Inguino-crural hernias: preoperative diagnosis and post-operative follow-up by high-resolution ultrasonography. A personal experience.

BACKGROUND: Hernia is an important pathology with an incidence of 5% in world population. The more affect region is the inguino-femoral. Normally the diagnosis was based on the clinical exam. A short time ago the high resolution ultrasonographic study was introduced. The purpose of our study was to value the sensitivity of US-HR in the preoperative diagnosis, in the postoperative follow-up and to compare the results to clinical exam. METHODS: 140 patients affect by inguino-femoral hernia underwent this study, 112 inguinal hernias, 28 femoral, 8 pediatric patients. 106 patients underwent repair through the prosthesis, in 34 Halstad-Postempsky's technique was carried out. Ultrasonography studied: a) inguino-femoral region, cord and scrotum (the study was effected in basal condition and through Valsalva's manoeuver, decubitus changes); b) hernia content (omenutm, bowel); c) hernial orifice and of hernial content's transit (direct or indirect); d) the relation with the inguinal ligament; e) the vascularization (power-doppler) and the pathological situation (presence or absence of liquid in the sac, parietal thickness, presence/absence of peristalsis), in case of hernia complication; f) the presence/absence of simultaneous pathologies (hydrocele, varicocele, cord's cyst). The postoperative study was effected after 7 days, 1-6-12 months we have observed: a) haematomas and seromes (under the skin, under the aponeurosis, scrotal); b) prosthesis displacement; c) prosthesis infection; d) prosthesis reject; e) recurrence (importance, site); f) we have carried out the treatment of the complications (echoguided drainage of serous and hematic collection). RESULTS: The sensitivity of US-HR in the diagnosis of hernia was 87.5%. The clinical exam arrived at an average of 72%, the comparison was favourable to US-HR (15.5%). The sensitivity in the diagnosis of complication arrived at an average of 85.5% for US-HR, and of 36% for clinical exam; the gap between the two techniques was elevated (49.5%). CONCLUSIONS: The US-HR showed an important accuracy and sensitivity thus to cover today an important role, after the clinical exam, in the preoperative diagnosis and in the postoperative follow-up of the inguino-femoral hernias.

[Reflections on mesenteric infarct]. / Riflessioni sull'infarto mesenterico.

The authors relate their statistic about mesenteric infarction in the last five years and they get out the starting point in order to check the characteristics of a disease, which is today distinguished by an infaust prognosis. After few mentions about etiopathology and pathologic anatomy they keep their attention on clinic manifestations of disease and on diagnostic research. After dealing with medical and surgical therapy they declare how more refined diagnostic technique could help early diagnosis and consequently decrease morbidity and morbidity, which are completely unacceptable.

[Short- and long-term monitoring with high-resolution ultrasonography of postoperative thyroid residue. Personal experience with 200 thyroidectomies]. / Monitoraggio a breve e lungo termine mediante ultrasonografia ad elevata risoluzione (us-hr) del residuo tiroideo post-operatorio Esperienza personale su 200 tiroidectomie.

BACKGROUND: After having abandoned conservative operations of the thyroid (partial resection, enucleal resection) today total thyroidectomy and sub-total thyroidectomy and near total thyroidectomy are the operations of choice. Cause the frequent post-operative scintigraphic signs, on the 3rd month, of thyroidal residue of significative size, founded in our patients operated for sub-total thyroidectomy, we begun to study the echografical monitoring of the thyroidal recess. METHODS: From January 1995 to December 1997 we operated 200 patients for Thyroidectomy. The kinds of operations were: total thyroidectomy for 96 patients (48%), sub-total thyroidectomy for 64 patients (32%), and near total thyroidectomy for 40 patients (20%). We controlled all the patients by ecografical monitoring of the thyroidal recess to detect and to determinate the possible thyroidal residue, that it will be monitorized on the 7th day, on the 1st month, on the 6th month and on the 12th month. We measured the thyroidal residual dimensions and volume. We recorded all the examinations by VCR or film and after we elaborated the results by exponential graphics. The patients that showed the thyroidal residues underwent to a scintigraphy. RESULTS: The thyroidal residuals were measured within the 7Th post-operative day. In the following controls we have noted a thyroidal residue hypertrophy. Multinodular goither was the disease with the highest degree of growth (until the 200% of the first measure of the residue). After an initial phase of growth almost all the patients showed a trend to the stabilization, with the exception only of the patient that suffered from multinodular goither. The scintigraphic examination was not realiable, in our experience, about the mathematic measurement of the thyroidal tissue, showing always an overvaluation of the residue. The best specificity was showed by US-HR. CONCLUSIONS: The patient that undergoes to total thyroidectomy needs an adequate suppressive and substitutive therapy. We identify the presence of several stimulating factors the growth of the residual thyroidal tissue that could arise to promote the hyperplasia and the hypertrophy of the parenchyma (EGF, TSG, TSI, PG). There are factors that are unidentified and are not subject to the suppression caused by substitutive therapy.

