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Experimental research faces two great problems: the significant reduction of public funding and the firm opposition of the public opinion. The law forbids the use of large animals, so that it is possible to use small animals only, which require microsurgical techniques. However, even a skillful surgeon does not know how to perform microsurgery and has to begin a long and tiring training to master techniques. We think that experimental surgery should play a role because it tests the validity and safety of new surgical techniques and allows special pathophysiological aspects to be studied. Furthermore experimental surgery could represent an essential stage in the training of young surgeons. We should find a balance between observance of the law and respect of the animals and, on the other hand, the role of experimental surgery because we should not forget that its most important aim is the improvement of the health of the humankind.

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Postoperative follow-up is the logical consequence of cancer treatment, but colorectal cancer follow-up does not achieve all its goals. These unfavourable findings induced us to assess whether follow-up also causes negative psychological stress in our colorectal cancer patients. In this trial 100 colorectal cancer follow-up patients were asked to compile three questionnaires: 1) the McGil Pain Questionnaires; 2) Profile of Mood Status; and 3) Locus of Control. The questionnaires were handed to the patients at follow-up and were compiled immediately. In addition, the patients were asked to answer the firsts two tests spontaneously 30 days after follow-up and mail the questionnaires. Our results showed that only 41% of the patients complied the tests 30 days after follow-up. The scores for pain and mood disorders were greater in women, especially during the "before follow-up" period. The third test revealed a prevalence of subjects with internal-type reinforcement. Our data revealed that: 1) patients tend to repress the problem; 2) women are affected by greater stress and anxiety; 3) subjects with internal-type reinforcement have a positive attitude during follow-up and this enables the ego to bear the anguish, process it and dilute it to anxiety, thus favouring future life experiences.

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The animals do not tolerate prolonged caval and/or portal clamping which induces negative pathophysiological events such as release of kinins, damage of the intestinal mucosa, and bacterial translocation. In human liver surgery, these problems have been solved by bio-pump for veno-venous bypass. In order to find a simple method to reproduce a veno-venous bypass, we developed the porto-intracaval shunt and used it in six adult rabbits. The shunt tested was a self constructed 7-french polyurethane shunt modeled as an inverted Y. The inferior vena cava vein below the diaphragm and below the liver and the portal vein were gently dissected. The two longer branches of the shunt were inserted in the cava vein, while the remaining branch of the Y shunt was inserted in the portal vein. After clamping the hepatic artery, the liver was partially resected in three animals and after 60 min the shunt was removed. The insertion of the shunt was always easy and the animals tolerated well the procedure and the anhepatic phase. Our study has been performed in order to test especially the technical feasibility of this shunt in an effort to reduce portal and caval stasis during the anhepatic phase of the surgical procedures that require caval and portal clamping. The technical feasibility has been obtained but we believe that the materials and dimensions of the shunt have to be perfected and adapted depending on the size of the cava and portal veins.

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The development of experimental microsurgery can be considered the natural evolution of a diffuse need to increase precision in many fields of surgery. Microsurgery accelerated the possibility of deepening many unclear aspects of pathophysiology, using miniaturized and reproducible experimental models. We report briefly on the fundamental principles of microsurgery and the most frequently performed and useful models of experimental microsurgery, especially to employ as training models for surgeons, but also as bases for developing new and always-welcome models.

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Many surgical procedures have been proposed in the treatment of varicocele; however, the rate of recurrence and of postoperative complications, together with important correlation of this disease with male sterility, has played an important role in determining the success of microsurgery. In the present brief review, the indications for microsurgery and microsurgical dissection and/or anastomosis are described in comparison to traditional surgery.

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Cancer of the extrahepatic biliary tract is a rare disease related to a severe prognosis. The resection of the extrahepatic biliary tract is a complex procedure and the preoperative assessment of resectability is made difficult because of the malignancies. Biliary cancer resection can be curative in some patients but in some cases a liver resection has also to be performed. The authors retrospectively analyzed their recent cases closely examining some anatomical and technical aspects of biliary cancer resection. Eight patients were treated, three had distal cancer, two a central and three a proximal one (Klatskin tumor). In seven patients (87%) the cancer had spread to the liver. In one patient there was a favourable anatomical variation. All eight patients underwent laparotomy and in two (25%) the biliary cancer could be resected but curatively only in one case. Six patients underwent palliative procedures with a maximal survival of 8 months. The only curatively resected patient is well, without recurrence, 13 months after surgery. These results are similar to those reported concerning resectability and survival but a higher rate of liver metastases strongly reduced the amount of possibly curative resections. The experience shows the importance of laparotomy and of the knowledge of anatomy for a correct approach to resection and palliation of this cancer.

