A comparison between endoscopic and microscopic approaches for stapes surgery: experience of a tertiary referral center.

PURPOSE: Otosclerosis is a common ear disease causing ankylosis of the stapedio-vestibular joint and conductive hearing loss. Stapedoplasty is the most advisable surgical solution. The restoration of hearing depends on the condition of the patient and the surgery itself. The aim of our work was to compare the surgical and audiological results of stapedoplasty performed with endoscopic versus microscopic technique. METHODS: This is a retrospective study of 254 patients treated with stapedoplasty with a microscopic approach (91/254) or with an endoscopic approach (163/254) between 2014 and 2021 at our tertiary referral center. Statistical significance of differences between the two methods was determined using the Mann-Whitney test for quantitative variables and the Wilcoxon matched-pairs signed-rank test for repeated measures. Categorical variables were assessed with Fisher's exact test. RESULTS: Both techniques improved the hearing status of patients, with no statistically significant difference between them. There was also no statistically significant difference in reported complications between the two techniques. There is a statistical difference (p < 0.001) in operating time between the two techniques: the endoscopic technique had a mean operating time of 39 min versus 45 min for the microscopic technique. CONCLUSIONS: The two techniques are comparable in terms of results and the choice depends on the surgeon's preferences and experience.

[Traumatic rupture of hepatic hydatid cyst]. / Rottura traumatica di cisti idatidea epatica.

Hydatid disease is endemic in some areas of the world. It is located mostly in the liver. The cysts rupture is possible after a trauma, or spontaneously by the increase of intracystic pressure. Rupture of the hydatid cyst requires urgent surgical intervention. We report our experience in treatment of traumatic rupture of hepatic hydatid cyst.

Peritoneal carcinomatosis from colorectal cancer: HIPEC?

Peritoneal carcinomatosis (PC) is a frequent terminal evolution from colorectal cancer. At the time of diagnosis of colon malignancies, PC affects approximately 10% of the patients [1]. Medical oncologists and gastrointestinal surgeons had considered it to be an untreatable condition for its unfavorable prognosis with a median survival of 6-9 months [1], suitable only for palliative treatment. Recurrence with carcinomatosis occurs in 25% of patients [2] and seems to be the only site of disease in 25-35% of these [3]. In a recent review of the literature on 12 trials, the incidence of peritoneal seeding during potentially curative surgery for PC from colorectal cancer varied from 3% to 28% [4]. Sugarbaker has suggested that peritoneal carcinomatosis is a locoregional cancer spread as a result of a molecular crosstalk between cancer cells and host elements [9]. Based on this concept and after Spratt first performed a debulking surgery (CR) followed by an intraperitoneal hyperthermic chemotherapy (HIPEC) in 1980 [5] and [6], numerous trials and investigations have been conducted on this technique [4]. Phase II studies on patients with PC of colorectal origin treated with CR plus HEPIC reported 5-year survival rates from 20% to 30% [7], while in a randomized controlled single-institution phase III trial this technique improved survival of patients affected by peritoneal carcinomatosis from colorectal malignancies (22.3 months versus 12.6 months) [8]. In all the series, an optimal cytoreduction is the most important prognostic factor for these patients [4]. The aim of this study is to demonstrate that peritoneum, as first line defense from carcinomatosis, is like an organ and so, the treatment of PC in selected patients should be a locoregional therapy with HIPEC in addition to CR [9].

Non-invasive cardiac monitoring by aortic blood flow determination in patients undergoing hyperthermic intraperitoneal intraoperative chemotherapy.

AIM: The aim of this study was to evaluate the haemodynamic changes in patients undergoing cytoreductive surgery and intraperitoneal hyperthermic chemotherapy (IPHC) using an echo-Doppler device (Hemosonic 100). EXPERIMENTAL DESIGN: haemodynamic and cardiac function variables during IPHC, using a closed abdomen technique, were measured with the use of a non-invasive esophageal echo-Doppler monitor. SETTING: operating room in an oncologic surgery department in hospital. Fifteen patients, ASA II or III with age ranging from 59 to 66 years were successively studied. All patients were under general anaesthesia with sevoflurane, remifentanil as titrated infusion, and cisatracurium for muscle relaxation. The standard monitoring included ECG, capnometry, invasive measurement of blood pressure and central venous pressure, pulsoximetry, diuresis, esophageal and tympanic temperature. Haemodynamic changes evaluated by an echo-Doppler device were recorded at predetermined times. RESULTS: A significant reduction in stroke volume (SV) and aortic blood flow (ABF) values was recorded (P<0.05) during the abdominal cavity filling, followed by a significant increase in total systemic vascular resistance values (P<0.05). A significant increase in SV, ABF and left ventricular ejection time was recorded 90 min after the start of IPHC procedure (P<0.05) when the body temperature increased. Peak velocity and acceleration values increased significantly at the same time. CONCLUSIONS: These results suggest that the echo-Doppler device (Hemosonic 100) provided an easy-to-handle, non-invasive and reliable tool to monitor changes in cardiac parameters during IPHC.