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Successful and rapid resolution of a serious cases of traumatic chylothorax by means of conservative management with TPN is reported. This method is clearly indicated as a mean of making up the calorie and amino acid need when litres of chyle are being lost every day. In addition, by resting the digestive tract it brings about a massive decrease in the production of lymph in the mesenteric district and thus leading to easier and earlier sufficiency of the collateral lymph drainage routes. The rapid decrease in quantity and the change over from chylous to serous chest drainage liquid after TPN are evidence of its soundness. An immediate lymphographic control revealed complete section of the duct. Two months later, collateral diaphragmatic and azygos circulation was observed. It is felt, therefore, that TPN extends the range of conservative management of posttraumatic and postoperative chylothorax.

The Authors, having observed a case of middle oesophageal web giving rise to severe dysphagia, discuss the aetiopathogenesis, the diagnosis and therapy of these rare oesophageal lesions. Because of its pathological feature, the reported case was succesfully treated by surgical resection of the ring, using a transthoracic approach.

During the last 12 years 7 patients with ulcerative colitis were treated because of an acute complication consisting in 2 cases of colonic perforation, 3 cases of toxic megacolon (two of them perforated) and 2 cases of massive enterorragia. In all patients an emergency total colectomy was performed resulting a mortality of 3 cases, two of which had required the removal in a second time of the rectal stump. In 3 or 4 recovered patients we performed in a period of 7-15 months an ileo-proctostomy once confirmed the healing of the ulcerative lesions in the residual rectum. The problems concerning the indications and surgical procedures involved in such cases are discussed on the base of the personal experience, with particular consideration on advantages and limits of preserving a rectal stump. The authors agree on an eclectic behavior considering each case on the base of pathological findings, the age and the general and psychic conditions of the single patient.

A series of 145 patients with cancer of the pancreas is presented. Radical surgery was performed in 23 cases. An assessment is made of anatomical and clinical factors likely to interfere with the results of surgery, particularly radical surgery. The mean survival after palliative operations was 5.5 months and after duodenocephalopancreatectomy 16.1 months. After resection, operative mortality as a whole was 21.6%, though in the last 5 years it had fallen to 8.8%. Actuarial survival after 1 yr was 56.3% and after 2 yr 18.8%. The average duration of the symptom picture was long due to the difficulty of making an early diagnosis. This has an adverse influence on the operability of cancer of the pancreas. On average, survival after resection was less in cases with infiltration of the lymph nodes, but not in those with extension of the neoplasia to neighbouring organs, such as the duodenum. The results of radical management were much the same as those reported in the literature and are regarded as unsatisfactory, even though better than those achieved with palliative surgery. Their improvement is discussed in the light of the technical features of duodenocephalopancreatectomy. It is felt that extensive lymphadenectomy is required and that this should be planned and performed in accordance with strict anatomical and surgical criteria.

The Authors review 86 cases, aged over 70, needing surgical treatment because of atherosclerotic obstructive disease of the lower limb, stage III-IV. 35 patients underwent thigh amputation with 14% mortality in the early post-operative period (30 days) and 32% in the late post-operative period, considered up to 6 months. For 38 patients who underwent a revascularisation procedure mortality resulted 8% in the 30 post-operative days and 10% at 6 months. Escluding the aorto-iliac reconstructions through a trans-peritoneal approach, the overall mortality is limited to 3,2%. A major amputation was avoided in 76% of patients who underwent a revascularisation. On the base of their results the Authors discuss the indications of direct surgery in treatment of advanced ischemic lesions in elderly patients concluding that a surgical correction should be always considered in the aim of avoiding or limiting the amputation. In these high-risk elderly patients the extra-peritoneal aorto-iliac reconstructive technique must be preferred together with extraanatomical femoro-femoral or axillo-femoral by-passes.

Two poststenotic subclavian artery dilatations are described. The distinction between a poststenotic dilatation and aneurysm is based on arteriography, showing associated with explorative arteriotomy, if needed. In the case of even wide poststenotic dilatation, the first rib only should be removed. The first rib resection in the described patients controlled after 2 and 7 years, was followed by reduction of arterial dilatation in one case and by stabilization in the other. This result confirms that arterial grafting must be considered only in the treatment of true poststenotic aneurysm.

The Authors report their experience (22 operations) concerning chronic bronchial suppurations of surgical interest. During the period considered (1964 - April 1982), among many pathological processes capable of conditioning a chronic bronchial suppuration, it has been observed a progressive decrease of "primitive" bronchiectasis and a percentage increase of "secondary" ones. Surgical treatment, unquestionably required in cases of cystic malformation or secondary obstruction, is now restricted to "primitive" cases with well-limited bronchiectasis or with complications (hemoptysis). Surgical therapy performed in these cases appears to grant good results both immediately (O% surgical mortality) and in the future.

110 of 126 patients treated with Halsted mastectomy and postoperative loco-regional radiotherapy, during period 1961-1969 have been controlled. Overall 5 years survival resulted as following: Columbia Clinical Classification stage A 90,6%, stage B 66,6%, stage C 28,5%, stage D 33,3%; 10 years survival in patients operated on in the period 1961-64 was: stage A 69,2%, stage B 53,3%, stage C 40%, stage D 0%. On the basis of the satisfing results obtained the authors conclude that it appears by now unjustified to modify this method in treating stage A and B breast cancer either utilizing less extended resections, or renoncing to the postoperative irradiation.

