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Unlabelled: INTRODUCTION MATERIAL AND METHODS: From January, 1990, to December, 1995, 138 consecutive patients with radically resected stage II and III rectal and rectosigmoid cancers were treated with adjuvant radiochemotherapy. Eighty-one patients with 24 months' follow-up were assessable. Low anterior resection (LAR) was performed in 64 (79%) patients and abdominoperineal resection (APR) in 17 (21%). Twentynine (36%) stage II and 52 (64%) stage III patients entered the study. Within 45-60 days from surgery all patients received 5-Fluorouracil chemotherapy at the dose of 500 mg/m2/iv/d 1-5, every 4 weeks, for six cycles. Chemotherapy cycles 3 and 4 were administered at the same daily dose on radiotherapy days 1-3 and 29-31. Radiotherapy total dose consisted of 45 Gy/1.8 Gy/day administered in 5 weeks with 18 MV photon beam to the pelvis with the four field "box" technique. Perineal scar was encompassed only after APR. A boost dose of 5.4 Gy to the tumor bed was given in 3 fractions of 1.8 Gy. Median follow-up was 37 months (range: 24-74 months)., Results and Discussion: Overall recurrent disease was reported in 28 of 81 patients (34%): local, systemic and both local and systemic relapses in 9 (11%), 14 (17%) and 5 (6%) cases, respectively. According to local extension, recurrence rates were 10% and 48% in stages II and III, respectively. Five-year overall and disease-free actuarial survivals were 64% and 61%, respectively. Median time to relapse was 15 months (range: 7-43 months). Significant prognostic factors for better tumor control were: stage (II vs III), disease site (proximal vs distal rectum), the surgical procedure (LAR vs APR), the number of involved nodes (< or = 4 vs > 4) and no extracapsular node invasion. The recommended dose of combined radiochemotherapy regimen used in this trial was generally well tolerated. The incidence of any grade > or = 3 acute toxicity (according to WHO grading) was 20% diarrhea, 6% tenesmus and 4% myelosuppression. Five (6%) patients had cronic diarrhea and other 3 (4%) radiotherapy-related severe late toxicity which required surgery., Conclusions: This study seems to provide similar survival and recurrence notes to other radio-chemotherapy regimens published in the literature. However, a more aggressive approach is warranted in stage III patients considering the low 5-year survival recorded.

The author gives some information about life in Perugia in the years 1883-87, when Ruggero Oddi was a medical student at the "Libera Università" of Perugia. Moreover the author gives notes about the Hospital and the University in those years with special reference to the situation of the Department of Physiology where the discovery of the sphincter of the common bile duct took place. Then, the author reports the most peculiar facts of Ruggero Oddi's life in a chronological way and finally, he deals with the history of Oddi's discovery of the sphincter of the common bile duct, when he was a student in the fourth year at the "Facoltà di Medicina e Chirurgia" in Perugia.

This was a non-randomized prospective study on the "sandwich" radiosurgical treatment of resectable rectal and rectosigmoid carcinomas. From December 1984 to December 1989, 100 patients were treated 86 of them are now evaluable. Mean follow-up was 38 months (range: 9-69). Surgery was abdomino-perineal resection in 33 cases and anterior resection in 53 cases. Radiotherapy was preoperative pelvic irradiation, with a single 500-Gy fraction, the day before surgery. To stages B2, C1 and C2 patients (Astler and Coller) postoperative radiotherapy was administered for a total dose of 4500 Gy (180 Gy/fraction, 5 fractions/week), with box technique, from a Co 60 unit or Linear Accelerator (photon 18 MV). Preliminary results indicate 8% (7/86) local recurrences and 9.3% (8/86) distant metastases. Five-year actuarial disease-free survival is 63.2% +/- 8 for stage B1, 55.6% +/- 19 for stage B2, and 40.2% +/- 13 for stages C1 + C2. Overall 5-year actuarial disease-free survival is 53% +/- 10. No lethal or severe complications were observed following treatment.

Personal experience with an extremely rare clinical picture, spontaneous rupture of the subdiaphragmatic oesophagus is reported. In the case in question, the laceration occurred in a free peritoneum, unlike what occurred in the first reported case, that of Strauch and Lynch in 1965, where the lesion was retroperitoneal. On the basis of this experience, certain pathogenetic and diagnostic factors are discussed, but most attention is paid to the surgical treatment of this exceptional lesion.

Rupture of the pericardium due to closed thoracic trauma is a very rare event which is hard to diagnose. It occurs in the form of two main clinical pictures: 1) severe chest trauma with massive haematoma requiring surgery and which permits diagnosis, and 2) precordial pain and clinical signs of pericardiac origin. Surgery is essential in view of the risk of lethal complications from cardia luxation. Operation consists of closure of the pericardiac lesion.

Personal experience with two cases of symptomatic occlusion of the subclavian artery treated with axillo-axillary by-pass is reported. The operating technique, in which the second portion of the axillary artery and a dacron blood conductor are employed, is described and the various transthoracic and extrathoracic operations that have been proposed are reviewed along with the advantages and disadvantages of each. It is concluded that axillo-axillary by-pass is a simple solution for a complex haemodynamic, clinical and therapeutic problem.

