[Upside-down stomach and hiatal hernia].

Hiatal hernias represent a special variant of diaphragmatic hernia in which there is a transdiaphragmatic migration of the stomach through the esophageal hiatus. There are 4 types admitted--sliding (type I), paraesophageal (type II), mixt-combining elements for both previous types (type III) and complex (type IV) and represents at most 5-15% from all hiatal hernias. Upside-down stomach is a special form of organoaxial volvulus of the entire stomach in a sac of mixt hiatal hernia (type III) or complex (type IV).

[Postoperative enteral feeding in digestive anastomosis with proximal oesophageal partner].

This paper aim is to discuss the advantages of enteral postoperative feeding on patients submitted to surgery finalized through an eso-digestive anastomosis; in these cases enteral feeding is often delayed 5-8 days after the surgery, and in case of an anastomotic dehiscence may be even impossible. Also, the paper promotes duodenostomy as an important enteral feeding way, and discusses the indications and contraindications of different enteral nutrition pathways in such cases. There were studied 230 cases, 149 cases submitted to cancer surgery and 81 cases with benign condition surgery followed by an eso-digestive anastomosis, in which the following enteral nutrition pathways was practiced: nasogastric or naso-esojejunal feeding tube (55 cases); Witzel jejunostomy (28 cases); gastrostomy (79 cases); duodenostomy (68 cases).

[Esophago-digestive anastomosis dehiscence].

This paper aim is to discuss the main etiopathogenic aspects responsible for eso-digestive anastomotic leakage, as well as prophylactic and therapeutic measures of this postoperative complication. There were studied 173 consecutive eso-digestive anastomosis: 103 anastomosis performed for malignancy and 70 anastomosis for benign conditions. Surgical operations followed by an eso-digestive anastomosis were: esophageal reconstruction for benign esophageal caustic strictures (n=67); total gastrectomy (n=55); total esophagectomy (n=13); total esophagectomy plus total gastrectomy (one case); eso-gastrectomies (n=34); upper gastric pole resection (n=2); distal esophageal resection (n=1).

[Acute mesenteric ischemia].

Acute mesenteric ischemia is not an isolated clinical entity, but a complex of diseases, including acute mesenteric arterial embolus and thrombus, mesenteric venous thrombus, and nonocclusive mesenteric ischemia. These diseases have common clinical features caused by impaired blood perfusion to the intestine, bacterial translocation, and systemic inflammatory response syndrome. There is substantial evidence that the mortality associated with acute mesenteric ischemia varies according to its trigger cause.

[Sentinel nodes in patients with breast cancer].

The aim of this paper is to debate, on the basis of medical literature review, the importance of detection the sentinel nodes in surgery of breast cancer. The beginning of the paper emphasized the problems of the sentinel nodes definition, and then we discuss the dates related to the history and the importance of the sentinel nodes knowledge that consist in the avoidance of axillary lymph nodes dissection in patients with breast cancer N-. Afterwards, we present the indications for detecting the sentinel nodes and the criterion to exclude from the detection of the sentinel nodes.

[Hemorrhagic intestinal lymphangioma --report of a case].

This paper presents the case of a male patient, 57 years old, admitted to the hospital for upper digestive bleeding revealed by melena stools. The upper digestive endoscopy has not discovered the source of bleeding. Conventional medical therapy, with hemostatics, proton pump blockers and transfusion, failed to stop the bleeding, requiring emergency surgery for stopping the bleeding.

[Duodenal post-bulbar ulcers. Diagnostic and therapeutic problems].

Our study upon 1235 cases of duodenal ulcers (1991 - 2001) revealed a decrease of its morbidity rate of 10 - 12%. However, the incidence of the post-bulbar duodenal ulcer (P.B.

[Cholesterol crystal embolisation in the course of treatment with low-molecular-weight heparins].

Cholesterol crystal embolisation is a rare complication of anticoagulant treatment of ulcerative atheromatosis to the great arteries. The embolisation is susceptible to affect both, the somatic and the visceral territory; clinical diagnosis is difficult, mainly because of the similarity between the embolisation symptoms and those produced by a complication of primary disease. The diagnosis is certain when the pathological examination reveal the presence of cholesterol crystal in arteriolar lumen, surrounded by inflammatory- cellular reaction (foreign-body reaction).

[Gastrointestinal stromal tumor (GIST) with jejunum localisation, unusual source of digestive bleeding. Considerations about two cases].

Gastrointestinal stromal tumors are those gastrointestinal tumors , which expression antigens for CD 117 and CD 34. GIST arise from c - kit gene mutation through inadequate function of KIT enzyme (thyroxine kinase). However, the name is gastrointestinal stromal tumor, their localisation maybe under esophagus, stomach, duodenum, small bowel or colorectal.

[Upper digestive tract bleeding from ulcer with unusual etiology].

Case report of 40 year old female, admitted in emergency because signs and symptoms of upper digestive tract bleeding. Reappearance of bleeding, during haemodynamic compensation and dramatic installation of a haemorrhagic shock determines the surgical intervention for haemostasis. During surgery we discovered a duodenal ulcer with hypertrophic vessels, penetrating the gallbladder, that in its clinical course eroded the cystic artery.

[Abdominal tuberculosis: clinical and therapeutic evaluation].

In this paper we present our experience concerning abdominal tuberculosis. The aim of this study is to evaluate various methods and to establish therapeutic approach to patients with abdominal tuberculosis. There were six patients (3 males and 3 females), aged between 22 and 67 years old, such as: 2 patients developed peritoneal tuberculosis, 3 patients developed intestinal tuberculosis and one patient developed mesenteric lymph node tuberculosis.

[A plea for the conservative treatment of breast cancer].

This article is a plea for the implementation of early-stage breast cancer conservative therapy into as many surgical clinics as possible. The aforementioned statement relies mainly on published papers and data (the protocol included) provided to us by Instituti Clinici di Perfezionamento di Milano experts in breast cancer conservative therapy and to a lesser extent on our not too numerous results (30 cases) obtained over the past 2 years since we applied the Milano protocol on a regular basis. Thus we support the view that the breast-conserving treatment is suitable for clinical stage I or II carcinoma whose tumors are 3 cm or less in greatest diameter, provided axillary lymphadenectomy is associated for prognostic and future management guidance reasons, but not for cure.

[Severe acute pancreatitis. Its management and experience].

The authors examined a group of 91 cases of acute pancreatitis hospitalised and treated between 1992 and 1996, using multiparametric bioclinical scores like Ranson, Imrie, Apache II systems and morphological scores obtained through C.T., they have divided the examined group into patients with A.