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The wider application of radiological examinations (ultrasound, computed tomography) has led to the pre-clinical discovery of "masses" in some organs, especially in adrenal gland. As these tumors are incidentally discovered, they are called "incidentalomas", and this term has been universally accepted. As soon as adrenal incidentaloma has been diagnosed it is important to establish if the patient has to undergo immediate surgical exploration or it is possible to follow the patient radiologically. Hormonally active adrenal metastatic tumors and adrenal incidentalomas greater than cm 5 should be surgically treated, while other adrenal tumors can be followed radiologically. Median anterior laparotomy or bilateral subcostal incision give a good surgical view. It is important the cooperation with endocrinologist, cardiologist and anaesthetist in order to control possible hypertensive rises during surgical operation.

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Diagnostic and therapeutic findings of benign hepatic tumors are analysed. In particularly the authors describe the more frequent tumors such as angioma, adenoma and FNH, but also give a guidelines on how to approach less frequent lesions.

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Quantitative alterations of the sexual hormones are present in cirrhotic patients whose testicular volumes are decreased with tubular atrophy in more than 50% of cases. The authors performed an experimental study utilizing end-to-side portacaval anastomosis in the rat in order to evaluate the consequences of the complete interruption of the portal blood to the liver in the male genital system, i.e. testicular alterations, due to the missing hepatic inactivation. Forty male Sprague-Dawley rats were used for this study. Twenty rats were subjected to end-to-side porta-caval anastomosis according to Lee, 10 rats underwent sham-operation while the remaining 10 rats were utilized as negative controls. The rats were weighed and necropsied three and six months after surgery and the liver and genital organs were weighed. In rats subjected to porta-caval anastomosis loss of weight was shown, about 20 g three months after surgery and 30 g six months after surgery, while other rats (sham-operated and negative controls) showed an increase of its weight, about 60 g after three months and 80 g after six months. In rats subjected to porta-caval anastomosis the liver was hypotrophic and its weight was decreased in comparison with the control group. In the same rats testicular volumes were decreased and hypotrophic in comparison with the control groups with average length 0.5 to 1 cm, while control groups showed values of 1.7 to 2.5 cm. Testosterone levels were 0.50 ng/ml in rats subjected to porta-caval anastomosis while in control groups the levels were 2.20 ng/ml.(ABSTRACT TRUNCATED AT 250 WORDS)

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Splenic abscess is rare and may be present either as a localized area in the spleen or as part of a generalized sepsis. A 35 year old man presented with a two month history of anorexia, weight loss, fever, abdominal pain and arthralgia. Multiple abscesses localized in the spleen were diagnosed by CT and splenectomy was performed.

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The authors report their experimental studies on early nutritional changes in 30 gastrectomized rats where intestinal continuity was restored by three different reconstruction methods, i.e., exclusion of the duodenum from alimentary transit (Sweet-Allen method), or duodenal recanalization (Longmire method) or double duodenal and jejunal recanalization (Moricca method). Ten sham operated rats were used as controls. Results showed that the group of rats which underwent Longmire's reconstruction presented better nutritional parameters (body weight gain, daily food intake, feeding efficiency, albuminemia) than the Moricca and Sweet-Allen reconstruction groups. These results became statistically significant when follow up was extended to 18 months by using an actuarial method. However, perioperative mortality rate was highest in the Longmire reconstruction group.

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Photon emission in the visible and near ultraviolet range by samples of human tissue removed during surgery has been measured by means of a low noise photomultiplier coupled to a data acquisition system. The results show that among the 25 analyzed samples the 9 from normal tissues had an emission rate of the order of some tens of photons/cm2 min, while most of the 16 tumor tissue samples had a very much higher rate.

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The correlation between hyperammonemia, during porto-systemic encephalopathy, and brain's lesions in patients died for porto-systemic encephalopathy is not demonstrated. The aim of this study has been to try a demonstration. A histological study of the brain, cerebellum, brainstem, and spinal cord was made in 60 rats: in 40 rats 1, 3 and 6 months after portocaval shunt, and in 20 rats sham operated. The brain, cerebellum, brainsteam and spinal cord have been fixed with paraformaldehyde (4%) and then sectioned for optical and electronic microscopic study. Ammonemia was measured regularly in the 40 rats with portocaval shunt, all the rats have been hyperammonemia since 10 weeks, after this period in 4 rats ammonemia was normal. In 20 rats sham-operated ammonemia was always normal. One month after surgery electronic microscopy revealed changes in the astrocytes characterized by nuclear swelling and lobulation. Three months after surgery this lesion was increased. After six months most lesions were noted in the hyperammoniemic rats. No similar lesions were observed in control rats. These results suggest that hyperammonemia is responsible of nuclear changes in the astrocytes of the patients died from hepatic encephalopathy.

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The Authors have experimentally verified Monteith's mathematical formula validity for determination of occlusal plane in edentulous patients in order to realize some complete dentures. They have held the inquiry on two groups of patients: group A, edentulous patients that need a complete denture for first time (ex novo); group B, patients that before had a complete denture and regretted a short aesthetic and functional adaptation. The results obtained for every patient confirm mathematical formula validity and show the importance of a correct determination of occlusal plane in edentulous patients for construction of complete dentures.

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