USE OF INTRAPERITONEAL PTFE DUAL-MESH IN A GIANT INCISIONAL HERNIA AFTER RENAL TRANSPLANTATION: A CASE REPORT

Objectives: We evaluated the incidence of incisional hernia after kidney transplantation, predisposing factors and the results of surgical repair of a giant incisional hernia by intraperitoneal PTFE dual mesh. Patients and methods: We report our experience about an incisional hernia in a 55 years male after renal transplantation treated with an intraperitoneal dual mesh prosthesis. The cause of incisional hernia was probably due to an urinoma for a total necrosis of distal graft ureter that needed to reopen in 2sd day post transplant with primary fascial approximation. Thirty days after transplantation we discovered a large incisional hernia that rapidly became monstrous with migration of o…

A simple method to treat post-kydney transplantation lymphocele

OBJECTIVE: To describe our experience with ultrasonic-guided instillation of povidone-iodine to treat post-kidney transplantation lymphocele. Patients and methods. We studied the safety and efficacy of this procedure for treatment of lymphocele in 6 male kidney transplanted recipients in which we assisted a progressive increase of creatinine and urinary proteins levels and color-Doppler ultrasonography demonstrated an increase (25,4%) of index of resistence (IR) Using eco-colorDoppler, the related-graft lymphocele location and the distance to the anterior abdominal wall were determined; then, a radiopaque double-lumen catheter was used to instillate 5% povidone-iodine 10 ml. Results. Percut…

PTFE mesh in renal allograft compartment sindrome

Nanofibrillar scaffold resists to bile and urine action: experiences in pigs

Biomaterial-based-scaffolds’ functions are to replace anatomical and functional features loss of an injured tissue. They can replace native tissue after their reabsorption. Material and methods. In our experimental procedures we utilized the PHEA-PLA+PCL scaffold in 2 female pigs to assess its resistance to bile and urine. Results. Both pigs survived to surgical procedures. After a month fibres appeared unchanged in term of form and dimension at electronic microscopy. Cells and ECM factors were founded inside the scaffold in a microscopical evaluation. Conclusion. Planar and tubular scaffolds were colonized by cells and extracellular matrix elements. The study conducted on pig suggested tha…

Video-assisted two-stage basilic vein transposition for creation of brachio-basilic arteriovenous fistulae

We report our experience in a mixed minimally-in- vasive technique for the two-stage transposition of basilic vein on a small series of eight patients. The operative tech- nique consisted of a modified endoscopic (1) approach for the two-stage transposition (2). The intervention was performed under Brachial Plexus Block (3).

Cell Therapy in Type 1 Diabetes

The incidence of diabetes mellitus has grown exponentially in the last few years. Etiopathogenesis of diabetes implies a ?-cells damage in the islet of Langerhans, either through an autoimmune reaction present in type 1 diabetic patients or through altered function within these cells that affect their ability to secrete a properly functioning insulin hormone, in patients suffering from type 2 diabetes. Exogenous insulin supply is, at the moment, the therapy of choice of the disease but it does not allow tight control of glucose regulation, leading to long-term complications. Over the past few decades, pancreas or pancreas-kidney organ transplantation has been the most effective treatment fo…

MESENCHIMAL STEM CELLS IN INFLAMMATORY BOWEL DISEASES: CLINICAL EVIDENCES AND POTENTIAL INSIGHTS FOR THE CLINICIANS

Mesenchimal stem cells (MSCs) have been used experimentally and clinically in the treatment of a wide variety of pathologies MSCs can be safely transplanted in autologous and allogenic ways as they are non-immunogenic, and consequently represent a therapeutic option for refractory connective tissue diseases, fibrosing diseases like scleroderma and fistulizing colitis like in Crohn's disease (CD). The immunomodulatory properties of MSCs have already shown promise when used as therapy for otherwise medically refractory CD. Accumulating evidence suggests that the properties may also be exploited of several other conditions. The currently available experimental and clinical data indicate that, …

SUPERIOR MESENTERIC VEIN THROMBOSIS AND CYTOMEGAOLOVIRUS: A DIAGNOSTIC DILEMMA, A CASE REPORT AND REVIEW OF THE LITERATURE

Superior mesenteric vein thrombosis (SMVT) is a rare condition, usually caused by infections, intra-abdominal inflammatory diseases, portal hypertension, hypercoagulable states, or contraceptive therapy. Due to its vague symptomatology, SMVT is often diagnosed only after an abdominal contrast-enhanced computed computed tomography (CT) scan. In this article, we present a case of SMVT in a patient with a history of contraceptive drug use and a recent cytomegalovirus infection. A 36-year-old female was admitted to our department with the clinical symptoms of an acute appendicitis. the patient was a smoker and had been using hormonal contraceptive for over a year. surgery was deemed the best co…

A complex case of fatal calciphylaxis in a female patient with hyperparathyroidism secondary to end stage renal disease of graft and coexistence of haemolytic uremic syndrome.

Background: Calciphylaxis is a potentially fatal complication of persistent secondary hyperparathyroidism; its cause is still not clear. Unfortunately there is no close relation in severity of clinical picture, serological and pathological alteration. For this reason the prognosis is difficult to establish. Administration of sodium thiosulphate may reduce the precipitation of calcium crystals and improve the general clinical conditions before surgical parathyroidectomy, which seems the only therapeutic approach able to reduce the mortality risk in these patients. Methods and Results: A 60 year old female patient suffering from End Renal Stage Disease, on haemodialysis from 2001 due to the o…

Colour Doppler-guided haemorrhoidal artery ligation: an adjunct in identification of haemorrhoidal vessels.

Not available (case report)

HUMAN FIBRIN GLUE SEALING VERSUS SUTURE POLYPROPYLENE FIXATION IN LICHTENSTEIN INGUINAL HERNIORRAPHY: A PROSPECTIVE OBSERVATIONAL STUDY.

Background: Patients who underwent primary inguinal hernia repair still report a high rate of postoperative pain after operation due to effect of mesh fixation by suture. An alternative is the use of human fibrin glue. We compared the two techniques. Methods: 468 patients randomly underwent primary inguinal hernia Lichtenstein repair fixing the mesh by suture or by human fibrin glue (HFG); in both cases themesh was fixed to the posterior wall of the inguinal canal and to the inguinal legament. results: No significant differences were recorded between the two groups in terms of complications, while the sutureless technique reduces the operative time and the postoperative pain. Conclusions: A…

A Good Breath of Oxygen for Beta-Like Cells Obtained From Porcine Exocrine Pancreatic Tissue

Ischemia is the most important factor that affects organ survival during harvesting. The two-layer method (TLM) is one of several cold storage solutions that seeks to preserve organs and cells avoiding in vivo and in vitro ischemia. We compared the retrieval of beta-like elements from exocrine pancreatic cells using TLM versus University of Wisconsin (UW) solutions. For this purpose pancreata laparoscopically harvested from 20 female pigs were preserved in UW solution or TLM before digestion. The resulting exocrine cells were divided into 2 groups: the first was cultured in a designed medium to allow differentiation into beta-like cells and the second was cryopreserved before the differenti…

Intraoperative cholangiography during cholecystectomy using a biliary-nose tube: Routinely used in patients with main bile duct stones

Background: Nowadays, the “gold standard” treatment for gallbladder stones is laparoscopic cholecystectomy but the risk of iatrogenic biliary duct injuries is increased compared to “open” surgery. Intraoperative cholangiography (IOC) can be useful to avoid biliary injuries but it can also be a no-safe procedure in center in which it is not routinely performed. Aim and objective: The aim of our study is to trust the efficacy of IOC in a patient with common bile duct (CBD) and gallbladder stones using a biliary-nose tube. Materials and methods: 135 patients with gallbladder and CBD stones were treated with sequential therapy and randomly divided into two groups. Laparoscopic cholecystectomy w…

Current Strategies for Tracheal Replacement: A Review

Airway cancers have been increasing in recent years. Tracheal resection is commonly performed during surgery and is burdened from post-operative complications severely affecting quality of life. Tracheal resection is usually carried out in primary tracheal tumors or other neoplasms of the neck region. Regenerative medicine for tracheal replacement using bio-prosthesis is under current research. In recent years, attempts were made to replace and transplant human cadaver trachea. An effective vascular supply is fundamental for a successful tracheal transplantation. The use of biological scaffolds derived from decellularized tissues has the advantage of a three-dimensional structure based on t…

Reoperation for persistent or recurrent secondary hyperparathyroidism. Surgical treatment of renal hyperparathyroidism

Background: Secondary hyperparathyroidism is a common acquired disorder seen in chronic renal failure. Its pathophysiology is mainly due to hyperphosphatemia and vitamin D deficiency and resistance. When medical treatment fails, subtotal and total parathyroidectomy with autotransplantation are the standard procedures, although both are associated with high recurrence rates. Methods and Results: 4 patients experienced persistence and 9 relapse. The first 4 were subjected to reoperation after 6 months for the persistence of symptoms due to the finding of a supernumerary adenomatous gland while the remaining patients at the reoperation showed in 5 cases 2 more glands in over thymic position, a…

Use of platelet concentrate gel in second-intention wound healing: a case report.