The Authors have subjected 14 migraine patients to Doppler ultrasonic technique. Examinations have been performed on both common carotid arteries, either in headache phase or in pain-free periods. Results in each case suggest variable hemodynamic patterns during migraine attacks. Possible pathogenic mechanisms are discussed.

The Authors report two cases of tracheal tumor operated with laryngeal release and tracheal mobilization following Dedo and Fishman. They discuss the indications and describe this technical procedure which has proved successful in obtaining a suture without traction also for 4 cm sleeve resection of trachea.

The authors report 21 cases of cervico-substernal and 9 cases of mediastino-cervical goiters. On the base of their experience they remark that the diagnosis of topographic mediastinal extent of goiter has never been a problem in the mean time that it remains difficult to recognize the possible tumoral nature of the lesion, also utilizing both thyroid angiography and superior caval phlebography. Removal of 27 of 30 goiters was effecuted by cervical approach alone. In two cases a thoraco-lateral approach was added to remove endothoracic neoplastic goiters and in the last case a partial sternotomy was necessary. The authors conclude that the occasional use of sternotomy is not the result of an aprioristic decision, but the consequence of a correct removal obtained through the cervicotomic approach, also for large mediastino-cervical goiters.

The Authors described their experience in 41 patients operated on because of gallbladder cancer. The overall mortality was 20%. Four cases suitables for a "radical" wide resection showed an average survival of 8 months, while 2 on 3 patients with in "situ" carcinoma treated by simple cholecystectomy are still alive at more than 3 years, the other dying after five years because of disease not related to the gallbladder cancer. The bad general prognosis of the disease is mainly related to the delayed diagnosis together with the anatomical relations of the gallbladder as demonstrated by the discouraging survival in the "radically" widely resected patients. It must be considered consequently categorical to realize an early cholecystectomy, the only possible preventive procedure, in the height risk patients.

The Authors present 33 cases of duodenal diverticula, 12 of which underwent surgical therapy. They analyse the clinical and therapeutic problems entailed in this surgica entity with particular reference to the frequency and gravity of emorrhagis complication. Concerning the surgical approach of ampullar and iuxta ampullar diverticula, Authors experience seems to advise indirect operations.

The Authors report 180 cases of transdudenal papillosphincterotomy. Medium follow-up at 5 years revealed a complete recovery in 87 of 100 controlled patients. Nine cases revealed persistence of some degree of dyspepsia, while a second operation was necessary for the remaining patients to remove recurrent calculi in 2 cases and because of Oddi's stenosis in other two cases. A 4,4% mortality operative was observed, following postoperative pancreatitis in 1,1%, duodenal fistula or haemorrhage in 1,6%, and 1,6% from other causes. On the basis of their results the Authors conclude that transduodenal papillosphincterotomy is an effective procedure in treating complicated lithiasic biliary disease when respecting the reported indications.

The Authors described a case of left hepatic artery aneurysm giving ris to haemobilia. A wide discussion is held on clinical and diagnostic aspects on this situation, often causing operations following each other, before that a correct surgical treatment is indicated. The patient underwent the left hepatic artery ligature, at present considered the choice method in the treatment of haemobilia following ruptured hepatic artery aneurysm.

A multicentric study was carried out involving six italian departments of general surgery to assess the efficacy of a low molecular weight (LMW) heparin called Fluxum compared to standard calcium heparin in low doses for prevention of postoperative thromboembolic complications (deep vein thrombosis and pulmonary embolism). 610 patients were treated; 308 (50.5%) of whom were treated with Fluxum at doses of 4,000 or 8,000 I.U. Axa once a day by subcutaneous injection and 302 (49.5%) with heparin calcium at doses of 5,000 I.U. two or three times a day by subcutaneous injection. We observed a total of 29 deep vein thrombosis (4.7%); 10 (3.2%) from the group treated with LMW heparin and 19 (6.3%) from the comparative group. During the study 4 (0.65%) pulmonary embolism were found, 1 (0.32%) in the group treated with LMW heparin and 3 (1%) in the group treated with calcium heparin. None serious hemorrhagic accident was reported during the study. The antithrombotic prophy laxis carried out with Fluxum was on the whole better tolerated than the treatment of the other group, registering a lower frequency of hematomas at the injection and surgical wound sites.

Thirty-seven patients with thyroid cancer were treated at 1a Clinica Chirurgica of Parma between 1962 and 1970. Fourty-five per cent of tumors were papillary, 24 per cent follicular, 2 per cent medullary, 9 per cent anaplastic. Surgery combined with ormonal therapy formed the commonest treatment. Eighty-five per cent of the patients with papillary carcinoma 70 per cent with follicular and 33,3 per cent with anaplastic carcinoma survived for 10 years. This present series indicates that total thiroidectomy combined with ormonal therapy influences the survival time, confirms the prognostic value of histology and shows that papillary node metastases do not prejudice survival.