A painless treatment for patients undergoing Milligan-Morgan haemorrhoidectomy.

"Weekly regimen of cisplatin (CDDP),epirubicin (EPI), fluorouracil (5FU) and folinic acid (FA) with G-CSF is active in advanced gastroesophageal (GE) and gastric (G) cancer: results of a phase II study”

Lateral internal sphincterotomy is still crucial to heal hypertonic chronic anal fissure and normalize the internal anal sphincter tone? Is V-en Y plastic a valuable alternative?

INTRODUCTION: The role of augmented internal anal sphincter (IAS) tone in the genesis of chronic anal fissure (CAF) is still unclear. Lateral internal sphincterotomy (LIS) is the most employed surgical procedure, aiming to reduce the IAS tone leaving a permanent anatomical alteration and it is burdened by high risk post-operative anal incontinence (AI). The aim of this work was to evaluate if the pre-operative manometric alterations of CAFs with hypertonic IAS would normalize after sphincter preserving surgical procedure. METHODS: We enrolled 108 consecutive patients affected by idiopathic and non-recurrent CAF undergone fissurectomy and anoplasty with V-Y cutaneous flap advancement and pha…

AUTHOR'S REPLY

Free perforation in Crohn's disease]

L’efficacia del trinitrato di glicerina allo 0,2% per uso topico nel ridurre il dolore post- emorroidectomia e favorire la guarigione delle ferite

The aim of the study was to evaluate whether topical application of 0.2% glyceryl trinitrate ointment could reduce post-haemorrhoidectomy healing time and pain both at rest and during defecation. Thirty patients with grade III and IV haemorrhoids were included in the study and divided into two groups. All patients underwent Milligan-Morgan haemorrhoidectomy, and anorectal manometry was performed before surgery and after 5 and 30 days. In one group a placebo ointment was applied to the perianal wounds, while in the other group a 0.2% glyceryl trinitrate ointment was used. Maximum resting pressure was reduced in the glyceryl trinitrate group and increased in the placebo group after 5 days. Po…

Use of fibrin glue in the treatment of pilonidal sinus disease: a pilot study.

BACKGROUND: Pilonidal sinus (PS) disease of the sacrococcigeal region is an acquired condition resulting from penetration of shed hair shafts through the skin. Different types of operations have been described in the letterature. More recently fibrin glue has been used with succesfull. Aim of this study was to assess the effectiveness of fibrin glue for the treatment of pilonidal sinus. PATIENTS AND METHODS: Eight patients age ranged 21,8 +/- 6,5 affected by PS disease of sacrococcigeal region were included in this study. All patients undergoing surgical operation under local anaesthesia. Following administration of 1% methylene blue through the main opening, a small vertical elliptical inc…

Granular cell tumor of stomach: report a case and review of literature.

Serum VEGF and b-FGF profiles after tension-free or conventional hernioplasty

The effectiveness of the topical use of 0,2% glyceryl trinitrate to decrease post –hemorrhoidectomy pain and to improve wounds healing.

Sulle modificazioni nella produzione dei fattori di crescita nei fluidi di drenaggio in pazienti sottoposti a riparazione di laparocele con apposizione di protesi in polipropilene.

Solitary Necrotic Nodule of the Liver: Different Pathological Findings Express a Different Histogenesis

Solitary necrotic nodule of the liver is a rare benign lesion the histogenesis of which is still debated. We here report the case of a patient who underwent laparoscopic cholecystectomy for gallstones and who was accidentally found to have a solitary necrotic nodule of 2 cm in the fifth segment of the liver. On the basis of the histological findings, the hypothesis that different pathogenetic mechanisms could be involved in the histogenesis of this lesion is discussed.

[Effectiveness of contemporary injection of botulinum toxin and topical application of glyceryl trinitrate against postoperative pain after Milligan-Morgan haemorrhoidectomy].

