A 3D totally absorbable synthetic mesh in antireflux surgery: Gore Bio-A tissue reinforcement for hiatal hernia repairing

Introduction Hiatal hernia, defined as “transitory or stable dislocation of a part of the stomach in mediastinum through the diaphragmatic crura delimiting esophageal hiatus”. Its appearance presupposes anatomic anomalies or weakening of structures and mechanisms able to maintain esophago-gastric junction and stomach in the abdominal cavity [1]. Classically hiatal hernia was classified in four types using Hill’s classification: Type 1 hiatal hernia is associated with GERD in 50-90% of cases, in facts its presence gradually compromises esophago-gastric junction’s continence favouriting the backwater of acid secretion and its reflux in contact with esophageal mucosa during transient relaxatio…

Fixation free incisional hernia repair with a newly designed mesh with integrated bands

Introdution: Implant fixation and how to ensure adequate mesh overlap are key issues in abdominal hernia repair. A newly developed technique for ventral and incisional hernia repair using a proprietary implant with incorporated straps makes fixation unnecessary through tissue friction. This new implant allows for a broader coverage of the abdominal wall and results in simplified repair. Midterm follow- up in a cohort of patients indicates a decrease in postoperative com- plications and no recurrences to date. Matcrial and methods: A lightweight, large porous polypropylene mesh with a central body and eight radiating arms was used to repair ventral or incisional hernia. The implant was place…

Il carcinoma della tiroide dalla diagnosi alla terapia

From 1999 to 2007 we performed 104 surgical operations for thyroid malignancies. Over the same period, 312 patients underwent surgery for benign lesions of the thyroid gland. The patients were subdivided on the basis of age bracket and gender and the distribution of cancer and benign nodules was evaluated. Feasibility and diagnostic accuracy of ultrasonography, scintigraphy and fine needle aspiration cytology were also evaluated. The incidence of thyroid cancer was 25% in all patients. Patients aged 71 had the highest rate of malignancies: 52% of patients under 30 years of age and 46% over 70 years. Males showed a higher incidence than females. The scintigraphic findings were an area of low…

Polipi neoplastici del colon –retto. Indicazioni e risultati preliminari della Polipectomia endoscopica.

Appendiceal mucinous neoplasms: An uncertain nosological entity. Report of a case

Introduction: Appendiceal mucocele is a relatively rare condition characterized by progressive dilation of the appendix caused by intraluminal accumulation of mucoid substance. Its incidence is 0.07 - 0,63% of all appendectomies performed. Case report: We report the case of a 70-year-old man who came to our observation with gravative pain in right lower abdominal region. A computed tomography abdominal scan revealed a cystic/tubular structure like an appendicular mass with wall enhancement but without calcifications suggestive of a mucocele. Into peritoneal cavity we found profuse mucinous material with a 1,5 cm size parietal nodule. We also identified a free perforation of the cecum with c…

Primary malignant fibrous histiocytoma of the mesocolon transversum.

Primary malignant fibrous histiocytoma (MFH) is a rare and biologically aggressive tumor. Differential diagnosis must include cystic neoplasms of the pancreas (mucinous and serous cystoadenoma or cystocarcinoma), cystic lymphangioma or mesothelioma and retroperitoneal haematoma. Making the right diagnosis preoperatively may be often difficult, but MFH may be suspected when a huge retroperitoneal mass is found at imaging in elderly patients. We report a case of a primary abdominal MFH originating from the mesocolon transversum.

Long-Term Results of Fixation-Free Incisional Hernia Repair Using a Tentacle-Shaped Implant

INTRODUCTION: The fixation and the overlap of the mesh represent an open issue in incisional hernia repair. An exclusively designed prosthesis has been developed to assure a suture-free repair and a broader coverage of the abdominal wall. This study describes the long-term results of incisional hernia procedures carried out positioning a tentacle-shaped implant through a specifically developed surgical technique. MATERIALS AND METHODS: A proprietary symmetrically-shaped flat mesh constituted by a large central body with integrated radiating arms was used to repair incisional hernias in 68 patients. The prosthesis was placed in preperitoneal/retromuscular sublay. The friction of the straps p…

Biologic response of inguinal hernia prosthetics: a comparative study of conventional static meshes versus 3D dynamic implants.

