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This experimental study compared the effects of laparoscopic (n = 31) and open (n = 32) cholecystectomy on gastric intramucosal pH (pHi). For this purpose, pHi was measured tonometrically before induction of anaesthesia, at 30-min intervals during surgery, and 1, 2 and 4 h after operation in otherwise healthy patients undergoing elective cholecystectomy. Additionally, perioperative arterial pH (pHa), arterial carbon dioxide tension (PaCO2), intramucosal carbon dioxide tension, arterial bicarbonate concentration, end-tidal carbon dioxide pressure (PECO2), levels of serum lactate, lactate dehydrogenase (LDH) and gamma-glutamyl transferase (GGT), haematocrit and arterial blood pressure were recorded. In the two groups no significantly different changes occurred in pHi, pHa, serum lactate concentration or haematocrit at any of the observation times. PECO2 and PaCO2 were significantly raised during the laparoscopic procedure, whereas levels of LDH and GGT and arterial blood pressure rose during and after open cholecystectomy. In spite of the increased intra-abdominal pressure and the peritoneal carbon dioxide absorption related to the creation of a pneumoperitoneum, no decrease in pHi was detectable during laparoscopic cholecystectomy.

Purpose: The aim of this study was to compare the value of endoluminal ultrasonography (ELUS) with magnetic resonance imaging (MRI) for preoperative staging of rectal carcinoma., Methods: Thirty-seven consecutive patients were examined by ELUS and MRI. Imaging results were compared with pathohistologic studies. A tumor extending beyond the bowel wall was considered to be "positive" and one within the bowel wall was considered "negative." Lymph node involvement was considered present if nodes equal to or greater than 5 mm in diameter were found in the perirectal tissue. For evaluating the differences between the two methods, the Mc Nemar test was performed., Results: T-Staging was correct in 88.2 percent (30/34) of patients by ELUS and in 82.3 percent (28/34) by MRI (difference not significant). N-Staging was correct in 80 percent (20/25) by ELUS and in 60 percent (15/25) by MRI (difference of borderline significance). A comprehensive preoperative staging (T + N) was made correctly in 68 percent (17/25) by ELUS and in 48 percent only (12/25) by MRI (difference not significant)., Conclusions: We suggest that ELUS and MRI must be evaluated within the framework of established parameters when treatment modalities such as preoperative radiation therapy and local or radical surgical approach must be decided.

Twenty-nine patients with cancer of the low rectum were treated by local excision performed by a transsphincteric approach (Mason's operation). Patient's selection requires a careful digital examination, biopsy, CT or MR and intraluminal ultrasound. In our series an accurate and strictly selection provides low recurrence rates with no mortality and low postoperative complications. Mason's operation, when criteria for appropriate patients selection are followed, is a valid alternative to mayor surgical procedures as APR.

On the basis of 45 cases of operated pseudocyst, the Authors tackle the problem of surgical tactis in treatment of these lesions and any complications. The paper outline the contribution that recent diagnostic methods--such as endoscopic retrograde cholangiopancreatography, computed tomography and ultrasonography--have made to solution of the problem and establishes the criteria for emergency or elective operation. In the first condition, consisting in cases of complications (haemorrhagic, suppurative, perforative etc.), abnormal development of pseudocysts and serious impairment of the patient's general conditions, the treatment of the pseudocyst generally takes the form of external drainage. The second condition, obtainable after a sufficient period of "ripening", usually consists in a cysto-digestive shunt or cysto-parenchymal demolition in view of the high morbidity arising from external drainage. Surgical treatment of the pseudocyst is completed by therapy of any basic chronic pancreatitis and by correction of probable associated lesions affecting the bile and digestive tracts and the splanchnic venous circulation. In the reported cases, 28 patients were treated by cysto-digestive shunt, 8 by cysto-parenchymal demolition and 9 by external drainage. There were 37 combined operations.

The authors describe 23 cases of distal splenorenal derivation after Warren. Of these patients, 17 received a complete followup clinical hematological and angiographic examination at an average remove of 10 months after surgery. The authors discuss their results and submit that the Warren operation, while really selcetive in most cases when performed, in the long run tends to shung rather too much blood away from the liver; in other words, the effectiveness of the shunt tends to exceed the intended drainage,which should be restricted to the gastro-esophageal vascular bed.

