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On the ground of a personal observation of juvenile popliteal obstructive arteriopathy, the Authors have considered, after a brief revision of the literature, the physiopathology and the pathologic anatomy about this pathology which, even if uncommon, must by anyhow taken into consideration among the possible causes of "claudicatio intermittens" in young patients. A right diagnosis can be made only during the surgical intervention, the indications of which are represented either by a clinic objectiveness consistent with a peripheral obstruction with description of chronic or openly acute arterial failure, or by an angiographic checking which shows a stop along the femoropopliteal axis. The prognosis is generally good, as the literature confirms, and particularly in the case observed by the Authors it was quite satisfactory after a follow up of four years.

Prompted by several cases of barium peritonitis of their own observation, the authors review the literature on the subject and outline the more common etiopathogenetic factors involved and gross and histological aspects of the disorders. After describing their own four cases of barium peritonitis, the authors outline some basic principles for the prevention and treatment of this rare complication.

A series of 38 cases of superficial thrombosis occurring during the period 1-12-1979 to 1-12-1981 was examined. The series included 10 cases of iatrogenic thrombophlebitis of the upper limbs, one case of Mondor's thrombophlebitis, and 27 cases of superficial thrombophlebitis of the lower limbs in subjects with essential varices of the legs. A particular predilection for women and for advanced age was noted, as well as particular frequency in the area of distribution of the Great versus and Small Saphenous Vein, and a sharp prevalence of segments below the knee as compared with the thigh. Treatment was always surgical, mainly directed to preventing any thromboembolic complications, shortening the healing times and eliminating the Varicose Disease, which is well known to constitute the basic aetiopathogenetic moment of superficial thrombophlebitis. In all cases where it was possible to follow this schedule the result was excellent, and no effects on the deep venous system or thromboembolic complications occurred. The 5 patients treated with simple ligature of the Saphenous Vein according to Cross had a recurrence of varicose disease in a period varying from 6 months to 1 years; two of them also had a relapse of the thrombophlebitic process.

Ten cases of abdominal internal hernia observed at the Niguarda Hospital Emergency Surgery Division, Milan, during the period 1969-1978 are described. Even though it is extremely uncommon, this form must be kept in mind in the course of differential diagnosis when the picture includes: typical and striking symptoms of ileal strangulation, radiographical evidence of marked distension of the ileal loops with hydro-air levels, and a negative history of abdominal surgery.

The Authors operated on a series of 173 patients with direct, indirect or relapsing hernia and crural hernia by Mc Vay's surgical procedure, of which they outlined the salient aspects. The study led to some statistical considerations with regard to the rate and time of appearance of the various types of subject hernia in the two sexes and also evidenced two cases of post-operative complication very probably due to the technique used. The follow-up evidenced only one case of relapse. Despite the small number of cases and the restricted nature of the follow-up, which varied from two years to six months, the Authors consider that Mc Vay's plastic surgery constitutes a highly reliable technique for treatment of both primitive and relapsing hernias. Particular practical interest attaches to the observation that 90% of patients were operated under epidural anaesthesia, which, given parity of results from the surgical standpoint, involves a considerably lower anaesthesiological risk than other types of anaesthesia.

The authors studied 500 pregnant women suffering from varicose pathology, they had the opportunity to observe in the years 1979, 1980, 1981. The range of age hit was between 18 and 46 years. A higher prevalence occurred in pluriparae (82.8%) in respect of primiparae (17.2%). As to the type of varicose pathology observed, 40% showed diffused teleangectasies; 30% essential varices weighing on small and large saphena; 20% associations of the two former types; 6.4% post-phlebitic syndromes with insufficiency of the deep communicating vessels, and 3.6% pudendae venous ectasies. The medical treatment, aiming to avoid venous stasis and rise in weight, was effected in 94% of cases: in 40% of cases a choice was also done for a pharmacologic treatment with synthetic glucofuranoside compounds, interrupted in 3.5% of the patients for the arising of more or less various symptoms of gastric intolerance. In the remaining 6% of cases, it was essential to adopt the surgical treatment, always performed after the 4th month of pregnancy and in epidural anaesthesia. As to the surgical indications, the authors remarked the higher frequency for the post-phlebitic syndromes with incompetence of the deep communicating vessels and serious tropic alterations, affecting in the rate of 40% the operated patients and 2.4% the varicose pathology they aggregately had the opportunity to observe. The other indications were the surface thrombophlebites (33.4%), varices with remarkable subjective troubles and cutaneous alterations of average and serious importance (6,6%) and larger caliper varices in pluriparae (20%). The authors, in the several middle and long term follow-up, never recorded any relapses in the patients surgically treated.

The authors describe a truly uncommon case of internal abdominal hernia attributable to malformation of the falciform ligament. The patient, a man aged 26, had complained in the past of cramping pain in the epigastric region, usually occurring after meals and sometimes ending with vomiting of ingested food; but all diagnostic methods and procedures had consistently ruled out any extant pathology of the stomach, duodenum, biliary tract, or pancreas. Present hospitalization was justified by a clinical picture suggesting peritonitis from perforated gastric or duodenal ulcer. At operation the authors found a strangulated loop of small intestine following left-to-right migration through a hole in the falciform ligament of the liver. In the authors' interpretation the background cause of the trouble was incomplete development of the falciform ligament, and the immediate cause of the acute episode was abnormal motility and exaggerated peristalsis of the ileum, possibly due to the presence of a diverticulum; the latter two conditions are invoked as a possible explanation for the repeated episodes of abdominal pain in the patient's history.

The Authors refer about a case of rare obstructive arteriopathy of the Hunterian superficial femoral artery, disease better known as Palma's Syndrome.

The AA. propose the utilization of the relaxing incision of the aponeurosis during the Hernioplasty according to McVay's procedure. The main advantage of such a method is the lower tension of the suture of the plasty, with several aspects, which take to a lower incidence of recurrences. Also anaesthesiological aspects tied to such a surgical procedure are considered, after having said precisely the indications of the known methods of anaesthesia.

The authors conducted a series of experiments concerning the condition of hypercoagulability of patients with a history of thrombosis, in view of determining whether or not the risk of thrombosis could be assessed by laboratory tests. To that end they assayed antithrombin iii activity and soluble fibrin complexes in their test subjects. Antithrombin activity was assayed by a chromogenic method; soluble fibrin complexes by the hemoagglutination test. The activity of antithrombon III was significantly reduced in patients with venous thrombosis, not so in arterial thrombosis. Testing for soluble fibrin complexes was invariably unrewarding, probably because the thrombosis episodes under investigation were of too long standing.