Our conclusions confirm the excellent advantages of stapled hemorrhoidectomy which allows the rapid recovery of patients and also promises the complete resolution of hemorrhoidal prolapse in the long term.

This review examines the incidence and implications of overwhelming infection in patients who have undergone splenectomy following trauma.Few topics have been so widely discussed in the last 10 years as the treatment of splenic trauma. Although splenectomy was considered the treatment of choice until recently, it is now held responsible for the onset of overwhelming postsplenectomy infection (OPSI) immediately or many years after surgery'.A large number of experimental and clinical studies from all over the world have contributed to our understanding of the physiology of the spleen and its role in the immunological defence against bacterial Several alternatives to splenectomy (non-operative treatment, splenic embolization, ligation of the splenic artery, splenorrhaphy, partial splenectomy, spleen autotransplantation) have been suggested and adopted after careful experimental studies5-'. Far from clarifying the ideal treatment for splenic trauma, the great mass of data render the choice of surgical treatment even more confusing. This is mainly due to failure to define the precise incidence of OPSI after splenectomy for trauma. The aim of this review is to stimulate a rational approach to resolve these problems. Definition of OPSIAlthough it is believed that Morris and Bullock were the first to hypothesize a n increased incidence of infection after splenectomy in 19199, it was not until 1952 that OPSI became seriously considered. In fact in that year King and Shumacker reported that two of five children who underwent splenectomy for spherocytosis died from the sudden onset of OPSI1o.The onset is sudden, the patient presenting with nausea, vomiting and mental confusion. He then goes into a coma and death occurs within a few hours of the onset of symptoms. Disseminated intravascular coagulation, severe hypoglycaemia, electrolyte imbalance and shock are frequently associated with OPSI'4. In our view, this clinical picture should be present when OPSI is diagnosed. On the contrary many authors have included under the heading OPSI other pathologies, such as subphrenic abscesses and laparotomy wound infections. These are related to the trauma but we d o not think that they should be part ofthe OPSI syndrome as they are not 'specific' septic events linked to splenectomy. In fact, they can also be observed after trauma to the liver, pancreas and especially to the large bowel.It is not easy t o give a precise evaluation of the incidence of OPSI despite the wealth of published information. In our opinion an exact definition of OPSI must be established, especially in the immediate postoperative period as fever, leucocytosis and pulmonary infections frequently occur also after other types of surgery. It is also vital to differentiate between data concerning OPSI incidence and mortality rate inThe clinical picture of OPSI is generally patients splenectomized for splenic trauma and those operated on because of haematological diseases. Incidence of OPSIO'Neal and McDonald reported 256 adults who had undergone ~plenectomy'~; 187 of...

It is a common opinion that general surgery is the first step for whoever approaches a surgical discipline, and that whoever practices training in general surgery should learn the rudiments of each surgical branch. The role of microsurgery in the training of the general surgeon has not been well-established. Clinical applications of microsurgery in general surgery are few and are rarely required, and have been connected strictly to restricted indications. However, we think that microsurgery could be very useful to the general surgeon because it allows the execution of experimental research on rats, the only possibility permitted by law. In these studies the microsurgeon can perform many times and in a short time the same surgical operation, thus improving his skill, and easily getting familiarity with surgical instruments and sutures.

The results of a study conducted to determine the usefulness of carcinoembryonic antigen (CEA) monitoring in the follow-up of patients with resected colorectal cancer are reported herein. The subjects of this study were 125 patients in whom CEA had been determined preoperatively and 239 patients in whom CEA had been monitored postoperatively. The results revealed increased preoperative CEA in only 24% of the subjects, and that this increment was correlated with subsequent more advanced tumor stage and a higher recurrence rate (P < 0.01). The postoperative CEA level exceeded the threshold in 71% of the patients affected by recurrence, 94.4% of whom developed liver metastases and 50%, nonhepatic recurrence. This marker showed elevated sensitivity for liver metastases (99%), whereas the sensitivity was lower for nonhepatic recurrence of the disease (94%). Thus, we concluded that CEA monitoring can be useful for preoperative colorectal tumor grading, even if its validity in the early diagnosis of recurrence is problematic, especially in terms of radical repeated surgery and survival.