Abstract Background Wound healing is a complex and dynamic process. Healing of acute and chronic wounds can be impaired by patient factors (that is, comorbidities) and/or wound factors (that is, infection). Regenerative medicine products, such as autologous/homologous platelet-rich plasma gel, may speed up the healing process. Autologous/homologous platelet-rich plasma is an advanced wound therapy used for hard-to-heal acute and chronic wounds. The cytokines and growth factors contained in platelet-rich plasma play a crucial role in the healing process. Case presentation A 61-year-old Caucasian male patient, suffering from mental retardation following meningitis, with a transplanted kidney …

Is secondary hyperparathyroidism-related myelofibrosis a negative prognostic factor for kidney transplant outcome?

Secondary hyperparathyroidism (HP) presenting with hypocalcemia and subsequent increased parathormone (PTH), is mainly identified in patients with chronic renal failure, which has been associated with variable degrees of bone marrow fibrosis. For suitable patients with end-stage renal disease (ESRD), kidney transplantation is recognized as the therapy of choice, being superior to dialysis in terms of quality of life and long-term mortality risk; in this regard interesting data show that increased time on dialysis prior to kidney transplantation is associated with decreased graft and patient survival. In our opinion an important and until now underestimated determinant of graft survival is t…

An old method for good new cells

The aim of this work was to demonstrate a greater number of viable cells using a micro-surgical in-situ perfusion to collect rat pancreata compared with the pancreas after exsanguination. We used 3 groups of 20 rats. Perfusion was performed by selective cannulation of the left common iliac artery with administration of UW solution at 4 degrees C. Collected pancreata were digested and cells separated by Ficoll gradient were placed in culture to permit adhesion to dishes. Cells were characterized and tested for viability. We observed a gain of about 14% in the number of viable cells compared with those obtained after exsanguination (P < .001 by chi-square).

Pancreatic islets from non-heart beating donor pig: Two-layer preservation method in an in vitro porcine model

Purpose Pancreata from non-heart beating donors could represent an unlimited source of islets if their cell viability can be efficiently preserved during the time necessary to process the organs by the use of a better solution of preservation compared to the classic University of Wisconsin solution. The aim of this study was to determine whether it is possible to obtain functioning “alive islets” from non-heart-beating donors by comparing, on a porcine model, the classic “UW ice-store” method with a two-layer cold storage method (TLM) using oxygenated Perfluorocarbons (PFC) and UW. Methods Whole pancreata were harvested from 20 NHBDs female pigs with similar characteristics and preserved fo…

PTFE mesh in renal allograft compartment syndrome.

We report a case of anuria in a 42-year-old female kidney transplant patient that occurred secondary to extrinsic compression from a large kidney being placed extraperitoneally in a small iliac fossa. Prompt reexploration in the immediate postoperative period resulted in salvage of the graft with restoration of kidney function. The abdominal wall was reconstructed using prosthetic mesh, which decreased the compartment pressure within the iliac fossa sufficiently to allow the renal vein patency and the kidney perfusion. We think that this tension-free surgical technique should be applied in those cases in which the retroperitoneal space is less than the size of the kidney to avoid renal allo…

ENTERAL NUTRITION SUPPORT TO TREAT MALNUTRITION IN INFLAMMATORY BOWEL DISEASE

Malnutrition is a common consequence of inflammatory bowel disease (IBD). Diet has an important role in the management of IBD, as it prevents and corrects malnutrition. It is well known that diet may be implicated in the aethiology of IBD and that it plays a central role in the pathogenesis of gastrointestinal tract disease. Often oral nutrition alone is not sufficient in the pathogenesis of gastrointestinal tract disease. Often oral nutrition alone is not sufficient in the management of IBD patients, especially in children or elederly, and must be combined with oral supplementation or replaced with tube enteral nutrition. In this review, we describe several different approaches to enteral …

Differentiation and characterization of rat adipose tissue mesenchymal stem cells into endothelial-like cells

In this study, mesenchymal stem cells were isolated from rat adipose tissue (AD-MSCs) to characterize and differentiate them into endothelial-like cells. AD-MSCs were isolated by mechanical and enzymatic treatments, and their identity was verified by colony-forming units (CFU) test and by differentiation into cells of mesodermal lineages. The endothelial differentiation was induced by plating another aliquot of cells in EGM-2 medium, enriched with specific endothelial growth factors. Five subcultures were performed. The expression of stemness genes (OCT4, SOX2 and NANOG) was investigated. The presence of CD90 and the absence of the CD45 were evaluated by flow cytometry. The endothelial-like…

Use of Intraperitoneal ePTFE Gore Dual-Mesh Plus in a Giant Incisional Hernia After Kidney Transplantation: A Case Report

We evaluated the incidence of and predisposing factors for an incisional hernia after kidney transplantation. Numerous techniques have been used to repair postoperative fascial dehiscences or simple incisional hernias, but no clear treatment exists for giant hernias. Our aim was to obtain (1) a safe procedure to repair a large abdominal defect and reinforce the surrounding, fragile zones and (2) a simple, rapid technique to reduce the operative time. Herein we have described the surgical repair of a giant incisional hernia using intraperitoneal Gore ePTFE dual-mesh plus (Gore-Tex; W. L. Gore, Flagstaff, Ariz, USA) in a 55-year-old man status-post renal transplantation. Total necrosis of dis…

Abnormal expansion of segmented filamentous bacteria in the gut

Human intestinal microbiota create a complex polymicrobial ecology characterized by high population density, wide diversity, and complexity of interactions. Any imbalance of this complex intestinal microbiome, both qualitative and quantitative, might have serious health consequences including an increase in the number and/or alteration in the type of bacteria in the upper gastrointestinal tract, which is referred to as small intestinal bacterial overgrowth (SIBO) syndrome. SIBO is frequently found in persons fulfilling criteria for irritable bowel syndrome (IBS), and the large overlapping of symptoms of these two pathological conditions led some authors to believe that IBS is secondary to S…

TRATTAMENTO MULTIDISCIPLINARE DELLA GANGRENA DI FOURNIER. CASE REPORT

Introduzione:Fournier ha descritto per la prima volta una fascite necrotizzante dei genitali e/o del perineo che può evolvere rapidamente in shock settico con mortalità fino al 67%1. Caso Clinico: Pz. maschio 50 a.a. con turbe psichiche e diabete mellito II sottoposto ad emorroidectomia. A 24 ore dolore distrettuale, iperpiressia, edema dello scroto, crepitio inguinale sottocutaneo bilaterale. Veniva effettuato drenaggio chirurgico urgente della regione inguinale bilateralmente e recentazione scrotale; nel post-operatorio NPT e terapia antibiotica e.v.(ertapenem sodico 1 gr/die e linezolidd 600 mg x 2/die). Doppia medicazione/die e curettage dei reliquati necrotici seguiti da lavaggi con be…

Transanal hemorrhoidal dearterialization versus Milligan-Morgan hemorrhoidectomy in grade III/IV hemorrhoids.

