Cardiac risk stratification in elective non-cardiac surgery: Role of NT-proBNP

AIM: The aim of the study was to investigate the utility of NT-proBNP measurement for the stratification of presurgical cardiac risk. METHODS: Cardiac risk before elective non-cardiac surgery was evaluated in 82 consecutive patients. From each patient a venous blood sample was drawn to determinate NT-proBNP levels. Patients were followed up over three months in order to detect the occurrence of cardiac adverse events. RESULTS: NT-proBNP was positively correlated (P<0.0001) with age, days of hospitalization (P=0.001) and ASA class (P=0.001). High surgical risk (P<0.0001), diabetes (P=0.004), dyslipidemia (P=0.006) and elevated levels of NT-proBNP (P<0.0001) were significantly correlated with…

Recurrent cystic lymphangioma of the neck. Case report.

Conservative management of intestinal obstruction by isolated intramural duodenal hematoma: A case report and review of the literature

The duodenal injuries occur in the 3-5% of blunt abdominal traumas. The isolated intramural duodenal hematoma is a very rare lesion. An early diagnosis and an adequate therapy are crucial because a delay, beyond 24 hours, increases the mortality from the 11% to 40%. However, diagnosis is often hindered by a lack of specific symptoms. We report a case of a 21 years-old man with an intestinal obstruction from isolated intramural duodenal hematoma occurred after a blunt abdominal trauma in a sport competition. The patient was treated conservatively with total parenteral nutrition, gastric decompression and intravenous PPIs. The progressive spontaneous resolution of the hematoma was checked wit…

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…

Search for the mutation of B-RAFV600E in FNA of thyroid nodules

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…

Case report: necrotizing fascitis of odontogenenic origin in a subject affected by uncompensated type 2 diabetes mellitus

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…

Body composition of individuals with polycystic ovary syndrome

Polycystic ovary syndrome (PCOS) is one of the principle forms of hyperandrogenism that affects women of reproductive age. Few studies have evaluated the body composition of patients with PCOS being based mainly on an evaluation of the quantity and distribution of the fat mass. Objectives: to evaluate the body composition of patients affected by PCOS and to establish the hormonal factors that determine possible differences in body composition compared with healthy women. Methods: 110 Caucasian women affected by clinical hyperandrogenism and/or irregular menstrual periods were included in the study; the control group was made up of 90 healthy Caucasian women, of reproductive age, without hyp…

The intraoperative use of the mini-gamma camera (MGC) in the surgical treatment of primary hyperparathyroidism Technical reports and immediate results from the initial experience.

The intraoperative use of the mini-gamma camera(MGC) in the surgical treatment of primary hyperpathyroidism.Technical reports and immediate results from the initial experience INTRODUCTION: The treatment of primary hyperparathyroidism consists almost exclusively in the parathyroidectomy. The preoperative imaging (ultrasonography, 99mTc sestamibi scan) can allow to localize the pathologic gland and perform minimally-invasive focused techniques, but in presence of ectopic or intrathyroidal glands, parathyroid hyperplasia or coexistent thyroid disease,the sensitivity of these imaging techniques worsens. The present study shows a new technique of preoperative scintigraphic imaging and describes…

The impact of conversion on the risk of major complication following laparoscopic colonic surgery: an international, multicentre prospective audit.

BACKGROUND: Laparoscopy has now been implemented as a standard of care for elective colonic resection around the world. During the adoption period, studies showed that conversion may be detrimental to patients, with poorer outcomes than both laparoscopic completed or planned open surgery. The primary aim of this study was to determine whether laparoscopic conversion was associated with a higher major complication rate than planned open surgery in contemporary, international practice.METHODS: Combined analysis of the European Society of Coloproctology 2017 and 2015 audits. Patients were included if they underwent elective resection of a colonic segment from the caecum to the rectosigmoid jun…

Linfoma a cellule B (maltoma) dello stomaco ed infezione da Helicobacter pylori

The authors, after illustrating physiopathologic aspects of gastric MALTomas, examine the H.P. infections and the possible relations between this kind of bacterium and gastric MALTomas. They hypothesize that H.P. infection represents an important predisposition to gastric lymphoma, due to anatomopathological modifications over gastric mucosa. They conclude that a decreasing of gastric lymphoma could be correlatable an opportune eradication of H.P. despite of at moment it's impossible hypothesize a marked decreasing of lymphoma by an eradication of H.P.

