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Background: In gastric cancer surgery, to search for a technique to remove the entire posterior mesogastric region using a standardised operation using well defined methods and anatomic-embryological planes., Methods: A concise description of the embryological evolution of the posterior mesogastrium allow the formation of the mesogastric fascia (and the supramesocolic fascia of the omentum--which is a continuation) to be documented. It is also clear that the mesogastric fascia is the embryological--anatomical equivalent of Treitz's fascia, pancreatic retro-head, and Toldt's retrocolic fascia, of which it is a structural continuation. Like Treitz's and Toldt's fascias, the mesogastric fascia also represents the surgical plane for the detachment of the region in question and allows maximum safety and radicality. By carrying out primary ligature of the arteries at the origin and the veins at the outlet, the entire posterior mesogastric region, with the relative lymph node stations, can be removed en bloc with maximum radicality and safety, and also in line with the principle of "no touch isolation". We used this technique to operate 61 cases, 17% of all cases of gastric carcinomas between 1973 and 1994., Results: Mesogastrectomy was required in 87% of cases with carcinoma in a high localisation or widespread nature of the linitis plastica type. Only 23 cases (37%) were at pTNM II and III A stages. Thirty-eight cases (63%) were at stages III B and IV. In non-selected cases and those with severe associated pathologies and undergoing emergency surgery, and those cases that were extended beyond mesogastrectomy, morbidity was above all linked to pleural effusion. There were only 2 cases (3%) of operating mortality owing to two technical errors: an esophago-jejunal anastomotic dehiscence (the only case in the series, 1.6%) caused by esophageal cancer nests in the suture and a case of necrosis in the left hepatic region following the section of the left gastric artery at the origin despite the existence of a large hepatic collateral vessel. The results for stages II and III A were excellent: stage II, 100% survival at 5, 10 and 15 years; stage III A 88% survival at 5 years, 70% at 10 years, 55% at 15 years, but only two deaths from neoplasia at 2.7 and 4.6 years. The results for stages III B and IV are comparable to large series undergoing traditional forms of surgery. Postoperative conditions of nutrition and quality of life were good and patients resumed activities with the aid of constant chlorhydric-peptic replacement treatment and the total extraction of gastric mucosa., Conclusions: We believe that mesogastrectomy represents a real advance in both technical terms and results for stages II and III A; it is debatable for stages III B and IV, although individual cases who survived for more than 10 years were also reported. The case of a stage pT3N0M1 = IV pathology, with a single hepatic metastasis that increased until one year and then spontaneously resolved leaving the patient alive and in good health 20 years and 6 months after the operation is truly amazing.

Background and Aim: 133 cases of occluded colorectal neoplasms (14% of the entire series): 30 (23%) of the right colon, 103 (77%) of the left colon-rectum; 69 males (52%) and 64 females (48%); mean age 67.5 years old, range 33-91 years. pTNM: stage II, 28 cases (21%); stage III: 43 cases (32%); stage IV, 62 cases (47%). The aim of this study was to resolve the occlusive symptoms and to treat the neoplasm in a single operation., Methods: In the 62 cases at stage IV, surgery was solely palliative: 49 (79%) derivations, 13 (21%) entero-enterostomies and 36 (58%) preternatural anus; 11 (18%) standard hemicolectomies, extended in two cases to hepatic resection, and 2 (3%) Hartmann's operations. In the 71 cases at stages II and III, surgery took the form of standard colic exeresis with primary ligature of the colonic vessels at source and at the outlet; 15 (21%) right colectomies, 50 (70%) left colectomies, extended in 6 cases (8%) to abdomino-perineal amputation; 6 segmentary colectomies, 3 (4%) of the transverse colon and 3 (4%) Hartmann's operations. The following aspects are essential in this single-stage surgery: urgency; massive dose antibiotic treatment limited to the pre- and perioperative stages; peritoneal cleansing using accurate, methodical, repeated and abundant lavage; perioperative colonic preparation using direct colotomic perioperative lavage or using a trans-buccoenteric access (using Grosz-Dennis tube); the peritonisation of the retroperitoneum with the omentum and the protection of the anastomosis using omental wrapping and active lavage and, for colorectal anastomosis, even using the 3-way tube, lavage and active aspiration, in a transanal trans- or sub-anastomotic position. Total parenteral feeding is useful for 6-7 days., Results: In the 62 cases at stage IV, postoperative morbidity was 3 cases (6%): 3 suppurations of laparotomy, and mortality occurred in 10 cases (16%): one case of anastomotic disunion (pre-Gullino's tube), 3 cases of septic shock and 6 cardiorespiratory failures. Mean postoperative hospitalisation was 14 days. All these patients died owing to the spread of neoplasms within 1-40 months, mean 13 months. The worst results were obtained in entero-enterostomies: 1-9 months, mean 5 months. In the 71 cases at stages II and III, postoperative morbidity was 3 cases (4%): a small anastomotic filtration after right colectomy and 2 suppurations of the laparotomic incision; mortality amounted to 10 cases (14%): one case of septic shock, one of acute hepatitis, one intestinal infarction and one cardiac infarction, 3 pulmonary embolisms and 3 cardiorespiratory failures. Mean postoperative hospitalisation was 13 days, only 10 in cases of left colectomy with anastomosis protected by Gullino's tube. The long-term results were very good in these 71 patients: over 5-year survival of 50% (Kaplan-Meier)., Conclusions: Using this courageous single-stage surgery, the results are optimal even at a distance, together with reduced surgical trauma and a shorter hospital stay.

