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The result of using traditional techniques in the treatment of large hernias of the abdominal wall (recurrent inguinal hernia and incisional hernia) are compared with those obtained by using prosthetic material. In most cases of incisional hernia the reconstruction was carried out by traditional techniques. Instead, the Authors' preference is for the use of prosthetic material in the treatment of recurrent inguinal hernia.

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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.

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The AA examine the most frequent causes of relapsing varices: they remember that the exact anatomic knowledge of sapheno-femoral and and sapheno-popliteal crosses in essential for the execution of an exact operation; rapidly they inspect the casuistry of S. Giuseppe Hospital, classifying the relapses on the base of a topographic standard and seeing that the technical mistake is essential for the relapses.

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The AA describe the different kinds of operation, on the base of the different kinds of relapsing varices. They outline the importance of a through isolation of internal saphena vein at sapheno-femoral "cross" and of external saphena at sapheno popliteal "cross" for avoiding "high" relapses. They they insist on the subfascial ligature of incontinent perforating veins and on the closing of open muscular breach though a "zed" stitch.

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The Authors present 8 cases of traumatic lesions of the stomach, during the course of closed abdominal trauma, observed in the First Aid and Emergency Surgery Division of the Niguarda Ca' Granda Hospital, Milan, in the years 1970-1979. They take this as the starting point for a re-examination of the etiopathogenetic and anatomopathological data, and for diagnostic, prognostic and therapeutic considerations.

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After some short notices on the physiopathology of thrombosis, the AA. consider clinic, symptomatology and surgical therapy for prevention of pulmonary embolism. They outline that only a precocious operation and an exact diagnosis can help the patient who had had an embolism; in the end they report two cases, describing the operation and its indications.

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Consideration is given to the problem of urinary incontinence within the framework of the wider syndrome defined as "perimenopausal cystopathy". The physiopathological factors are analysed and the clinicodiagnostic and therapeutic problems defined. The Authors then report data of their own cases.

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The Authors describe two cases of abdominal hernia through the linea semilunaris (spigelian hernia) of their own observation; they outline the anatomic substrate and clinical picture of this condition and conclude by advocating surgical correction as a constant indication.

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In the light of their first-hand experience in actual clinical cases, the authors review the problems of surgical anatomy of the deep lobe of the parotid gland in malignancy. After discussing certain differences between normal and surgical anatomy of the region, they explore therapeutic possibilities and conclude that also in malignancies involving only the deep lobe of the gland the treatment of first choice is still total parotidectomy with preservation of the facial nerve.

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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.

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118 cases of traumatic lesions of the liver have been reviewed. The patients were admitted to the First Aid and Emergency Surgery Division of Niguarda General Hospital between 1965 and 1976. The statistico-clinical data were elaborated in accordance with classical subdivisions of each disease form and compared and discussed, as far as possible, with similar data provided by the recent literature. Stress is laid on the increase in the number and gravity of cases in recent years, the prevalent localization of lesions in the right lobe, the importance of trauma pathogenesis for diagnostic and therapeutic purposes, and diagnostic difficulties. The importance of peritoneal probing and dialysis and of the examination for bile salts in the urine are underlined. As for treatment, the various surgical techniques are mentioned and discussed in relation to the characteristics of the traumatic lesion; the commonest technique was simple suture of the break in the liver parenchyma. Mortality was 33.05%. The cause of death in the 39 cases is mentioned.

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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.

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