[Periampullar tumors: role of intraoperative color-Doppler ultrasonography in the evaluation of vascular invasion. Methods available to the surgeon and personal experience]. / I tumori della regione periampollare: ruolo della ultrasonografia color-doppler intraoperatoria nella valutazione della invasione vascolare. Metodiche a disposizione del chirurgo ed esperienza personale.

BACKGROUND: Tumors of the head of the pancreas and of the periampullary region, similar nosologic entity, represent the fourth most common cause of cancer death. These tumors are characterized bt high mortality rate associated with a low percentage of surgical resectability. Vascularly involvement is, in our experience, one of the criteria of exclusion for curative surgical resection. For this reason regional pancreasectomy don't show, in several case records, comforting datas about survival. METHODS: From 1995 to 1998 we introduced in the operative practice the color--doppler ultrasonography to diagnose vasculary involvement. We evaluated twenty patients that previously were candidated for surgical therapy consisting in a duodenal-pancreasectomy. All the patients were staged by preoperative abdominal ultrasound, E.R.C.P., CT, and angio M.R.I.. In no one of these patients were founded signs of vascularly involvement. We recognized by intraoperative color-doppler ultrasound three microscopic invasions of spleno-mesenteric-portal vasculary axis. RESULTS: U.S. I.O. C.D. in our case reports has underlined a sensibility and specificity of 100%. It has discovered, also, a false positive for neoplastic thrombosis, and a case of false negative. CONCLUSIONS: Intraoperative ultrasound shows a high sensibility about the intraoperative staging for the bibliopancreatic tumors. The study about the possible vascularly involvement is helped by the application of the colour in terms of an high sensibility and diagnostic care.

[Minimally invasive percutaneous ultrasonography-guided treatment of postoperative splenic abscess. Personal experience with 5 clinical cases]. / Terapia mininvasiva percutanea ultrasonoguidata degli ascessi post-chirurgici della milza. Esperienza personale su cinque casi clinici.

INTRODUCTION: Splenic abscesses are very rare pathologies encountered in daily clinical practice. The treatment, after failure of other medical treatments, has basically been surgical, in spite of large diffusion of percutaneous echo and CT techniques. The initial hesitation in applying this sort of method was caused by an unfounded fear of difficult management of haemorrhagic complications. METHODS: In our Clinic we treated 6 postoperative abscesses, observed in 5 patients. One of these (16%) was double and 3 concomitant with other intraperitoneal abscessual septic collections, which received priority in percutaneous treatment. In four cases (67%), Van-Sonnemberg drainage catheters were placed which caliber varied from 12 to 14 F. In the remaining two cases, we evacuated the abscess using an echo-guided needle puncture. In two cases we applied fibrinic glue; in one case as a haemostatic agent and in the other, to protect the wide abscessual cavity. RESULTS: We recorded the resolution of the symptomatology and instrumental findings in all patients. One patient died two weeks later due to unrelated causes. We recorded one minor complication which involved an intra-abscessual haemorrhage, which was then treated by fibrinic glue (Tissucol). CONCLUSION: Echo-guided percutaneous treatment, at present, is the treatment of choice for both multiple or single splenic abscesses. This treatment is not used for the miliaric form because we believe that in this case, the most appropriate choice is intensive medical treatment, which if fails, may require splenectomy.