The authors describe their experience in 23 cases of biliary tract drainage by the transhepatic-percutaneous approach in the course of obstructive jaundice of diversified origin. This can be done for essentially three reasons, namely to alleviate jaundice preoperatively, to provide permanent bile drainage in patients not amenable to surgery, and to relieve excess pressure in surgical anastomoses of the biliary passages. On the basis of biological considerations (relationship between severity and duration of cholestasis on the one hand and postoperative mortality and morbidity on the other), and in light of their own results, the authors argue in favor of this procedure, explaining that it is only mildly traumatic to the patient, easy to perform, attended by a low quota of complications, and above all effective as a drainage; also, it does not unduly prolong the preoperative period for patients scheduled for further and major surgery. Also in view of the current role of PTC in the diagnosis of obstructive jaundice, they submit that transhepatic-percutaneous drainage should be done right next to recognition of dilatation of the intrahepatic bile passages by CAT or echotomography.

The authors show a casuistry of 125 operations of SPV, and comment on the clinical and physiopathologic presuppositions justifying the indications to SPV in the field of gastroduodenal peptic pathology. They report the results of the gastric probings, both basal and after stimulation with pentagastrin in the pre- and postoperative phase, and after a year. They face the problem of pyloroplastics, and appraise the elements indicating and contra-indicating it in association to SPV.

The findings observed with computed tomography (CT) in such pancreatic emergencies as necrotic-hemorrhagic pancreatitis, pancreatic abscess, broken pseudocyst, and pancreatic ascites with mediastinitis are presented. The value of CT in these conditions, which often require surgical intervention, is discussed. Computed tomography appears to be the ideal diagnostic procedure, especially for surgical treatment planning in pancreatic abscess. No deaths occurred in a group of pancreatic abscesses treated surgically with CT assistance.

Personal experience (12 cases) and a literature review (165 cases) of trans-hepatic embolization of oesophageal varices are evaluated; indications, contra-indications, complications and results are discussed. Results are analyzed in term of: history of past bleeding, bleeding at the moment of the procedure, successive surgical or medical treatment. Moreover portal haemodynamics variations induced by the procedure are evaluated.

A group of 24 patients in senile age was subjected to major demolition operations, for purposes of radical removal of gastric carcinoma (total gastrectomy, subtotal resection, oesophago-gastric resection). In six patients the major operation was widened by partial demolition of neighbouring organs (liver, colon, pancreas). The flattering results (both immediate and long-term) obtained from this operation and the progress reached in the knowledge and correction of the senile physiopathological alterations allow encouraging developments to be forecast for this surgery, the success of which is subject to careful tactical selections and to close multidisciplinary cooperation directed to strengthening vital reserves, assistance of main functions and prompt recognitions and treatment of any complications.

This is a report on 28 Warren-Shunts, 17 of these patients had undergone clinical, hematological and angiographic controls 2--46 (mean 10) months after the operation. The critical evaluation of the results shows that the Warren derivation, which is selective at the moment of operation, develops in the following time some hepatofugal circulation. This is a more radical effect than the intended drainage of the gastro-esophageal venous bed alone.

The Authors' aim was to assess the effectiveness of Sequential Scintiphotography of the Liver with 99mTc-HIDA (SSFH) in the evaluation of post operative jaundice, in operations of biliary derivation (43 observations in 28 patients). SSFH proved to be highly reliable even in comparison with more laborious procedures (such as Transhepatic Cholangiography), and superior to equally simple procedures such as Echo Tomography and Computerised Tomography, evidencing itself as the investigation of choice for the study of this pathology, especially in long-term follow-ups.

The authors describe one case of relapsing postoperative atelectasis occurring with considerable severity after an upper left lobectomy for malignancy in a man of 68. Said complication recurred no fewer than six times during a hospital stay of 44 days and constituted a major threat to the good outcome of surgery. The patient was finally discharged in good conditions, and a later recheck revealed no important alterations in the surviving lower left lobe.

The Authors report a case of bilemia, a complication of hepatic biopsy. They analyse the physiopathogenetic problems and those of surgical tactics, and emphasize the importance of retrograde and/or interoperative cholangiography ii the diagnostics of such disease.

Adenomiosis of Vater's papilla is an organospecific dysplastic process, clearly linked to age and not dependent on other pathological processes of the biliary axis. The reasons for which it is diagnosed in preoperative biopsies with a frequency lower than should be expected on the basis of investigations performed on cadavers are stated. In particular, pathogenetic weight is stressed as a cause of Vaterian stenosis, especially in elderly subjects cholecystectomized many years earlier.

18 patients underwent CT-investigation with bolus injection of contrast medium 5 to 11 years after splenorenal Warren shunt. According to this investigation all patients were found to have developed hepatofugal collaterals in consequence of distal splenorenal anastomotic suction. In most cases the portal liver perfusion was maintained. These effects are not homogeneous and show variations from patient to patient.