The TramEC "double cross" mesh: a new experience for repairing groin hernia. Our experience with 280 patients.

AIM: The purpose of this work is to provide a detailed account of a new technique for open prosthesis hernioplasty, a technique that makes use of a pre-shaped TramEC mesh made of polypropylene monofilament and created by the author. Specific descriptions are offered in regard to the shape of the mesh, the hernioplasty technique and the physiopathologic characteristics. METHODS: From 2000 to 2001, a total of 280 hernioplasties were performed with the TramEC technique. A follow-up of these patients was done after 1 week, after 3 months and after 1 year. An ecography of the groin was executed on all patients after 1 week in order to verify the presence of seromas. RESULTS: No recurrence was observed in 55.7% of patients examined after 1 year. Two patients (1.2%) experienced chronic but not debilitating pain. CONCLUSION: The author believes that with the TramEC mesh a precise overlap is formed between the mesh itself and the floor of the groin canal, thus creating the conditions required for avoiding empty spaces in order to favour the fibroplasias and amalgamation of tissues: basic parameters in avoiding recurrences. In addition, the mesh not only repairs the hernial defect but also strengthens the internal inguinal ring by virtue of its "double cross" structure. Because of the device's anatomical shape and the simplicity of the technique, we optimise the operation in terms of time and reproducibility.

Bleeding peptic ulcer occurring in hospitalized patients: analysis of predictive and risk factors and comparison with out-of-hospital onset of hemorrhage.

We reviewed 84 consecutive cases of peptic ulcer hemorrhage, which occurred, in an area of 270,000 people, from 1986 to 1988, in patients already hospitalized for other diseases (in-bleeders). These subjects were compared with a prospective series of 386 patients who initially bled as out-patients and were then admitted (out-bleeders). Of 84 hemorrhages in hospitalized patients, 41 followed major surgery, while 43 were associated with other severe conditions. Bleeding site was duodenal in two thirds. Mean age was 67 +/- 15 years versus 59 +/- 15 among out-bleeders. Fifty percent of in-bleeders had recently received nonsteroidal antiinflammatory drugs (NSAIDs), and one third were on anticoagulants and 10% on corticosteroids; in 39 (46%) bleeding was shown to be persistent or recurrent, 5 (5.9%) underwent endoscopic and 18 (21%) surgical therapy; 29 died (34%). The corresponding figures among out-bleeders were: further bleeding 80 (20.7%), endoscopic therapy 12 (3.1%), surgery 25 (6.5%), deaths 17 (4.4%). As regards in-bleeders, only active bleeding and endoscopic stigmata emerged as statistically significant risk factors for further bleeding. The latter was shown to be significantly related to mortality. The most relevant finding was, however, that NSAIDs and anticoagulants, in association with stress and aging, are very frequently involved in peptic ulcer bleeding of hospitalized patients. The fatal outcome of one third, despite all available treatments, highlights the importance of prevention against drug- and stress-related mucosal damage in in-patients suffering from severe diseases.

[Gastrointestinal hemorrhage from a duodenal diverticulum]. / Emorragia gastrointestinale da diverticolo duodenale.

Duodenal diverticuli are often asymptomatic and are occasionally found during the course of X-ray tests or autopsy. They are sometimes manifested in the form of symptoms related to a complication (hemorrhage, perforation, occlusion). The paper reports a case of gastrointestinal hemorrhage caused by a duodenal diverticulum which was then successfully operated. The Authors affirm that in these cases the resection of the portion of the duodenum with the diverticulum (provided the papilla is not affected) is preferable to direct hemostasis or duodenocephalopancreatectomy.

Splenic torsion: a rare cause of splenomegaly.

The authors report a rare case of splenomegaly, caused by recurring splenic torsion in a 31-year-old patient. On the basis of this experience and literature data, pathogenetic, symptomatological, diagnostic and therapeutic aspects are discussed. Analysis of the clinical history and diagnostic procedures confirm the difficulty in ascertaining this condition preoperatively. In any case, splenic torsion should be considered in the differential diagnosis of painful splenomegalies.

[A splenic autograft in omental pockets following splenectomy for trauma. The authors' personal experience of 10 cases]. / Autotrapianto splenico su tasche omentali dopo splenectomia per trauma. Esperienza personale su 10 casi.

