Minerva chirurgica
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Twelve cases of peritonitis due to sigmoid diverticulitis managed by minimal surgery are reported. Morbidity involved two cases of stenosing sigmoiditis on which sigmoid resection was successfully carried out. Although it is considered that radical surgery is the optimal solution, it is also recalled that the prime objective is to cure the peritonitis, so each case must be assessed carefully on its own merits since the condition is a complication of a benign disease and the risk of emergency sigmoid resections is by no means negligible.
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Surgical patients with a chronic energy deficit display a particulare metabolic situation known as chronic shock, marked by deficient utilisation of energy. The picture is related to functional disorders of the cell enzymes, following incomplete resynthesis due to the lack of substrates. The main features are: a) lactic metabolic acidosis due to anaerobic oxidation, usually with insufficiency of the Krebs cycle; b) exaggerated protein catabolism, due to utilisation of amino acids as the energy substrate; c) incomplete utilisation of the (mostly endogenous) substrates available, with lactacidaemia, aminoacidaemia, and increased lipidaemia. A rational form of treatment is proposed after careful analysis of these features and their corresponding clinical phenomena.
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The literature data concerning the incidence of Meckel's diverticulum in the adult and the frequency of its complications are examined and problems associated with the preoperative diagnosis of this form are discussed. Reference is made to the limitations of abdominal scintiscanning and the encouraging results obtained with superior mesenteric arteriography in diverticular bleeding. Five cases of Meckel's diverticulum in the adult are presented. Stress is placed on the need to explore the ileum during appendicectomy to enable diverticula to be detected and removed, since they are often the cause or the site of complications, even in the adult.