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The authors report their experience of the posterior rectal access route. They used this route to operate 7 patients with rectal carcinoma during the period February 1989-October 1994; 3 patients were affected by villous adenoma, 3 by adenocarcinoma, and 1 by pelvic recidivation. Of the 3 patients suffering from adenocarcinoma, two underwent palliative treatment owing to their poor general conditions and the systemic nature of the base pathology, consisting in the exeresis of the tumour using a posterior route. The third patient was treated using a combined abdominal-posterior route; the site of the tumour and the presence of a narrow pelvis would in fact have made an "ultra low" front resection highly risky, whereas coloanal anastomosis (pull through) might have jeopardized efficacious anal continence. On the basis of their experience the authors indicate the posterior access route as a therapeutic possibility in the treatment of medium-low rectal tumours at an early or very advanced stage. The posterior approach is only justified in other forms if combined with laparotomic access. An oncologically correct operation is therefore guaranteed in full respect of sphincteric function.

The authors report a case of cystic dilatation of the choledochus associated with narrow stenosis at the confluence of the left and right hepatic ducts which was found to be inflammatory on histological examination. This pathology is becoming an increasingly more commonplace clinical finding. The case reported here is particularly interesting owing to the onset of the disease and the way in which it was treated. An attempt was made to treat the patient using a simple operation which was to the least radical possible. The authors take this opportunity of reviewing the literature on the subject.

The authors report 2 cases of amebic hepatic abscess, through to their observation with a little interval of time one from another and both coming from the same small town. Transmission modalities, the diagnostic approach and the therapeutic possibilities are discussed on the basis of personal experience.

The authors analyse and evaluate the clinical records of 45 patients treated in the last 4 years for pancreatic cancer and neoplasm of the bilioduodenapancreatic area, comparing the results with data available in the literature. In the group of patients treated with resection (12 cases), postoperative morbidity and mortality were respectively 28% and 6%, and three-years survival was 22%. The authors discuss particularly about reconstruction ways after duodenopancreatectomy, showing good results after reconstruction by Y loop sec. Roux and pancreato-jejunal anastomosis.

The authors report a case recently brought to their observation: T.A., a 77 year old patient, operated on in July 1990, for aortic aneurysm with axillo femoral by-pass. The patient was reoperated on the 5th day for ischaemic necrosis of the descending colon. In 1992 he was operated in another hospital for right iliac branch removal of the by-pass and performing of extra-anatomic bifemoral by-pass for right iliac branch infection of anatomic prosthesis. He was brought to our observation in March 1993, after the patient was refused in other Centres because of purulent abscess located near the aortic prosthesis and in the right iliac fossa, with a fistula to right superior anterior iliac crista. The patient was operated on in April 1993, with an explorative laparatomy to drain the abscess and to remove the aortic prosthesis. The aorta was sutured with closed bottom by means of delayed points. The postoperative course was regular and an arteriography performed three months after confirms the good running of the axillo-femoral by-pass and of the bifemoral one previously performed. The authors because of their experience and the bibliographical data underline the goodness of the axillo-femoral by-pass in serious infections of an aortic prosthesis.

The authors present their personal experience in the surgical treatment of 256 cases of patients suffering from inguinal hernia, using the Shouldice technique in local anaesthesia. Minor incidence intra and postoperative complications compared with other types of anaesthesia, the possibility to converse with the patient during the operation and if necessary to invite him to cough in order to exclude the presence of other associated hernias or to assay the robustness and the resistance of the plastic, minor frequency of relapses compared with other operating techniques (1.5% in the Shouldice against 3% of the Bassini), and last but not least the possibility of early discharge from hospital and more swift resumption of work, confirm the full validity of this hernial plastic surgery.

The authors report their experience of the treatment of 43 cases of perforated colonic diverticula. The operations were: 12 primary resections-anastomoses; 7 resections-anastomoses with protective colostomy; 2 operations of suture and drainage; 22 Hartmann's resections. The authors believe that Hartmann's resection is the operation of first choice in cases of diffuse or stercoraceous peritonitis. This operation another the removal of the sick part of intestines without exposing the patient to the possible complications of an operation "at risk", and allows a late recanalization destitute of risk: in our experience 13 cases of 22 (59%).

The authors report about a case of celiac axis obliteration, noticed during an operation of pancreaticoduodenectomy for pancreatic formation. The arterial flux of sovramesocolic district took place completely through the gastroduodenal artery. To complete the operation the authors were obliged to stop the circulation of the pancreaticoduodenal artery and to rivascular the common hepatic through bypass with aorta. The authors confirm the importance of arteriography for the study of expansive lesions of the pancreas, liable to surgical treatment as well to avoid treating urgently similar cases or due to anatomic variants.

The paper reports the Authors' experience during the period 1989-91 and refers to 80 operated cases of rectum-sigma cancer. Given that data reported in the literature affirm that the limit of oncological safety is 1.5-2 centimetres distal from the tumour, and owing to their use of mechanical staplers, the Authors were able to use the preferred anterior section followed by low or very low colo-rectal anastomosis in 96% of cases. Miles' technique for abdomino-perineal amputation was only resorted to in 4% of cases. Tumours parameters, short- and medium-term complications and the results of a short-term follow-up are all discussed. The Authors compare their experience with that of other researchers reported in the literature.

The paper describes a recent case of neurilemmoma of the stomach. Following a review of the literature, the Authors focus their attention on the diagnostic difficulties and the choice of therapy. Tomography, arteriography and gastroscopy with multiple biopsies may at times be misleading depending on the development of the tumour. Most Authors agree that local resection or, when possible, enucleation are the most appropriate forms of therapy.

Doppler arteriography with chromatic frequency analysis is a new and very sound diagnostic method in cases of vascular disease. It can be carried out with apparatus such as the Echoflow (reg'd), a natural development of the Doppler technique ultrasonography. Vessels are shown in red, yellow, or blue, depending on the rate of their intraluminal flow. Surface arteries lying 5-6 cm below the skin and not hidden by bone can be studied. Preliminary results on 23 supra-aortic trunks, 21 lower extremity arterial systems, and 5 upper limb systems are described. The use of the instrument in other situations in also recommended.

Systematic examination of the upper aortic arch vessels by direct Doppler ultrasonography of the common and internal arteries is proposed, together with calculation of the flow rate, pressure-perfusion index, carotid ratio, and carotid distensibility index on a systematic basis. Obligatory compression movements to evaluate the several supplementary pathways in the case of disease are also recommended to complete the examination.