La terapia delle emorroidi di III e IV si basa sul trattamento chirurgico. All’emorroidectomia secondo Milligan Morgan (MM), da molti chirurghi considerata il gold standard, si affiancano attualmente metodi chirurgici considerati meno invasivi come la Procedura per Prolasso ed Emorroidi (PPH) e la dearterializzazione emorroidaria transanale (THD). Gli Autori hanno voluto confrontare in un trial prospettico e randomizzato la emorroidectomia secondo MM e la THD nel trattamento di emorroidi di III e IV grado valutandone i risultati a breve e medio termine. Materiali e metodi: Tra gennaio 2010 e marzo 2013 sono stati reclutati 87 pazienti con emorroidi di III e IV grado secondo la classificazio…

A Misunderstood intestinal perforation believed acute pancreatitis: A case report

Acute pancreatitis represents one, possible but rare, of the several complications of laparoscopic cholecystectomy. In the case reported, a 31-year-old female patient complained of abdominal pain after laparoscopic cholecystectomy. The clinical picture, the high values of serum amylase, lipase and white blood cell count and the subsequent abdominal computed tomography (CT) led to diagnose an acute biliary pancreatitis. This was pharmacologically treated, but the patient worsened in a few days. A contrastenhanced CT showed the presence of free air and effusion into the peritoneal cavity. The patient was submitted to another intervention, which revealed a 1-cm jejunal perforation. The injured…

A New Prosthetic Implant for Inguinal Hernia Repair: Its Features in a Porcine Experimental Model

Even after more than 100 years of inguinal hernia repair, the rate of complications and recurrence remains unacceptably high. In the last decades, few effective advances in surgical technique and materials have been made. The authors see them as minor adjustments in the shape and materials of the prosthetic implants. Still, the underlying genesis of inguinal hernia remains undefined. Based upon this, it seems the surgical repair of inguinal protrusions cannot be based upon the pathogenesis because the etiology to date has not been addressed. Most hernia repairs are performed with some degree of point fixation (sutures/tacks) to stop the mesh from migrating and creating high recurrence rates…

OBTAINING MESENCHYMAL STEM CELLS FROM ADIPOSE TISSUE OR MURIN ORIGIN: EXPERIMENTAL STUDY.

The aim of this study was to isolate and characterize rat adipose Derived Mesenchymal Stem Cells (AD-MSCs) in order to evaluate their proliferative potential and their ability to different cell types. AD-MSCs and Derived Mesenchymal Stem Cells (BM-MSCs) have the same characteristic in terms of plasticity. The advantage of adipose tissue is that it is an easier accessible source and it offers a large amount of MSCs by less invasive surgical tecniques. MSCs were obtained from subcutaneous adipose tissue of Wistar rats. first of all microbiological controls were made to exclude the presence of bacteria of fungi in then tissue. Adipose tissue was mechanically and enzimatically fragmented and st…

Rottura di rene trapiantato.Analisi di due casi

Tecniche di allungamento della vena renale destra in corso di chirurgia di banco nel trapianto di rene da donatore cadavere

Use of Marginal Donors in Kidney Transplantation: Our Experience

The use of elderly donors has been advocated to expand the organ donor pool because of increased needs and the organ shortage. The aim of this study was to analyze whether the use of elderly donors and marginal kidneys affected the outcome of renal transplantations. Herein we presented data on 126 kidney transplantations performed from January 1996 to September 2003 using 32 marginal donors (group A) and 94 ideal donors (group B). We analyzed the medical and surgical complications and the graft survivals at a median follow-up of 18 months. Medical and surgical complications occurred in 22% and 5% versus 7% and 4% in groups A and B, respectively. The mean cold ischemia time and the mean age …

SEVERE STREPTOCOCCUS PYOGENES SURGICAL SITE INFECTION AFTER INGUINAL LIPOMA REMOVAL

Surgical site infections (SSI) are a common cause of health care-associated infections. They are localized in the surgical incision site and can lead to deep tissues spreading. Among the wide spectrum of SSIs , we will consider specifically group A streptococcus cellulitis. This kind of infection can have a negative evolution and result in necrotizing fasciitis (NF), previously known as streptococcal gangrene. The term NF indicates a rare necrotizing infection involving any of the soft tissue layers that still have a high mortality rate from 7% to 76%. An early diagnosis and urgent treatment are key to ensuring the safety of the patients’ life. A 64-year-old man underwent a complete surgica…

"Pure" large cell neuroendocrine carcinoma of the gallbladder. Report of a case and review of the literature

Primary Neuroendocrine Tumours (NETs) of the gallbladder are rare. Among all NETs of the gallbladder, large cell neuroendocrine carcinoma (LCNEC) is exceedingly rare. In most of the cases LCNECs are combined with other histological components. We reviewed clinical presentation and management of all patients with "pure" LCNEC from published literature since the first case was published in 2000, as well as one patient from our experience. Only 7 cases of "pure" LCNEC has been described in the last 15 years, our case is the eighth. The diagnosis of gallbladder NETs is rarely made preoperatively since the presentation generally consists of non-specific symptoms including upper abdominal pain, d…

Obtaining Mesenchymal Stem Cells From Adipose Tissue Of Murin Origin: Experimental Study

Intraoperative measurement of parathyroid hormone: A Copernican revolution in the surgical treatment of hyperparathyroidism

Intraoperative parathyroid hormone (PTH) monitoring in the setting of the operating room represents a valuable example of the rationale use of the laboratory diagnostic in a patient-oriented approach. Rapid intraoperative PTH (ioPTH) assay is a valid tool for an accurate evaluation of the success of parathyroid surgery. The reliability of the user-friendly portable systems as well as the collaboration between operators and surgical staff allow the one-site monitoring of the ioPTH decrements on the course of the surgical management of hyperparathyroidism. The rapid answer provided by an effective decrement of PTH during parathyroidectomy contributes dramatically to the efficacy of parathyroi…

Probiotics, prebiotics and symbiotics in inflammatory bowel diseases: state-of-the-art and new insights

Inflammatory bowel disease (IBD) consists of two distinct clinical forms, ulcerative colitis (UC) and Crohn's disease (CD), with unknown aetiology, which nevertheless are considered to share almost identical pathophysiological backgrounds. Up to date, a full coherent mechanistic explanation for IBD is still lacking, but people start to realize that the pathogenesis of IBD involves four fundamental components: the environment, gut microbiota, the immune system and the genome. As a consequence, IBD development might be due to an altered immune response and a disrupted mechanism of host tolerance to the non-pathogenic resident microbiota, leading to an elevated inflammatory response. Consideri…

Evidence of Absorptive Function in vivo in a Neo-Formed Bio-Artificial Intestinal Segment Using a Rodent Model.

A promising therapeutic approach for intestinal failure consists in elongating the intestine with a bio-engineered segment of neo-formed autologous intestine. Using an acellular biologic scaffold (ABS), we, and others, have previously developed an autologous bio-artificial intestinal segment (BIS) that is morphologically similar to normal bowel in rodents. This neo-formed BIS is constructed with the intervention of naïve stem cells that repopulate the scaffold in vivo, and over a period of time, are transformed in different cell populations typical of normal intestinal mucosa. However, no studies are available to demonstrate that such BIS possesses functional absorptive characteristics nece…

MANAGEMENT OF LEIOMYOMA OF THE TRANSVERSE COLON: CASE REPORT

Colonic leiomyoma is a mesenchymal tumor that arises from the muscularis mucosae or muscularis propria and is composed of well-differentiated smooth muscle cells with no atypia. It is often incidentally found since its growth affects the submucosal layer and the lesion is covered with normal epithelium. Endoscopic ultrasonography is recommended to define the grade of infiltration of the tumor and eventually lymph node involvement. Histological examination is critical to establish the nature of the tumor and its behaviour. In the case of a voluminous tumor surgical treatment is needed. we report case of a patient that underwent colonoscopy showing the presence of a neoformation at 70 cm from…

Histologic effects of university of wisconsin two-layer method preservation of rat pancreas.

Marginal donors represent a poorly utilized source of organs for transplantation despite their availability. The key is to reduce the ischemic damage in the effort to improve organ quality. This study investigated the histologic effects after in situ perfusion of preservation with a two-layer method compared with the classic University of Wisconsin preservation in term of tissue integrity and number of viable exocrine cells in the rat pancreas both after exsanguination and at 8 weeks of cryopreservation. Pancreata harvested from 60 rats were collected using 3 methods: two-layer method following University of Wisconsin perfusion; exsanguination; and classic University of Wisconsin perfusion/…

Bone Resorption in Kidney Transplant Recipients

Early diagnosis of persistent hyperparathyroidism (HP) following kidney transplantation may prevent worsening of osteodystrophy and potential damage to the graft. We evaluated the utility of collagen pyridinoline (PYD) and deoxypyridinoline (DPD) urinary cross-links beyond the common HP markers to evaluate 70 selected stable recipients between 1997 and 2006 who were divided into 2 group depending on the immunosuppressive protocol. All patients showed elevated levels of urinary cross-links even though calcemia and phosphoremia values were normal. Their mean creatinine level was slightly increased. Data were assessed as mean values +/- SD. All variables underwent a correlation matrix analysis…

Laparoscopic lower lateral incisional hernia repair after kidney transplant

Eight-point compass rose underlay technique in 72 consecutive elderly patients with large incisional hernia

Summary Background Repair of incisional hernia (IH) in the elderly is a challenge for the surgeon. Primary closure is preferable but is not always possible because of high recurrence rates of IH repaired without a prosthesis and/or possible respiratory and cardiovascular complications due to extreme tension of the margins. We report our experience with underlay mesh placement in elderly patients with large IH. Methods A total of 72 patients from January 2003 to December 2009 underwent IH repair involving placement of an intraperitoneal Gore® DualMesh® prosthesis. The prosthesis was first anchored at eight points in a compass rose pattern using a Gore® suture passer and then firmly secured t…

ADVANCED ENDOSCOPIC IMAGING FOR SURVEILLANCE FOR DYSPLASIA AND COLORECTAL CANCER IN INFLAMMATORY BOWEL DISEASE: COULD THE PATHOLOGIST BE FURTHER HELPED?

