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The case of a 27-year-old woman, admitted to our surgical ward with symptoms of epigastric-ache, postmeal vomiting and significant weight loss, is reported. Clinical and radiographic suspicion of mesenterium commune, with duodenal compression due to bands, requested an explorative laparatomy that confirmed the mesenterium commune presence with left caecum and colon adhesion and left Bochdaleck hernia, which is rare in adult age.

A retrospective study is reported carried out on a group of 166 patients affected by dyspeptic syndrome who presented at least 3 of the 9 symptoms which characterise this pathology. One hundred and twenty-eight patients underwent prokinetic drug therapy and 38 received placebo. Clinical parameters were evaluated following one month of therapy all patients in order to compare them to basal values. The results obtained confirm a satisfactory efficacy of the prokinetic treatment in improving dyspeptic symptoms. Although administered to a smaller number of patients, placebo was also found to play an important role in the multifactorial etiopathogenesis of the dyspeptic syndrome on a functional basis.

A pre-and intraoperative diagnostic protocol offering morphological and functional evaluation of the bile ducts, Oddi's sphincter, duodenum, and pancreas was employed to classify 633 patients with biliary lithiasis into 6 groups and hence the therapeutic application of 6 surgical techniques, namely: 1) cholecystectomy alone; 2) choledocholithotomy plus closure of the choledoch; 3) choledocholithotomy plus Kehr drainage; 4) papillosphincterotomy alone; 5) papillosphincterotomy plus anterior seclective duodenal vagotomy; 6) hepaticojejunostomy, so as to ensure a rational choice of the best operation fro each situation. Comparison with the literature and prior personal results substantiated the soundness of this approach, as shown by a marked reduction of complications, mortality and residual disease on both short and medium-term follow-up.

86 carefully selected patients with cholesterinic cholecystic lithiasis were submitted to litholytic treatment with chenodesoxycholic acid at a dose of 15 mg per kg of body weight as part of a multidisciplinary therapeutic approach to biliary lithiasis. Follow up of these patients up to 24 months showed the positive action of the drug on dyspeptic pain symptomatology, the absence of significant side effects, and the absence of hepatotoxic effects of chenic acid at therapeutic doses, as well as its effectiveness with respect to total or partial litholysis in 78% of patients. These data confirm the positive role of litholytic treatment as an alternative to cholecystectomy in highly selected patients treated at specialist centres.

234 partial gastrectomies, according to Billroth II technique, were performed for peptic ulcer disease in selective patients from 1969 to 1977. A postoperative study has been carried out to check the efficiency of such operation in the treatment of peptic ulcer disease. Postoperative treatment of peptic ulcer disease. Postoperative mortality was 3.8%, while immediate surgical complications were 6.4%. 145 of this patients could be followed with a special regard for sex, age, way of living, general conditions, ulcer's location and the persisting symptoms at the time of the study. 124 patients (84%) showed good general conditions while 6 (4.1%) needed a second operation for recurrent peptic ulceration or alkaline reflux gastritis. Although this procedure has showed fairly good clinical results the Authors point out the high rate of postoperative mortality for a basically benign disease and the presence of some unpleasant digestive sequelae. Attention is payed to some factors that may play an important role on the pathophysiology of these sequelae.

Experimental studies and clinical observations are referred to in stressing the frequent correlation between duodenal, biliary and pancreatic disturbances, and the importance of the role of spontaneous or iatrogenic impairment of Oddi's sphincter in the origin of this pathology. These physiopathological concepts are regarded as fundamental in the correct surgical management of cholelithiasis. A pre- and postoperative diagnostic protocol designed to investigate the anatomofunctional aspects of the duodenum and pancreas as well as bile duct morphology and Oddi sphincter function is described. Its employment enabled 633 cases to be divided six well-defined groups for diversified treatment.

Haemorrhoid cryosurgery in 528 cases operated since the University of Genoa Colon and Rectum Diseases Centre opened is illustrated. It is shown that the complete success of this technique is dependent on careful preoperative assessment, adoption of a suitable method, and proper post-operative management. An analysis of these three parameters is followed by a description of the immediate and 1-yr follow-up results observed in the reported series. The soundness of the method is asserted. Stress is laid on the fact that cryosurgery offers a valid alternative to conventional surgical methods, provided its indications are strictly adhered to.

The correlation between state of preoperative immunity assessed by in vitro test and the onset of postoperative septic complications has been evaluated. 153 patients subjected to surgery of choice have been examined. Before the operation cutaneous delayed hypersensitivity tests with recall antigens (streptokinase-streptodornase, purified tuberculoprotein and candidine) were carried out. 111 patients were classed as immunologically normal (at least one positive test) and 42 were anergic (no positive test) Among the former, 12 cases (10.8%) showed post-surgical septic complications, while among the latter, fully 24 (57%) suffered from infectious processes. It is concluded that, although numerous factors make patients prone to infection during the postoperative course, immunitary conditions play a very important part. Prophylactic measures are therefore suggested for anergic patient prior to surgery, measures that are essentially represented by parenteral support feeding and immunostimulation.

A colosphincterometrographic study in 40 normal subjects revealed the existence of a colosphincteral reflex hitherto unknown to man. In all cases, insufflation of 30-40 cc air into a balloon placed 50 cm from the anus produced a relaxation of the internal sphincter muscle of the anus (colosphincteral reflex), a subjective feeling of imminent defaecation, and reflex contraction of the external sphincter muscle. The discovery of this new reflex suggests that the physiological mechanism of defaecation may even commence above the ampulla recti, which has always been regarded as the only reflexogenic segment of the large intestine.

