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Authors report a recent case of cholecysto-gastric fistula. On the basis of their own experience and of the literature, authors discuss the pathogenesis of the cholecysto-enteric fistulas and underline the relative non frequent of fistulas with the stomach. Authors stress the available diagnostic and therapeutic features and believe that this disease deserves, whenever possible, a surgical correction.

Aim: Systematic exposure and isolation of the inferior laryngeal nerve in thyroid surgery is a secure method to prevent complications. The knowledge of the nerve anatomy and its anomalies is essential to reduce laryngeal nerve injuries. By a re-examination of literature we underline the importance and some particular anatomical aspects of the anomalies which, even if rare, present an incidence of about 1%., Methods: From January 1995 to December 2002 in our hospital we performed 299 interventions for thyroid diseases: total thyroidectomy (254 cases), partial thyroidectomy (45 cases). In 2 cases we observed a high variant (type I) of non recurrent laryngeal nerve., Results: The global incidence of non recurrent laryngeal nerve was 0.66% (2/299 operations) and 0.72% if we consider the explorations of the cervical right side (2/274) where this anomaly is more frequent. The incidence of nerve injuries was 2/299 (0,66%); we had no complications in the 2 cases of non recurrent nerve observed., Conclusions: Our experience in thyroid surgery confirms the common opinion that only the knowledge of the laryngeal nerve anatomy and the awareness of its anomalies, associated to the systematic exposure of the nerve during surgery can prevent surgical injuries.

Congenital anomalies of the inferior vena cava are a relatively rare pathology, usually with an asymptomatic iter. They are usually diagnosed by chance during surgery on the aorta or retroperitoneal structures. From bioptic material their incidence is estimated to be 2-3% and the percentage of intraoperative findings varies in different series between 0.2 and 0.6%. Of the various kinds of anomaly, caval duplication and a left-positioned vena cava are those most commonly found. The recent report of a case of a malpositioned vena cava and iliac veins prompted us to re-examine the literature and revise our series of cases.

Background and Aims: The aim of this study was to evaluate the results obtained using Scopinaro's biliopancreatic diversion technique (AHS-BPD) in the surgical treatment of morbid obesity., Methods: A retrospective study was carried out in 69 patients with a follow-up ranging between 6-44 months. All patients were operated and monitored by the Obesity Surgery Centre operating in Sardinia since february 1995 at the Department of Emergency Surgery of Sassari University. All the patients were severely obese with a mean BMI of 51.58 and, in the majority of cases, presented associated metabolic diseases with the following incidence: type 2 diabetes in 40.57%, arterial hypertension in 36.23%, severe alteration of lipid status in 52.17%; in overall terms, a plurimetabolic syndrome was present in 24.63% of cases. All patients underwent biliopancreatic diversion using Scopinaro's classic technique (AHS-BPD). Controls were carried out at set intervals (1-3-6-12-18 and 24 months) to evaluate weight loss and the metabolic effects of surgery in terms of the lipid, glucose and protein status., Results: Results were good, as confirmed by the marked weight loss (BMI after 24 months: 30) and the normalisation of cholesterol and glycemia. No major reductions were observed in proteinemia and albuminemia levels., Conclusions: In the light of these results, the authors affirm that Scopinaro's technique is a valid solution for the treatment of morbid obesity. Its relatively invasive nature is justified by the results obtained in terms of weight control and its effect on associated metabolic diseases.

Background and Aims: The aim of this study was to compare the experiences and results achieved by a single surgeon using total thyroidectomy and partial exeresis in the treatment of uni- and multinodular euthyroid goiter., Methods: The results of two groups of operations performed at two different periods were analysed: a more recent group (1995-97) in which management tended to prefer total thyroidectomy, and a retrospective group (1984-1994) in which a more conservative attitude was adopted to benign thyroid pathology., Results: An analysis of the results and complications in each group showed that there were no statistically significant differences between the percentage of recurrent and parathyroid lesions during total thyroidectomy and partial exeresis. In practice, the risk of these lesions is higher during redo surgery for cancer and/or recurrence. The recidivation of goitrogenic pathology is high, amounting to around 29% of total cases. The most significant findings, however, which further justifies the use of total thyroidectomy is the increasingly frequent observation of "occult carcinomas" within the benign pathology, registered in the retrospective group (13.27%) and in the more recent one (12.35%)., Conclusions: On the basis of this analysis, the authors confirm their support for the use of total thyroidectomy on principle as the correct and rational treatment for euthyroid goiter, and reserve the use of conservative treatment for single nodular lesions where it is possible to perform a correct hemithyroidectomy and isthmectomy following the patient's informed choice.

