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…

Tyroid surgery with “ligasure

PTFE mesh in renal allograft compartment sindrome

Trapianto di insule di Langerhans

Trattamento laparoscopico del Mielolipoma surrenalico: caso clinico e revisione della letteratura.

Adrenal myelolipoma is a rare benign, non-functioning tumor consisting of fat and hematopoietic tissues. In January 2005 we had observed an adrenal myelolipoma in 70 year old man. During the follow-up for bladder urothelioma, an abdominal CT revaled a well delineated 4x4 cm homogeneous fatty mass in the right suprarenal area with negative attenuation values. The functional study of adrenal gland was normal. The patient underwent videolaparoscopic right adrenalectomy (Gagner technique). Postoperative course was uneventful. The istological diagnosis showed adrenal myelolipoma. We conclude that videolaparoscopic adrenalectomy should be considered the gold standard treatment for benign adrenal …

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Background: Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods: This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, r…

Is there an inguinal sphincter in the groin area? Is the impairment of this sphincter due to adhesional phlogosis leading to indirect inguinal hernia?

Confezionamento di fistola artero-venosa nativa per l’emodialisi

Intraoperative Parathyroid Hormone Monitoring During Parathyroidectomy for Hyperparathyroidism in Waiting List and Kidney Transplant Patients

This report describes the use of the intraoperative parathyroid hormone (ioPTH) assay during parathyroidectomy in waiting list and transplanted patients. ioPTH levels were determined in 40 patients on the waiting list for kidney transplantation with secondary hyperparathyroidism who underwent subtotal parathyroidectomy and 9 transplanted patients with tertiary hyperparathyroidism who underwent removal of hyperplasic glands. Rapid PTH levels decreased significantly at each time period; the percentage decrease in rapid PTH levels was 61.3% among patients with IPT II and 70.2% in patients with IPT III at 10 minutes and 86.5% in patients with IPT II and 91% in patients with IPT III at 15 minute…

Thyroidectimy using the Harmonic scalpel. Retrospective analisis of 188 consecutive cases

Elective surgery system strengthening: development, measurement, and validation of the surgical preparedness index across 1632 hospitals in 119 countries

© 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 licenseBackground: The 2015 Lancet Commission on global surgery identified surgery and anaesthesia as indispensable parts of holistic health-care systems. However, COVID-19 exposed the fragility of planned surgical services around the world, which have also been neglected in pandemic recovery planning. This study aimed to develop and validate a novel index to support local elective surgical system strengthening and address growing backlogs. Methods: First, we performed an international consultation through a four-stage consensus process to develop a multidomain index for hospital-level assess…

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

Videolaparoadrenalectomy, our experience

Vascular complications following bladder drained, simultaneous pancreas-kidney transplantation: the University of Miami experience

Vascular complications remain a significant nonimmunologic source of pancreas allograft loss. From February 1993 through January 1998, we performed 98 simultaneous pancreas-kidney transplantations (SPK) using pancreatic exocrine bladder drainage in patients with type 1 insulin-dependent diabetes mellitus and end-stage renal disease. They originally received quadruple immunosuppression, and since May 1997 triple immunosuppression protocol (tacrolimus, mycophenolate mofetil, and steroids). The patients' mean age was 37 years (range 24-53 years), including 50 women and 48 men with a mean follow-up of 42 months. The overall rate of vascular complications was 6% (5 patients). The vascular compli…

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…

Gangrena dei genitali di Fournier

Fournier’s disease in an acute pathologic process of cellulitis and necrotising fascitis involving the male genitals with a mortalità of 30-50 %. The main causes are periurethral and perirectal infections, immunodepressive syndromes, diabetes mellitus and traumas. Mixed types of infections involve aerobic and anaerobic germs, the latter being responsible for necrosis of the subcutaneous tissue. Therapy is synergic and multi-disciplinary, antibiotic with radical and reconstructive surgery. The Authors report a case of Fournier’s gangrene. The discuss about various type of necroting diseases; the different etiological agents. Spreading ways of infectionthrough extermal genitalia,anatomical st…

SURRENALECTOMIA LAPAROSCOPICA DESTRA PER MIELOLIPOMA, CASE REPORT

La colecistectomia laparoscopica nel paziente uremico

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…

Advantage of eradication therapy for Helicobacter pylori before kidney transplantation in uremic patients.