Despite improvements in prosthetics and surgical techniques, the rate of complications following inguinal hernia repair remains high. Among these, discomfort and chronic pain have become a source of increasing concern among surgeons. Poor quality of tissue ingrowth, such as thin scar plates or shrinking scars-typical results with conventional static implants and plugs-may contribute to these adverse events. Recently, a new type of 3D dynamically responsive implant was introduced to the market. This device, designed to be placed fixation-free, seems to induce ingrowth of viable and structured tissue instead of regressive fibrotic scarring. To elucidate the differences in biologic response be…

Carotid and peripheral atherosclerosis in patients who underwent primary percutaneous coronary intervention and outcome associated with multifocal atherosclerosis.

AIM: The aim of our study was to determine if patients with multifocal atherosclerosis have a worse prognosis than patients with atherosclerosis only in the coronary bed. METHODS: We studied 45 subjects admitted to intensive coronary care unit of the Division of Cardiology with the diagnosis of acute myocardial infarction (AMI). Traditional cardiovascular risk factors were investigated and laboratory analysis included measurement of plasma lipids, glycemia, fibrinogen and high-sensitivity-C-reactive protein (hs-CRP). Each patient underwent coronary-angiography as well as carotid and peripheral arterial ultrasound examination. A follow-up of 13+/-2 months was performed. RESULTS: We found tha…

TRATTAMENTO ENDOSCOPICO DEL CARCINOIDE GASTRICO. A PROPOSITO DI UN CASO CLINICO

Laparoscopic cholecystectomy in a patient with Steinert myotonic dystrophy. Case report.

Myotonic dystrophy (MD) is a serious multi-systemic autosomal dominant disease. The estimated incidence is 1 in every 8000 births, with an estimated prevalence of between 2.1 and 14.3 cases per 100,000 inhabitants. Signs and symptoms vary from a severe form of congenital myopathy, present from birth and often fatal, to a classic form and a delayed form, which generally presents after the age of 50 and in which the only sign is a cataract and life expectancy is completely normal. We describe the clinical case of a 40-year-old woman with Steinert myotonic dystrophy who underwent laparoscopic cholecystectomy (under general anesthesia) for symptomatic gallbladder stones. The conduct of anesthes…

Linfangioma cistico addiminale: un'origine dbattuta.

Open mini-invasive cholecystectomy in high risk elderly. A review of 121 consecutive procedures.

INTRODUCTION: the report describes the features of a low cost, open mini-invasive procedure for cholecystectomy in a sample of 121 consecutive high risk elderly (ASA score 3 to 5). PATIENTS AND METHODS: the surgery is performed through a 3 - 4 cm right subcostal skin incision. An optimal exposition of the operating field was achieved thanks to an innovative three valve retractor. RESULTS: a mean hospital stay of 3,02 days, low complication rate and 2,4% mortality are the results of the described procedure. CONCLUSIONS: in high risk elderly the results are extremely encouraging, particularly in comparison with both laparoscopic and traditional open cholecystectomy. The open minisurgical chol…

Physical behavior and morphology of biaxially rolled low-density polyethyleneX

Abstract Biaxial rolling was carried out on low-density polyethylene, and the rolled samples were studied using various techniques. Scanning electron microscopy and analysis of transport properties were used to obtain structural information, which was correlated to thermomechanical and dynamic-mechanical behavior. Results indicate that the initial morphology is destroyed by rolling and that clumps of molecules, like fibrils, are generated parallel to the rolling plane. The molecular orientation in the plane is mainly radial, with some reinforcement, particularly at high rolling degree, along axes diagonal with respect to the rolling directions. The rolling drastically reduces the molecular …

Fixation-free inguinal hernia repair using a dynamic self-retaining implant.

