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The Authors consider the trans-scission approach as a quick and safe alternative approach for doing intrahepatic bilio-intestinal anastomoses for the surgical treatment of well confined cancers of hepatic hilus (type I and II of Bismuth e Corlette). This approach should be recommended particularly when the presence of anatomical variations makes the hilar approach hazardous.

The authors analyze data of 100 consecutive mediastinoscopies, performed for diagnostic and/or staging purposes in suspected or known bronchogenic carcinomas. They confirm once again how mediastinoscopy is, in many cases, the only diagnostic procedure that can give, at the same time, a preoperative histological diagnosis and a quite accurate staging, thus avoiding useless exploratory thoracotomies.

The Authors on the basis of their own experience and scientific literature, study the indications to the surgical treatment of pulmonary metastasis. Surgical treatment usually produces a palliative result, bettering the quality of life. For some other Authors, surgical treatment if there are no local recurrences and metastasis, could produce complete healing.

The authors discuss the role of surgical treatment in patients with highly malignant soft tissue sarcomas in the limbs. A careful analysis is made of different therapies on the basis of the results obtained by the authors and those reported in the literature. The anatomic classification of lesions is based on functional anatomic compartments, defined as intra- or extracompartmental. If a lesion was within an intrafascial compartment, all the muscles with intact fascial sheaths have up till now been removed "en bloc" to obtain radical margins. Many authors now think that all manifest disease be removed with a generous soft tissue margin on all sides to ensure adequate local treatment. Amputation has commonly been performed for extracompartmental lesions, but a multinodal treatment programme, including limb-sparing resection and tumour-bed radiation, should now be considered if possible in the management of these tumours.

Organochlorine pesticides and their degradation products can affect humans in several ways and are detected in human tissue, including placental tissue and umbilical cord blood. We report the results of preliminary research conducted to determine the levels of p-p'DDT in maternal and umbilical cord blood during labor and to estimate the possible consequences of this product for calcium metabolism. The results confirm that p-p'DDT is transferred to the fetus through the placenta and indicate the existence of a complex fetal-maternal p-p'DDT distribution mechanism.

Satisfactory results obtained, lasting for years in some cases, following azygos-portal disconnection in selected patients with bleeding oesophageal varices, portal hypertension, splenopathy and gastroduodenal ulcer are referred to. It is suggested that wider use should be made of this technique, particularly in patients in poor condition, because the long-term picture does not include the hyperammoniaemic encephalopathy often associated with extensive portosystemic shunts.

The authors analyze different therapeutic modalities for gallbladder can and discuss indications, value and limitations on the basis of the results obtained by their own experience on 13 cases as well as literature data.

For several years the determination of maternal serum alpha-fetoprotein (MSAFP) levels has been utilized to screen the patients at increased risk for foetal neural tube defects. In this way, various problems have been more and more dealed, from the definition of "cut-off" levels which could be guarantee an acceptable rate of diagnoses, limiting however the number of normal pregnancies which undergo further ascertainments, to the search of indoneous protocols of diagnostic approach in cases of high MSAFP levels. The wide clinical use of MSAFP determination has lead to the availability of a large number of data in various classes of obstetrics population, and to search for new diagnostic chances offered by this metodology. Among these, a great interest has been pointed out to the use of MSAFP determination to screen for Down's syndrome foetuses and to utilize MSAFP as a predictive index of perinatal pathology. The Authors describe their own experience in these diagnostic fields.

Personal experience of 6 hepatectomies at the some time as primary colorectal tumour excision is reported. Like most Italian and foreign Authors, the paper stresses the negligible mortality and morbidity after this double surgery. Moreover, in these particular patients, it was never necessary to postpone hepatectomy. Finally, emphasis is placed on the importance of intraoperative echography for the identification of micrometastasis in one or two lobes, for the correct staging of the primary tumour and for oncologically appropriate hepatectomy.

This paper reports the results obtained with various hormonal parameters (HPL, E3, alpha-FP) in evaluating fetal wellbeing during pathologic pregnancies. The expression of hormonal parameters in terms of standard deviation (S.D.) provides a constant endocrine index throughout pregnancy, independently of the adopted parameter. Such methodology reduces error and simplifies interpretation of data. The hormonal index is important not only for reliable diagnosis of a pathologic situation, but also because of its simple interpretation for clinical and practical purposes.

The validity of a selective surgical attitude towards primary tumours of the hepatic hilus after accurate pre- and intra-operative staging is stressed. Moreover the active management for both radical and palliative purposes is justified by some personal observations of the specific anatomoclinical behaviour of these tumours.

The limit of the classic diagnostic protocols following the evidence of high maternal serum alpha-fetoprotein levels is represented by the high number of amniocenteses performed and that, in the most part of cases, give false negative results. Now days the introduction of high resolution ecographic equipments allows to us, in many cases, to clarify the diagnostic without further examinations. The Authors propose a diagnostic protocol that include the execution of high resolution ultrasound at the second withdrawal of serum alpha-fetoprotein, limiting the use of amniocentesis only when is necessary to determine the fetal karyotype. An high sensibility diagnostic system with a favourable cost/benefit ratio results from this approach.

Fetal heart rate (FHR) variability appears to be an "early warning system" of fetal hypoxia. FHR variability has been utilized in clinical practice to examine fetal wellbeing. Since 1976 we have used a standardized scoring system to evaluate the cardiotocograph. To eliminate subjective aspects in FHR variability analysis we propose a programmable device utilizing a microprocessor. Preliminary results encourage us to continue this research.

After mentioning the lymphangiographical methods for the study of the lower limb channels, the authors illustrate a new technique which allows, in at least 15% of cases, the simultaneous study of both the superficial and deep lymphatic systems.

Maternal serum alpha-fetoprotein (MSAFP), anatomic anomalies and precocious defects of foetal growth were shown as possible "indicators" of foetal chromosomal pathology, in particular Down's syndrome, and thus suggested for prenatal screening of risk patients for this chromosomal abnormalities. The Authors carried out a retrospective study on 1472 patients who underwent amniocentesis for prenatal diagnosis. Between the 15th and the 20th week, a dosage of MSAFP was effected, in order to evaluate if the serum concentration of this substance could predict Down's syndrome. A contemporary study by echographic monitoring was effected on 500 patients from the 1st trimester of pregnancy, in order to detect possible foetal growth retardation precociously and to determine the karyotype in these cases. Results are very interesting and suggest both the dosage of MSAFP and the ecographic monitoring for prenatal screening of trisomy 21, especially in maternal age classes younger than 40 years, where the cost/benefit ratio of screening for maternal age is less favourable.