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AIM: The purpose of this study is to verify the role of gastroesophageal reflux as responsible for otolaryngological symptoms; it is often difficult to identify, both because of its subtle and aspecific clinical-endoscopic picture and because the traditional distal esophageal pHmetry may show readings which are still within the norm at this level. The esophageal pHmetry carried out at proximal level gives greater diagnostic accuracy. METHODS: We use a catheter with 3 antimony electrodes, 2 of them placed at the esophageal level, respectively at 5 and 20 cm above the inferior esophageal sphincter, and 1 in the stomach. We studied 3 groups of patients: 41 asymptomatic no-refluxer patients (group I, control), 59 refluxer patients with only typical esophageal symptoms (group II) and 68 patients with laryngo-pharyngeal symptoms suffering from acid reflux (group III). RESULTS: At both the proximal and distal esophageal levels, the reflux, with reference to control, turned out to be significantly higher in groups II and III, both as regards the number of episodes (p<0.01), the time of acid exposition (p<0.01), the length of the longer reflux (p<0.01), whereas no differences were found between groups II and III. The proximal esophageal acid refluxes in both groups II and III occurred mainly in the upright position: alone (57.2% and 62.5% respectively) or combined with supine position (23.8% and 34.0% respectively). CONCLUSION: Our experience suggests that the esophago-gastric pHmetry with 3 electrodes represents an effective procedure for the correlation between otolaryngological symptoms and gastro-esophageal reflux.

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The best treatment of bile duct lithiasis in the era of the laparoscopic cholecystectomy has not yet been defined, as we can choose between different kinds of therapies which range from the traditional laparotomic treatment to the more modern endoscopic and laparoscopic techniques. Although in some centres a wholly laparoscopic access to the bile duct is used, we believe that the fastest, safest and most reliable method is still the sequential treatment, endoscopic and laparoscopic. In our experience the endoscopic cleaning of the choledochus was performed in 87.1% of the cases, with no mortality and 4.2% morbidity.

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We evaluable the efficacy and reliability of 24-hour pH monitoring studing the gastro-esophageal reflux. 119 patients with gastro-esophageal reflux disease (MRGE) and 60 normal subjects were tested with this method ambulatorially. The study time started at January 1991 and finished at May 1994. Symptoms of MRGE showed high specificity but a low diagnostic sensitivity; moreover they are not able to foresee oesophageal damage. On the contrary the pH monitoring showed a 95% sensitivity. DeMeester's parameters identify refluxer subjects effectively, linking it to oesophageal damage severity. Symptoms and mucoesophageal damages are distributed equally on every kind of reflux patients including upright refluxers.

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Of the therapeutic aids currently available for the treatment of liver metastases, surgical treatment, when possible, has acquired an irreplaceable role. The exact criteria needed to establish a correct indication still have to be established. Various factors have been examined so far: number, site, dimensions of the metastases and features of the primary tumour whose prognostic importance does not lend itself to unequivocable interpretation. Personal experience of a series of 11 surgically treated cases seems to confirm that of the parameters analysed, the tumour-host relationship remains the most important prognostic factor.

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Thirteen cases of acute IIIrd degree pancreatitis and 5 homogeneous cases of IInd degree, treated surgically during the first 48 hours from onset of the symptomatology, are described. The importance of careful cardiorespiratory, haemodynamic and metabolic monitoring to establish the most appropriate moment for intervention after a period of intensive therapy designed to restore the basic parameters is stressed. In the present series, total mortality was 44%. Forms with biliary aetiology have the best prognosis and justify the earliest possible surgical intervention.

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Results obtained in the surgical management of 36 cases of perforated duodenal ulcer treated between January 1976 and November 1979 are presented. A choice was made between three methods (suturing, excision plus pyloroplasty and truncular vagotomy, and Péan-Billroth resection and reconstruction) in the light of the duration of the disease, the extent of the duodenal alterations, and the concomitance of serious disorders. No account was taken of age, the time elapsed between perforation and treatment, or the extent of peritoneal reaction.

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Reference is made to the literature and personal experience in an assessment of the rôle of total parenteral nutrition in ulcerative colitis. An estimate is made of the position of this form of treatment with respect to conventional medical and surgical management, and its influence on the natural course of the disease. The results observed in 6 patients treated in this way are reported and the treatment protocol employed for the management of ulcerative colitis in a surgical department is described.

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Differential haematological and instrumental examinations (OGTT, protracted fasting, i.v. tolbutamide, blood insulin, pancreatic scintiscanning, oesophagogastroduodenoscopy, panoramic abdominal arteriography, and selective arteriography of the coeliac trunk), preceded subtotal pancreasectomy in a severe case of hypoglycaemia attributable to organic hyperinsulinism. Epstein's method was used to extract insulin from the pancreatic tissue for radioimmunological assay.

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