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Aim: General intelligence of patients with neglect has been poorly investigated and data at present are contrasting. Moreover it is not yet defined whether the presence of anosognosia for hemiplegia is associated with intellectual impairment in patients with neglect., Methods: In this prospective study the authors evaluated the verbal intelligence quotient in neglect patients. This study was carried out on 33 patients with left hemiparesis: 11 patients had neglect (group N), 11 had neglect + anosognosia (group N+A) and 11 had neither neglect nor anosognosia (control group)., Results: Patients of group neglect + anosognosia had significantly lower verbal IQ (VIQ) and mini-mental state examination (MMSE) scores than those of neglect (respectively: P=0.004 and P=0.000) and control groups (respectively: P=0.041 and P=0.000). No significant differences were detected between neglect and control groups for VIQ and MMSE. In N+A group VIQ score was lower than 90 in 81.8% and MMSE score was lower than 24 in 100% of patients. Moreover, 18.2% of N+A patients had VIQ score lower than 80 and 45.4% had MMSE score lower than 18/30. Also 9.1% of neglect group had VIQ score lower than 90 and 36.4% MMSE scores less than 24/30, but none of these patients had VIQ and MMSE scores respectively lower than 80 and 18/30. Similar data were present in control group., Conclusions: This study focuses on mental impairment in neglect + anosognosia patients and indicates that A for hemiplegia is a condition that more often occurs when severe mental impairment is present.

Background: To assess which factors determined conversion to laparotomy in patients undergoing laparoscopic elective cholecystectomy., Setting: department of General Surgery. University of Genoa. Italy., Methods: Two hundred sixty-four consecutive laparoscopic cholecystectomies were performed in our Department., Interventions: laparoscopic cholecystectomy was performed according to Dubois's technique. Duration of the procedure was not considered a reason for conversion., Results: 121 patients showed "difficult intraoperative situations" with further conversion risk factor. Conversion to laparotomy was necessary in 11 patients (4.16%). Five patients underwent conversion in the first 50 cases (10%), while six in the last 214 (2.8%). We had to convert to open cholecystectomy only in eleven patients, despite the high rate of technical difficulties and anatomic anomalies even in cases which, in the past, represented a contraindication to this kind of technique. The use of new instruments and new surgical techniques has reduced to only factors of increased risk in those situations that in the past were considered as contraindications to laparoscopic cholecystectomy., Conclusions: Conversion to open cholecystectomy is based on the surgeon's decision and the safety should be the main consideration in performing laparoscopic cholecystectomy. The use of a careful dissection could avoid the conversion in many patients.

Background: It is our habit to employ an open drainage after thyroid surgery in our department. We have also found a large number of surgical infections in these patients (5.8% vs 2.5). Aim of the study is to evaluate prospectively if contamination happens during surgical procedure or in a later time according to the presence of the open drainage., Methods: From October 1995 to November 1996, 113 patients who underwent a subtotal thyroidectomy were randomized into two groups: group A with antibiotic prophylaxis (57 patients) and group B without it (56 patients)., Results: One case (1.7%) of sepsis among 57 patients of group A and 2 cases (3.4%) among 56 patients of group B were observed., Conclusions: No statistical difference was found between the two groups despite antibiotic prophylaxis covering surgical procedure. It is personal opinion that sepsis arose after surgical procedure, due to the presence of the open drainage.

Six groups of patients for a total of 120 cases were examined for cervical wound suture results. Different synthetic absorbable sutures and different suture techniques were employed. Good aesthetic results were always obtained in long-term follow-up. The patients sutured with Polydioxanone, a monofilament with prolonged breaking strength retention, had a lower incidence of local complications.

Increased survival rates after esophagectomy for cancer and the significant development of forms of therapy alternate to surgical treatment, today compel surgeons to devote far more attention to the methods will pursue in reconstructing the alimentary tract after removal of the esophagus. Nine patients with esophago-gastro-plasty and 6 with esophago-jejuno-plasty, after esophagectomy for cancer, experienced a study of esophageal function. The study consisted of extended esophago-gastro-intestinal manometry, performed both while at digestive rest after a semi-solid meal, and of scintigraphy, performed to investigate gastric emptying. 24-hours esophago-gastric pH-metry was also executed, along with basal and stimulated acidity metering in, patients with gastroplasty. The fundamental alterations, from the manometric point of view in esophago-gastro-plasty, are the absence of phase III of the IMMC interdigestively and in the absence of a motor response when ingesting the meal. Scintigraphically this coincides with a fundamental alteration of gastric tubule emptying. On the contrary, in jejunoplasty the jejunal loop retains adequate motility, both during the interdigestive phase and following a meal. Such strikingly diverse motor behavior explains the higher quality of life of patients with jejunoplasty versus patients in whom the stomach is used to substitute for the esophagus.

Until a few years ago, surgical technique and the age-old convictions of oncological radicality rejected very low rectal resections for cancer, particularly as the problem of postoperative incontinence did not exist. Currently, on the other hand, with the advent of mechanical staplers, the surgeon attempts increasingly to reconcile the possibility of using new sphincter-saving techniques with adequate oncological radicality, backed by accurate pre- and intraoperative staging. It is underlined that postoperative assessment of sphincter function in all its aspects, both clinical and instrumental, may be useful for the purpose of clarifying what anatomical structures should really be saved, delegated to retaining sphincter sensitivity and reflexes, so improving the functional results of operations. In addition, the almost rare identification of manifest or latent postoperative incontinence would make it possible to intervene in operated patients, for example by functional reeducation techniques as happens in the relatively recent biofeedback techniques.