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The Hartmann procedure has, in emergency colo-rectal surgery, many implications. The decision is based on clinical, radiological, instrumental and pathological findings. The authors report the results of 76 Hartmann's procedures performed between 1986 and 1995 and compare their results with those found in the current medical literature on the topic. In particular, they draw attention to an increased use of this procedures in colo-rectal emergencies; the morbility and mortality rates confirm the severity of the clinical cases that can be treated with this operation. To improve results the authors propose a therapeutic plan that uses a score for stratification of the risk (MPI, APA-CHE II, SSI, Hinchey); so the surgeon can choose the best surgical operation. Finally, the authors underline the importance of the principles of oncology surgery in colo-rectal cancer.

The treatment of NIDDM patients with secondary failure to sulfonylureas is still a debated problem. In this study we compared in NIDDM patients with secondary failure to glyburide, the effect of adding a single, low-dose bed time either NPH or ultralent insulin injection (0.15-0.2 U/kg) to the previously ineffective sulfonylurea treatment. Both NPH and ultralent insulin therapy have been demonstrated to be effective in ameliorating metabolic control in NIDDM patients with secondary failure to sulfonylureas. However, the addition of bed-time ultralent insulin caused a greater and significant decrease in post prandial plasma glucose. In contrast, the average fasting plasma glucose decrease was significantly greater after NPH insulin administration. These results indicate that in NIDDM patients with secondary failure to glyburide bed-time ultralent insulin administration is a better tool to improve the post prandial plasma glucose.