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The authors analyse the factors that have conditioned the early development of day-surgery in Italy and enumerate its fields of application. They outline the history of day-surgery and report the results of studies, citing laws, documents, rules and guidelines governing its application in Italy today. They also analyse the reasons why a more widespread use of day-surgery is proving difficult in Italy. They consider the surgeon's liability and briefly report the results of day-surgery activity at the "G. Martino" Polyclinic Endocrine General Surgery Unit in Messina, consisting in over 3000 operations since 1987. In conclusion, they consider the undoubted advantages of day-surgery for selected operations and stress that it is an effective alternative in comparison with the traditional hospital stay, according to the new philosophy inspiring modern medical care, namely, that of "operating better, in the patient's interest, at lower cost, and quickly".

The aim of this article was to present a case of gastrointestinal stromal tumour (GIST) presenting with acute intestinal bleeding. The Authors outline the histogenetic, clinical, diagnostic and prognostic profile of this pathology. Technical progress in immuno-histochemical and ultrastructural diagnostics has made possible to go beyond the old definition of gastrointestinal stromal tumours and identify several subgroups of such tumours on the basis of nervous and/or muscular phenotypic differentiation. The histopathological and structural variety of GIST accounts for their different clinical manifestations and variable and unpredictable biological behaviour. Histological criteria are by no means of absolute value: tumours considered benign on the basis of histology may present a malignant behaviour in the course of time, with the development of metastases and recurrences. In this regard, a number of predictive malignancy indices have been identified such as the patient's age, tumour size, presence of haemorrhage and necrotic areas, high mitotic index (> 5 mitoses/50 HFP), and kit-gene mutations. The Authors stress the diagnostic importance of 99m Tc-RBC scintigraphy in the case reported and agree with the literature as to the appropriate therapy, consisting in intestinal resection. The therapy of active GIST is essentially surgical and consists in resection of the intestinal tract affected by the tumour: lymphadenectomy must be performed only in case of need, because GIST metastasis preferably via the blood stream. As far as therapy is concerned, the demonstration of kit-gene mutation, expressed by the more aggressive forms, has made it possible to produce an inhibitor of protein tyrosine kinase Ber-Abl, which causes selective inhibition of cellular proliferation both in vitro and in vivo and induces apoptosis of Ber-Abl positive cell lines.

They conclude that numerous factors contribute towards causing haemorragic complications, such as the technique used for haemostasis, the drainage, and the haemorragic risk factors presented by the individual patient. Prevention of bleeding, however, will depend essentially on the surgeon's experience and the precautions he takes. Of particular interest is the use of FloSeal (collagen and thrombin gelatine) to treat bleeding from retroneural arterial vessels, wich has often been seen to pose a serious problem for the surgeon. The results obtained in the case series described confirm the validity of this haemostatic sealant (arrest of bleeding in 100% of treated patients).

The authors examine the complications of open prosthetic surgery for incisional hernias and analyse them from different points of view. The case series includes, over a period of 16 years, 492 hernioplasties for incisional hernias and 160 (32.5%) for large incisional hernias. The authors stress that the best results have been achieved by the retromuscular placement of prostheses. They conclude that while, on the one hand, the successful use of prosthetic material has marked the end of the inoperability of this pathology, such procedures are closely associated with the development of complications, which were unknown in the pre-prosthetic era and are sometimes very serious and linked to the site of the prosthesis and to the kind of material used.

The authors examine a number of aetiological, diagnostic and therapeutic aspects of iatrogenic injuries to the colon on the basis of an analysis of their own experience and a review of the literature. They highlight the low incidence of this kind of injury, which accounts for only 0.3% of all visceral injuries. Endoscopy and laparoscopic surgery are the most important causes of iatrogenic injuries to the colon. The authors conclude that these injuries are less serious and have a better prognosis than other kinds of colon perforations, because the colon is "clean" and it is possible to obtain an early diagnosis. Exceptions are lesions that occur in the course of a barium enema since these are associated with a high mortality rate which in some series may be as high as 100% of cases owing to the high toxicity of the barium contrast medium.

We report a case of a suppurative hydatid cyst of the pancreas treated surgically (internal drainage on Roux "Y" loop). Follow-up at 6 months revealed no evidence of the cyst. We emphasise the low incidence of the disease in a pancreatic site (02-2% in the literature). This was the first case in our experience despite the fact that Sicily is an area in which the parasite is endemic. We also emphasise the preoperative diagnostic difficulties: ultrasonography and computed tomography yielded very images very similar to those of a pseudocyst or cystic carcinoma. In most cases, in fact, as in the one reported here, the condition is diagnosed during surgery.

The authors report their 14 years experiences with inguinal hernia repair in elderly. The result were compared with young (< 75 years old), and confirmed that there were no significant differences between the 2 groups. The study confirmed the safety and effectiveness of the "tension-free" technique under local anaesthesia, which is proposed as the treatment of choice in elderly.

In thyroid surgery, an emergency tracheostomy is mandatory, as is well known, in acute pre- and postoperative asphyxia due to obstruction of the upper airways, especially in cases of malignant tumours. In particular conditions, in the presence of benign thyroid disease and when there is no reduction in the laryngo-tracheal lumen, tracheostomy has an important precautionary function following total thyroidectomy. The authors describe their experience with 6 patients treated by precautionary tracheostomy after total thyroidectomy for benign thyroid disease, analysing the indications and the advantages of this method.