Inguinal hernia repair remains controversial, despite advances in technique and materials. Conventional implants are typically static (passive) and do not move in concert with the groin's motility. Inguinal hernia repair with mesh fixation on dynamic groin structures are not tension free, and are associated with tissue tearing, bleeding, hematoma, and nerve entrapment--all which might contribute to mesh dislocation. The poor quality of tissue ingrowth within static meshes/plugs embodies another crucial issue in prosthetic hernia repair. Because the prosthetics used for inguinal hernia repair are incorporated by rigid fibrotic tissue (hence the term "scar plate"), the regressive tissue leads…

Observational study: The use of the ventralight Echo PS (positioning system) prosthesis in the treatment of incisional hernia

The treatment of incisional hernias, especially those that are multiple or recurring, has always represented important challenges for surgeons. An incisional hernia is a mechanical damage of the abdominal wall that can result in respiratory problems and alterations of splanchnic circulation, especially when in large size hernias. The increasing availability of prostheses with greater resistance Romato infections and tension, lightness, biocompatibility, and reduced visceral adhesions has improved outcomes and minimized relapses. It is still important, however, to carefully choose the type of prosthesis and surgical technique, whether laparotomic or laparoscopic, correlated to the positionin…

Analisi dei fattori di rischio dell'ipoparatiroidismo transitorio e definitivo nei pazienti sottoposti a tiroidectomia

Obiettivi. Con questa revisione della letteratura ci proponiamo di valutare quali sono i fattori che possono essere valutati nei pazienti da sottoporre a tiroidectomia ai fini di una migliore gestione preoperatoria e post-operatoria dell’ipoparatiroidismo transitorio e definitivo. Discussione. L’ipoparatiroidismo transitorio è una complicanza potenzialmente grave che include una vasta gamma di segni e sintomi che permane solo per poche settimane dopo l’intervento chirurgico. L’ipoparatiroidismo definitivo si verifica quando è necessario un trattamento medico per un periodo maggiore di 12 mesi. I fattori di rischio che ne possono influenzare l’insorgenza in seguito ad interventi di tiroidect…

COMPARING THE BIOLOGICAL RESPONSE OF CONVENTIONAL STATIC MESHES AND DYNAMIC RESPONSIVE IMPLANTS

Introduction: Inguinal hernia repair represent one of the most performed surgical procedure in the world. Notwithstanding the progress in prosthetic material and surgical procedures, the rate of complications remains high. Actually, chronic pain and discomfort are often source of debate among herniologists. Poor quality of tissue incorporation, such as stiff scar plaque leading to mesh shrinkage, is the typical results of conventional static implants that may lead to these adverse events. Recently, a new type of prosthesis, a 3D dynamic responsive implant, was introduced to the market. This device, designed to be positioned fixation-free, seems to induce the development of viable and more s…

Laparoscopic management of adrenal tumors: A four-year experience in a single center

AIM: Today laparoscopy is considered the first choice treatment of many adrenal tumors, although its use is still controversial for large adrenal masses and incidentally found adrenal cortical carcinoma. METHODS: From January 2009 to February 2014 we performed 42 lateral transperitoneal laparoscopic adrenalectomies. The indications for surgery were non-functioning adenoma larger than 4 cm or rapid growth and hormone-secreting tumor. The diagnosis was confirmed in all cases with computed tomography and magnetic resonance imaging and also metaiodobenzylguanidine scintigraphy if pheochromocytoma was suspected. In all cases we realized a complete preoperative hormonal study. We describe and ana…

Ruolo della videolaparoscopia nei pazienti con ischemia intestinale manifesta o sospetta.

Ruolo della videolaparoscopia nei pazienti con ischemia intestinale manifesta o sospetta..

Post-traumatic lipoma of the parotid gland: case report

The incidence of lipoma among parotid tumours ranges from 0.6% to 4.4%, with most series reporting an incidence of 1%. The most common origin of these tumours, in the parotid gland, is from the superficial lobe and, only rarely, from the deep lobe. Lipomas, upon clinical history, are found to be most frequently related to an episode of trauma. Computed Tomography scan and Magnetic Resonance Imaging can lead to a pre-operative diagnosis of lipoma. The case is described of lipoma of the superficial lobe of the parotid gland.

COMBINED INGUINAL HERNIA, A PROGRESSIVE PROTRUSION DISEASE

Crystal cell pattern modification in a melanotic tumor strain of Drosophila melanogaster.

3rd instar larvae of the melanotic tumor tu-pb strain of Drosophila melanogaster hold a lower number of free-circulating crystal cells in their hemolymph than the wild type ones. This pattern could result from an abnormal retention of mature crystal cells in the hematopoietic organs, as the strong hemocyte melanization inside the lymph glands of heat-treated tu-pb larvae seems to demonstrate. Melanotic tumor formation and modification of the crystal cell pattern may be related.