Personal experience with glucagon in 15 cases of acute pancreatitis is reported. Complete remission of pain within 2-3 hr after infusion of the drug was noted in 85% of the series, together with normalisation of blood amylase within 48-72 hr. Glucagon inhibits pancreatic secretio&n. Vairous theories concerning its mechanism of action are examined.

Reference is made to personal experience in affirming that the treatment of perforated duodenal ulcer should set out to resolve both the perforation and the ulcer at the same time. Troncular vagotomy combined with pyroloplasty is put forward as an effective way of achieving this, and long-term results on a par with those obtained electively are described.

Case of stenosis of the left flexure of the colon caused by pancreatitis is reported. The relevant literature is surveyed and an account is given of the pathogenesis of this forms, and the examinations required in its diagnosis, particularly coloscopy. A preference is expressed for an internal colic derivation (colon-colon anastomosis) rather than resection, on account of the smaller degree of risk involved.

Personal experience in 87 cases of vagotomy and gastric drainage is presented. Pyloroplasty according to Heinecke-Mikulicz was performed in 50 cases and drainage according to Judd in 9. Three groups were distinguished on the basis of the presence of a "gastroduodenal canal" and "pseudodiverticula". Twenty-two patients were subjected to a Finney pyloroplasty, radiologically visible is a transparent line from the large curvature of the antrum to the lesser curvature medially. Jaboulay-Alexiu gastroduodenostomy was performed in 6 cases. Here anastomosis between the large curvature and the second duodenal portion was noted, with preservation of the pylorus. Mention is made of the difficulty of recurrent ulcer diagnosis and the exact interpretation of the appearance of the antrum, pylorus and duodenum after drainage operations of this type.

A case of hernia-induced occlusion of the small intestine through an orifice of the broad ligament of the uterus is reported. After reviewing the literature, the pathogenetic aspects are considered, with reference to the congenital or acquired origin of the defect. Clinically, the most significant factors for diagnosis are the patient's multipara condition, previous obstetrico-gynaecological operations, signs of mechanical type intestinal occlusion and palpation of a parauterine mass. Surgical treatment involves straightforward mechanical ileus with repair of the occluding orifice.

The pathogenetic and diagnostic features of false aneurysm of the left branch of the hepatic artery are discussed in the light of a personal case. It is felt that ligation of the vessel constitutes the treatment of choice, whereas hepatic resection should be undertaken in the case of very peripheral aneurysms.

Personal experience with respect to the diagnosis and treatment of bleeding oesophageal varices in patients with cirrhosis is described. Diagnosis is directed both to the establishment of the site of bleeding and the disease responsible and to the evaluation of risk in view of the possibliity of portal decompression. Treatment is aimed at stopping bleeding and at lowering this risk so that as many patients as possible can be operated with an acceptable degree of surgical risk.

An original technique for the repair of recurrent inguinocrural hernia destruction of the inguinal ligament is presented. A prosthetic lamina is applied in the subperitoneal space against the deep fascia of the inguinocrural musculature. It is held in place by intra-abdominal pressure and ordinary stitches. The subumbilical median route is used and the peritoneum and hernia sac are stripped from the abdominal wall.

The usefulness of endoscopic examination of patients subjected to vagotomy and drainage for duodenal ulcer is stressed, since it permits recurrences and ineffective treatment to be detected, along with the control of other parameters, such as the appearance of the mucosa, the performance of gastric drainage, the features of peristalsis and gastric tone, and the performance of the cardial sphincter. Data from a series of 43 endoscopies performed after 192 vagotomy and drainage operations carried out between 4-1973 and 5-1976 are presented.

Starting from a clinical case in which a trans-obturator by-pass was necessary, the most recent findings as regards the technique of this and its indications are reviewed. The procedure is to be considered a valid alternative in cases of ischaemic revascularization when the usual Scarpa triangle route cannot be used.

Endoscopy following operations on the stomach showed inflammation or ulceration attributable to no-absorbable suture threads in a number of cases. The pathogenetic and clinical features of this picture are described. Complete remission was obtained after endoscopic removal of the foreign body.

A case of intestinal stenosis in a subject who had received an abdominal injury four weeks earlier is presented. The relevant literature is surveyed and the pathogenesis of this unusual condition is examined. Post-traumatic stenosis of the small intestine is seen as an example of ischaemic stenosis.

A distinction is drawn between two main groups of patients with continuous and massive haemorrhage respectively in bleeding duodenal ulcer, and the criteria upon which this distinction is based are described. The two main types of surgery proposed for the treatment of this complication of duodenal ulcer (vagotomy and gastric resection) are examined. The conclusion is drawn that vagotomy (truncular with drainage, or superselective with or without drainage) is to be preferred to gastric resection in the light of personal experience, and with particular reference to operative mortality and the recurrence of haemorrhage and ulcers.

Personal experience in intrahepatic biliojejunal anastomosis is described, along with the operative tactics and techniques now employed. Stress is laid on the importance of peroperative cholangiography in the division of patients into two groups with respect to drainage of intrahepatic bile, depending on whether or not a wide pathway exists between the two halves of the liver. The strategy to be used for each group is explained.

6 cases of upper extremity embolism observed over the past three years are reported. Fogarty embolectomy was carried out in all patients, favourable revascularization results being obtained in 5. Forearm amputations was necessary in 1 case owing to the presence of ischaemic lesions that were already advanced at admittance, further proof that results depend above all on the vitality of the extremity rather than on the duration of the arterial occlusion.