Patients with inflammatory bowel disease (IBD) have an increased risk of developing intestinal cancer. The magnitude of that increased risk as well as how best to mitigate it remain a topic of ongoing investigation in the field. It is important to quantify the risk of colorectal cancer in association with IBD. The reported risk varies widely between studies. This is partly due to the different methodologies used in the studies. Because of the limitations of surveillance strategies based on the detection of dysplasia, advanced endoscopic imaging and techniques involving the detection of alterations in mucosal antigens and genetic abnormalities are being investigated. Development of new bioma…

Intraoperative cholangiography during laparoscopic cholecystectomy: What role?

Aim: Laparoscopic cholecystectomy has increased the number of iatrogenic lesion of the biliary tree. In this study, we evaluate the role of intra-operative cholangiography in prevention of biliary tree iatrogenic lesions and early identification of choledocolithiasis, during laparoscopic cholecystectomy. Material of study: 169 patients who underwent laparoscopic cholecystectomy, were evaluated by means of intra-operative cholangiography. Patients were divided into two groups basing on the risk to develop biliary tree lithiasis. Discussion: Patients with a higher risk of postoperative complications effectively showed cholangiographic anomalies, including duct stones, dilations, anatomical va…

Renal Allograft Compartment Syndrome: Is It Possible to Prevent?

Renal allograft compartment syndrome (RACS) is a complication characterized by increased pressure over 15 to 20 mm Hg of the iliac fossa site of transplanted kidney that can lead to a reduction of the blood supply to the graft, resulting in organ ischemia. This study aims to evaluate, through a review of the literature, the incidence, detection, treatment, and possible prevention of RACS. The incidence of this complication, which appears generally in the immediate post-transplantation period, is currently approximately 1% to 2% and is underestimated because of poor nosography for the presence of symptoms common to other post-transplantation complications. Doppler ultrasound is indispensable…

Isolation & culture of b-like cells from porcine Wirsung duct

A case of renal carcinoma metastasis simulating a thyroid goiter

Background: Although the thyroid is a highly vascularized gland, it is not a common target of metastasis from extrathyroidal cancer. Clear-cell renal carcinoma (cRCC) frequently metastasizes to the thyroid, representing 2-3% of all adult tumors, and more than 40% of patients present with metastases at diagnosis. The presence of cRCC thyroidal metastases makes the differential diagnosis from thyroid clearcell carcinoma extremely difficult. Patients and Methods: A 70-year-old woman presented with a mild compressive symptomatology due to a recent multinodular thyroid goiter with a ‘simple’ multinodular ultrasound pattern, in the absence of signs of malignancy and with normal findings for hormo…

Laparoscopic Repair of Boundary Incisional Hernia in a Kidney Transplant Patient: A Safe Tacks-Fibrin Glue Combined Mesh Fixation Technique.

Abstract Background Incisional hernia in renal transplant patients is a complication that negatively affects the global outcome of transplant and quality of life. The repair of this condition was classically made by open repair with mesh. Increasing evidence suggests that laparoscopic repair could be advocated as the technique of choice in these patients with optimal results. However, the fixation of mesh should be performed by a mixed combination of fibrin sealant (lateral margin of wall defect) and tacks (medial margin). The tacks fixation of the mesh along the lateral margin of the wall defect, close to the graft, is generally difficult for the small size of the remaining aponeurotic pla…

Topic: Incisional Hernia - "Difficult case" as specialistic case: real loss of substance, multi recurrences, infections, fistulas, lombocel, burst abdomen, reconstruction of the entire wall.

The complex interplay between vitamin D deficiency and diabetes

It has been recently highlighted the link between vitamin D and metabolic and immunological pro- cesses, which established its role as an essential component of human health preservation. Vitamin D has been defined as natural immune modulators, and through the activation of its receptors (VDRs), it regulates calcium metabolism, cellular growth, proliferation and apoptosis, and other immunological functions. In this setting, vita- min D has also been reported to influence glucose regulation via effects on insulin secretion and action. Vitamin D deficiency is strongly associated with obesity mostly due to the storage of vitamin D in adipose tissue because of its lipophilic properties. The dec…

Using Polymeric Scaffolds for Vascular Tissue Engineering

With the high occurrence of cardiovascular disease and increasing numbers of patients requiring vascular access, there is a significant need for small-diameter (&lt;6 mm inner diameter) vascular graft that can provide long-term patency. Despite the technological improvements, restenosis and graft thrombosis continue to hamper the success of the implants. Vascular tissue engineering is a new field that has undergone enormous growth over the last decade and has proposed valid solutions for blood vessels repair. The goal of vascular tissue engineering is to produce neovessels and neoorgan tissue from autologous cells using a biodegradable polymer as a scaffold. The most important advantage of …

POSSIBLE RELATION BETWEEN GUT MICROFLORA COMPOSITION AND ONCOGENIC RISK: IS STIMULATION OF INFLAMMATION THE ONE RING OF CONNECTION?

Human intestinalmicrobiotais characterizedby highpopulationdensity, wide diversity and complexity of interactions. Dysbiosis, both qualitative and quantitative, might have serious health consequences including an increase in the number and/or alteration of bacteria colonizing the gastrointestinal tract, which could be referred as gut microflora imbalance (GMI). GMI is frequently found in patients suffering from irritable bowel syndrome; this is the reason why some authors believe that IBS is secondary to GMI. Interestingly, GMI is also found in about 25% of Crohn’s disease patients. Stimulation of inflammation by the ‘dangerous bacteria’, through specific activation of the intestinal immune…

Dissecting the different biological effects of oncogenic Ras isoforms in cancer cell lines: Could stimulation of oxidative stress be the one more weapon of H-Ras?

Abstract Ras proteins are small GTPase functioning as molecular switches that, in response to particular extracellular signalling, as growth factors, activate a diverse array of intracellular effector cascades regulating cell proliferation, differentiation and apoptosis. Human tumours frequently express Ras proteins (Ha-, Ki-, N-Ras) activated by point mutations which contribute to malignant phenotype, including invasiveness and angiogenesis. Despite the common signalling pathways leading to similar cellular responses, studies clearly demonstrate unique roles of the Ras family members in normal and pathological conditions and the lack of functional redundancy seems to be explainable, at lea…

Beyond islet trasplantation in diabetes cell terapy:from embryonic stem cells to transdifferentation of adult cells

Exogenous insulin is, at the moment, the therapy of choice of diabetes, but does not allow tight regulation of glucose leading to long-term complications. Recently, pancreatic islet transplantation to reconstitute insulin-producing cells, has emerged as an alternative promising therapeutic approach. Unfortunately, the number of donor islets is too low compared with the high number of patients needing a transplantation leading to a search for renewable sources of high-quality -cells. This review, summarizes more recent promising approaches to the generation of new -cells from embryonic stem cells for transdifferentiation of adult cells, particularly a critical examination of the seminal work…

Comparison between local and regional anesthesia in arteriovenous fistula creation.

Purpose Assessment of the effectiveness of Brachial Plexus Block (BPB) via axillary approach compared to regional anesthesia for arteriovenous fistula surgery in patients affected by end-stage renal disease. Methods We compared forty patients randomly divided into two groups. Group A underwent BPB procedure with 15 mL ropivacaine 1% and 10 mL of saline (0.9% NaCl) via axillary approach. Group B received local anesthesia with lidocaine 2%. The forearm blood vessels were assessed by Doppler ultrasonography before and after the intervention. Results BPB performed on Group A was associated with a considerable venous dilation and a significant decrease (48.7%, P&lt;.05) in pulsatility index (PI)…

Suture intradermiche totali

Two kind of total intradermal suture techniques are described in the present report. These procedures allow an effective reduction of post-operative pain of surgical wound, prevent infections, cut down tissutal trauma, achieve better aesthetic results, making easier postoperative patient''s management. From January 2001 to December 2007, 1,427 patients underwent surgical treatment and the wounds have been sewn with self-locking knots or intradermal skin closure with introflecting knots. This kind of procedures allow a sharp reduction of postoperative pain as well as the incidence of wound infections. Also the number of wound medication required after surgery is significantly reduced.

