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The vasculogenic erectile impotence, caused by occlusion and/or stenosis of arteries supplying the penis, is the most common cause of erectile failure in men over 40 years. The vasculogenic impotence is more found by peripheral vasculopathies like diabetes mellitus and nicotine abuse. It is important that the precise site of vascular lesion is established with selective arteriography of the hypogastric-internal pudendal axis. The specific aim of surgery is to increase the cavernosal arterial perfusion pressure and blood inflow in patients with vasculogenic erectile dysfunction secondary to pure arterial insufficiency. There have been multiple revascularization techniques described for the treatment of proximal or distal occlusion with variable results. Microsurgery is important for distal lesions and we think that the best candidates for the Michal II procedure seem to be those with localized obstruction of the internal pudendal, while venous arterialization is the preferred procedure for patients with pathological cavernous or dorsal penile arteries. In this paper the most important procedures to restore physiological erection are presented; however no single revascularization procedure has been generally accepted as a definitive answer to this problem. There is a need for further prospective studies with longer follow-up and more objective investigations.

Among the pathologies responsible for dysphagia in the elderly, the aortic compression on the distal oesophagus awakens a certain clinical interest. Cipho-lordosis, which is often present in aged females, worsens the effects of this compression causing other kinkings on the oesophagus already hypokinetic because of the age (presbyoesophagus). This illness often shows scare symptoms, but sometimes requires a pneumatic dilation to allow normal food assumption of the patient. The authors report on their experience of two cases, clearly documented from the diagnostic point of view; the first one was given medical treatment, the second one was treated with a pneumatic dilatation of the cardias.

The authors describe a case of a submucosal lipoma of the large intestine. Family, physiological, and remote anamnesis of the patient was negative to inflammatory or neoplastic intestinal diseases. The symptomatology was not characteristic like the several cases reported in the literature, by abdominal cramps, subocclusion or total occlusion crisis and rectal bleeding. The patient presented with a symptomatology characterized by altered bowel habit, and evacuations of blood-stained feces. The clinical diagnosis was difficult for the aspecific symptoms referred. A barium enema and colonoscopy examination showed a suspected benign neoformation localized within the sigmoid colon. The patient underwent surgery and the following histologic exam exhibited a submucosal lipoma with an atrophied superficial epithelium replaced by necrotic and granular tissue, marked architectural disarray of glandular crypts and intensive inflammatory infiltrate of tunica mucosa.

The paper gives a short critical bibliographic review of colonic preparation for endoscopy, focusing on the out-patient use of gastrointestinal endoscopy. A method of preparation based on dietary restrictions plus cathartics is proposed that allows the number of enemas used to be reduced to a minimum. The results obtained in 265 out-patients undergoing colonoscopy confirm the efficacy, practicality and tolerability of the method.

The Authors report their experience with stapler model T.A. 30 in lung resections; 100 stapled sutures were carried out in the IV Surgical Department of the University "La Sapienza" of Rome, during the period 1980-88. The use of stapler with two rows of staples allows a secure closure of the bronchial stump. Moreover, it prevents granulomas caused by suture material. The bronchopleural fistulas, serious complications of manual suturing, did not occur. Finally, this method is simpler and rapidly feasible in comparison with classic ones.