PURPOSE: After haemorrhoidectomy the maximum resting pressure (MRP) of the anal canal is significantly increased. This increase play an important role in the making of postoperative pain. Recently, both the topical application of glyceryl trinitrate (GT) and the intrasphincter injection of botulinum toxin (Tox), resulted effective, in reducing temporary the MRP although with different mechanism of action. In this study the effectiveness and safe of contemporary injection of Tox and topical application of 300 mg/die of GT after Milligan-Morgan haemorrhoidectomy, were evaluated. MATERIALS AND METHODS: Ten patients, undergoing Milligan-Morgan haemorrhoidectomy for 3rd and 4th degree haemorrhoi…

Acute inflammatory response after inguinal and incisional hernia repair with implant of polypropylene mesh of different sizes.

Impact of different texture of polypropylene mesh on the inflammatory response.

Efficacia della contemporanea iniezione di tossina botulinica ed applicazione perianale di trinitrato di glicerina in funzione antalgica dopo emorroidectomia sec. Milligan-Morgan

Emorroidi e Ragadi

IL VARICOCELE RECIDIVO

Enterobius vermicularis infestation of the appendix mimicking acute appendicitis in a young Italian boy Case report.

Enterobius Vermicularis (EV) is the most commonly identified heminth incidentally found within the appendix of a clinically diagnosed appendicitis. This simple presence of EV may cause appendicular colic, primarily affecting children, it is an important cause of negative appendicectomy. We report a case of a young male who presented with clinical features of acute appendicitis. Laparoscopic appendicectomy was uneventful and pathologic examination revealed the presence of an EV infestation originating from the lumen of his vermiform appendix. KEY WORDS: Acute appendicitis, Diagnosis, Enterobius Vermicularis.L’Enterobius Vermicularis (EV) è il più frequente ossiuro identificato occasionalment…

Jejunal cystic lymphangioma in adult with rapid growth]

Cytokines and growth factors in wound drainage fluid from patients undergoing incisional hernia repair.

Knowing the dynamics of growth factor and cytokine secretion within the site of a surgical operation is important, as they play a crucial role in the pathophysiology of wound healing and are a target for modifying the repair response. The aim of this study was to evaluate the production of several cytokines and growth factors in the drainage wound fluid from patients undergoing incisional hernia repair: namely, interleukin (IL)-6, IL-10, IL-1alpha, IL-1 ra, interferon-gamma, vascular endothelial growth factors and basic fibroblast growth factor. Ten female patients with abdominal midline incisional hernia undergoing surgical repair were included in this study. In all cases, a closed-suction…

Gastrointestinal bleeding due to angiodysplasia in patients with type 1 von Willebrand disease: report on association and management

La perforazione in peritoneo libero nella malattia di Crohn

Free perforation in abdominal cavity in patients with Crohn's disease is a rare entity as attested from the data reported in the literature. It is a very dangerous event and requires a surgical urgency management. The Authors reported two cases of free perforation, in patients with Crohn' disease, undergoing surgical operation in urgency. Analyzing pathogenesis, difficulty in diagnosis making and therapeutic choices, they underline that CT is very useful in the diagnosis, while resection of the perforated intestinal tract represent the best surgical treatment.

Linfangioma cistico del digiuno a rapida crescita nell’adulto

Abdominal cystic lymphangiomas are a rare pathology that are related to abnormal development of the lymphatic system. They predominate in a children and are very uncommon in adults. Here the authors report a case of a cystic intra-abdominal lymphangioma in a 64-years old woman in which the cyst was situated in the mesentery of the jejuneum, with rapid growth. Ultrasonography, computed tomography and magnetic resonance imaging led us to evaluate a cystic characterizations and his site. Surgical excision remain the treatment of choice because we can establish an histologic diagnosis. Complete surgical excision of cyst, although it can be difficult, consent a definitive healing.

