ACROMORFO study: gait analysis in a cohort of acromegalic patients.

PURPOSE: In acromegaly, skeletal complications resulted to be associated with low quality of life (QoL) and high risk of falls. The aim of the present study was to perform a quantitative assessment of movement through gait analysis technique in patients with acromegaly. STUDY POPULATION: Thirty-three acromegalic patients [9 with active disease (AD), 14 with controlled disease (CD) and 10 with disease remission (RD)] and 20 healthy subjects were enrolled for the study. MEASUREMENTS: Kinetic and kinematic data were collected with 3D-gait analysis. Kinematic data were processed to compute the Gait Profile Score (GPS), a parameter that summarizes the overall deviation of kinematic gait data relative to unaffected population. RESULTS: The acromegalic group showed longer stance phase duration (p < 0.0001) compared to controls. The GPS and several gait variable scores resulted to be statistically higher in the acromegalic group compared to healthy controls. GPS values were significantly higher in AD compared to CD (p < 0.05) and RD groups (p = 0.001). The AD group presented significantly higher values in terms of hip rotation and ankle dorsiflexion compared to CD and RD groups and with regard to the foot progression compared to RD. Interestingly, patients with RD exhibited a more physiological gait pattern. CONCLUSION: Acromegalic patients showed quantitative alterations of gait pattern, suggesting instability and increased risk of falls. Arthropathy, along with its associated abnormal joint loading, proprioceptive impairment and hyperkyphosis could be contributing factors. Disease control and remission appear to improve postural balance. A better knowledge on walking performance in acromegaly would help to develop specific rehabilitation programmes to reduce falls' risk and improve QoL.

Complications after gastroplasty and gastric bypass as a primary operation and as a reoperation.

BACKGROUND: Since 1991 we performed vertical banded gastroplasty (VBG) as our surgical treatment of choice for morbid obesity in 680 patients, and since 1996 we also performed Roux-en-Y gastric bypass (RYGB) in 36 patients. For revisional surgery, the surgeons chose procedures based on their experience. METHODS: We recorded early complications (0.6%) and late complications (8.5%) after the primary operations. When staple-line disruption or stenosis of the banded stoma occurred after VBG, revisional surgery was performed with re-VBG or conversion to RYGBP. Some early complications needed emergency operation for bleeding or gastric perforation. RESULTS: Mortality was zero. Reoperation with re-VBG and RYGBP was effective in all patients, but for many, a long stay in hospital was necessary because reoperation had a high rate of early and late complications, 33.8% and 21.8% respectively. CONCLUSION: The treatment of complications after VBG with re-VBG and RYGBP had danger. We believe that when VBG failure occurs, to avoid dangerous complications again, we should perform a biliopancreatic diversion, which does not involve a gastric restriction.

[Surgery of inguinal hernia: our experience]. / Chirurgia dell'ernia inguinale: nostra esperienza.

The study is based on 848 patients that had surgery for inguinal hernia from January 1990 to May 1996. It compares the results obtained using the traditional plastic, called "direct suture", with the results of plastics with prosthesis. A special attention is given to tension-free techniques carried in local anesthesia, undoubtedly considered advantageous because of the technical simplicity in association with the total absence of postoperative complications and relapses, when correctly executed.

Orientaçäo atual em abscessos subfrênicos: contribuiçäo clínica / Up-to-date orientation in subphrenic abscesses: clinical contribution

Os traumatismos e as agressöes cirúrgicas abdominais representam, pelo menos na experiência dos autores, as causas que levam mais freqüentemente à formaçäo de abscessos na cavidade peritoneal. Näo obstante os progressos da antibioticoterapia e das técnicas de assepsia, a sua freqüência torna-se alvo de interesse. A presença de febre e leucocitose no pós-operatório ou em paciente politraumatizado devem sempre fazer suspeitar do aparecimento de tal complicaçäo. Um tratamento precose e adequado torna-se fundamental para eliminar o estado tóxico que a coleçäo purulenta produz e permitir a sobrevida do paciente

[Crohn's disease of the appendix: a rare nosological entity]. / Il morbo di Crohn dell'appendice: una rara entità nosologica.

