Optimal treatment duration of glyceryl trinitrate for chronic anal fissure: results of a prospective randomized multicenter trial.

Background: Chronic anal fissure (CAF) is a painful condition that is unlikely to resolve with conventional conservative management. Previous studies have reported that topical treatment of CAF with glyceryl trinitrate (GTN) reduces pain and promotes healing, but optimal treatment duration is unknown.

Methods: To assess the effect of different treatment durations on CAF, we designed a prospective randomized trial comparing 40 versus 80 days with twice daily topical 0.

[Stapled hemorrhoidectomy: critical observation on state of art].

The authors review pros and cons of stapled hemorrhoidectomy (SH). Postoperative primary lower than after hemorrhoidectomy, but no data are available on the long term recurrences in large prospective series. Severe postoperative complications have been reported and SH seems less effective in patients with 4th degree files.

[Lung surgery in the elderly].

Lung surgery in the elderly, once considered a major risk, to be avoided if possible has become more popular in recent years as a result of many factors. First: lung cancer incidence has increased significantly in every age group but mostly in the elderly. Second: diagnosis at an early stage of the disease is higher in patients over 70 due to more frequent medical control in old subjects.

[Duodeno-gastric reflux in gallbladder stones and after laparotomic cholecystectomy].

Background: Duodeno gastric reflux (DGR) is still a not well-defined condition, even though it has been the subject of different studies for many years.

Methods: The authors examine its relation with gallstones before and after the surgical removal of the gallbladder. After examining various study techniques, they present their experience of DRG.

[Gastroduodenal reflux after laparotomic or laparoscopic cholecystectomy].

Background: The authors analyse gastroduodenal reflux (GDR) in the light of the progress made over the past ten years. The good results achieved using mini-invasive techniques in cholecystectomy prompted the authors to compare laparotomic and laparoscopic cholecystectomy in order to evaluate the influence of both techniques in determining GDR and clinical symptoms.

Methods: Symptoms were evaluated before and after surgery in 30 patients operated using a laparotomic technique and in 30 patients operated using a laparoscopic technique.

[Current diagnosis of gastroesophageal reflux disease: learning experience].

The authors report their study on gastro-esophageal reflux disease, a pathology that has become increasingly common over the past years reflecting both a real increase and the use of new and more sophisticated and reliable diagnostic methods and tests. It can be included in the group of pathologies absorbing the largest proportion of financial resources, even exceeding biliary lithiasic disease according to American studies. The authors start by analysing the symptoms of gastroesophageal reflux disease, drawing a distinction between typical (heartburn, epigastric pain and postprandial regurgitation) and atypical symptoms (laryngotracheal symptoms, bronchopulmonary symptoms and esophageal motor incoordination).

[Ileal occlusion caused by enterolith migrated from Meckel's diverticulum].

The authors present a case report of an intestinal obstruction due to a relatively big coprolite migrated from a large Meckel's diverticulum to the distal Ileum. The patients apparently healthy and a vegetarian, complained on admission of the absence of emission of faeces and gas since four days before with noticeable abdominal distension. In the physical examination he presented intestinal meteorism, a hard abdomen, painful on deep palpation in the median quadrants, especially in the epigastric and mesogastric ones.

[Essential varicocele. Which treatment?].

Purpose of the paper is to sum up the problem of surgery of idiopathic varicocele according to the present possibilities, both surgical and sclerotic. A wide review of the literature underlines a high rate of relapses and persistence of the disease (with a percentage from 10 to and 10%) following the two most used technique: retrograde sclerotic therapy under radioscopic control and surgical retroperitoneal or inguinal ligature of the internal spermatic vein; this technique was preferred by us until 1997. The percentage of failures, high with reference to the benign form of the disease (over 10% in our series of more than 100 patients submitted to clinical and flow-meter examinations) let the authors suggest a combined and simultaneous operation of ligature both internal and external of the spermatic vein at the level of the internal inguinal ring.

[Surgery of large ventral hernias. Personal experience in 1990-1997].

Background: The surgical treatment of large wall defects conventionally defined as an extension over 10 cm is discussed. The difficulty to contain the bowels that have lost law of domicile in the abdominal hollow, constitutes motive for notable increase of the endo-abdominal Pressure with serious consequences in the postoperative course and this leads to the use of prothesis meshes that allow the closing of the abdominal hollow with the Tension-Free technique.

Methods: Personal experience embraces 45 patients, with large wall defects, divided into 21 patients with overumbilical location, 14 with umbilical location, 10 with periumbelical location; a simple suture has been used in 7 cases, the reconstruction of the wall according to Stoppa in 36 cases and the apposition of Goretex net internally and Marlex net externally in 2 cases.

[Surgery of dysphagic diseases. Personal experience (349 surgical interventions)].

The authors report their surgical experience relating to dysphagic diseases of the esophagus (349 cases). In the light of these results, they describe the different surgical techniques used in the various pathologies: 1) Esophageal diverticula: The value of a careful evaluation of subdiverticular spasm is emphasised using preoperative manometry in cervical and epiphrenic diverticula, leading to subdiverticular myotomy when present. 2) esophageal achalasia and intermediate motor disorder: A clear difference must be drawn between these two diseases owing to the different motor behaviour of the esophagus.

[The diagnosis and therapy of dysphagic disorders of the LES].