Ileus following spontaneous jejunum intramural hematoma: case report and review of the literature.

Anticoagulant therapy may cause the onset of a spontaneous intramural hema- toma of the small bowel, in the jejunum, ileum or duodenum. A 53-year-old woman on therapy with heparin for previous pulmonary embolism was admitted for abdominal pain and vomit. Computed tomography scan visualized an intramural hematoma of the jejunum causing subtotal obstruction of the intestinal lumen. The patient underwent resection of a part of the jejunum, securing intestinal continuity by a mechanical side-to-side anastomosis. The postoperative course was regular, but the initial anticoagulant therapy was reduced to prevent recurrence. In conclusion, spontaneous hema- toma of small bowel can occur as a compli…

Il trattamento medico e chirurgico nei pazienti affetti da iperparatiroidismo secondario e terziario. Revisione della letteratura

Introduzione: L’iperparatiroidismo è un’alterazione fisiopatologica della secrezione di paratormone dovuta o da un rilascio autonomo e anomalo (iperparatiroidismo primario o terziario) da parte delle paratiroidi o da un’alterazione dell’omeostasi del calcio che stimola l’eccessiva produzione di paratormone (iperparatiroidismo secondario). Obiettivi: Il trattamento clinico dell’iperparatiroidismo secondario o terziario non è univoco. Sorge pertanto la necessità di una revisione delle attuali metodiche diagnostico-terapeutiche. Discussione: Nell’iperparatiroidismo secondario (2HPT) si ha una progressiva iperplasia delle paratiroidi e un incremento della produzione di paratormone. Tra le cause…

Surgical vascular access in the porcine model for long-term repeatedblood sampling

A simple technique for implanting a long-term jugular catheter in piglets under general anesthesia is described. We report our experience in 10 young female pigs with a body weight of 20-30 Kg. The surgical procedure involves implantation of a jugular central venous catheter (11Fr polyurethane) tunneled in the subcutaneous fat layer of the neck. This procedure may be performed in about 15 minutes. The maintenance of the catheter is described which allows several daily blood samples to be taken. This procedure reduces both the stress in piglets and the chance of catheter dislodgement due to the animals scratching or rubbing. Blood sampling can be easily performed with a low incidence of infe…

Renal Transplantation by Automatic Anastomotic Device in a Porcine Model

Automatic vascular staplers for vascular anastomoses in kidney transplantation may dramatically reduce the operative time and, in particular, warm ischemia time, thus increasing the outcome of transplantation. Ten pigs underwent kidney auto-transplantation by automatic anastomotic device. Kidneys were collected by laparotomy with selective ligations at the renal hilum and perfused with cold storage solution. To overcome the shortage in length of renal hilum, a tract of the internal jugular vein was harvested to increase the length of the vessels. The anastomoses were totally performed by the use of the anastomotic device. On 10 kidney transplants, nine were successful and no complications o…

The sentinel node biopsy is not contraindicated in multifocal breast carcinoma

Aim. Following the availability of the results ofvalidation studies, the sentinel lymph node biopsy(SLNB) has replaced routine axillary dissection(AD) as the new standard of care in early unifocal breast cancers.Multifocal (MF) and multicentric (MC) tumours have been considered as a contraindication for this technique due to the possible incidence of a higher false-negative rate. In this retrospective study we try to demonstrate the usefulness of SLNB in MF/MC breast carcinoma. Patients and Methods. Eight hundreds and fiftyeightpatients with breast carcinoma underwent a conservative surgery and sentinel node excision. Ninety-four out of 858 patients had histological diagnosis of multifocal …

Fentanyl and sufentanyl in fast track anaesthesia for major intra-abdominal surgery

Background and aim: Major intra-abdominal surgery is estimated to have high costs annually in Italy. In an attempt to decrease surgery costs and improve outcome for patients, fast-track programs have become popular. This is especially due both to the improvement of surgery and to the new anesthetic agents (regarding pharmacokinetic and pharmacodynamic) resulting in better care for patients. The aim of this study was to evaluate two different anesthetic protocols in patients undergoing scheduled anesthesia including the combination of two different opioids (fentanyl or sufentanil) with the same hypnotic and muscle relaxant. Material and Methods: 40 patients, with an American Society of Anest…

LONG-TERM RESULTS AFTER ENDOSCOPIC DILATION OF POST-OPERATIVE COLO-COLONIC ANASTOMOTIC STENOSES. OUR EXPERIENCE IN 42 PATIENTS.

The aim of this study is to evaluate long-term complications and patient's quality of life after the endoscopic treatment of benign anastomotic colo-colonic strictures. From January 2000 to November 2008,, 42 patients who had undergone surgery for colorectal cancer were endoscopically treated for a postoperative symptomatic stricture. The dilation were performed using a 20-30 mm pneumatic dilator. The clinical results were classified in relation to the abdominal symptomatology reported by the patients, and were evaluated in the short-term (one-week) and long-term (mean follow-up.36 months)period. Results: 15 patients underwent a total of 22 dilating sessions; 9 patients had a single dilatin…

Comparison between Rapid Intraoperative and Central Laboratory Parathormone Dosage in 12 Kidney Transplant Candidates

Abstract Background The rapid intraoperative parathormone (PTH) and at central laboratory PTH dosage gives similar results. The central laboratory provides results in longer times and higher costs. Intraoperative measurement can reduce time and costs during parathyroidectomy. Methods Twelve patients undergoing parathyroidectomy for hyperparathyroidism renal transplant candidates were included. Diagnosis was made by laboratory tests (serum calcium, PTH) and imaging techniques (ultrasonography and scintigraphy). All patients presented PTH levels of >400 pg/mL (the limit value to be maintained in list for kidney transplantation) and resistant to medical therapy. For each patient, 2 blood sampl…

Struma ovarii. Case report and revision of the literature

Struma ovarii is a rare form of ovarian neoplasm, entirely or predominantly composed of thyroid tissue. This tumour generally has a benign biological behavior, although some cases of malignant transformation have been reported (5-10%). The tumour usually presents as an asymptomatic mature mass that may measure as much as 10 cm in diameter. The presence of ascites is possible (15-20%), and in a few cases the association of ascites and hydrothorax has been recorded (Pseudo-Meigs Syndrome); a close relationship between ascites and high levels of Ca-125, that may wrongly induce to a diagnosis of ovarian carcinoma is present. Other possible clinical consequences are compressive symptoms on adjac…

INTRAPERITONEAL MESH IN ELDERLY PATIENTS WITH LARGE INCISIONAL HERNIAS. A RAPID AND SIMPLE SURGICAL TREATMENT

Enteral Nutrition in Pancreaticoduodenectomy: A Literature Review

Pancreaticoduodenectomy (PD) is considered the gold standard treatment for periampullory carcinomas. This procedure presents 30%–40% of morbidity. Patients who have undergone pancreaticoduodenectomy often present perioperative malnutrition that is worse in the early postoperative days, affects the process of healing, the intestinal barrier function and the number of postoperative complications. Few studies focus on the relation between enteral nutrition (EN) and postoperative complications. Our aim was to perform a review, including only randomized controlled trial meta-analyses or well-designed studies, of evidence regarding the correlation between EN and main complications and outcomes af…

Use of monitoring intraoperative parathyroid hormone during parathyroidectomy in patients on waiting list for renal transplantation.

