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The aim of surgical treatment of fistula-in-ano is to eradicate the suppurative process permanently without compromising faecal continence. The appearance of a recurrence of fistula-in-ano is often due to non-identification of the internal opening by the surgeon, and to the presence of complex fistulae. We evaluated the clinical course of 214 patients in a randomised. controlled trial with respect to the recurrence rate of anal fistula with or without preoperative endoanal ultrasonography. In this study we demonstrate that endoanal ultrasonography was the most accurate diagnostic modality for detecting internal opening and complex fistulae. Therefore, endoanal ultrasonography is reliable and useful in the preoperative assessment of anal fistula, and particularly for decreasing the recurrence rate of this disease.

Introduction: The aim of the study was to define the therapeutic approach used for obstructing colon cancer., Patients and Methods: In the period 1990-2002 in the Emergency Surgery Department of the University of Naples Federico II, 81 patients underwent colon surgery for obstructing colon cancer (25 M, 57 F, age range: 55-88 years, mean: 72). Were performed subtotal colectomies, left or right hemicolectomies, sigmoid colectomies, anterior resections, temporary or permanent enterostomies. The authors put morbidity and mortality in touch with the type of surgical operation and with results of the literature., Results: Mortality was 32%: 2.4% as a result of an anastomotic dehiscence; 4.9% for cardiovascular pathologies; 1.2% for sepsis; 23.4% for metastasis. Morbidity for anastomotic leakage was 4.9%: 2.4% after left emicolectomy and colo-colonic anastomosis; 1.2% after right emicolectomy and ileo-colonic anastomosis; 1.2% after defunctioning colostomy and left emicolectomy after 20 days., Conclusions: This experience suggests that a subtotal colectomy with primary anastomosis (one stage) can be performed more safely, by an experienced, skilled surgeon, in patients in good clinical conditions with acute obstruction of the colon. Healing remains a process depending more on the patient than on any aspect of the surgical technique. A defunctioning colostomy may be idealfor surgeons with little experience in colorectal surgery and in high risk patients with a very poor prognosis (unresectable lesions).

The authors discuss Superior Thoracic Outlet Syndrome (STOS), which is characterized by aspecific symptomatology. However, some tests may be used to reveal the specificity of the disease. In the past, treatment was often followed by recurrence of the disease. In the last ten years, the Roos operation has been used with a high success rate.

The authors report their experience of the endoscopic removal of 350 polyps of the colon. Vegetating lesions of doubtful endoscopic appearance and nature were excluded from this study. Indications regarding intestinal cleaning and the most appropriate pharmacological preparation are given on the basis of personal experience. No patient had to be hospitalised and the colon was fully explored in all cases; the cecum was reached in 85% of cases. The maximum limit of endoscopic removal was 5 cm due to the greater risk of complications and presence of cancer on polyps. A total of up to 8 polyps were removed in a single session in cases of multiple polyposis. From 1986 to 1992 350 polypectomies were performed in 177 patients, of which 301 were adenoma (85.9%) and 49 mixed (14.1%). Adenomas were 80.5% tubular, 13.6% tubulo-villous and 4.3% villous. Cancer was found on polyps in 5 cases (1.6%). 146 polyps were found in the rectum (41.8%), 84 in the sigma (24%), 76 in the descending (21.7%), 21 in the transverse (6%), and 23 in the right colon (6.5%). Patients were aged between 3 and 81 years, and the most frequently affected age bracket was between 40-70 years. Follow-up consisted in checks at 6, 12 and 24 months in cases of adenoma and quarterly checks during the first year in the event of carcinoma in situ. The decision to use a diathermic loop or hot biopsy was made in relation to lesion size, reserving the former for polyps with diameters of over 8 mm. All polyps under 5 cm were removed and subjected to histological tests. No cases of early or late complications were reported in the 350 polypectomies performed. The authors indicate the criteria of choice which led to surgical resection of the first instance. In the event of in situ carcinoma, endoscopic removal is considered sufficient provided that it is radical. The following must be evaluated in the case of invasive carcinoma: tumor size, the degree of differentiation, lymphatic or vascular invasion and generic or specific risk factors linked to the individual patient.

Adrenal cysts are uncommon. A case of left adrenal cystic lymphangioma in 16 year old boy is reported. The adrenal cyst was a chance finding during radiological investigation for abdominal pain. Ultrasound and CT scan showed the cyst and suggested the correct diagnosis of cystic lymphangioma of the left adrenal gland. The patient underwent surgery and a left adrenalectomy was performed. Histology confirmed the previous diagnosis of cystic lymphangioma.

The authors have evaluated the efficacy of Fluconazole (400 mg/iv/die for three days and after 200 mg/iv/die for 18 days) in three AIDS and SNC Cryptococcal infection patients. Two patients have shown healing of meningeal syndrome and negative isolation after 21 days of therapy; one patient, however, died because of Cytomegalovirus pneumonia. It is of note that early spinal puncture in AIDS patients with neurological symptoms enables an early diagnosis and immediate therapy. Fluconazole treatment has been well tolerated and immediately effective to resolve two of the cases observed; the oral prophylaxis with 100 mg/die of Fluconazole after 6 months has been effective to prevent the relapses of the disease.

In AIDS, immunitary system dysfunctions are manifold and regard both T and B-lymphocytes. The increased levels of circulating immune complexes (CIC) in HIV-Ab positive patients, immune complexes abnormalities, should be considered as an epiphenomenon of humoral immunity altered function; therefore, they are devoid of any diagnostic value.

The present study was designed to demonstrate the role of homosexuality in transmission of HIV infection. The results, in cases showed by authors, suggest that the homosexuality is not significative for transmission in HIV infection. Whereas it is significative (56.52%) in transmission of syphilis. The study has demonstrated that homosexuals are not disposed very much to the use of sexual prevention.

Surgical indications in URC are examined in relation to various situations of election, emergency and urgency. The various possible surgical procedures are analysed, stress being laid on criteria of choice which take account of the seriousness of the disease and of the different technical solutions now available. A series of 30 operations in 145 cases of URC is presented and complications examined in relation to the type of operation performed and to the indications. Stress is laid on the importance of intervening adequately so as to achieve the best prognostic results.

The authors studied 54 patients suffering from rheumatoid arthritis by sigma SR method. The sigma SR, unlike the ESR, often reveals inflammatory activity in patients suffering from possible or probable rheumatoid arthritis and is very useful to diagnose the disease. The sigma SR constantly increases when the disease is in active period, unlike the ESR, in patients affected by classic or definite rheumatoid arthritis. The authors conclude the sigma SR determination is useful in every case of rheumatoid arthritis, especially when the disease is at beginning and is difficult to be diagnosed, i.e. cases of possible and probable rheumatoid arthritis, and when clinical and biohumoral picture disagree.