A study was made of the risk factors causing a high incidence of surgical wound infections in clean operations. Identification of these factors in the preoperative stage allows the patients to be divided into two categories: a high risk (about 10% of patients for surgery) and low risk. By giving antibiotic prophylaxis only to patients at high risk, the incidence of postoperative infections can be reduced, decreasing the number of extra days in hospital and consequently lowering costs. This is a new approach to the problem of surgical wound infections since not only is it based on the usual classification of operations into clean, clean-contaminated, contaminated and dirty, but it also takes into account the defensive capacity of the target of the infection: the patient.

Nipple secretion is an important clinical symptom in the context of breast pathology second only, in terms of incidence and diagnostic role, to the presence of a mammary nodule. Its importance derives from its possible association with cancer (from 3% to 47%) of which it may be the earliest sign, even if it is most often in relation to a benign pathology. The authors report their experience from 1988 to the present in 60 cases of mammary secretion out of 1200 patients attending the clinic.

The authors analyse their experience of 30 cases of which 25 underwent surgery. In addition to the onset of complications, indications for surgery were based on the presence of severe painful symptoms which did not respond to medical treatment. Over the past few years the latter have represented one of the main indications with a success rate of between 80-90% of cases. The type of surgery must be personalized to the characteristics of each individual patient on the basis of morphological alterations of the gland, which are easily defined during a preoperative study using CPRE, ultrasonography and CT. Of these, CPRE has been found to be the most reliable in diagnostic terms, since it can detect structural alterations at a relatively early phase and is of considerable value in differential diagnosis, which is at times extremely difficult, with pancreatic carcinoma.

Trans-mesenteric hernia is a rare case of intestinal obstruction. A peculiar characteristic of this form of hernia is the absence of a sack and recess; in the majority of cases, hernia is due to congenital defects of the mesentery. In clinical terms, hernia is manifested by signs of intestinal occlusion in patients of any age. Occasionally, hernias may be found during surgery or autopsy.

Having underlined the importance of an extremely early diagnosis of gastric cancer, the paper focuses on the diagnostic capacities of endoscopy and bone x-ray using a dual-contrast technique. From an analysis of published reports and on the basis of their own experience, the authors prefer, whenever possible, to combine the two methods, since this is the only way of revealing minimum neoplastic stomach lesions in almost 100% of cases.

A case of primary duodenal adenocarcinoma is described. A discussion is made about the rarity of this tumor that, as it is frequency misdiagnosed in cases of malignant neoplasms of the papilla of Vater and of terminal part of the common biliary duct, may be greater than all previously thought. Tumors of the third part of duodenum are even more uncommon. Whipple resection seem the best cure of this tumors, as results from long term survival.

Even though the present tendency is to make use of radical operations, such as pericystectomy, hepatic resection and lobectomy, in the surgical management of hydatidosis of the liver, marsupialisation is still the method of choince in a large and clearly defined number of cases. While usually simple, this operation may prove difficult and complex when used on cysts of the cupola, since it may often be necessary to mobilise the liver to a large extent and employ damaging approach routes. A description is offered of a particular technique for tunnelling the desinage tube which considerably simplifies marsupialisation in cases of this kind.

Out of 3000 radiograms of the upper gastrointestinal tract, followed by an endoscopic examination, performed at the Institute of Clinica Chirurgica of the University of Sassari from 1974 to 1980, the Authors found only three cases of gastric diverticula. This confirms the relative rarity of this disease. On the basis of these three observations, an analysis of some of the clinical and therapeutical aspects of gastric diverticula is then made.

A personal venous thrombectomy technique employing a modified Fogarty catheter is described. The end of the catheter to which the syringe is normally applied is cut off to enable it to be used in a retrograde manner. In this way, thrombectomy is always performed in the direction of the current, irresapective of the site of the thrombosis in the venous axis of the lower limbs. This type of operation offers two advantages. It preserves the integrity of the valves and does away with the risk of intraoperative embolisms. It is described as "physiological thrombectomy". If the thrombosis involves the entire iliac-femoro-popliteal axis, the catheter is inserted retrogradely via the small saphenous at the, and removed via an iliac phlebotomy obtained by means of an extraperitoneal abdominal incision. When the thrombosis is femoropopliteal only, the catheter is inserted through the origin of the small sphenous and withdrawn via the venous incision. Lastly, in cases where the common iliacofemoral axis alone is involved, retrograde insertion takes place through the large saphenous vein in the inguinal region. Preliminary results obtained with the technique are described.