The aim of this study was to evaluate if Doppler indexes of left ventricular filling are related to exercise capacity. Since a correlation between left ventricular filling pattern and causal blood pressure has been recently reported along a wide range of pressure values, a group of subjects with blood pressure ranging from normal to severely elevated values was studied. Twenty-four subjects (11 normotensives, 13 mild to severe hypertensive patients) underwent an echo-Doppler study and a maximal multistage cycloergometric exercise test. Since the cycloergometric test was limited by fatigue or dyspnea in all subjects, exercise duration was used as an effort tolerance index. Echocardiographic indexes of systolic function resulted normal in all subjects. Significant relationships with exercise duration were found for several indexes of left ventricular filling (A peak: r = -.743, p < .0001; A/E ratio: r = -.606, p < .005; early filling fraction: r = .639, p < .001). Exercise time was also significantly related to casual blood pressure, both systolic and diastolic. The relationships between transmitral blood flow and exercise capacity seem to indicate that an impairment of ventricular relaxation (as indicated by the progressive increase of atrial contribution) is associated with a decreased exercise tolerance, possibly because a progressively lower activation of Frank-Starling mechanism. Diastolic function thus seems to be able to affect exercise tolerance even in subjects with normal systolic function and blood pressure ranging from normal to severely elevated values.

The authors examine the most recent findings on arterial hypertension with particular emphasis to morphological changes of the arterial wall and to the results of nicardipine treatment in spontaneous hypertensive rats (SHR). According to these assumptions the authors evaluate the effects of nicardipine on the microvascular network by means of a funduscopic examination in 8 hypertensive patients. The preliminary data suggest that nicardipine has a positive structural and morphological effect on the vessel network.

After the colon, the duodenum is the most common site of diverticula. The Authors describe their experience of the surgical treatment of 27 patients suffering from duodenal diverticulosis. Treatment of diverticula was associated with therapy for more severe underlying pathologies in 23 cases. Four cases underwent elective treatment for symptomatic diverticulosis. No major complications or increase in the average time spent in hospital were observed in either group.

Personal experience of 32 cases of colon diverticula observed between 1972 and 1989 is reported. Nine conservative operations and 23 resections of the perforated segment of the colon, followed 20 times by primary anastomosis, were performed. The importance of removing the sector of the colon involved is reiterated. It is concluded that a sectorial type primary resection-anastomosis is advisable in the case of generalised peritonitis, preceding the operation with an abundant peritoneal wash-out. Protective colostomy can be avoided by using an endoluminal active aspiration tube. In a series of 11 primary resection-anastomosis operations carried out in the presence of general peritonitis, anastomotic dehiscence was never observed.

Several data suggest the possible involvement of serotonin (5HT) and of the serotoninergic (5HTergic) system in the pathophysiology of essential hypertension. Our study aim was thus to measure a peripheral 5HTergic marker, such as platelet 5HT uptake, in 8 hypertensive patients, as compared with healthy controls. All subjects included underwent evaluation of the pain threshold, in view of the possible relationship between mechanisms involved in pain modulation and those regulating blood pressure. The results showed a decrease of the maximal velocity (Vmax) of platelet 5HT uptake in the patients, who also exhibited an increase in the pain threshold. These data, although preliminary, are suggestive with regard to an increased concentration of extraplatelet 5HT, which might play a role in both hypertension and the change in pain threshold.