In this study, the authors describe a case of Crohn's disease confined to the vermiform appendix out of a total of 1,263 appendectomies performed over the past 10 years in a Clinical Surgery Department (Clinica Chirurgica III) of the Policlinico S. Orsola in Bologna. In agreement with other reports in the scientific literature, the essentially non-specific clinical picture prevents pre-operative identification of the condition, whereas a diagnosis of Crohn's disease can be reached only on the basis of histological characteristics. The extreme rarity of Crohn's disease confined to the appendix is, however, confirmed. Follow-up at 3 years revealed no involvement of other areas of the digestive tract.

[2 cases of chylothorax during total parenteral nutrition: the etiopathogenetic considerations]. / Su due casi di chilotorace in corso di Nutrizione Parenterale Totale: considerazioni etio-patogenetiche.

The authors report the onset of bilateral chylothorax during postoperative total parenteral nutrition. They underline the peculiar origin of the complication. Therefore, attention is payed to the possible pathogenic causes. The overload of fluids, in the elderly with minimal functional reserves, may increase central blood pressure, so to adversely affect lymphatic drainage causing chylothorax.

[Acute intermittent porphyria: a clinical case]. / La porfiria acuta intermittente: caso clinico.

The acute intermittent porphyria is a rare but very interesting disease from the surgical and anaesthesiological point of view. On the basis of recently observed case the Authors review clinical and pathophysiological data of this entity simulating a variety of acute abdominal conditions and involving important problems from the anaesthesiological and pharmacological point of view. As a matter of fact, the administration of some drugs can provoke a crisis that often involves serious complications (coma), sometimes lethal (respiratory paralysis). However, when a patient needs a surgical treatment for different reasons, the awareness of this condition enables to plan an anaesthesiological management free of risks.

[Annular pancreas in the adult (clinical study)]. / Il pancreas anulare dell'adulto (contributo clinico).

The authors report a double observation of anular pancreas which appeared with different signs. After discussing the different etiopathogenetic moments, they point out the variety of the therapeutical behaviour in front of such a rare disease.

[Case of mucoid hydro-adenocarcinoma of sudoriferous glands (clinical report)]. / Su un caso di idroadenocarcinoma mucoide delle ghiandole sudoripare (contributo clinico).

The authors show a rare case of mucoid hydro-adenocarcinoma of sudoriferous glands. After discussing its anatomo-pathologic aspects and diagnostic difficulties, they dwell upon the prognostico-therapeutical problems of such neoplasm.

[Esophagotracheal fistula without esophageal atresia: discussion of 2 cases (author's transl)]. / La fistola esofago-tracheale senza atresia esofagea: considerazioni su due casi.

The authors report two cases of esophagotracheal fistula without esophageal atresia, of their own observation, on the grounds that the anomaly is less rare than common belief would have it; in fact, available literature indicates that a good many cases go undetected. So, in the presence of clinical evidence suggesting an esophagotracheal fistula, one must do everything possible to diagnose it correctly and to take timely corrective action in view of forestalling severe respiratory complications. The predominant oblique cranial orientation of the fistular passage creates considerable difficulty in radiological detection, although this difficulty is lessened by modern roentgenocinematography. Surgical correction, at any rate, solves all extant clinical problems at the same time as it eliminates possible complications.

[Circular myotomy in the reconstructive therapy of esophageal atresia. Experimental study in the rabbit]. / La miotomia circolare nella terapia ricostruttiva delle atresie esofagee. Studio sperimentale nel coniglio.

The authors report their experimental results in 22 rabbits subjected to circular myotomy of the esophagus, with radiological followup and final autopsy verification. This relatively simple surgical procedure may prove valuable for the correction of neonatal atresia of the esophagus; in particular, when done upon the cranial stump, it affords primary anastomosis of the viscus without undue tension even in cases of faulty esophageal continuity involving a length of several centimeters.