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Despite what is commonly believed, the diagnosis of acute appendicitis is not always easy. Proof of this is the high rate of negative appendicectomies performed yearly in any surgery unit. "Unnecessary" operations involve a huge waste of resources and are sometimes associated with severe complications. In an attempt to obtain a more accurate diagnosis many authors recommend the routine use of sophisticated investigations, which are not always non-invasive and sometimes fail to yield encouraging results. The aim of this study was to retrospectively analyse a group of patients with suspected appendicitis and establish whether certain clinical and instrumental parameters may improve the surgeon's management of such cases and reduce the misdiagnosis rate. Our false-positive rate is in line with those of other studies conducted with the routine use of advanced diagnostic tests without any waste of financial resources or increase in time to diagnosis. These data suggest the superiority of traditional guidelines, based on a careful clinical diagnosis and on common laboratory examinations and ultrasonography, while advanced investigations should be reserved for diagnosing the few ambiguous cases, which are generally confined to more elderly patients.

The Authors report a case of acute abdomen caused by a perforated solitary diverticulum of the cecum recently treated. This is a rare disease that usually is diagnosed, in the surgical theatre because it is a topic of emergency surgery. From Literature analysis it is obvious that a correct preoperative diagnosis is difficult to make because of the large number of possible abdominal pathologies with similar symptoms. Also the therapeutic approach is so extremely variable that the operation could range from a simple conservative type to right hemicolectomy. A proper approach will be conservative with a simple diverticulectomy when the inflammatory reaction is localized in the colonic wall while a right colectomy could be performed when the inflammatory reaction is more advanced or a large mass suggestive of a carcinoma is present.

Congenital deficiency or acquired laxity of the suspensory ligaments, that usually hold the spleen in place in its compartment, may result in extreme splenic mobility. Consequently, this mobility predisposes to torsion of the elongated splenic vascular pedicle creating a situation of acute abdomen due to haemorrhagic infarction. Various imaging modalities for diagnosing the wandering spleen such as ultrasonography, CT scan, MR-angiography, nuclear scan and arteriography are of great value both in the asymptomatic condition and in acute abdomen. We report on an unusual case of wandering spleen with torsion of the pedicle in a middle-aged woman which we casually diagnosed intraoperatively. It was not possible to preserve the wandering spleen by means of splenopexy because the splenic infarction required a splenectomy. Though the condition was not diagnosed prior to surgery, prompt intervention enabled the prognosis to remain unvaried. We review the cases reported in the literature and discuss the diagnostic and therapeutic problems raised by this rare condition.

Carcinoma of the body and tail of the pancreas still remains the disease form with the worst prognosis and evolution. In spite of a huge improvement in diagnostic methods, anaesthetic and surgical procedures and pre- and postoperative assistance, the results in terms of early diagnosis and long-term survival have been generally disappointing. The authors describe their own experience regarding three such tumours treated in five years, analysing the literature data, and referring to the current guidelines in diagnostics and surgical therapy. They then go on to propose a step-by-step approach to the management of these patients. The difficulty of obtaining an early diagnosis of the disease which derives from many factors, such as unspecific and late appearing symptoms, is stressed. They conclude by confirming the need to perform a radical resection, if possible, which, together with a combination of radio- and chemotherapy, is the only procedure capable of holding out some hope of a cure.

Taking as their starting point a case of greater omental torsion recently observed in their surgical department, the authors carefully review the topic and the relevant literature data. This is a rare condition, which though presenting diagnostic difficulties which make it hard to identify preoperatively, poses no problems of a therapeutic nature.

The knowledge acquired in recent years in the field of etiopathogenesis of materials for prosthesis and of surgical technics regarding inguinal hernias together with a renewed interest for local-regional anesthesia has created a real revolution in a field that for almost 100 years had been dominated by the same uncontrasted ideas. The fundamental stages in the evolution of surgical technics are reviewed as well as the most recent discoveries in the field of biochemical textiles and prosthesis available today that have contributed to the development of new surgical methods. These, distinguishing between "open" and laparoscopic technics, are compared on the basis of the data found in the literature concerning recurrence, morbidity, period of convalescence and costs. Personal experience concerns the last four years with 632 patients treated, some in emergency conditions and others in programmed operations, using the foremost methods of "open" surgery but preferring, among these, those that are tension free. The follow-up involved 84% of the patients for a period of no less than 18 months. A reduction of complications and of relapses was obtained: 5-9% in traditional operations against 0.5% for those that were tension free. With this type of operation the postoperative hospitalization was considerably reduced so that 35% of them could fit into the "one day surgery" category. On the basis of these results it is stressed that both the laparoscopic technics and the tension free technics offer advantages as compared to so called traditional methods; however, even though the first type seems to assure a shorter postoperative period, there is the inconvenience of higher costs and the necessity of general anesthesia.

Even though the primary carcinoma of the gastric stump is a tumor that will diminish in frequency in the years to come, it is still a topic of scientific studies. The authors report their experience with four cases of primary carcinoma of the gastric stump treated surgically as compared to 89 cases of carcinoma of the stomach operated in the same period. After some comments on the etiopathogenesis that is at the basis of the neoplastic mutations of the remaining gastric epithelium, clinical, prognostic and pathologic features that differentiate this type of tumor from those which develop in unoperated stomachs are examined and, then, the most frequent therapeutic approaches are illustrated. In conclusion, it is sustained that patients who have undergone partial gastrectomy for benign disease should be closely followed-up from the tenth year after the operation and, in any case, in those who are over fifty years of age.