This report describes the use of intraoperative parathyroid hormone (ioPTH) assay during parathyroidectomy for patients with secondary hyperparathyroidism on the waiting list for renal transplantation. The levels of ioPTH were determined among waiting list patients undergoing subtotal parathyroidectomy and tertiary hyperparathyroidism patients undergoing procedures. The levels of ioPTH were significantly reduced at 10 minutes by 59.7,3% among with secondary hyperparathyroidism and 68.9% among tertiary hyperparathyroidism. A 15 minutes it was 85% in secondary hyperparathyroidism and 89.7% in tertiary hyperparathyroidism. A decrement of 50% in basal values at 10 minutes and 85% decrement or m…

Isolation and colture of beta-like cells from porcine Wirsung duct

We sought to develop a protocol to isolate and culture porcine Wirsung duct cells in order to determine their potency to differentiate into insulin-expressing beta-like cells. The porcine Wirsung duct isolated by a surgical microdissection was digested with collagenase P and trypsin to dissociate ductal cells. These elements were cultured in serum-free supplemented media: for 2 weeks. Thereafter the cells were exposed to varying concentrations of glucose (0, 5.6, 17.8, and 25 mmol/L) to induce a beta-like phenotype, as identified by immunohistochemical staining. Cell growth proceeded slowly for the first 2 weeks of culture. After glucose induction for 2 weeks, they formed pancreatic islet-l…

Laparotomic vs laparoscopic ovariectomy: comparing the two methods. The ovariectomy in the bitch in laparoscopic era

BACKGROUND: The aim of the present work is to evaluate the effectiveness of the use of ultrasound scalpel during laparoscopic ovariectomy in the bitch. METHODS: Two groups of 10 subjects each, of different races and ages, were compared. In the first group, ovariectomy was performed laparoscopically, using harmonic scalpel to remove ovary. In the second group surgery was performed by means of classical laparotomy. RESULTS: Pre-operative time was similar in both groups. Total operative time, from incision to skin suture, showed significant difference between the two groups, being laparoscopy faster than laparotomy. Partial operative time for bilateral oophorectomy resulted lower using open te…

Double Endocrine Neoplasia in a Renal Transplant Recipient: Case Report and Review of the Literature

Abstract Introduction The incidence of cancer compared for age groups is 3–4 times higher in transplant recipients than the general population. The increased risk is related to immunosuppressive therapy as well as the use of increasingly older donors and recipients. Although cardiovascular disease with a functioning transplant is the leading cause of death (47%), cancer mortality is significant especially among older patients. However, the most frequent posttransplantation cancers relate to hemolymphopoietic organs and skin, whereas the occurrence of solid tumors elsewhere is rare. Herein we have described a rare case of synchronous double malignancy of endocrine organs (thyroid-adrenal) in…

VITOM® 3D in Arterio-Venous Fistulas: Single Centre Preliminary Surgical Experience

Background: Arteriovenous fistula (AVF) is the vascular access of choice for hemodialysis patients. A correct microsurgical vascular anastomoses is essential to the optimal care of patients. Loupes can help surgeons perform such procedures, but often cause neck or back pain and fatigue. Aim: This study aimed to evaluate whether a video telescopic operating microscope (VITOM®; Karl Storz Endoscopy GmbH, Tuttlingen, Germany) could be used as a substitute for loupes to create microsurgical vascular anastomoses. Methods: We evaluated microsurgical anastomoses with VITOM® in 10 patients (6 male, 4 female) from January 2019 to December 2019. The created anastomoses were 7 side-to-side, 2 side-to-…

Argentum-quarz solution in the treatment of anorectal fistulas: Is it possible a conservative approach?

Patients suffering from chronic intestinal diseases (Crohn's disease, Ulcerative Colitis, Indeterminate Colitis) are prone to the development of pyogenic complications. These complications are most commonly in the form of perianal or intraabdominal abscesses and/or fistulas. The treatment of these complications are managed differently but, after an initial treatment based on medical or minimally invasive management, the solution of the pathological condition is always achieved by a surgical procedure. In the last few years prospective studies have proposed an alternative conservative therapeutic approach based on application of fibrin glue in the healing of patients with fistulas-in-ano. In…

Struma ovarii:revisione della letteratura, considerazioni su un caso clinico

Sistemic calciphylaxis and thrombotic microangiopathy in a kidney transplant patient: Two mixing fatal syndromes?

Abstract Abnormalities in calcium and phosphorus metabolism are common and metabolic bone diseases develop often in patients with chronic renal failure (CRF). Effective clinical management includes measures to control phosphorus retention and prevent hyperphosphataemia, to maintain serum calcium concentrations within the normal range and to prevent excess parathyroid hormone (PTH) secretion by the judicious use of vitamin D sterols. Certain of these interventions, however, appear to increase the risk of soft tissue and vascular calcification in patients with End Stage Renal Disease (ESRD), so current therapeutic approaches are thus being re-evaluated in an effort to limit these risks. Patie…

Bioengineered vascular scaffolds: the state of the art

To date, there is increasing clinical need for vascular substitutes due to accidents, malformations, and ischemic diseases. Over the years, many approaches have been developed to solve this problem, starting from autologous native vessels to artificial vascular grafts; unfortunately, none of these have provided the perfect vascular substitute. All have been burdened by various complications, including infection, thrombogenicity, calcification, foreign body reaction, lack of growth potential, late stenosis and occlusion from intimal hyperplasia, and pseudoaneurysm formation. In the last few years, vascular tissue engineering has emerged as one of the most promising approaches for producing …

Electrospun Polyhydroxyethyl-Aspartamide-Polylactic Acid Scaffold for Biliary Duct Repair: A Preliminary In Vivo Evaluation

Abstract Tissue engineering has emerged as a new approach with the potential to overcome the limitations of traditional therapies. The objective of this study was to test whether our polymeric scaffold is able to resist the corrosive action of bile and to support a cell's infiltration and neoangiogenesis with the aim of using it as a biodegradable tissue substitute for serious bile duct injuries. In particular, a resorbable electrospun polyhydroxyethyl-aspartamide–polylactic acid (90 mol% PHEA, 10 mol% PLA)/polycaprolactone (50:50 w/w) plate scaffold was implanted into rabbit gallbladder to assess the in vivo effects of the lytic action of the bile on the scaffold structure and then as a tu…

Localization of sentinel lymph node in breast cancer. A prospective study

Abstract Introduction Sentinel Lymph Node Biopsy (SLNB) is the standard of care for staging axillary lymph nodes in women with breast cancer and clinically negative nodes. It is associated with reduced arm morbidity, moderated or severe lymphoedema, and a better quality of life in comparison with standard axillary treatment. Unfortunately, skip metastases makes all minimally invasive approaches, such as axillary sampling, unreliable. The aim of the present clinical prospective study is to evaluate the position of SLN in an important number of cases and establish the real incidence of skip metastases in clinically node-negative patients. Patients and methods A cohort of 898 female patients w…

“Magnifying glass” for difficult radiocephalic arteriovenous fistulas

Background: Some uremic patients suffering from diabetes, atherosclerosis or simple by absent or exhausted peripheral vascular bed require bigger effort in creating arteriovenous fistula. Although it is possible to use prosthetic graft for difficult cases, the use of native vessels falls always in the respect of patient’s quality of life. A help for these cases comes from the use of a microsurgical technique for creating vascular access. Patient and Methods: For this study we evaluated the 72 patients underwent microsurgical radiocephalic fistula comparing them to a homogeneous group of 72 patients underwent traditional surgery. The patients were followed up at 1, 2 months and 1 year. Resul…

A case report of a difficult dissection of the iliac vessels conducted by means of the harmonic scalpel during a kidney transplantation

Background. The “difficult” preparation of iliac vessels in the kidney transplant recipient caused by a perivascular fibrosis with satellite lymphadenopathy is sometimes burdened by post-transplant complications (lymphocele, seroma and hematoma). Both iliac vascular adhesions and satellite lymphoadenopaty are often due to reiterate femoral cannulation aimed to hemodialysis. Patients and Methods: The case report concerns a 60 years old female uremic patient, on dialysis for about 4 years with perivascular fibrosis and pelvic lymphadenopathy caused by bilateral femoral artery catheterization. In the course of kidney transplant, preparation of the iliac vessels was performed by ultrasonic scal…

GRANULOMATOUS MASTITIS DURING CHRONIC ANTIDEPRESSANT THERAPY: IS IT POSSIBLE A CONSERVATIVE THERAPEUTIC APPROACH?

