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This study investigates the relationship between long COVID and health-related quality of life (HRQOL) in patients discharged for 6 months. It included 192 patients with a history of severe COVID-19 and 192 patients with a history of non-severe COVID-19 patients that were selected through quota sampling methods from the Medical Care Monitoring Center (MCMC) of hospitals in Shiraz, Iran, in 2020. Phone-based interviews were conducted to collect data using the short form of the 12-item health-related quality of life (SF-12) questionnaire. Descriptive statistics, including mean (standard deviation) and frequency (percentage), were utilized. Statistical tests, such as the chi-squared test, independent samples t-test, Fisher's exact test, and multiple linear regression models were performed. Statistical analysis was performed using SPSS software version 24, with a significance level of 0.05. Among 384 patients, 79.95% were married, with a mean age of 53.95 years. The majority of patients in both groups were male (57.81% in the severe group and 51.04% in the non-severe group). Patients with severe COVID-19 had significantly lower quality of life scores compared to those with non-severe COVID-19 (p < 0.001, 34.45 [SD = 6.59] versus 39.64 [SD = 5.07]). Furthermore, multiple linear regression analysis indicated that severe COVID-19 inducts a significant negative effect on HRQOL in patients after adjustment of confounders (p < 0.001, B =  - 4.84). Patients with severe COVID-19 had lower HRQOL compared to those with a non-severe level. It is necessary to consider implementing policies aimed at providing social, psychological, or medical support to improve the HRQOL of patients with a history of severe COVID-19., (© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Background: Although local excision (LE) after neoadjuvant treatment (NT) has achieved encouraging oncological outcomes in selected patients, radical surgery still remains the rule when unfavorable pathology occurs. However, there is a risk of undertreating patients not eligible for radical surgery. The aim of this study was to evaluate the outcomes of patients with pathological incomplete response (ypT2) in a multicentre cohort of patients undergoing LE after NT and to compare them with ypT0-is-1 rectal cancers., Methods: From 2010 to 2019, all patients who underwent LE after NT for rectal cancer were identified from five institutional retrospective databases. After excluding 12 patients with ypT3 tumors, patients with ypT2 tumors were compared to patients with ypT0-is-1 tumors). The endpoints of the study were early postoperative and long-term oncological outcomes., Results: A total of 177 patients (132 males, 45 females, median age 70 [IQR 16] years) underwent LE following NT. There were 46 ypT2 patients (39 males, 7 females, median age 72 [IQR 18.25] years) and 119 ypT0-is-1 patients (83 males, 36 females, median age 69 [IQR 15] years). Patients with pathological incomplete response (ypT2) were frailer than the ypT0-is-1 patients (mean Charlson Comorbidity Index 6.15 ± 2.43 vs. 5.29 ± 1.99; p = 0.02) and there was a significant difference in the type of NT used for the two groups (long- course radiotherapy: 100 (84%) vs. 23 (63%), p = 0.006; short-course radiotherapy: 19 (16%) vs. 17 (37%), p = 0.006). The postoperative rectal bleeding rate (13% vs. 1.7%; p = 0.008), readmission rate (10.9% vs. 0.8%; p = 0.008) and R1 resection rate (8.7% vs. 0; p = 0.008) was significantly higher in the ypT2 group. Recurrence rates were comparable between groups (5% vs. 13%; p = 0.15). Five-year overall survival was 91.3% and 94.9% in the ypT2 and ypT0-is-1 groups, respectively (p = 0.39), while 5-year cancer specific survival was 93.4% in the ypT2 group and 94.9% in the ypT0-is-1 group (p = 0.70). No difference was found in terms of 5-year local recurrence free-survival (p = 0.18) and 5-year distant recurrence free-survival (p = 0.37)., Conclusions: Patients with ypT2 tumors after NT and LE have a higher risk of late-onset rectal bleeding and positive resection margins than patients with complete or near complete response. However, long-term recurrence rates and survival seem comparable., (© 2022. The Author(s).)