Personal experience on 10 patients splenectomised for trauma and subjected to splenic autotransplantation on omental pockets is reported. After describing autotransplant candidate selection criteria and the surgical technique followed, the flattering results are reported. Particularly interesting was the fact that no local suppuration was encountered and the transplant took in all patients, as demonstrated by scans carried out with labelled red globules and radiocolloid.

[Non-traumatic colic perforation in free peritoneum. Apropos of 61 cases]. / Perforazioni coliche non traumatiche in peritoneo libero. A proposito di 61 casi.

Sixty-one non-traumatic perforations in free peritoneum are reported. The principal aetiology is diverticulitis (35 cases) followed by cancer (22 cases). 18 derivations were carried out, 34 colectomies without anastomosis, 5 ideal colectomies and 4 diverticulectomies. Total mortality was 19.7-14% for diverticulitis, 22.2% for perforations at the cancer site, 50% from diastasic perforations. Stress is laid on the need to treat colic perforation by colectomy without anastomosis, confining derivation openeum. Sixty-one cases.

[Leiomyosarcoma of the Meckel's diverticulum (presentation of a new case)]. / Il leiomiosarcoma del diverticolo di Meckel (segnalazione di un nuovo caso).

A new case of Meckel's leiomyosarcoma is described. The rarity of the disease, the problems of differential diagnosis and the difficulty of establishing the malignant nature of the condition and thus the prognosis justify the report together with a review of the most recent literature.

[Thin-needle aspiration cytology of palpable lymph nodes. Analysis of 702 consecutive cases]. / La citologia per aspirazione con ago sottile di linfonodi palpabili. Analisi di 702 casi consecutivi.

Seven-hundred-two needle aspirates were taken from palpable lymph nodes between january 1982 and june 1987. Cytohistological correlation in about 70% of the preparations showed that the technique is capable of detecting neoplastic cells in 99% of metastases and in 90% of lymphoma cases. Certain technical aspects of smear preparation are pointed out with a view to reducing the percentage of inadequate samples (14% in the present series) and the position of the technique among other diagnostic procedures is discussed, with evaluation of advantages and limitations.

[Intra-abdominal rupture of varices of the round ligament: a rare cause of hemoperitoneum in patients with cirrhosis]. / La rottura intra-addominale di varici del ligamento rotondo: rara causa d'emoperitoneo nel cirrotico.

The authors report two cases of haemoperitoneum due to intra-abdominal rupture of the round ligament in cirrhotic patients with portal hypertension. A review of the literature on the subject reveals the rarity of such observations. The eventuality must be borne in mind, however, in the treatment of the haemorrhagic complications of portal hypertension in view of the associated high mortality. Simple ligature of the bleeding varix is the operation which offers the greatest possibility of survival.

[Lesions caused by the ingestion of caustics]. / Lesioni da ingestione di caustici.

The diagnostic and therapeutic approach to the maiagement of lesions caused by ingestion of caustic substances has made substantial progress in the past few years and has now been codified. The linch-pins of the present approach are emergency endoscopy for an immediate assessment of the lesions and total parenteral nutrition to reduce the morbidity in patients whose lesions may be expected to take a long time to heal or may require surgical repair. The diagnostic and therapeutic protocol advocated derives from a close examination of the literature and from personal experience.

[Recent traumatic rupture of the diaphragm in patients with multiple injuries]. / Le rotture traumatiche recenti del diaframma nei politraumatizzati.

The authors report on 16 cases of recent traumatic diaphragmatic lesions in polytraumatized patients referred to them over the period 1979-86. After examining the diagnostic problems relating to this type of lesion, the authors describe the anatomico-topographical, clinical and therapeutic aspects. They conclude by stressing the need to explore the diaphragmatic cupulae systematically in the course of surgery for blunt abdominal trauma.

[Traumatic chylothorax (apropos of a case following a closed vertebral-thoracic injury)]. / Chilotorace traumatico (a proposito di un caso consecutivo a trauma chiuso vertebro-toracico).

The authors report a case of chylothorax due to blunt trauma with fracture of the spine in a man aged 60. After mentioning the possible pathogenesis and clinics of the case shown, the Authors explain the treatment successfully adopted, that is, the ligature of thorax duct at his inlet in the thorax through right thoracotomy on the 5th intercostal space.