Case report: Bilateral femoral fracture in a young fertile age woman

Benign multicystic mesothelioma: A case report of recurrent disease in a young adult with familiarity for renal cell carcinoma

Benign multi-cystic peritoneal mesothelioma (BMCM) is a very rare disease (about 150 cases observed). The aetiology is currently little-known, and the data collected, without having achieved conclusive re sults, identify two possible causes: neoplastic and reactive inflammatory. This case report refers to a recidivism of BCMC in a patient whose brother, few months before, underwent a left nephrectomy and right renal Radio Frequency Termo Ablation (RFTA) for bilateral papillary renal cell carcinoma. For the recurring trend, the onset in a male young patient without chronic inflammatory diseases evidence, the presence of a first degree relative with a rare carcinoma we supposed a neoplastic a…

Post-ERCP pancreatitis: A single center experience and an update on prevention strategies

Pancreatitis is the most frequent complication of the ERCP; in unselected patients the incidence is 3.5%, reaching 25%, and is mild-moderate in 90%. A stratification of patients into low or high risk is important to provide adequate information to patients and to decide when refer them to tertiary centers; moreover, many prophylactic measures have been proposed over years. Our aim was to select risk factors for PEP and compare them with current literature in order to propose adequate preventive strategies.It was analyzed the occurrence of Post-ERCP Pancreatitis in a series of 492 consecutives patients treated with ERCP by two expert interventional endoscopists. The possible risk factors wer…

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…

Emergency hernia repair in the elderly: multivariate analysis of morbidity and mortality from an Italian registry

Abstract Purpose The incidence of inguinal hernia is higher in elderly because of aging-related diseases like prostatism, bronchitis, collagen laxity. A conservative management is common in elderly to reduce surgery-related risks, however watchful waiting can expose to obstruction and strangulation. The aim of the present study was to assess the impact of emergency surgery in a large series of elderly with complicated groin hernia and to identify the independent risk factors for postoperative morbidity and mortality. The predictive performance of prognostic risk scores has been also assessed. Methods This is a prospective observational study carried out between January 2017 and June 2018 in…

Complication of endoscopic tattooing: a case report of covered perforation

Aim Laparoscopy is considered a good approach in treatment of colorectal neoplastic diseases; the endoscopic tattooing is then recommended (Evidence Level III and grade of recommendation A) to mark a lesion or a polypectomy site for intraoperative identification. We describe the case of perforation after tattoing treated conservatively. Case report 63 years old woman, underwent colonoscopy for lipoma tattooing with India ink SPOT® solution kit and saline test. Immediately after the procedure the patient has been referred the appearance of colic epi-mesogastric pain and fever; Computed Tomography (CT) without MDC identified an irregular thickening of transverse colon with some microbubbles c…

Role of prophylactic central neck dissection in cN0-papillary thyroid carcinoma: Results from a high-prevalence area

BACKGROUND: Prophylactic, compartment-oriented central neck dissection (CND) for cN0 papillary thyroid carcinoma (PTC) is not widely practiced. We examined our results with this surgical approach. METHODS: A cohort of 158 patients operated on for the classical variant of PTC at a follow-up of 1-22 years (mean: 6.6) were enrolled. The patients with a preoperative diagnosis of cN0 PTC (group A, 59 patients) underwent total thyroidectomy (TT) + CND. In the patients with incidental postoperative diagnosis of malignancy (group B, 99 patients) a TT alone was performed. RESULTS: Ninety-six T1, 36 T2, 26 T3/T4 PTC patients were enrolled. The overall biochemical/scintigraphic recurrence rate (15 pat…

