The case of a 27-year-old woman, admitted to our surgical ward with symptoms of epigastric-ache, postmeal vomiting and significant weight loss, is reported. Clinical and radiographic suspicion of mesenterium commune, with duodenal compression due to bands, requested an explorative laparatomy that confirmed the mesenterium commune presence with left caecum and colon adhesion and left Bochdaleck hernia, which is rare in adult age.

A retrospective study is reported carried out on a group of 166 patients affected by dyspeptic syndrome who presented at least 3 of the 9 symptoms which characterise this pathology. One hundred and twenty-eight patients underwent prokinetic drug therapy and 38 received placebo. Clinical parameters were evaluated following one month of therapy all patients in order to compare them to basal values. The results obtained confirm a satisfactory efficacy of the prokinetic treatment in improving dyspeptic symptoms. Although administered to a smaller number of patients, placebo was also found to play an important role in the multifactorial etiopathogenesis of the dyspeptic syndrome on a functional basis.

Computerized Dynamic Endothermy (CDE) has been applied to the evaluation of the gastroenteric microcirculation. This new method enables mucosal temperature changes to be detected in a dynamic and functional way. With preventive induction of a temperature change (cold stimulus), the instrument measures the time required for the establishment of previous mucosal temperature. Computerized data are displayed in the form of a time/temperature curve. Results obtained on rabbits showed, during ischaemic conditions, a greater reduction of gastric layer temperature during cold stimulus than in basal conditions, followed by a slower return to basal temperature during the recovery time.

The latest investigations in the field of clinical immunology have proposed ways of assessing immunological efficiency that have also been used to identify patients most susceptible to infectious complications. The assessment of delayed hypersensitivity response (DHR) using anamnestic antigens is currently the most common method. The results of a polycentric study are presented. The study was conducted on a group of healthy subjects from various Italian regions divided into three age classes. Positive responses to the MT were noted in 96.4% of the population studied. The incidence of energy was statistically higher among females than males, while the mean response to the MT expressed in millimetres was statistically higher in males. Though 7 antigens were administered, the responsive population reacted on average to 3. The highest incidence of positive responses was to Candida, with Trichophyton responsible for the fewest.

A controlled study was carried out on 60 patients undergoing laparotomy to assess the role of a thymic factor (TP-1 Serono) in the prevention of postoperative infections. All patients entering the study were preoperatively shown to be at risk of sepsis on the basis of the response to skin multitest system for assay of delayed hypersensitivity (Multitest C.M.I. System). The patients were also postoperatively monitored with the same system. The lower incidence of infections in patients treated with the thymic factor with respect to untreated patients (p less than 0.05) and the postoperative response to skin tests have confirmed the efficacy of the thymic factor under study in the prevention of postoperative infections.

Biofeedback training is proposed as rehabilitative training for patients with permanent colostomoies to help them achieve fecal continence. The results of a preliminary study of 18 patients are reported.

Motor activity of the colon and reflex behaviour of the anal sphincters in normal subjects and in patients with idiopathic constipation were studied using a novel probe with 5 open-end tips to measure pressures, and 3 balloons for stimulation of the distal colon. Constipation appeared to be associated with an increased threshold of the inhibitory relaxation reflex of the internal anal sphincter (41.7 in normals and 65.7 in patients), and in particular with a blunted sensation of the defaecation urge (51.0 in normals and 112.8 in patients). Single-blind comparison with a placebo showed that cisapride, a new gastrointestinal prokinetic substance, had a significant effect on the sensation threshold, which normalized or improved in 15 out of the 16 patients studied.

The manometric recording of Lower Esophageal Sphincter (LES) has been made in 8 patients who have undergone surgical apposition of Angelchik prosthesis for hiatal hernia. The patients underwent an esophageal manometric study in the preoperative period, one month and one year after the intervention. In the preoperative patients, the mean LES pressure was 10,3 +/- 0,5 mmHg and there was sphincterial incoordination to peristaltic waves after swallow. In one month postoperative patients the LESP was 20,1 +/- 1,0 mmHg (p less than 0,001), and one year after the LESP was 17,0 +/- 0,3 (p less than 0,001) with an ameliorated coordination of the LES activity in response to swallow. Therefore, during postoperative manometric controls the Authors identified a high pressure subdiaphragmatic zone unmodified by deglutitory acts which was not present in the preoperative investigation. Probably the presence of this zone would been explained as a consequence of mechanical action of the prosthesis and the postsurgical fibrino-reaction around the prosthesis. The Authors discussed the results obtained and their importance to Angelchik prosthesis employment for surgical correction of hiatal hernia.