Pre-operative chemoradiotherapy (CRT) followed by surgical resection is still the standard treatment for locally advanced low rectal cancer. Nowadays new strategies are emerging to treat patients with a complete response to pre-operative treatment, rendering the optimal management still controversial and under debate. The primary aim of this study was to obtain a snapshot of tumor regression grade (TRG) distribution after standard CRT. Second, we aimed to identify a correlation between clinical tumor stage (cT) and TRG, and to define the accuracy of magnetic resonance imaging (MRI) in the restaging setting. Between January 2017 and June 2019, a cross sectional multicentric study was performed in 22 referral centers of colon-rectal surgery including all patients with cT3-4Nx/cTxN1-2 rectal cancer who underwent pre-operative CRT. Shapiro-Wilk test was used for continuous data. Categorical variables were compared with Chi-squared test or Fisher's exact test, where appropriate. Accuracy of restaging MRI in the identification of pathologic complete response (pCR) was determined evaluating the correspondence with the histopathological examination of surgical specimens.In the present study, 689 patients were enrolled. Complete tumor regression rate was 16.9%. The "watch and wait" strategy was applied in 4.3% of TRG4 patients. A clinical correlation between more advanced tumors and moderate to absent tumor regression was found (p = 0.03). Post-neoadjuvant MRI had low sensibility (55%) and high specificity (83%) with accuracy of 82.8% in identifying TRG4 and pCR.Our data provided a contemporary description of the effects of pre-operative CRT on a large pool of locally advanced low rectal cancer patients treated in different colon-rectal surgical centers., (© 2021. The Author(s).)

This study was performed to investigate published literature about the association between measles, mumps, and rubella (MMR) vaccine and COVID-19. This is a systematic review in which the databases of Chocrane, Pubmed, Scopus, Web of Science as well as reliable journals including Lancet, New England Journal of Medicine, Jama and also Centers for Disease Control and Prevention (CDC) publications were searched.Out of 169 documents discovered during the literature review, 56 ones were somehow related to the association between MMR vaccine and COVID-19, of which 11 ones mentioned the association between these two, and 8 of them contained a hypothesis about this relationship. A quasi-trial study reported the positive effect of the MMR vaccine on reducing the severity of COVID-19 symptoms among those who received it. Also, a cross-sectional study showed an association between the level of Immunoglobulin G (IgG) mumps and COVID-19. Moreover, a genomic data analysis study also reported the effect of Rubella Immunoglobulin G (IgG) level on COVID-19. It seems that due to the similarity of respiratory diseases including measles, rubella, and mumps to COVID-19, MMR vaccine should be investigated more deeply to see if it is effective in order to deal with this novel disease., Competing Interests: None., (IJMEG Copyright © 2021.)

Since the beginning of the pandemic due to the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and its related disease, coronavirus disease 2019 (COVID-19), several articles reported negative outcomes in surgery of infected patients. Aim of this study is to report results of patients with COVID-19-positive swab, in the perioperative period after surgery. Data of COVID-19-positive patients undergoing emergent or oncological surgery, were collected in a retrospective, multicenter study, which involved 20 Italian institutions. Collected parameters were age, sex, body mass index, COVID-19-related symptoms, patients' comorbidities, surgical procedure, personal protection equipment (PPE) used in operating rooms, rate of postoperative infection among healthcare staff and complications, within 30-postoperative days. 68 patients, who underwent surgery, resulted COVID-19-positive in the perioperative period. Symptomatic patients were 63 (92.5%). Fever was the main symptom in 36 (52.9%) patients, followed by dyspnoea (26.5%) and cough (13.2%). We recorded 22 (32%) intensive care unit admissions, 23 (33.8%) postoperative pulmonary complications and 15 (22%) acute respiratory distress syndromes. As regards the ten postoperative deaths (14.7%), 6 cases were related to surgical complications. One surgeon, one scrub nurse and two circulating nurses were infected after surgery due to the lack of specific PPE. We reported less surgery-related pulmonary complications and mortality in Sars-CoV-2-infected patients, than in literature. Emergent and oncological surgery should not be postponed, but it is mandatory to use full PPE, and to adopt preoperative screenings and strategies that mitigate the detrimental effect of pulmonary complications, mostly responsible for mortality.