In vivo liver expression of TLR2, TLR3 and TLR7 in chronic hepatitis C

The role of innate immune response mediated by Toll-like receptors in HCV infection, is not yet well understood and there is a lack of data regarding liver tissue expression of these molecules in chronic hepatitis C (CHC). Our study is aimed to investigate ex vivo, liver expression of TLR2, TLR3 and TLR7, which are more involved in the immune-pathogenesis of CHC, and to explore possible correlations with features of disease. We obtained liver biopsies and collected peripheral blood mononuclear cells (PBMC) from 23 consecutive patients with CHC and from 6 patients of control, without liver disease, undergoing surgery for cholecystectomy. The levels of TLRs mRNA in the samples were determined…

Production of VEGF and b-FGF in the drainage fluid from patients undergoing incisional hernia repair

Wound healing is a complex process involving interaction between different cell types, such as growth factors. Among these, vascular endothelial growth factors (VEGF) and basic fibroblast growth factors (b-FGF) are the most important. The aim of this study was to assess the production of VEGF and b-FGF in wound drainage fluid from patients undergoing incisional abdominal hernia repair. Ten female patients with abdominal midline incisional hernia undergoing surgical repair were included in this study. In all cases a closed suction drain was placed in the wound below the fascia and removed on postoperative day 4. Wound fluid was collected on the I, II, III and IV day and its amount at each ti…

A painless treatment undergoing Milligan-Morgan hemorrhoidectomy

Background: Postoperative pain associated with Milligan Morgan haemorrhoidectomy (MMIf) remains problematic. Most patients complaint a severe pain on defecation and in the 1st postoperative week because of secondary infection a fid sphincter spasm. We studied the effect of metronida zole, lactulose and glyceryl-trinitrate on pain after MMH. Method: Thirty patients were randomly assigned to two groups. The 1st received a treatment with oral laxative (lac- tulose 66,7%) metronidazole and a topical glyceryl-trinitrate ointment at 0,2% both pre and postoperative; the 2nd received a placebo at the same dosage. The amount of pain in the 1st week and at the time of two defecation, postoperative an…

Long term outcomes of fissurectomy and anoplasty for chronic anterior anal fissure without hypertonia: low recurrences and continence conservation

Aetiopathogenesis of Chronic Anal Anterior Fissure (CAAF) remains poorly understood. Some anatomical, clinical and functional features suggest that pathophysiology may be linked to a reduced anal canal pressure. LIS appear illogical as a treatment for CAAF and the employ of techniques aiming to save the integrity of the sphincterial system appears more sensible. The aim of this study was to evaluate 5 years results of fissurectomy and anoplasty with cutaneous V-Y advancement flap in patients affected by CAAF without IAS hypertonia.We enrolled 20 women, affected by idiopathic and non-recurrent CAAF without hypertonic IAS. All patients were followed up for 5 years after surgery with evaluatio…

Gastrointestinal bleeding in patients with von Willebrand disease; how long we can wait for surgery?

LONG-TERM MANOMETRIC STUDY OF ANAL SPHINCTER FUNCTION AFTER HEMORRHOIDECTOMY

BACKGROUND AND AIM: Data on maximum resting pressure (MRP) and maximum squeeze pressure (MSP) changes after hemorrhoidectomy are not univocal and follow-up of patients undergoing surgery is mostly short-lived. The aim of this study was to prospectively examine during 1-year follow-up the long-term manometric results of MRP, MSP, and ultra slow wave activity (USWA) within a set of patients undergoing Milligan-Morgan hemorrhoidectomy as compared to healthy controls. MATERIALS AND METHODS: Twenty patients with hemorrhoids of third and fourth degree were enrolled and anorectal manometry was performed preoperatively, on the 5th day, and after 1, 6, and 12 months after surgery. RESULTS: On the 5t…

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 …

Sulle modificazioni nella produzione di citochine nei fluidi di drenaggio in pazienti sottoposti a riparazione di laparocele con apposizione di protesi in polipropilene.

Concomitant inflammatory pseudotumor of the liver and spleen.

