[Endoscopic retrograde cholangiography in the diagnosis of hepatic hydatidosis]

The Authors studied the role of E.R.C.P. in the presurgical investigations of hepatic hydatid cyst in a consecutive series of 24 patients. The reasons for admission and presurgical investigation (blood test, chest X-ray, plain abdominal X-ray, intravenous cholangiography, ultrasonography, liver scintigraphy, C.T., E.R.C.P.) are evaluated and compared. The results showed a good correlation, as related to the cyst and biliary tree relationship between operative findings and E.R.C.P. The E.R.C.P. provided an etiological diagnosis in obstructive jaundice and showed a biliary tract involvement by the cyst both in patients with a complication at admission or in the past history and in 25% of the asymptomatic patients (pericystic bilioma, exterior compression of bile ducts, direct communications between cyst and biliary tree).

[The solitary thyroid nodule. Diagnostic and therapeutic problems]

The records of 93 patients who underwent surgery for solitary thyroid nodule were reviewed. It is emphasized no findings or diagnostic studies currently available which are sufficiently specific to differentiate benign from malignant lesions. All solitary nodules should be removed by excision of the involved thyroid lobe followed pathological examination: operative complications are rare.

[Duodenal leiomyosarcoma with left hepatic metastasis treated by total exeresis (author's transl)]

A case of duodenal leiomyosarcoma associated with a single liver metastasis successfully treated by gastro-duodenal resection and left lateral hepatic segmentectomy in one stage is reported. The result of hepatic resection for metastatic cancer depends on the location and the histological nature of the primary tumor, on the type of hepatic resection and on the number of metastatic deposits. The patient is alive 26 months postoperatively and there is no evidence of any recurrence.

[Digestive hemorrhages and intestinal metastases of chorioepithelioma]

An unusual case of digestive haemorrhage due to colic metastasis of choriocarcinoma is reported. Reference is made to the fact that the literature contains only three other cases of intestinal metastasis from choriocarcinoma and one from haemorrhagic destructive mole. Note is taken of the fact that the multiplicity of secondary sites may lead to haemorrhage in other districts, particularly the brain. Even so, the digestive haemorrhage is often the introductory sign of the primary neoplasia. The various ways of preoperatively diagnosing its nature and site are discussed. It is also shown that surgical management can be combined with suitable chemotherapy to achieve encouraging results.

[The choice of operation in perforated gastroduodenal ulcer]

The main point for a surgeon treating a perforated peptic ulcer is to choose between a simple treatment of the complication and a treatment both of complication and ulcer disease. So, the A. have analysed their series of 58 patients with perforated peptic ulcer: one patient underwent nasogastric suction as suggested by Taylor, 16 patients underwent suture plication of the perforation, 41 underwent immediate gastrectomy. A fully follow-up was performed: in the suture-plication group only 28.5% was symptonfree, the remaining 71.5% had recurrent dyspepsia or underwent definitive gastrectomy. Follow-up results of the immediate gastrectomy patients and elective gastrectomy patients are the same. The A. discuss the different procedures of treatment and their specific indications. Surgical treatment is the selected one and simple suture and immediate gastrectomy are not opposite.

[Anicteric calculosis of the common bile duct]

In a series of 158 patients who underwent surgical treatment for biliary lithiasis, we have had 109 (69%) lithiasis of the gallbladder (CC) and 48 (31%) lithiasis of the common bile duct. In the last group 19 (38%) were without jaundice (CAEC) and 30 (62%) with jaundice (CIEC). We have compared the three group of patients (CC, CAEC and CIEC). It has come out that CAEC is between CC and CIEC and that attacks of biliary fever and high levels of alkaline phosphatase and transaminases in the serum are the helpful findings for preoperative diagnosis. Intravenous cholangiograms can confirm the diagnosis in 80% of one series but the operative cholangiography remains the definitive test. Finally CAEC seems to be the "benign" lithiasis of the common bile duct, a first stage that getting worse will became CIEC.

[Current trends of complementary therapy in radical surgery of colo-rectal cancer]

Large surgical series are agreed on the fact that the prognosis for radically operated colorectal cancer has improved little in the last twenty years. Reasons for these failures are, of course, local or remote recurrences. To improve the number of stable cures, experiments have been carried out with complementary or coadjuvant techniques whose purpose is to limit intra-operative dissemination of the tumour and to monitor the number of cancer cells that might remain after radical surgery. Such techniques have been applied at preoperative, intra-operative and post-operative phases. Results obtained so far have been uncertain but seem to point to the usefulness of intraoperative procedures in reducing the number of local recurrences and of postoperative chemotherapy with 5 FU which has improved five-year survival indices by 5-7%.