Frailty and emergency surgery in the elderly: protocol of a prospective, multicenter study in Italy for evaluating perioperative outcome (The FRAILESEL Study)

Improvements in living conditions and progress in medical management have resulted in better quality of life and longer life expectancy. Therefore, the number of older people undergoing surgery is increasing. Frailty is often described as a syndrome in aged patients where there is augmented vulnerability due to progressive loss of functional reserves. Studies suggest that frailty predisposes elderly to worsening outcome after surgery. Since emergency surgery is associated with higher mortality rates, it is paramount to have an accurate stratification of surgical risk in such patients. The aim of our study is to characterize the clinicopathological findings, management, and short-term outcom…

Histologic considerations about a rare case of recurrent incisional hernia on McBurney incision.

Incisional hernias are often related to longitudinal or transverse laparotomy with an incidence that rises from to 2 to 23 %. The oblique incision often used to surgically treat acute appendicitis has little probability to develop incisional hernia with an estimated incidence less than 2%. Some series report 0.1 - 0.9% of it. Anatomic, physiologic and histologic factors have been implicated in herniation development, such as intra-abdominal pressure or alteration on tissue components; many different risk factors can be taken into account to justify this rare condition such as female gender, diabetes, peritonitis, abscess or appendiceal phlegmon as the cause of the first operation, wound inf…

Pancreatite acuta. Validità ed attualità dei fattori prognostici

Evaluating the incidence of pathological complete response in current international rectal cancer practice: the barriers to widespread safe deferral of surgery

INTRODUCTION: The mainstay of management for locally advanced rectal cancer is chemoradiotherapy followed by surgical resection. Following chemoradiotherapy, a complete response may be detected clinically and radiologically (cCR) prior to surgery or pathologically after surgery (pCR). We aim to report the overall complete pathological response (pCR) rate and the reliability of detecting a cCR by conventional pre-operative imaging.METHODS: A pre-planned analysis of the European Society of Coloproctology (ESCP) 2017 audit was performed. Patients treated by elective rectal resection were included. A pCR was defined as a ypT0 N0 EMVI negative primary tumour; a partial response represented any r…

An international multicentre prospective audit of elective rectal cancer surgery; operative approach versus outcome, including transanal total mesorectal excision (TaTME)

Introduction: Transanal total mesorectal excision (TaTME) has rapidly emerged as a novel approach for rectal cancer surgery. Safety profiles are still emerging and more comparative data is urgently needed. This study aimed to compare indications and short-term outcomes of TaTME, open, laparoscopic, and robotic TME internationally. Methods: A pre-planned analysis of the European Society of Coloproctology (ESCP) 2017 audit was performed. Patients undergoing elective total mesorectal excision (TME) for malignancy between 1 January 2017 and 15 March 2017 by any operative approach were included. The primary outcome measure was anastomotic leak. Results: Of 2579 included patients, 76.2% (1966/257…

Autologous adipose-derived stromal vascular fraction and platelet concentrates for the treatment of complex perianal fistulas

Abstract Background Complex perianal fistulas are a major challenge for modern surgery since 10–35% of patients have functional problems after treatment. Sphincter-saving techniques have a wide range of efficacy (10–80%). We hypothesised that autologous adipose-derived stromal vascular fraction in combination with platelet rich plasma is a new therapeutic strategy with enhanced cure and function preservation rates. Methods Adult patients with complex cryptoglandular perianal fistulas were treated with injection of autologous adipose-derived stromal vascular fraction in combination with platelet rich plasma around and inside the fistulous tract between May 2018 and April 2019 at the General …

A rare case of abdominal cocoon.

