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Successful management of vaginal aplasia in two patients with Rokitansky-Küster-Hauser syndrome by means of Vecchietti's technique is reported.

A personally observed case of biliary ileus triggers this description of its clinical features, blood chemical and diagnostic aspects and surgical treatment. Emphasis is placed on the importance of the preoperative rehydration and restoration of the electrolyte balance in patients with upper intestinal occlusion which reduces the risk involved in subsequent surgery.

Sixty-eight eyes presenting with congenital glaucoma and operated on by goniotomy, have been followed up for 1 to 10 years. Intra-ocular pressure was normalized in 91.18 p. cent of cases by one or more goniotomies with or without medical treatment. We have also analyzed the functional results of these operations.

Between January 1983 and July 31, 1988 at the 1st Division of General Surgery of Cuneo S. Croce Hospital, 57 patients (33 m, 24 f) were subjected to abdomino-perineal amputation for rectal A.D.K. A definitive colostomy was fashioned for all patients. Neostoma complications were encountered in 33% of cases. 91% of patients completed the rehabilitative programme and 40% saw satisfactory results as regards the regularisation of the alvus and return to social life.

On the basis of experience acquired through 11 cases of acute mesenteric infarction personally observed over a 10-year period (1-1-1978-31-12-1987) and on the basis of a review on the literature, the usefulness for the purposes of early diagnosis and consequent early treatment of monitoring the essential, typical biological and clinical parameters of patients at risk of acute mesenteric infarction are reported.

A series of 172 cases of acute pancreatitis encountered between 1-1-79 and 30-4-88, including 57 treated with somatostatin is presented. A comparison between the latter and the other cases treated with a variety of drugs (aprotinin, cimetidine, ranitidine) led to the following conclusions: 1) somatostatin significantly improves the clinical course of acute oedematous pancreatitis with circumscribed necrosis; 2) it makes no difference to the development of cases with diffuse necrosis and haemorrhage.

The treatment adopted in 11 cases of acute mesenteric infarction is described: 6 cases involved arterial occlusion due to embolism and 5 arterial occlusion due to thrombosis. Six explorative laparotomies, 4 intestinal resections and one embolectomy of the superior mesenteric artery were carried out. Mortality was 63%. Stress is therefore laid on the need for very early, etiopathogenetic accurate diagnosis so as to commence treatment during the phase of reversible ischaemic intestinal lesion, targeting treatment to the cause of the ischaemia. The problem of the postoperative treatment problem is then discussed with special regard to the treatment of shock, the prevention of recurrences and the short intestine syndrome.

The symptomatology and diagnostic procedure adopted in 11 cases of acute mesenteric infarction are examined. Stress is laid on the importance of early, aetiologically accurate diagnosis for the purpose of instituting profitable treatment. In order to comply with such needs it is essential to perform urgent selective arteriography and/or urgent laparoscopy which only with rare exceptions is carried out even in hospitals that should be better equipped.

The authors, after a short introduction of physiopathology, report on 17 patients who underwent a total (10 cases) or a subtotal (7 cases) gastrectomy for cancer at various times and then submitted to hemochromocytometric test and Schilling test modified by Katz and Bell. On the bases of information given by the tests, some clinical and therapeutic considerations are made.

The prognostic factors regarding colon-rectal cancers in the under-40s are examined. A personal series of 15 cases shows that the incidence of tumour recurrence is higher and the disease-free interval shorter than in patients not selected for age and that 5-year survival is much less. These results permit the hypothesis of greater aggressiveness in colorectal cancers in the young, something that justifies the severer prognosis by comparison with the elderly population.

The problem of obstructed emptying of the gastric stump after Billroth II operations in patients previously treated with H2 receptors is discussed. Statistical comparison using the Student's "t" test revealed a significant difference (t = 2.173) between those given and not given H2-antagonists and confirmed the existence of greater postoperative hypotonia in the gastric stumps of the former group. This clinical syndrome demands careful monitoring of the hydroelectrolytic balance and possibly the use of a double naso-gastric and nasojejunal tube as a precaution to ensure the delivery of the jejunal contents to the stomach. The gastrokinetic drugs metoclopramide and domperidone are also beneficial.

A series of 592 cases of gastric carcinoma operated on between January 1960 and December 1974 at the S. Croce Hospital at Cuneo is reported. The following observations were made: greater frequency in males (68.25%). The following localizations: cardiac portion 31 cases; fundus 20; body 93 and antropyloric 249. Cancer ulcer in 5.06% of cases. Cancer on the gastric stump in ulcer resections in two cases. The following operations were performed: Gastric resection in 325 cases: operative mortality (O.M.) 5%; 5-year survival: 18%. Total gastrectomy in 38 cases: O.M. 13.1%; 2-year survival: 21%, 5-year survival 5.2%. E.A.G. in 61 cases; O.M. 17.8%; survival: 6 months; maximum 26 months. Gastrostomy in 16 cases; Expl. laparotomy in 150 cases. Survival was only a few months in these two latter groups. Out of all operations 5-year survival was 6.7% and 27.4% in so-called curative interventions. In principle, gastric resection is still considered to be the most valid approach.

Certain aspects of OPSI (Overwhelming Post-Splenectomy Infection) are examined, mainly its considerable gravity, its relatively high incidence, especially in children; its difficult prophylaxis with a report on personal experience of ectopic autotransplant of spleen tissue in two young patients after splenectomy for traumatic rupture. The technique was found to be simple and quickly performed. Scintigraphic follow-up for over 4 years after the operation showed satisfactory growth in the transplanted spleen tissue.