ABSTRACT From January 1999 to February 2007, 61 end-stage renal disease (ESRD) candidates for kidney transplantation underwent an esophagogastroduodenoscopy (EGDS) to detect Helicobacter pylori (HP). We correlated treatment for HP before transplantation and upper digestive tract hemorrhagic complications and possible recurrence of peptic disease posttransplantation. The 32 (52.4%) HP-Positive cases were divided into 2 groups: (1) 17 patients who underwent treatment for the eradication of the infection with 40 mg/d omeprazole for 4 weeks, 500 mg claritromycin twice daily for 7 days, and 2 g/d amoxicillin for 7 days; and (2) 15 untreated patients. No significant differences were found in the …

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…

Ruolo della Colonscopia nella sorveglianza dei pazienti operati di cancro del colon rettale.

SUCCESSFUL ARTERO VENOUS FISTULA USING CARDICA C-PORT xA SYSTEM IN AN ELDERLY UREMIC PATIENT. A CASE REPORT.

INTRODUCTION AND AIMS: In artero venous fistula (AVF) hand-sewn anastomoses are considered the gold standard. These are performed generally with a double running suture. These suturing techniques yeld excellent results, despite being time-consuming, difficult to perform with small vessels, and associated with a significant learning curve. These device are intented to enable rapid, precise and reliable anastomoses in AVF without artery cross-clamping. METHODS: We report the case of a male 65 years old uremic patient with serious atherosclerosis that, in local anesthesia, underwent proximal AVF by mechanical anastomosis between cephalic vein and radial artery without arterious cross-clamping.…

Il gozzo nel paziente uremico cronico, Analisi della nostra esperienza nell'ambulatorio dei pazienti in lista d'attesa per trapianto renale

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

Secondary Hyperparathyroidism and renal transplantation.

La colecistectomia con procedura minivasiva open nei soggetti anziani ad alto rischio

Electrophoresis of proteins and DNA on horizontal sodium dodecyl sulfate polycrylamide gels

Iperparatiroidismo terziario

Ligasure haemorrhoidectomy: our experencie on fifty patients

The role of colonscopy in patient follow-up after surgery for colorectal cancer

SARS-CoV-2 infection and venous thromboembolism after surgery: an international prospective cohort study

SARS-CoV-2 has been associated with an increased rate of venous thromboembolism in critically ill patients. Since surgical patients are already at higher risk of venous thromboembolism than general populations, this study aimed to determine if patients with peri-operative or prior SARS-CoV-2 were at further increased risk of venous thromboembolism. We conducted a planned sub-study and analysis from an international, multicentre, prospective cohort study of elective and emergency patients undergoing surgery during October 2020. Patients from all surgical specialties were included. The primary outcome measure was venous thromboembolism (pulmonary embolism or deep vein thrombosis) within 30 da…

Reliability of the bright liver echo pattern in diagnosing steatosis in patients with cryptogenic and HCV-related hypertransaminasaemia.

Aim To evaluate the reliability of the bright liver (BL) echo pattern on ultrasound to detect histological steatosis in chronic cryptogenic hypertransaminasaemia (CCH) and hepatitis C virus (HCV)-related forms of hypertransaminasaemia. Materials and methods One hundred and fifty patients, 54 with CCH and 96 with HCV hypertransaminasaemia (76 genotype 1/2 and 20 genotype 3), were enrolled. Histological steatosis was measured as the percentage of hepatocytes involved. The reliability of the BL sign was estimated using the sensitivity, specificity, positive and negative predictive values. Results Histological steatosis was present in 102/150 patients (68%) divided into 59/96 (62%) in the HCV g…

