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Introduction: Esophageal perforation has been considered a catastrophic and often life-threatening event, with very high mortality rates. Most of the cases are due to a complication in endoscopic manouvers and the best treatment, conservative rather than aggressive, remains a controversial topic., Material and Methods: In 1995-2005 period we observed 7 cases of esophageal perforation, 5 women and 2 men mean age 73.2 y (range 60-87). Three cases are due to foreign body ingestion, 2 cases to endoscopic manoeuvres, 2 cases were spontaneous. In 3 cases the lesion was in the cervical tract of the esophagus, in the thoracic tract the others. All the patients were admitted very early to our Unit and presented disphagia, vomiting and dyspnoea, 2 out of them also a pleural effusion. In iatrogenic perforation we performed a cervicotomy and a drainage of mediastinic abscess, while in spontaneous lesions mono (one case) or bipolar esophageal exclusion (one case) with primary suture, jujunostomy and drainage of pleural effusion were the treatment. In foreign body perforation we performed thoracotomic and cervicotomic esophagotomy, extraction of the foreign body, direct suture with pleural or muscle protection. We didn't observe any intra or post-operative mortality. About the complications, we observed a bilateral pleural empyema, a chylous fistula, a digestive bleeding due to gastric ulcer, a laparotomic infection, a parossistic FA and a persistent esophageal fistula. Mean hospital stay was 24.3 days (range 10-43). All the patients were discharged to the hospital in good conditions., Conclusions: In conclusion in most of the cases of esophageal perforation the surgical treatment is the treatment of choice for its lower morbidity and mortality and good functional results.

The adrenal glands are often the site of metastases. However, there is much discussion as to the benefits of surgical resection. Personal experience of surgical treatment in 4 patients, one of whom died postoperatively after bilateral adrenalectomy for metachronous metastases, is reported. Surgery achieved pain relief in all patients, average survival was 30 months and 1 patient is still alive after 68 months. The present study shows that surgery is advisable in patients who present the following characteristics: 1) the primary tumor has been resected or is radically resectable, 2) there is no evidence of other metastatic lesions, 3) the adrenal metastasis is unilateral and complete resection is possible, 4) the patient's general physical condition is good.

Postoperative morbidity and mortality were correlated with the preoperative results of three widely used pulmonary function tests (FVC, FEV1, FEV1/FVC) in 100 consecutive patients who underwent pneumonectomy for lung carcinoma. Factor analyzed following operation included thirty-day mortality, incidence of cardiovascular and respiratory complications, number of individuals requiring prolonged mechanical ventilation. Nineteen patients had a forced vital capacity (FVC) of 70% or less of the normal value, seven had a one-second forced expiratory volume (FEV1) of 1.5 liters or less, and thirty-three had a FEV1 of less than 2 liters. Fourteen patients had a FEV1/FVC ratio of 65% or less. There were no differences in morbidity or mortality between these patients and those presenting higher test scores. As a general rule, decisions regarding operability and extent of resection cannot be made solely on the basis of the three spirometry tests reviewed.

The Authors studied the effects of a short-term prophylaxis (Aztreonam + Clindamycin) administered to 259 patients operated on for colo-rectal diseases. Thirteen wound sepsis (5.15%) and 49 different infections (19.44%) occurred in this group of patients. The study confirms the link between P.N.I. greater than 50 and the incidence of wound infections. The incidence of urogenital sepsis was correlated with the catheterization period (greater than 6 days), operative time (greater than 200 min.), hospitalization (greater than 12 days) and age (greater than 70 years). General tolerance to the antibiotics was good.