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The aim of this work was to describe the model and clinical results obtained by the Niguarda Trauma Team referral center for major trauma, in Milan. The Trauma Team is organized as a trauma service, where general surgeons, anesthesiologists, orthopedic surgeons and neurosurgeons work on a 24 hour rotation. When not in duty in the rotations, specialists work in their specific elective activities. The director of the Trauma Team has the responsibility for discussion and application of protocols, clinical assistance, quality assessment and training. The results of 1334 consecutive cases of major trauma during a 51 month period were reviewed using the trauma registry. 39% overtriage, which increased over the years, and 1.12% undertriage were recorded. Mortality of patients with injury severity scores > 15 was 21%, with a progressive decrease over the years. Blunt trauma accounted for 91.75% and were road-related in most cases. Skeletal injuries were the most frequent findings, but brain and thoraco-abdominal injuries were associated with a higher risk of death. 1476 surgical procedures (16.93% general surgery and 111 interventional angiographic studies) were performed. Quality assessment revealed a significant decrease in preventable deaths within the first 72 hours, after excluding patients admitted in extremis. The results presented in this study demonstrate the possibility of realising a model of organized trauma care in an emergency department in Italy, with patient outcomes comparable to those obtained in Trauma Center in other countries.

An analysis of the current status of carotid body tumors (chemodectomas) including the report of one additional case is presented. Comments are made regarding the clinical recognition and treatment of chemodectomas in general. Historical, anatomic, physiologic and pathologic features are emphasized.

The Author considers 80 cases of mesenteric infarct which have been observed in the emergency Ward of the Milan Ospedale Maggiore. A discussion follows of the problem of etiology on hand of the literature and of the most recent views on the functional infarct. Attention is given to macroscopical and microscopical anatomy and pathogenetic interpretation is offered, basing upon the results of experimental investigation work. The Author underlines the most important characters of the clinical picture as derived from their experience, discusses the diagnosis and offers a schema for therapy on hand both of classical knowledge and of the new possibilities offered today by modern surgery and by the adoption of new drugs. It is concluded that the statistical data show a considerable decrease of recent operative mortality both compared to recent years and to percentages reported by other AA.

A woman aged 15 without any notable pathological history, was submitted to an operation because of a gradual growth of her umbilical region for a month. A tumor as large as an hazel-nut, was an angiofibroma of the round ligament of the liver. The round ligament may give cysts and tumors as the allantois does. If the tumors are generally malignant when situated in allantois, they would not always be mild when in the round ligament, as attested by a late observation in litterature.

The Authors have collected during 28 years 26 cases of acute perforation, in free peritoneum, of gastrojejune ulcers in subjects who, in precedent times, had been operated for gastro-duodenal ulcer. In 24 cases the rafia has been practised, with 5 deceased: in two cases immediate resection has been practised, with two recoveries. The Authors do some considerations about the aetiopathogenesis of peptic post-resection ulcer and about its perforative complication, and also about the urgent surgical therapy that, except exceptional cases for special anatomic-pathological conditions, must be limited to the simple rafia, referring to futher time radical gastro-jejune-resection.

Functionally, cronic, athrophic gastritis is associated with a disturbance of gastric mucosal resistance. Alteration of the gastric mucosal barrier is thought to play a major role in the pathogenesis of the cancer of the stomach, particularly in presence of a special histological picture of mucosal intestinalisation.

Hundred twenty five patients with multiple areas of injury requiring surgical repair outside of the abdomen too were subjected to laparotomy. In patients with multiple areas of trauma the abdomen is almost always suspect. The proliferation of diagnostic tools to detect intraperitoneal damage have, in some ways, helped phisicians decide as to laparotomy. However, when multiple injuries are present, particularly of the central nervous system, classical findings of peritoneal damage are difficult to elicit. A diagnostic laparotomy does not add significantly to the overall morbidity or mortality, for that we think is still a place for diagnostic laparotomy in patients with multiple trauma.

Our experience with 26 Patients who sustained traumatic laceration of the diaphragm caused by blunt forces is described. Automobile accidents were the most frequent cause of rupture and young adult males the most vulnerable. The left hemidiaphragm is most frequently injured, but with sufficient force significant tears in the right hemidiaphragm will occur. Most of these patients sustained injury to multiple organ systems. The preoperative diagnosis of traumatic diaphragmatic hernia is based on a high index suspicion, close and continued observation of the patient, and correct interpretation of roentgenograms of the chest. The mortality rate is high owing to the magnitude of the injuries.

After a brief review of the literature, 42 cases of Douglas-pouch peritonitis are described, with particular regard to those cases arosen as a complication of acute appendicitis. Symptomatology and anatomo-pathological pictures are carefully described and the most likely pathogenetic causes are discussed. Particular attention is paid to the surgical techniques used.