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The diaphragmatic hernia described by Morgagni in 1761 and by Larrey in 1829 is a rare diaphragmatic anomaly that may be considered nearly always congenital. It is called in so many ways, but the authors think that "anterior diaphragmatic hernia of Morgagni-Larrey" is the most correct name. Usually asymptomatic in the first years of life, it may be discovered by chance or cause problems in the adult or elderly patient. The Morgagni-Larrey hernia includes every peritoneal or visceral hernia across an anterior diaphragmatic door limited by the right xifosternal-costal wall and, on the back, by diaphragm, pleura and pericardium. Morgagni-Larrey hernia usually has a peritoneal sac, that distinguishes this hernia from the Bochdalek one. Because of the presence of the sac, Morgagni-Larrey hernia probably begins in the fetal phase of diaphragmatic evolution, when pleura and peritoneum separate and the diaphragm becomes a real muscle. The hernia often contains: transverse colon, liver, epiploon, but sometimes there may also be small bowel, stomach, pancreas, gallbladder. The diagnosis of Morgagni-Larrey hernia is usually radiological; a thoracic radiography can demonstrate the presence of diaphragmatic hernia especially when the viscera contained in the sac contain air. So you can see different images in a second radiography one hour later to the first, depending on variation of contained air.(ABSTRACT TRUNCATED AT 250 WORDS)

The authors report a series of 10 reconnections, 4 after Hartmann operations for cancer, 3 after Mikulicz for diverticular disease, 1 after Hartmann for diverticular disease, 2 after Hartmann for traumatic perforation of sigma. Neither surgical complications nor death are reported. To reduce the risk of complication it is necessary to execute colorectal restoration with careful fiming. After the Hartmann operation you must operate in the shortest time. After operations for diverticular disease, you must operate after the lowest period of 6 months.

An assessment was made of environmental micro-organisms isolated in the University of Turin Intensive Surgical Care Unit and Emergency Surgery Department to determine the possible exogenous origin of post-operative infections. The enzymatic characters and antibiotypes were determined for some species, and subsequently compared with similar characters of the "in vivo" isolated flora. A monthly disinfection method based on comparison among three antiseptic agents (chlorexidine, formaldehyde and formotetronium) considerably reduced the flora. The data obtained, while showing that most of the infections observed were endogenous, also provided indications on the way in which the spread of certain Gram-negative germs, often involved in post-operative and post-traumatic infections, could be contained.

Considerations of a physiopathological nature are expressed with regard to haemorrhagic multiple-injury patients in the light of the experience acquired in first-aid practice at the University of Turin department of emergency surgery. While treatment of the basic injury is the key to therapy, sufficient infusion management and careful monitoring of coagulation parameters before and during transfusion may be of fundamental importance in survival. By the same token, not all blood products available can be used indiscriminately. A treatment and monitoring protocol for the reinstatement of volaemia and corpuscle mass, and for the correction of coagulopathy due to loss, consumption and wash-out is proposed.

Of 144 patients treated with T.P.N. in the period 1-5-1987/30-9-1988, 128 have been to have an operation. Their survival at the time of the removal, the post-operating mortality, the average stay in hospital, have been compared with those of other 128 patients non-treated with T.P.N., suffering from similar pathologies and who had operation of the same kind. The obtained results have stressed in the patients treated with T.P.N. as in those who had not, a survival at the time of the removal of 75% contrary to 62.5%, a post-operating mortality of 25% contrary to 37.5%, an average post-operative stay in hospital of 13 days contrary to 15 days. The statistical elaboration executed with chi 2's test with Yates' correction, provided 0.25 less than P greater than 0.50, so data non particularly meaningful. In our casuistry the percentage of surviving in the patients treated with T.P.N. as to those not treated, is nevertheless, very encouraging; furthermore, we most think that only by taking advantage of T.P.N. has been possible to extend the operability to patients that in the past because of well on years, or because of dangerous surgical illnesses joined to dismetabolic and cardiovascular diseases, were judged not operable.

The large amount of data resulting from arterial and venous HGA's and analysis of expired gases carried out during the monitoring of critical surgical patients has been statistically reduced to only seven parameters. Personal Mini Computer software able to quantify or predict the necessity for mechanical ventilatory assistance in individual cases has been developed on the basis of the 7 parameters. The system, presently used only as a check, has been found very reliable. Two cases are reported in order to illustrate its use in intensive treatment.