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

Urinary collagen cross-links to evaluate hyperparathyroidism in kidney transplant patients

INTRODUCTION AND AIMS: One of most common complication following kidney transplantation is reappearance of hyperparathyroidism (HP) some months after normal serum levels. An early diagnosis represents the best prophylaxis measures to prevent worsening of osteodystrophy and potential damage to the graft and vascular tissue.The aim to our study was to evaluate, beyond the common HP markers, if the urinary cross-links of the collagen PYD (pyridinoline) and DPD (Deoxypyridinoline) are useful markers able to show increasing levels of parathormone. METHODS: We evaluated 50 stable kidney transplanted patients divided into 2 group (A: 38 pts and B: 12 pts) dependent on the type of their immunosuppr…

Role and clinical importance of Helicobacter pylori infection in hemodialysis patients

Dyspepsia is an extrarenal symptom frequently found in hemodialysed patients; it is due to chronic renal failure, and uremic gastritis is a specific associated condition in chronic renal failure (CRF). On the other hand, in the general population, Helicobacter pylori infection is an important dyspepsia-related risk factor; its close connections with gastro-duodenal pathology are already known, above all the peptic disease in a really exclusive way. By observation of a dyalitic group of patients, opportunely matched with a no CRF group, we evaluated CRF-associated uremia and Helicobacter pylori infection which could eventually interact causing symptoms and lesions. A statistical analysis of …

Endoscopic screening of the upper and lower digestive tract of the patients with chronic renal failure on waiting list for renal transplantation

Il reintervento per l'iperparatiroidismo renale persistente o recidivo

Iniziali esperienze sull'impiego di un dispositivo per l'anastomosi vascolare meccanica per le fistolle arterovenose per l'emodialisi.

INTRODUZIONE ED OBIETTIVI Nella costruzione delle fistole artero-venose, il confezionamento manuale dell’anastomosi è il gold standard.Generalmente questa è realizzata con una o due suture a sopraggitto in continua o talora a punti staccati. La tecnica è abbastanza standardizzata,anche se può richiedere una significativa spesa di tempo, specie in presenza di vasi di piccolo calibro, e una curva di apprendimento anche lunga. Riportiamo la nostra esperienza sull’uso di un dispositivo che permette di rendere l’esecuzione di quest’intervento più rapida, precisa e senza il clampaggio preventivo dell’arteria. MATERIALI E METODI Abbiamo impiegato la suturatrice meccanica per il confezionamento di …

The use of marginal donors in kidney transplantatio: our experience

Mesh fixation in hernia repair suture versus human glue fibrin.

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.

L'utilità della colonscopia nel follow-up dei pazienti operati per cancro del colon-retto. Analisi retrospettiva e revisione della letteratura

La colecistectomia con procedura mininvasiva open nei soggetti anziani ad alto rischio.

Intraoperative Parathyroid hormone monitoring during parathyroidectomy for renal hyperparathyroidism

Videolaparosurrenectomia.nostra esperienza

La chirurgia delle lesioni nodulari tiroidee: analisi di 592 casi

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

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…

Colecistectomia mininvasiva open. Risultati su una casistica di 285 pazienti consecutivi non selezionati. Confronto con la VLC e la colecistectomia tradizionale.

Histological findings of the internal inguinal ring in patients having indirect inguinal hernia

BACKGROUND: Aiming to deepen the understanding of the factors involved in the genesis of groin hernia, this study is focused on identifying the histological changes within the muscle fibers of the internal inguinal ring in patients having indirect inguinal hernia. METHODS: In eight patients with primary or recurrent bilateral indirect inguinal hernia who underwent a Stoppa open posterior inguinal hernia repair, a tissue specimen from the edge of the internal inguinal ring was biopsied and histologically examined. RESULTS: In all of the tissue samples, remarkable degenerative changes such as fibrohyaline degeneration of the muscle fibers, vascular congestion, and phlogistic infiltration thro…

Thyroid surgery with the system Ligasure.