On the basis of the observation that the dumping syndrome is seen very rarely now compared to the past, experimental and clinical research was carried out with a view to explaining this phenomenon. These studies showed that it is possible that the gastric antrum plays a basic role in the pathogenesis of the dumping syndrome.

The Authors report their experience of postoperative cholangiomanometry carried out through a T-tube on 19 patients; in 13 of such patients the Oddi's sphincter was intact, while 6 of them underwent sphincterectomy. In 8 patient's a manometric study of the duodenum was associated. They performed both variable flow and pressure and constant flow manometry and their results show that such examination is a reliable test both for the functional evaluation of the surgical procedure, and for the study of the action of various drugs on Oddi's sphincter function and its correlation with duodenal motility.

A review of the techniques and presentation of a new method.--Cholangiomanometric techniques and methods described in the literature are reviewed, with particular reference to their associated anaesthesiological and pharmacological problems. Original physiological concepts are relied on in a proposal for the adoption of a new intraoperative method with pharmacological tests and specifically direct to functional evaluation of Oddi's sphincter as a means of determining indications for surgery.

Computerized Dynamic Endothermy (CDE) has been applied to the evaluation of the gastroenteric microcirculation. This new method enables mucosal temperature changes to be detected in a dynamic and functional way. With preventive induction of a temperature change (cold stimulus), the instrument measures the time required for the establishment of previous mucosal temperature. Computerized data are displayed in the form of a time/temperature curve. Results obtained on rabbits showed, during ischaemic conditions, a greater reduction of gastric layer temperature during cold stimulus than in basal conditions, followed by a slower return to basal temperature during the recovery time.

The manometric recording of Lower Esophageal Sphincter (LES) has been made in 8 patients who have undergone surgical apposition of Angelchik prosthesis for hiatal hernia. The patients underwent an esophageal manometric study in the preoperative period, one month and one year after the intervention. In the preoperative patients, the mean LES pressure was 10,3 +/- 0,5 mmHg and there was sphincterial incoordination to peristaltic waves after swallow. In one month postoperative patients the LESP was 20,1 +/- 1,0 mmHg (p less than 0,001), and one year after the LESP was 17,0 +/- 0,3 (p less than 0,001) with an ameliorated coordination of the LES activity in response to swallow. Therefore, during postoperative manometric controls the Authors identified a high pressure subdiaphragmatic zone unmodified by deglutitory acts which was not present in the preoperative investigation. Probably the presence of this zone would been explained as a consequence of mechanical action of the prosthesis and the postsurgical fibrino-reaction around the prosthesis. The Authors discussed the results obtained and their importance to Angelchik prosthesis employment for surgical correction of hiatal hernia.

Colonsphinctorometrography (CSMG) is a new, original method for the simultaneous investigation of the motility of the descending colon, sigmoid colon, rectosigmoid junction, rectum, and internal and external anal sphincters. A 60 cm open-ended tip sound with an external diameter of 10 mm is used. Three 3 cm long stimulating balloons are located at points 15 cm, 30 cm, and 50 cm along its length. A basal recording is taken for about 15 min with the patient absolutely at rest. The balloons are then inflated to measure the kinetic responses of colon and anal sphincters to stimuli of different volume. In addition to offering a pressure recording for the left colon and internal sphincter, the method also provides an EMG for the external sphincter and a pneumogram.

The latest investigations in the field of clinical immunology have proposed ways of assessing immunological efficiency that have also been used to identify patients most susceptible to infectious complications. The assessment of delayed hypersensitivity response (DHR) using anamnestic antigens is currently the most common method. The results of a polycentric study are presented. The study was conducted on a group of healthy subjects from various Italian regions divided into three age classes. Positive responses to the MT were noted in 96.4% of the population studied. The incidence of energy was statistically higher among females than males, while the mean response to the MT expressed in millimetres was statistically higher in males. Though 7 antigens were administered, the responsive population reacted on average to 3. The highest incidence of positive responses was to Candida, with Trichophyton responsible for the fewest.

Segmental small and large bowel transit time of 25 healthy volunteers have been studied, as a control group, by means of radio-opaque markers prepared and administered according to an original method. The same study has been subsequently carried out on 37 patients suffering for chronic non organic constipation. The resulting data, though poorly homogeneous, may however, be plotted in 8 classes; each class groups subjects presenting very similar segmental transit time whose changes are less than 4 hours. The first class gathers the 8.1% of the cases, presenting in increased small bowel transit time; the patients of the second class (5.4%) has resulted affected by "right colon constipation syndrome"; another 5.4% of patients, plotted in the third class have shown a permanence time of the markers in the transverse colon of about 190 hours, while the 10.8% fourth class and the 16.2% fifth class have presented a 97 and 150 hours' one respectively. The patients of the sixth class (21.6%) have shown long lasting permanence of markers in the left colon and in the rectum. The 13.5% of cases, gathered in seventh class, has shown an increased transit time through the whole colon, while at last the eight class (19.0% of patients) has resulted affected by dischezia. The described method has thus revealed useful in the study of bowel segmental transit time from a topographic diagnostic point of view.

The Authors report on their cases of biliary surgery reoperation, necessary in 267 cases out of 3193 primary operations. After a short discussion of the aetiological, diagnostic and therapeutic problems of relapsing biliary pathology, they compare their results with those of the most important sets of cases reported in world literature.

Previous studies have demonstrated that changes in endoduodenal pressure may cause pancreatic alterations in biliary diseases. Anterior selective vagotomy of the duodenum was devised to reduce duodenal motility. An experimental study showed that such a surgical procedure is followed by a marked decrease in the overall duodenal kinesis, with disappearance of the highest pressure peaks.