We report the case of a 53-year-old man with inflammatory pseudotumor (IPT) of the liver and spleen. This concomitant association has rarely been reported. The patient presented with a hypoechoic mass in the liver and a clinical picture of recurrent sepsis; hematochemical exams and imaging data were nonspecific. Antibiotic therapy improved the clinical course, but did not resolve it definitively. After 50 days of therapy, as the hepatic mass decreased a similar lesion appeared in the spleen. The final diagnosis was made on splenectomy and an intra-operative biopsy of the residual liver lesion. The diagnostic problems encountered in this very rare association of IPT of the liver and spleen w…

MODIFIFICATIONS IN THE PRODUCTION OF CYTOKINES AND GROWTH FACTORS IN THE DRAINAGE FLUIDS FOLLOWING MESH IMPLANTATION AFTER INCISIONAL HERNIA REPAIR

L'EFFICACIA DEL TRINITRATO DI GLICERINA ALLO 0,2% PER USO TOPICO NEL RIDURRE IL DOLORE POST-EMORROIDECTOMIA E FAVORIRE LA GUARIGIONE DELLE FERITE

The aim of the study was to evaluate whether topical application of 0.2% glyceryl trinitrate ointment could reduce post-haemorrhoidectomy healing time and pain both at rest and during defecation. Thirty patients with grade III and IV haemorrhoids were included in the study and divided into two groups. All patients underwent Milligan-Morgan haemorrhoidectomy, and anorectal manometry was performed before surgery and after 5 and 30 days. In one group a placebo ointment was applied to the perianal wounds, while in the other group a 0.2% glyceryl trinitrate ointment was used. Maximum resting pressure was reduced in the glyceryl trinitrate group and increased in the placebo group after 5 days. Po…

Acute phase response in oldest-old individuals after surgical stress.

IMPACT OF DIFFERENT TEXITURE OF POLYPROPYLENE MESH ON THE INFLAMMATORY RESPONSE

Giant condyloma acuminatum quickly growing: case report

Background. Giant Condyloma Acuminatum (GCA) is a rare, slow growing, large cauliflower tumor of the penile foreskin and peria- nal region with benign histologic appearance but high propensity for lo- cal invasion and recurrences. GCA is associated with Human Papillo- ma Virus (HPV) types 6 and 11 and it also has considerable risk of neo- plastic transformation into fully invasive squamous cell carcinoma in- to about 5 years. Objective. Because of the rarity of perianal GCA, to date there is no general agreement on the best method for treatment. We wanted to know if surgical approach only was a good method to treat our case. Case report. A 28 years old man, HIV-negative, with a 4 years hi- …

Production of cytokines at the operation site

BACKGROUND AND AIM: Cytokines are part of a family of molecules involved in the initiation, control and termination of the events that occurs in wound healing process. Aim of this study was to evaluate the production of some cytokines [interleukin (IL)-6, IL-10, IL-1alpha, IL-1ra, interferon (IFN)-gamma] in the drainage wound fluid from patients undergoing incisional hernia repair. METHODS: Ten female patients with abdominal midline incisional hernia undergoing to surgical repair were included in this study. In all cases a closed suction drain was placed in the wound below the fascia and it was removed on the 4th postoperative day. Wound fluid was collected on the 1st, 2nd, 3rd and 4th day …

BOTULINUM TOXIN VS. TOPICAL GLYCERYL TRINITRATE OINTENT FOR PAIN CONTROL IN PATIENTS UNDERGOING HEMORRHOIDECTOMY: A RANDOMIZED TRIAL

PURPOSE: The maximum resting pressure in the anal canal is greatly raised after hemorrhoidectomy. This increase is likely to be the cause of postoperative pain, which is still the most troublesome early problem after hemorrhoidectomy. This study was designed to compare, after hemorrhoidectomy, the effects of intrasphincter injection of botulinum toxin vs. application of glyceryl trinitrate ointment in improving wound healing and reducing postoperative pain at rest or during defecation. METHODS: Thirty patients with hemorrhoids of third and fourth degree were included in the study and randomized in two groups. Anorectal manometry was performed preoperatively and 5 and 40 days after hemorrhoi…

Il varicocele recidivo