of the operated stomach].

Endoscopy following operations on the stomach showed inflammation or ulceration attributable to no-absorbable suture threads in a number of cases. The pathogenetic and clinical features of this picture are described. Complete remission was obtained after endoscopic removal of the foreign body.

[Intrahepatic bilio-jejunal anastomosis].

Personal experience in intrahepatic biliojejunal anastomosis is described, along with the operative tactics and techniques now employed. Stress is laid on the importance of peroperative cholangiography in the division of patients into two groups with respect to drainage of intrahepatic bile, depending on whether or not a wide pathway exists between the two halves of the liver. The strategy to be used for each group is explained.

[Stenosis of the left angle of the colon caused by chronic pancreatitis].

Case of stenosis of the left flexure of the colon caused by pancreatitis is reported. The relevant literature is surveyed and an account is given of the pathogenesis of this forms, and the examinations required in its diagnosis, particularly coloscopy. A preference is expressed for an internal colic derivation (colon-colon anastomosis) rather than resection, on account of the smaller degree of risk involved.

[Post-traumatic stenosis of the small intestine].

A case of intestinal stenosis in a subject who had received an abdominal injury four weeks earlier is presented. The relevant literature is surveyed and the pathogenesis of this unusual condition is examined. Post-traumatic stenosis of the small intestine is seen as an example of ischaemic stenosis.