Background: In the last decade's robotic gastrectomy (RG) has increasingly widespread as a valid minimally invasive option for treatment of gastric cancer. In literature, evidence of its routine use is not yet well established. The aims of this study are to report our initial experience and to present possible advantages of our hybrid operative technique for subtotal gastrectomy., Materials and Methods: Retrospectively, we analyzed data from 41 patients (22 male and 19 female) who underwent robot-assisted laparoscopic subtotal gastrectomy (RALG) with D2 lymphadenectomy using the da Vinci XI robotic system. Inclusion criteria were gastric cancer in the middle or lower portion of the stomach amenable of radical subtotal gastrectomy without preoperative suspicion of positive lymph-nodes or other organs involving and distant metastasis. All the procedures were performed by attending surgeons., Results: The mean operative time was 270 min with one case of conversion to open surgery. The mean age was 71.4 (IQR 68.2-76.8) with 43.9% of patients classified as ASA (American Society of Anesthesiologists) score ≥3. The median of lymph-nodes retrieved was 25 (IQR 19-35). No intra-operative complications occurred. Time to resume a soft diet was 5 days. Patients were hospitalized a median of 7 days. According to pathological AJCC-TNM, 21 patients were classified as advanced gastric cancer. Post-operative morbidity was recorded in 9 patients (21.9%) with major complications requiring surgical operation in 4 patients (9.8%). Elevated ASA score, fewer lymph-nodes retrieved and ICU recovery requirements were significant increased in patients with major complications., Conclusion: The preliminary results demonstrated that robot-assisted laparoscopic subtotal gastrectomy is safe and feasible. In particular, we found that the da Vinci platform improves surgeon abilities to perform an adequate lymphadenectomy and digestive reconstruction. Further studies are necessary to better clarify the role of this high-cost technology in minimally invasive treatment of gastric cancer., Competing Interests: None., (© 2021 The Authors. Published by Elsevier Ltd on behalf of IJS Publishing Group Ltd.)

Background: The COVID19 pandemic had a deep impact on healthcare facilities in Italy, with profound reorganization of surgical activities. The Italian ColoRectal Anastomotic Leakage (iCral) study group collecting 43 Italian surgical centers experienced in colorectal surgery from multiple regions performed a quick survey to make a snapshot of the current situation., Methods: A 25-items questionnaire was sent to the 43 principal investigators of the iCral study group, with questions regarding qualitative and quantitative aspects of the surgical activity before and after the COVID19 outbreak., Results: Two-thirds of the centers were involved in the treatment of COVID19 cases. Intensive care units (ICU) beds were partially or totally reallocated for the treatment of COVID19 cases in 72% of the hospitals. Elective colorectal surgery for malignancy was stopped or delayed in nearly 30% of the centers, with less than 20% of them still scheduling elective colorectal resections for frail and comorbid patients needing postoperative ICU care. A significant reduction of the number of colorectal resections during the time span from January to March 2020 was recorded, with significant delay in treatment in more than 50% of the centers., Discussion: Our survey confirms that COVID19 outbreak is severely affecting the activity of colorectal surgery centers participating to iCral study group. This could impact the activity of surgical centers for many months after the end of the emergency.

Aim: Pathological complete response (pCR) and clinical outcomes [overall survival (OS), disease-free survival (DFS), locoregional control (LC)] were evaluated in a single-institution experience of different schedules of neoadjuvant chemoradiotherapy (CRT) for patients with locally advanced rectal cancer (LARC)., Patients and Methods: Data for 322 patients with LARC were retrospectively analyzed. pCR was evaluated according to Mandard tumor regression grade (TRG). The Kaplan-Meier method was used to estimate OS, DFS and LC., Results: Three hundred and three (94.1%) patients underwent surgery. pCR was observed in 81 patients (26.7%), with TRG1-2 rate of 41.8%. The 5- and 10-year OS, DFS and LC rates were 82.5%±2.5% and 65.5%±3.8%, 81.2%±2.4% and 79.3%±2.9%, 93.1%±1.7% and 90.5%±2.1%, respectively., Conclusion: Neoadjuvant CRT in LARC patients resulted in favorable long-term oncological outcomes, with a high pCR rate and acceptable toxicity., (Copyright© 2020, International Institute of Anticancer Research (Dr. George J. Delinasios), All rights reserved.)

In recent years, hybrid organic-inorganic halide perovskites have been widely studied for the low-cost fabrication of a wide range of optoelectronic devices, including impressive perovskite-based solar cells. Amongst the key factors influencing the performance of these devices, recent efforts have focused on tailoring the granularity and microstructure of the perovskite films. Albeit, a cost-effective technique allowing to carefully control their microstructure in ambient environmental conditions has not been realized. We report on a solvent-antisolvent ambient processed CH 3 NH 3 PbI 3-x Cl x based thin films using a simple and robust solvent engineering technique to achieve large grains (>5 µm) having excellent crystalline quality and surface coverage with very low pinhole density. Using optimized treatment (75% chlorobenzene and 25% ethanol), we achieve highly-compact perovskite films with 99.97% surface coverage to produce solar cells with power conversion efficiencies (PCEs) up-to 14.0%. In these planar solar cells, we find that the density and size of the pinholes are the dominant factors that affect their overall performances. This work provides a promising solvent treatment technique in ambient conditions and paves the way for further optimization of large area thin films and high performance perovskite solar cells.