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…

GIANT INCISIONAL HERNIA IN THE ELDERLY PATIENT. A RAPID AND SIMPLE SURGICAL TREATMENT

Intraoperative parathyroid hormone monitorino durino parathyroidectomy for renal hyperparathyroidism

TWO STAGE TRASPOSITION OF BRACHIO-BASILIC ARTERO-VENOUS FISTULA (BBAVF)BY ULTRACISION.

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

Screening endoscopico del tratto digestivo superiore ed inferiore del paziente uremico da sottoporre a trapianto renale.

Allergic Rhinitis and its Impact on Asthma (ARIA) Phase 4 (2018): Change management in allergic rhinitis and asthma multimorbidity using mobile technology

Allergic Rhinitis and its Impact on Asthma (ARIA) has evolved from a guideline by using the best approach to integrated care pathways using mobile technology in patients with allergic rhinitis (AR) and asthma multimorbidity. The proposed next phase of ARIA is change management, with the aim of providing an active and healthy life to patients with rhinitis and to those with asthma multimorbidity across the lifecycle irrespective of their sex or socioeconomic status to reduce health and social inequities incurred by the disease. ARIA has followed the 8-step model of Kotter to assess and implement the effect of rhinitis on asthma multimorbidity and to propose multimorbid guidelines. A second c…

I trapianti in rapporto ai mass media: dal trionfalismo alla ricerca esasperata della malpractice

Sphincter-like motion following machanical dilation of the internal inguinal ring during indirect inguinal hernia procedure

INTRODUCTION: Even today, there is still great speculation as to the underlying pathogenesis of inguinal hernia. As a result, it could be extrapolated that the vast majority of repairs are based upon conjecture. Most current repairs are founded upon the principle of "closing the defect" in the anatomy, either by suturing closed under tension, covering with a mesh or obliterating the defect with a plug. Many variants of each method are refined to achieve better clinical outcomes. Yet few, if any, strive to understand a fundamental question: "What has gone wrong with the normal physiological and anatomical mechanisms that prevent abdominal structures protruding through the abdominal wall?" We…

I TUMORI DEL RENE: INQUADRAMENTO NOSOLOGICO, STAGING E FATTORI PROGNOSTICI

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…

Use of intraoperative parathyroid hormone in waiting list and kidney transplant patients

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…

Secondary Hyperparathyroidism and renal tranplantation

Informed consent in high-risk renal transplant recipients.

Abstract Before performing a clinical, diagnostic, and/or therapeutic action, the doctor is required to provide the patient with a bulk of information defined as informed consent. This expression was used for the first time in 1957 during a court case in California and the two words— informed and consent —are used together to underline the fact that the patient cannot give his or her true consent without first receiving correct information concerning the medical act in question. With regard to the medicolegal aspects governing organ transplants, despite the bulk of detailed work performed by health service workers involved in this surgical field with the aim of preparing adequate informed c…

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

MONITORAGGIO ECO-COLORDOPPLER DEL RENE TRAPIANTATO.NOSTRA ESPERIENZA

Introduzione: La metodica ultrasonografica, come è noto, scevra da complicanze, ripetibile, non invasiva ed altamente tollerata dal paziente, consente un attento monitoraggio sia delle caratteristiche anatomomorfologiche del graft (ATN,rigetto,intossicazione da farmaci,infarto),sia l’immediata diagnosi di complicanze post-operatorie (raccolte fluide perirenali, idronefrosi,trombosi vascolari).L’integrazione con power-colordoppler consente altresì il corretto monitoraggio delle condizioni di perfusione d’organo, desunte dai dati connessi alla valutazione seriata delle resistenze parenchimali. Materiali e metodi: La casistica è limitata agli ultimi tre anni di attività su un gruppo di 22 pazi…

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…

Intraoperative parathyroid hormone monitoring during parathyroidectomy for hyperparathyroidism in waiting list and kidney tranplant patients

