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Aim: From 1996 the adenocarcinoma of the esophago-gastric junction (AEG) is divided into 3 types according to Siewert's classification. For AEG type I and III the surgical treatment is codified, while for type II is still controversial. The aim of our study is to understand what is the better surgical treatment for AEG type II., Methods: From 1990 to 2002 we have performed 111 resections for adenocarcinoma of the cardia: 25 for AEG type I (all esophago-gastric resection), 39 for type II (22 esophago-gastric resection, 17 extended total gastrectomy with esophageal resection) and 47 for type III (8 esophago-gastric resection, 39 extended total gastrectomy with esophageal resection)., Results: The morbidity and mortality rates are 17 and 5.4%, without significant difference between the different surgical treatment (p>0.01). The 5 year survival rate is 35%. Significant prognostic factors are the staging TNM (p=0.002) and principally the presence of metastatic lymph nodes (p=0.001). For AEG type II any significant difference in survival is associated with surgical strategy, also in early stage (p>0.01)., Conclusions: According to the results of our study and those of the other authors, who have showed that a 10 cm distance of the neoplasm by the gastric side and the esophageal one could assure oncologic radicality and also that metastatic lymph nodes below pylorus and near greater curvature are uncommon, we can consider esophago-gastric resection for AEG II a speedy, safe and oncologically correct surgical treatment.

Authors describe a new technique of mechanical cervical anastomosis using a new, particularly long, stapler, the ECS Ethicon. Mechanical anastomosis at neck level is difficult to perform with stapler now in use, so manual anastomosis is usually preferred. However the percentage of leakage is relatively high. The possibility of doing a mechanical anastomosis introducing the stapler through the pylorus is described. At the moment cases are too few to give a full evaluation of this new technique, but certainly it could be a valid alternative, safer and quicker, to manual anastomosis.

The paper reports the epidemiology and causal factors of esophageal carcinoma, and compares the authors' personal experience with already published data. The clinical importance of epidemiology is stressed as a means of identifying risk factors for esophageal carcinoma, thus aiding an early diagnosis. The authors underline the central role of surgery in the treatment of esophageal carcinoma.

Two cases of congenital diaphragmatic hernia affecting the central tendon are described. The anatomic, etiologic, pathogenic and clinic characteristics of this uncommon disease are then discussed. Finally some considerations about indications on how to operate on these congenital hernias and different repairing surgical techniques are made.

The results obtained in the study of the pre- and postoperative immunological picture in 25 patients suffering from carcinoma of the pavement epithelium of the oesophagus are reported. From this study it emerges that in the preoperative period, the serum levels of immunoglobulin and complement as well as the lymphocyte subpopulations do not present significant changes, whereas 44% of the patients present cell-mediated immunity certified by the skin test. On the other hand, in the postoperative period there is a sharp reduction in the OKT4/8 ratio due in the main to a relative increase in suppressor lymphocytes. In conclusion, the value of skin tests in "in vivo" anergic patient research is underlined, evidencing the need for a programme of immunostimulation in the postoperative period.

Two cases of pulmonary hernia, different in etiology and therapeutic indications, are described. We are discussing, then, anatomic, etiologic, pathogenic and clinic characteristics of this uncommon disease. At last, Authors, are making some considerations about indications on how to operate on pulmonary hernias and different repairing surgical technics.

Malignant tumours of the oesophagus cannot always be handled radically; in personal clinical experience, only a third of patients suffering from oesophageal carcinoma have been subjected to radical oesophagectomy. The purpose of palliative treatment is to suppress dysphagia and restore possibly natural, adequate feeding. As for techniques, intraluminal catheterization by the combined endoscopic and gastrotomic route has been personally preferred to surgical bypass and gastrostomy whose palliative value should be confined to cases in which no other technique can be used. Good results have been obtained with catheterization and patients have been able to feed themselves naturally without noting the ineluctability of their disease.

In the context of major surgery the predictive significance of respiratory function tests in relation to postoperative pleuro-pulmonary complications is assessed. A statistical analysis is performed on a series of 85 oesophagectomy after thoracotomy and laparotomy. The most significant respiratory function indices are found to be those relating to volume restriction and the Mottley index.

Three recently observed cases of Castleman's tumour are described. A brief summary of the clinical histories, themselves of little significance, the histological, diagnostic and therapeutic aspects of the disease are examined. The series is shown to be fully in line with those reported in the literature, and support is given to the view that the tumour is of inflammatory origin.

The Authors present 6 cases of oesophageal leiomyomas operated on during the past 15 years at the Institute of Surgical Pathology of the University of Turin and compare the results with those in the literature. The pre-operative diagnosis was not always possible and often difficult: it was however, helped by many clinical and instrumental examinations. The treatment of choice was surgery, usually by enucleation or occasionally by gastroesophageal resection. There was no operative mortality and no recurrences have been observed.