Laparoscopic deroofing of the solitary non parasitic cysts of the liver is a safe and effective procedure. This technique allows a wide access for surgical treatment of cysts localized in segments II, III, IVb, V, and VIII of the liver. On the contrary, the posterior segments, VI and VII, and the segment IVa, are difficult to approach laparoscopically. This report describes a laparoscopic technique used in treating 3 cases of symptomatic solitary cysts of the posterior segments of the liver. The patients were placed in the left lateral position. The fenestration treatment was easy and the mobilization of the right hepatic lobe was not required. At one year follow-up, neither postoperative complications nor recurring episodes were observed.

Background: This study aimed to compare the safety, efficacy and clinical benefits of laparoscopic splenectomy (LS) to open splenectomy (OS) in patients with hematologic disorders., Experimental Design: prospective study;, Setting: II Department of Surgery, Santa Maria Nuova Hospital, Reggio Emilia and III Department of Surgery, Santo Spirito Hospital Pescara;, Patients: 48 consecutive adult patients underwent splenectomy; 30 patients under-went LS and 18 OS. Perioperative characteristics, outcomes, complications and costs were comparatively analyzed., Results: Mean age was 35.3 years in the LS group, and 40.8 in the OS group. Mean spleen size was 11.7 cm in the LS group and 15.2 cm in the OS group. Accessory spleens were found in 5 patients in the LS group and in 4 patients in the OS group; 4 conversions to laparotomy occurred in the LS group. A total of 4 complications occurred in 3 patients of the LS; 9 complications occurred in 5 patients of OS group. Mean surgical time was 141.5 minutes for LS and 89.7 minutes for OS (p<0.005). Mean postsurgical stay was 5.8 days in the LS group and 8.5 days in the OS group (p<0.005). Response rates were similar in both groups., Conclusions: LS is comparable to OS in terms of efficacy and safety and it is associated with a shorter hospital stay. LS should become the technique of choice for treatment of intractable benign hematologic disease.

The problems of the surgery of bulky laparoceles began to find concrete solutions with the introduction of materials of synthesis that can be used to reinforce or to substitute the abdominal wall. Despite that, the ideal prosthesis has still not been found, the Dacron (Mersilene), the Polypropylene (Marlex, Prolene) and PTFE (Goretex) are today considered the best materials for the alloplasty. The authors describe their experience in matter of bulky laparocels treated with the technique of Rives. 49 patients have been operated, using Dacron in 44 cases and Polypropylene in 5. They had no mortality and no relapse, while the most frequent complication was 6 seromas, all resolved with conservative therapy. In their series 3 infections of the subcuticular occurred more of which required the removal of the prosthesis.

Carcinoma of the gallbladder is the most frequent neoplasia of the biliary tract with an incidence of 2.5-4.4 cases for every 100,000 inhabitants; it more often affects females and elderly patients (60-70 years). It is an extremely malignant tumour with an often fatal prognosis owing to both its site and the generally late diagnosis; the majority of patients in fact undergo surgery at an advanced stage of the disease when surgery is only palliative. At the Surgical Division of S. Massimo Hospital in Penne (PE) a total of 897 operations on the gallbladder and biliary tract were performed between 1988 and 1994, revealing 21 cases of carcinoma of the cholecyst (2.3%). Sixteen patients were female (male-female ratio 1:3.2) with a mean age of 67.8 years (range 58-83 years). These patients were divided into 5 stages according to the UICC-1992 classification: 80.9% of cases were stage 3-4. Diagnosis was performed intraoperatively in 2 patients, whereas in 3 cases cancer had been diagnosed by the anatomo-pathologist. A total of 3 simple cholecystectomies were performed, 4 were associated with hepatic resection and lymphadenectomy of the hilus and hepatoduodenal ligament; surgery was enlarged in 2 cases due to the involvement of adjacent organs. After exploratory laparotomy, palliative surgery was performed in the remaining 12 patients in the form of biliary and derivation. Four system were implanted for intra-arterial chemotherapy. The most frequently found histological type was adenocarcinoma (76.2%). The mean survival rate of patients who died was 7.6 months. Six of the operated patients are still alive, of whom only one with a follow-up of 4 years. In conclusion, the authors agree with those who consider carcinoma of the gallbladder generally fatal in view of the rarity of early diagnosis and the difficulties of performing radical therapy.