Granulomatous mastitis is a rare benign inflammatory disease of the breast with multiple etiologies such as tuberculosis, sarcoidosis, foreign body reaction, and mycotic and parasitic infections. In contrast, idiopathic granulomatous mastitis (IGM) is characterized by the presence of chronic granulomatous lobulitis in the absence of an obvious etiology. Clinically and radiologically it may mimic breast carcinoma and so awareness of surgeons, pathologists, and radiologists is essential to avoid unnecessary mastectomies. Cases of IGM are reported during antidepressant therapy in patients also showing high levels of prolactinemia. In these cases, we believe that surgical excision must be avoid…

OneShot-M: A New Device for Close Laparoscopy Pneumoperitoneum

Introduction. The induction of pneumoperitoneum is the first and most critical phase of laparoscopy, due to the significant risk of serious vascular and visceral complications. The closed technique for the creation of pneumoperitoneum could lead to several surgical complications. The present study aimed to overcome the complications associated with the insertion of Veress needle, improving its use, and facilitating the rapid creation of pneumoperitoneum. Methods. Thirty large white female pigs were enrolled in our study. A common plunger was modified in order to allow the passage of a 15-cm long Veress needle. This method was applied to 26 laparoscopic procedures (26 pigs) of several speci…

RECURRENT RENAL CARCINOMA MIMICKING A GOITRE: A CASE REPORT

Although the thyroid is a high vascularised gland, it is not common terget of metastases from extraglandular cancer. We reported a case of a 70 year-old woman who underwnt total thyroidectomy for multinodular goitre. In the patient's clinical hystory a nephrectomy was carried out 2 years before due to unspecified causes. The histopathological examination of the thyiroid showed a pattern compatible with clear cell renal carcinoma metastasis. The patient's relatives revealed, when questioned again, that the nephrectomy was due to the presence of a clear renal cell carcinoma keep concealed to the patients. Thanks to a timely intervention, the mass was removed and a better survival was guarante…

The use of a new kind of low profile retractor for arteriovenous fistula procedure simplifies and speeds up the intervention

Purpose The aim of this study was to demonstrate the effectiveness of a new kind of disposable surgical retractor in arteriovenous fistula (AVF) procedures in order to achieve an easier, faster and safer surgical intervention. Methods Between January and June 2008, 22 AVF procedures were performed using the 3PAWS ReeTrakttrade; (Insightra Inc. - Irvine, Ca., USA) a self-retaining, low profile retractor. An equivalent patient sample, in which an AVF was performed using conventional retraction devices, was considered for comparison of the intra- and post-operative results. Results In all of the 22 AVF procedures performed, the ReeTrakt™ system has simplified the performance of the surgical te…

Post-transplantation tertiary hyperparathyroidism.

Tertiary hyperparathyroidism is intended as a state of excessive autonomous excretion of parathyroid hormone after longstanding secondary hyperparathyroidism. It is a condition of a severe hyperparathyroidism that persists in the renal recipient despite a successful transplantation. The high levels of parathyroid hormone lead to a worsening of graft function accompanied by systemic symptoms. This article reviews the main aspects related to tertiary hyperparathyroidism from mechanism of pathogenesis to prevention and treatment, suggesting some indications about the best management of patients on a waiting list for kidney transplant.

Superior mesenteric vein thrombosis following open right hemicolectomy and cholecystectomy. Case report

INTRODUZIONE: La SMVT è una seria, rara complicanza della chirurgia addominale. I fattori di rischio sono molteplici, ma scarsamente descritti tanto che i dati sono insufficienti per creare gold standard per la diagnosi e trattamento. La SMVT ha un ampio spettro di presentazioni cliniche, così che spesso la sua diagnosi precoce può essere complessa. CASE REPORT: Una donna obesa di 56 anni con un disordine protrombotico ereditario è stata sottoposta ad emicolectomia destra e colecistectomia open; l’immediato decorso post-operatorio è stato regolare e la paziente è stata dimessa in quinta giornata post-operatoria. In ottava giornata post-operatoria la paziente ha presentato dolore addominale …

Mediastinal syndrome from plasmablastic lymphoma in human immunodeficiency virus and human herpes virus 8 negative patient with polycythemia vera: a case report

Background: Plasmoblastic lymphoma is a rare and aggressive subtype of diffuse large B cell lymphoma, which occurs usually in the jaw of immunocompromised subjects. Case presentation: We describe the occurrence of plasmoblastic lymphoma in the mediastinum and chest wall skin of an human immunodeficiency virus-negative 63-year-old Caucasian man who had had polycytemia vera 7 years before. At admission, the patient showed a superior vena cava syndrome, with persistent dyspnoea, cough, and distension of the jugular veins. Imaging findings showed a 9.7 × 8 × 5.7 cm mediastinal mass. A chest wall neoformation biopsy and ultrasound-guided fine-needle aspiration biopsy of the mediastinal mass allo…

Does Conservative Surgery for Breast Carcinoma Still Require Axillary Lymph Node Evaluation? A Retrospective Analysis of 1156 Consecutive Women With Early Breast Cancer.

Abstract Background The role of axillary surgery for early breast carcinoma treated with conservative surgery and radiotherapy is currently the subject of considerable investigation. Recent studies have supported the noninferiority of avoiding axillary surgery in terms of overall survival when sentinel lymph node biopsy (SLNB) presents ≤ 2 positive lymph nodes, thus sparing the patients from complications. There are some ongoing studies investigating the possibility of omitting SLNB. Axillary study seems to be sufficiently replaced by SLNB for staging the disease. Axillary surgery maintains a therapeutic role in the presence of > 2 metastatic lymph nodes at SLNB. Patients and Methods We per…

An unexpected surprise at the end of a "quiet" cholecystectomy. A case report and review of the literature

BACKGROUND: Anatomic unexpected variations in biliary tree may be discovered during laparoscopic cholecystectomy. CASE REPORT: A 57-year-old man was admitted for abdominal pain, vomiting and mild jaundice. Abdominal ultrasonography revealed a gallbladder containing multiple stones and biliary sludge. All pre-operative investigations showed no anatomical variations in extrahepatic biliary tree. During surgical intervention an accessory extrahepatic duct, connecting the IV segment of the liver to the fundus of gallbladder, was discovered. CONCLUSIONS: Pre-operative routine investigations for gall stones diseases may not reveal anatomic variations of biliary tree.

APPROCCIO MULTIDISCIPLINARE AL GOZZO RECIDIVO CON GRAVE STENOSI TRACHEALE: UN CASO CLINICO

INTRODUZIONE Il reintervento per patologia a carico della ghiandola tiroidea è raro, ma risulta spesso indicato nelle ricomparsa di patologia nodulare dopo interventi parziali. La ricorrenza della patologia multinodulare si aggira infatti intorno al 12% di tutti gli interventi sulla tiroide. Questi interventi di totalizzazione possono talvolta richiedere la collaborazione di equipe chirurgiche con diverse specialità in successivi steps temporali. MATERIALI E METODI Il caso clinico riguarda una donna di 72 anni sottoposta 40 anni prima ad intervento di tiroidectomia parziale che riferisce la comparsa di voluminosa tumefazione in sede sottojoidea nell’arco di 2 mesi accompagnata da crisi resp…

Intraperitoneal coated polypropylene hernia meshes: the dark side of the moon.

To date, the use of meshes in repairing abdominal wall defects has brought many advantages, especially in terms of recurrence prevention, but it is not exempt from complications, such as chronic pain, entero-cutaneous fistulas and intestinal obstruction. Here we report a case of intestinal obstruction in a patient with a large umbilical hernia treated laparoscopically by means of a composite polypropylene mesh, six year before.A 49-year-old man came to our care with a 3-day history of central and right lower abdominal quadrant pain and a clinical picture of intestinal obstruction. Six years before the patient underwent a laparoscopic intervention to repair his umbilical hernia, with the pos…

VITOM® 3D system in surgeon microsurgical vascular training: our model and experience.

LETTER TO EDITOR

The long-term effects of probiotics in the therapy of ulcerative colitis: a clinical study

Aim: Intestinal dysbiosis seems to be the leading cause of inflammatory bowel diseases, and probiotics seems to represent the proper support against their occurrence. Actually, probiotic blends and anti-inflammatory drugs represent a weapon against inflammatory bowel diseases. The present study evaluates the long-term (2 years) effects of combination therapy (mesalazine plus a probiotic blend of Lactobacillus salivarius, Lactobacillus acidophilus and Bifidobacterium bifidus strain BGN4) on ulcerative colitis activity. Method: Sixty patients with moderate-to-severe ulcerative colitis were enrolled: 30 of them were treated with a single daily oral administration of mesalazine 1200 mg; 30 pati…

NUTRITION IN IBD PATIENT'S: WHAT ARE THE PROSPECTS?