Primary motor disorders of LES causing dysphagia consist in cardial achalasia and intermedius motor disorder (IMD), the last one different from achalasia because of normal motor pattern of the esophageal body. In this paper diagnostic and therapeutic procedures are examined according to an experience of 94 surgically treated cases (22 rioperations for surgical failures). Cardial dilatation as treatment of choice is recognized only for IMD in which a normal peristaltic behaviour of the esophagus can avoid the high danger of GER.

[Dilatation versus surgery in the treatment of cardial achalasia].

Both surgery and dilatation are useful for the treatment of cardial achalasia. The authors make a wide review of the literature with particular attention to reports comparing results of these procedures. This review evidences that surgery gives better results than dilatations (84.

[Intestinal perforation caused by a chicken bone: apropos of a clinical case].

Ingestion of foreign bodies (FB) seems to be a relatively common occurrence in certain classes of people. The majority of ingested objects reach the stomach end 80% of these pass spontaneously without complications. However nearly 20% of FB that pass from the stomach result in complication distally such to required a surgical operation.

[Prosthetic materials in surgery of esophageal cancer. Personal experience].

Even if the incidence of esophageal carcinoma is low (25% in comparison to rectal cancer) the total mortality of this disease is very high (superior to rectal cancer itself according to Am.Ca.SO.

[Use of an anesthetic cream in the surgical treatment of phimosis].

The authors present their technique of local anaesthesia in the surgical treatment of phimosis using a cream composed of an eutectic mixture of lidocaine and prilocaine (Emla). This cream, unlike injectable local anaesthetics, allows surgical procedures to be performed on the prepuce without pain.

Infectious aneurysm of the interosseous artery at the forearm. Case report.

The case of an infectious aneurysm of the interosseous artery at the right forearm is reported, with presenting symptoms consisting in pain, loss of motor functions and paresthesias. The association of occupational trauma and hematogenous bacterial grafting were the possible etiologic agents. Diagnostic evaluation included ultrasound, Doppler study, CT-scan and arteriography, but the exact origin of the mass from the interosseous artery could be detected only at operation.

[Epidemiology of esophageal cancer].

The Authors examine the epidemiological features of esophageal cancer. This tumor is today the fourth neoplasm of the digestive tract, and represents 2-5% of all tumors.

Subcapsular splenic hematoma due to infectious mononucleosis.

Spontaneous subcapsular splenic hematoma formation without rupture in infectious mononucleosis is a very unusual occurrence. A conservative management is successful in those patients in stable condition. We describe the presentation and the clinical progress of a case in whom a sudden enlargement in hematoma's diameter needed a splenectomy to avoid the risk of blood effusion in the abdominal cavity.

[Dysphagia associated with aorto-cardiac compression on the distal esophagus: a rare event but not exceptional in the elderly].

Among the pathologies responsible for dysphagia in the elderly, the aortic compression on the distal oesophagus awakens a certain clinical interest. Cipho-lordosis, which is often present in aged females, worsens the effects of this compression causing other kinkings on the oesophagus already hypokinetic because of the age (presbyoesophagus). This illness often shows scare symptoms, but sometimes requires a pneumatic dilation to allow normal food assumption of the patient.

[Reappearance of esophageal peristalsis after treatment of achalasia. Reality or artifact?].

The authors discuss the question of the reappearance of esophageal peristalsis following surgical or dilating treatment in patients with a diagnosis of cardiospasm. On the basis of their experience and an extensive review of the literature, the authors affirm that the reappearance of motor activity should not be attributed to a condition of pure achalasia but rather to an intermediate motor disorder with pseudo-achalasic characteristics which are difficult to discriminate.

[Special problems in the surgical treatment of megaesophageal cardial achalasia. A clinical case].

The paper report the case of a patient brought to the Authors' attention suffering from megaesophageal cardial achalasia who had already undergone gastroduodenal resection according to BII. It was considered worthwhile to report this case due to the problems which arose concerning the choice of a thoracic rather than abdominal route owing to the impossibility of associating cardiomyotomy with anti-reflux plastica surgery because of the reduced dimensions of the stomach.

[Prognostic factors in bronchopulmonary neoplasms].

The paper aims to illustrate the current state of knowledge regarding the prognostic factors of lung cancer. The disappointing results obtained using therapeutic modes (an overall 5-year survival rate of 15%), together with the considerable variability of the natural history of lung cancer, should be attributed to a group of prognostic factors, of varying importance, which can be subdivided into three categories: those concerning the characteristics of cancer, those inherent to the patient's conditions and those related to the type of operation. The paper underlines that histotype, TNM staging, the assessment of the nuclear degree and ploidy class play a correct and real prognostic role, and that only surgical treatment, if indicated, can offer a real life expectancy (40% 5-year survival rate in operated patients).

[The use of human fibrin glue in fistulous pathology of the lung].

Currently, bronchopleural fistulas present a decreasing complication rate in thoracic surgery, especially since surgical management of tubercular infections is no longer needed. The introduction of non-reacting suture materials and the technological advances have also lowered the incidence of such complication. Although fistulas tend to be chronic, their treatment is possible.

[Current aspects and controversies in reconstructive surgery after esophagectomy: personal experience].

The authors report their series of 184 esophagectomies performed both for benign (44) and malignant (140) diseases. On the basis of their experience and supported by Literature data, it is believed restoration of digestive continuity offers two main points of discussion: choice of the intestinal tract for the interposition and type of anastomosis to perform. The nature of the lesion and its level seems to play the most important role in the choice.