Intraoperative cholangiography, a diagnostic method through images introduced in to clinical use in 1932, has recently become a different technical support from that attributed by traditional surgery and it has got a different diagnostic meaning with the introduction of video surgery. The authors used it in 54 of 194 patients submitted to a CVL, always making use of the trans-cystic access, with a percentage of success of 82.6%. It was not possible in 8 patients due to the complete section of the cystic duct during the work (3 cases) and the impossibility of introducing the catheter (5 cases). There is still no common agreement about the opportunity to use IC daily: the authors think selective use is better preceded by a careful clinical laboratory instrumental preoperative study to find patients with the common duct stone. Besides, they are of the opinion that a rigorous surgical technique is fundamental to reduce the lesions of the VBP that there are not in their experience.

The active-site structure of the paramagnetic cyanomet complex of the cooperative homodimeric hemoglobin from Scapharca inaequivalvis has been investigated by solution homonuclear NMR. In spite of the large size (32 kDa), the residues on the key proximal F- and distal E-helices could be sequence-specifically assigned and placed in the heme pocket in a manner common to diamagnetic systems. These backbone assignments were greatly facilitated by the significant dispersion of backbone chemical shifts by the highly anisotropic paramagnetic susceptibility tensor of the low-spin ferric state. The remainder of the residues in contact with the heme are assigned based on unique contacts to the heme predicted by the crystal structure and the observations of scalar connectivities diagnostic for the residues. The magnitude of the dipolar shifts for non-ligated residues was used to determine the anisotropy and orientation of the paramagnetic susceptibility tensor, and the major axis found tilted from the normal in a manner similar to that found for the Fe-CO unit in the crystal structure. The combination of NOESY inter-residue and heme-residue contacts, paramagnetic-induced relaxation and correlation between observed and dipolar shifts provide a description of the heme cavity in cyanomet Hb that is essentially the same as found in the carbonmonoxy Hb crystal structure. The pattern of both the heme methyl dominant contact shifts and the heme meso-proton dominant dipolar shifts are shown to be consistent with the orientation of the axial His. It is concluded that the present homonuclear NMR methods allow effective solution structure determination in the cyanomet form for dimeric Hb and suggest profitable extension to the tetrameric vertebrate hemoglobins.

Plain abdominal film is the method of choice in the assessment of intestinal obstruction. This technique exhibits some limitations and must be frequently correlated with other diagnostic tools. Of them, US has been recently reported to allow the morphofunctional study of intestinal loops with high accuracy. Nevertheless, the literature on the usefulness of US disregards a sign of great interest, i.e., extraluminal fluid between bowel loops. Our personal experience in 56 adult patients with surgically confirmed small bowel obstruction suggests that this findings, demonstrated by US in 43 patients (73%), identifies early intestinal wall damage with high sensitivity. US, depicting fluid between bowel loops, can distinguish the various stages of obstruction, with major consequences on clinical management. US and plain abdominal film findings allowed us to distinguish three stages of obstruction: simple obstruction (15/56 patients, 27%), uncompensated obstruction (26/56 patients, 46%), and complicated obstruction (15/56 patients, 27%). These three evolutive stages exhibit different severity and require different surgical approaches.

Meckel's diverticulum is a pathology not rarely found everyday clinical medicine especially when it present with one of its complications. The specific diagnosis is a bit difficult to put because of the low sensibility and specificity of symptoms of diagnostic and instrumental techniques used. The reported case shows a rare type of complication constituted by the phlogosis of Meckel's diverticulum, itself due to an extraneous thing ingested by the patient. The authors discuss the entity of the manifestations of this pathology and highlight every aspects.

The Authors report three cases of epidermoidal carcinoma arising from a congenital cyst of the anterolateral region of the neck. This type of tumor, rarely found in daily practice, arises from a degenerate branchial tissue and differential diagnosis often includes nodal involvement from systemic neoplasias. However, diagnostic criteria of such diseases are well defined; furthermore the rarity of branchial carcinoma is opposed to the high frequency of metastatic lymph nodes deriving from tumors with similar histological aspects located in other sites which could alter the real percentage of branchial tumor manifestation.