Abdominal cocoon is a rare cause of intestinal obstruction usually diagnosed incidentally at laparotomy. It manifests by forming a membrane that typically encases the small bowel loops, leading to mechanical obstruction. Preoperative diagnosis is difficult. The etiology of this condition is not well understood; however, it is a form of chronic irritation and inflammation.A 33 years old male, from Bangladesh, presented to our emergency department complaining of abdominal pain, nausea, and vomiting. CT abdomen shows a picture of intestinal obstruction at the level of the small intestine. Intraoperative findings showed encapsulation of small bowel by a dense whitish membrane as a cocoon. Histo…

A primary subcutaneous hydatid cyst in the thigh. A case report

Hydatid disease is a parasitic disease considered endemic in many parts of the world such as South America, Middle East, Africa, Australia and the Mediterranean regions. Liver and lung hydatid disease accounts for 90% of all echinococcal cysts. Primary hydatid disease of subcutaneous sites is rare and the subcutaneous localization of a solitary hydatid cyst accounts for 1.6%. Not enough data exist for this localization, and only many heterogeneous data are described in order to define this rare condition.We present the case of a 68-year-old-woman affected by a mass in upper-medial side of her right thigh with a 12-year-growing history. Anamnestic data were accurately collected. Many differe…

Diffuse malignant biphasic peritoneal mesothelioma with cystic areas

We report a case of peritoneal biphasic mesothelioma with cystic areas in a patient with professional exposure to asbestos. It showed focal epithelial glandular and papillary proliferations, also presenting fluid filled cysts, whose wall consisted of a proliferation of spindle cells. Atypia and mitoses were very scanty. EMA, vimentin, CK5/6, D2-40, calretinin and P53 were positive and desmin was negative in both epithelial and spindle areas, including the ones surrounding the cystic spaces. These findings gave an essential aid in the differential diagnosis with a benign cystic mesothelioma and with a cystic epithelial mesothelioma with secondary pseudosarcomatous myofibroblastic proliferati…

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…

LA COLITE ULCEROSA

Solitary metastasis from melanoma causing bowel perforation

Skin melanoma can metastasize to any organ or tissue. The median survival in patient with intestinal metastases is inferior to 7 months compared to other sites metastasis. A wide intestinal resection including the resection of the mesentery with lymph nodes remains the main treatment due to the low morbidity and mortality rate it is also associated with.We took under analysis a recent case of acute abdomen for small bowel perforation from intestinal metastases in a patient with metastatic melanoma who was under treatment with Pemrolizumab. A bowel resection was performed and no other lesions were found in the abdominal examination. However, the chemotherapy was stopped due to the advanced a…

Heterogenous forms of dyslipidemiain women with polycystic ovary syndrome

Forms of dyslipidemia are very common in individuals affected by polycystic ovary syndrome (PCOS), but in addition to plasmatic lipids, it is necessary to evaluate the alterations in the atherogenic lipoproteins (Lp) and apolipoproteins (apo). In our study we measured the concentrations of apoB, Lp(a) and low density lipoproteins (LDL) in 42 patients with PCOS (age: 28 +/- 7 years, body mass index: 27 +/- 5 kg/m-) and 37 healthy women (of the same age and body mass index). Methods: values of Lp(a) >30 mg/dl were considered high, whereas for apoB, values >100 g/l were considered high. Results: the patients with PCOS showed an increase in triglycerides (p=0.0011) and low levels of high densit…

COMBINED INGUINAL HERNIA, A PROGRESSIVE PROTRUSION DISEASE

Three-port colectomy: reduced port laparoscopy for general surgeons. A single center experience

To evaluate three-port colectomy as an alternative reduced-port laparoscopy technique in colonic surgery.Retrospective study carried out through the analysis of 32 consecutive patients that underwent alternatively to a three ports left colectomy or a conventional laparoscopic colectomy for colonic diseases in order to evaluate the benefits of the reduced-port technique. A multivariate analysis among duration of surgery, hospital stay and conversion rate was performed using the OLS regression and the binary logistic regression.We found a reduced operative time in the three-port colectomy in comparison to the four-port technique (p=0.07). The hospital stay was not found related to the number …