Summary: Inflammatory Bowel Disease (IBD) is a chronic disorder characterized by a relapsing-remitting course, which alternates between active and quiescent states, ultimately impairing a patients quality of life. The two main types of IBD are Crohn's disease (CD) and Ulcerative Colitis (UC). In physiological conditions the gut is costantly exposed to various antigens, commensal microflora and pathogens and the inflammatory response is finely balanced. It is thought that a vast number of environmental risk factors may be implicated in the development of IBD, including smoking factors, dietary factors, psycological stress, use of non-steroidal anti-inflammatory drugs and oral contraceptives,…

Electrospun biodegradable materials for vascular regenerative medicine

Objectives: There is a rising interest for the development of small-sized blood vessels substitutes. Several studies have been focused on the development of a biodegradable graft temporarily able to substitute the blood vessels and allow their complete regeneration after a certain time. We tried to develop a biodegradable material, with optimal mechanical characteristics and the capacity to allow cells adhesion, differentiation and proliferation by electrospinning to obtain a nano-fibrillar scaffold starting from a polymeric solution. Methods: We report the in vivo application on rats of two new electrospun biodegradable materials, specifically designed to create tubular structures. Both bi…

Ileus Following Spontaneous Jejunum Intramural Hematoma: Case Report and Review of the Literature

Anticoagulant therapy may cause the onset of a spontaneous intramural hematoma of the small bowel, in the jejunum, ileum or duodenum. A 53-year-old woman on therapy with heparin for previous pulmonary embolism was admitted for abdominal pain and vomit. Computed tomography scan visualized an intramural hematoma of the jejunum causing subtotal obstruction of the intestinal lumen. The patient underwent resection of a part of the jejunum, securing intestinal continuity by a mechanical side-to-side anastomosis. The postoperative course was regular, but the initial anticoagulant therapy was reduced to prevent recurrence. In conclusion, spontaneous hematoma of small bowel can occur as a complicati…

VALUTAZIONE ECO-COLOR-DOPPLER DEL RENE TRAPIANTATO. REVIEW DELLA CASISTICA E VALUTAZIONE CRITICA

Un caso complesso di calcificassi associata ad iperparatiroidismo secondario (IPTII) con coesistenza di sindrome emolitico uremica SEU) in paziente già sottoposta a trapianto di rene

Introduzione La calcificassi è l’estrema complicanza potenzialmente letale dell’iperparatiroidismo IPT spesso di tipo II. La sua patogenesi è dubbia in quanto concorrono variabili di tipo individuale legate ad una complessa reazione di ipersensibilità in presenza di PTH, vitamina D ed ipercalcemia.Una non sempre correlazione tra gravità dei segni clinici ed alterazioni laboratoristiche ed anatomo-patologiche rende difficile la prognosi. Il sodio tiosolfato e.v. può ridurre la precipitazione di calcio e disostruire le arterie migliorando il quadro clinico rappresentando oltre alla paratiroidectomia (PTX) l’unica terapia capace di ridurre l’elevato rischio di mortalità Materiali e metodi: Il …

Post-transplant renal lymphocele treated by percutaneous ultrasono graphy guide aspiration and instillation of povidone-iodine

Use of the monitoring of intraoperative parathyroid hormone during parathyroidectomy in waiting list for renal transplantation patients

ENDOTRACHEAL STENT IN A CASE OF SEVERE TRACHEAL STENOSIS FROM RELAPSING GOITER

Objectives:The surgical approach for tracheal complications in thyroidectomy sometimes requires tracheotomy in urgency for supporting the airways flow (especially in presence of giant goiter). Nevertheless, tracheotomy, even if necessary to guarantee the restoration of respiratory function, it can not be considered as definitive therapy in presence of alterations of trachea (i.e. stenosis) susceptible to heal. An useful help in clinical management comes by tracheal prosthesis as we showed in a case of a giant relapsing multinodular goiter. Materials and methods: A 72 yr old woman, affected by giant relapsing goiter rapidly growing, came to our observation with severe orthopnea, due to steno…

A NEW KIND OF DISPOSABLE AUTOSTATIC SURGICAL RETRACTOR IN INGUINAL HERNIA REPAIR

Objectives: The aim of this study is to demonstrate the effectiveness of a new kind of disposable autostatic surgical retractor in hernias procedures in order to achieve an easier, faster, and safer surgical intervention. Material and Methods: Between January and March 2008, 42 inguinal hernioplasty procedures have been performed using the 3PAWS model of ReeTrakt™ a self-retaining, low profile retractor. Equivalent patients samples, in which operations were performed using conventional retraction devices, were considered for comparison of the intra and postoperative results. Results: In all of the 42 inguinal hernioplasty procedures performed, the ReeTrakt™ system has simplified the perform…

Uso del dosaggio del paratormone intraoperatorio nei pazienti sottoposti a paratiroidectomia in lista d'attesa per trapianto renale

SUCCESFULLY TREATED HEMOLITIC UREMIC SYNDROME (HUS) BY PLASMA APHERESIS AFTER KIDNEY TRANSPLANTATION

Objectives: The HUS is a rare disease; it exists a kind related to acute toxicity by Cyclosporine on the short time following kidney transplantation. Although the causes of this syndrome are still unclear, data from the literature show that patients with high levels of Reactive Antibodies (PRA test), Alport syndrome (as primitive renal disease), or which have history of HUS present a higher risk of HUS after renal transplantation. Materials and Methods: We report a case of a 58 yr old woman whose cause of uremia we did not know dependent on an episode of HUS. The patients underwent renal transplantation from deceased donor and treated with Cyclosporine, Mycophenolate Mofetil and steroids as…

Il trapianto di rene nell'anziano: quali sono i limiti? Aspetti etici e valutazione del paziente

Linfocele post-trapianto:esperienza del nostro centro

USE OF HARMONIC SCALPEL FOR BRACHIO-BASILIC VEIN TRANSPOSITION IN AUTOGENOUS PROXIMAL ARTERIOVENOUS FISTULA

Objectives: This study evaluates the effectiveness and helpfulness of ultrasonic surgical device for atraumatic surgical dissection and hemostasis in brachio-basilic vein transposition. Since prosthetic grafts have been reached poor results and high costs, the primary use of autogenous AVF is recommended. Materials and Methods: From March 2004 to March 2009 67 cases (61 F ; 6 M; mean age 52 years) of brachio-basilic arteriovenous fistulae (BBAVF) were fashioned; in second stage, after vein maturation (about 30 days), we performed a superficial transposition of arterialized basilic vein by harmonic scalpel (UltracisionTM).. Results : On 67 cases of transposition of BBAVF 2 cases failed after…

Secondary Hyperparathyroidism and renal transplantation

Trattamento minilaparotomico dei linfoceli post trapianto renale

USO DEL BISTURI AD ULTRASUONI IN UN CASO DI DISSEZIONE "DIFFICILE" DEI VASI ILIACI IN CORSO DI TRAPIANTO DI RENE

Introduzione: La preparazione “difficile” dei vasi iliaci nel ricevente causata da uno stato di fibrosi serrata periavventiziale con linfoadenomegalia satellite a volte è gravata da complicanze nel post trapianto ( linfocele, sieroma ed ematoma). Le aderenze tra l’asse vascolare iliaco e soprattutto la linfoadenomegalia sono spesso dovute al cateterismo femorale. Materiali e metodi: Il caso clinico riguarda una paziente di 60 anni, da circa 4 anni in dialisi per insufficienza renale cronica di n.d.d. con fibrosi periavventiziale dell’asse iliaco e linfoadenomegalia satellite da cateterismo femorale bilaterale. In corso di trapianto di rene la preparazione dei vasi iliaci è stata effettuata …

Rottura di rene trapiantato : analisi di due casi

KIDNEY TRANSPLANTATION IN ELDERLY PATIENTS: OUR EXPERIENCE

USO DELLA PROTESI INTRAPERITONEALE IN PTFE IN UN GRANDE LAPAROCELE DOPO TRAPIANTO RENALE : CASE REPORT

Introduzione Il caso riguarda il trattamento chirurgico con l’utilizzo di protesi intraperitoneale dual mash PTFE di un laparocele in un paziente di 55 aa sottoposto a precedente trapianto di rene. Tale complicanza derivava da un urinoma per la necrosi massiva dell’uretrere distale del graft; per cui il pz. è stato sottoposto a reintervento in 2 giornata post trapianto con ricostruzione del piano del muscolo aponeurotico. A circa un mese dal trapianto comparsa di tumefazione in sede incisionale, che rapidamente si è evoluta fino a raggiungere le caratteristiche del grande laparocele.Gli esami strumentali evidenziavano la presenza dell’omento e del piccolo intestino nel sacco erniario. Mater…