UTILIZZO DI RENI MARGINALI: NOSTRA ESPERIENZA

Introduzione La scarsa disponibilità di organi e l’incremento del numero dei pazienti trapiantabili ha condotto all’utilizzo di graft provenienti da donatori anziani o marginali. Lo scopo del presente studio è quello di analizzare i risultati di pazienti sottoposti a trapianto renale da donatori anziani o marginali. Metodi Tra gennaio 1996 e settembre 2007 abbiamo eseguito 137 trapianti renali. 39 da donatori marginali (gruppo A) e 98 da donatori ideali (gruppo B). Dopo un follow-up di 18 mesi abbiamo analizzato i risultati ottenuti in termini di complicanze mediche e chirurgiche e di sopravvivenza dell’organo. Risultati L’analisi dei dati ha dimostrato nel gruppo A un tasso di complicanze …

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…

Giant incisional hernia in the ederly patient. A Rapid and simple surgical technique

Objectives The aim is to obtain a) a safe procedure to repair the large abdominal defect and reinforce the fragile zones around; b) a simple and rapid technique to reduce the operation time. Materials And Methods Retrospective review of medical records of 72 elderly patients in whom intraperitoneal mesh placement was used between January 1988 and June 2005. Results No intraoperative complication occurred. In the postoperative stage 7 seromas, 4 haematomas, 2 infections occurred, all solved with conservative treatment. Conclusion The incidence of incisional hernia (IH) vary between 1% and 15 %, with increasing risk of recurrence in relation to the age of patients, wound infection, obesity an…

FUNZIONALITA' RENALE E INDICE DI RESISTENZA (IR)

INTRODUZIONE La valutazione dell’indice di resistenza renale (IR) nel post trapianto è stata largamente dibattuta e nonostante mostri valori differenti nei vasi iterlobulari rispetto a quelli interlobari il suo valore diagnostico è ormai indiscusso. Nel seguente lavoro i risultati dei valori medi di IR renale valutati nei tratti distali delle arterie interlobulari sono stati correlati alla funzionalità renale. METODI Da gennaio 2001 a maggio 2007 in 55 pazienti sottoposti a trapianto renale abbiamo eseguito, durante un follow-up medio di 6 mesi, una valutazione ecodoppler del graft e del tratto distale delle arterie interlobulari. Tutti gli esami sono stati condotti dallo stesso esaminatore…

Secondary Hyperparathyroidism and renal transplantation

Trattamento chirurgico di un caso di fibroistiocitoma maligno del mesocolon trasverso

INTRODUZIONE: I fibroistiocitomi (MFH) sono dei sarcomi che originano dai tessuti molli, solitamente si localizzano nelle estremità dell’organismo nel tronco e nel retroperitoneo; la localizzazione dei MFH primitivi a livello addominale e/o intestinale è molto rara, infatti non più di 40 casi sono stati descritti a tutt’oggi in letteratura. CASO CLINICO: Paziente donna di anni 80 nella quale è stata osservata una tumefazione localizzata a livello della regione epigastrica e dell’ipocondrio di destra, di consistenza teso elastica, ricoperta da cute integra e associata a sintomatologia dispeptica. Gli esami di laboratorio erano nella norma eccetto l’Emoglobina di 8,2 gr/dl, i Globuli Rossi di…

Trattamento minilaparotomico dei linfoceli post trapianto renale

The use of a tailored mesh with special design for ventral hernia repair. Preliminary report

Introduction: The study describes a modified technique for ventral hernia repair based upon a tension free, fixation free, and dynamic compliant implant. Material and methods: A unique geometrical shaped light weighted, large porous polypropylene mesh was created consisting of a large central body and six radial arms, designed to pass through the tissues and hold the mesh in place without tension. We used the mesh in a small exploratory cohort of patients with ventral hernia. The mesh was placed sublay by taking each of the six straps and passing from below the muscle, through the muscle allowing the fixation free strap to sit with friction within the tissues. This was designed to give a te…

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

Funzionalità renale e indice di resistenza(IR)

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…