Although a few modifications are found in DNA, 93 modified nucleosides have been found in the various RNAs. For the most part, the chemistry and structure that modified nucleosides, individually and in combination, uniquely contribute to DNA or RNA function have yet to be explained. However, there are ten physicochemical contributions that can be attributed to modified nucleosides. Of particular interest is the increasingly documented relationship between the presence of modified nucleosides in tRNAs, and the site and affinity of Mg2+ binding to RNA and its effect on function.

The authors describe a case of giant vesical calculus in an 89 year old patient. The diagnosis, as in the other cases reported in the international literature, was made after a series of laboratory and instrumental exams, for groups reported by the patient in the lower abdomen. Operated for the removal of the vesical calculus, he was considered healed after a fortnight. The vesical calculus has a mixed composition and it weighs about 380 grams. The revision of the literature shows the various chemical composition of the vesical calculus that does not permit to identify a common aetiology. It is not possible to demonstrate if the formation of this kind of calculus is primary (in the urinary bladder) or if it is proper of the high urinary tract or mixed. The most recurrent causes being various and different confirm the mixed aetiopathologic theory. The diagnosis, often casual, is made thanks to the most common diagnostic exams; as it is difficult to make a complete cystoscopic control because the bladder is almost completely occupied by the lithiasic formation. The surgical therapy consists of a epicystotomy with a following removal of the calculus. In literature, moreover, cases treated with extra-body lithotripsy are not reported, on the contrary ot happens daily for the lithiasis of the high urinary tract.

The authors present the guidelines which have been followed to introduce into their own Surgical Division an alternative method to cholelithiasis treatment: laparovideocholecystectomy (l.v.c.). They point out how the directions for use of the new surgical method, in place of the traditional laparectomic technique, must be limited to non-complicated cholelithiasis cases, especially in the initial learning stages. That sets the global "morbility" of the above said l.v.c. beneath the cholecystectomy performed with traditional technique. In addition, they point out the sure economic advantages at social and contributions level arriving at the conclusion that l.v.c. is the best treatment for Gallstones.

The authors describe two cases of recent observed internal-hernia, regarding in the first case the right para-duodenal dimple, and in the second a mesenteric breach. They report the clinic presentation and the diagnostic and therapeutic approach compared with the data deriving from the international literature. A complete clinical classification of the internal-hernia is illustrated showing the different clinical signs. The respective symptomatology that in the initial phases of this pathology is not too evident, shows that the internal hernia should always be held in due consideration at the moment of diagnosis because the consequent mortality due to complications such as intestinal-gangrene is rather high.

The authors discuss their experience of six cases of cancer of the gastric stump observed by them in the period from 1988 to 1992 inclusive. All the patients were operated; five total gastrectomies and a gastric re-resection were effected. In association also the spleen was removed in four patients, in one of them a hepatic metastasectomy and a distal pancreasectomy were effected. In the discussion the problems concerning the diagnostic and therapeutic implications with some references to the more likely etiopathogenetic theories were dealt with.

The Chilaiditi syndrome or viscero hepato diaphragmatic interposition is a rare anomaly. The authors describe one case they observed. Even if it is often asymptomatic, it may manifest also by recurrent sub-occlusion or occlusion. Only a few patients need corrective surgical operation. The operation of choice is hepatic extra-peritonealization, which after replacement of the dislocated gastroenteric tract, brings the superior face of the liver again into direct contact with the related diaphragmatic dome.

The authors discuss a case of Grynfeltt's quadrilateral lumbar hernia in an 85-year-old patient. These rather rare hernias can be classified as Grynfeltt's hernias of the superior lumbar space, as Petit's inferior lumbar space and as diffused hernias concerning the whole hip. In our case this hernia was located in the superior lumbar space and it was delimited on the upper part by the 12th rib and by the serratus posterior-inferior muscle; in the lower part by the internal oblique muscle and by the lumbar quadratus muscle. Surgical treatment was effected by plastic surgery with synthetic material put in the extra-peritoneum space and fixed by serum-muscular stitches. Postoperative control effected after a month from the operation proves a good keeping of the plastic surgery reconstruction with total disappearance of the hernia.

Following a discussion of the various methods of colorectal anastomosis in cancer surgery, the Authors describe a technical variant using a mechanical stapler in a high rectal location. The rapidity of anastomosis as well as the decreased risk of dehiscence, fistula and stenosis are underlined.

Three cases of chronic gastrointestinal bleeding are described; the Authors emphasize the important role of mesenteric arteriography in establishing site and nature of bleeding. The review of international literature shows a success rate between 41 and 73% of cases studied with this method after negativity of other diagnostic procedures.