[Abdominal compartment syndrome in video laparoscopic surgery. Etiopathogenetic aspects, physiopathology and personal experience]. / La sindrome addominale compartimentale in chirurgia videolaparoscopica. Considerazioni etiopatogenetiche, fisiopatologia ed esperienza personale.

The abdominal compartment syndrome (ACS) is a very seven pathology, consequence oh abdominal injuries and traumatism, acute pancreatitis, aortic aneurism rupture, acute peritonitis. The etiopatogenesis is the increase of intra-abdominal pressure with systemic consequences for cardiorespiratory and renal failure. The authors after careful physiopathologic consideration, describe, a case report of ACS in the laparoscopic cholecystectomy for acute cholecystitis. To conclusion, we report very important the accurate intraoperative monitoring of vital parameters (PCO2, PO2, Pa, Fc, PVC, Ph, Diuresis) and immediate decision at laparotomic conversion for abdominal decompression.

[A peculiar anomaly of the main biliary duct: choledochal cystic dilatation]. / Una particolare anomalia della V.B.P.: la dilatazione cistica del coledoco.

The Authors report a case of choledochal cystic dilatation and examine this particular anomaly of the main biliary duct analysing the complex classification. After a brief review of the embryology of the hepato-pancreatic ring, etiopathogenetic theories, clinic characteristics, as well as diagnostic and therapeutic possibilities for this affection are taken into account. It is concluded that the best therapeutic choice should be always based on an accurate evaluation of the anatomo-pathological conditions in each single case.

[Preoperative staging of colorectal neoplasms: importance of the echo-endoscopy]. / La stadiazione pre-operatoria delle neoplasie colo-rettali: importanza dell'ecoendoscopia.

The A. A., after having confirmed how the timely diagnosis of cancer of the Sigma-Rectum section is the result a complicated and articulate diagnostic iter, describe the advantages of using the ultrasonography-endoscopy. Therefore they relate their experience, comparing the outcome of this research with that of the TC images and above all with the histo-pathological surveys on the removed sechions. They conclude affirming that a higher percentage of the diagnostic care is a clear evolution in the correct pre-operating stage of these neoplasias.

[Spontaneous retroperitoneal hematoma from ileopsoas muscle bleeding. A case report]. / L'ematoma retroperitoneale spontaneo da sanguinamento del muscolo ileopsoas. Considerazioni su un caso clinico.

The Authors report a case of spontaneous retroperitoneal hematoma due to iliopsoas muscle bleeding. The different causes responsible of such hematomas are taken into account as well as clinical, therapeutical and pathophysiologic aspects connected with the spontaneous bleeding of the iliopsoas muscle. As in the case observed, the Authors suggest that often a careful wait-and-see approach represents the most appropriate therapeutical choice.

[ Tissue and blood CEA levels in stomach cancer]. / I dosaggi del CEA tissutale e sierico nel carcinoma dello stomaco.

The assays of serum CEA is a useful prognostic marker in patients with stomach cancer. In this study pre-operative serum CEA and tissue CEA in tumour or biopsy were assayed in a group of patients with gastric carcinoma in order to assess their prognostic roles. Based on an analysis of the results the authors affirm that high serum CEA levels in patients with advanced stages of stomach cancer indicate a fatal prognosis, and likewise the finding of tissue CEA in loco-regional lymph nodes at the same concentration as that in the primary tumour is also the sign of a severe prognosis.

[Clinical considerations on spontaneous pneumothorax]. / Considerazioni cliniche sul pneumotorace spontaneo.

The authors, after confirming the social interest of spontaneous pneumothorax, report the results of their experience taking hint from it for some clinical considerations. They mention different therapies suggested for the treatment of this disease; particularly they dwell upon aspiration techniques considered today the treatment of choice in most cases. They conclude affirming that this technique improves results, diminishes risks and complications, and considerably reduces hospitalization.

[Idiopathic retroperitoneal fibrosis]. / La fibrosi retroperitoneale idiopatica.

The authors, on the basis of a case recently observed dwell upon the natural history, the etiopathogenesis, and diagnosis of idiopathic retroperitoneal fibrosis. After confirming that medical therapy may be successful in selected cases only, different surgical procedures are analysed. It is concluded that outcome and prognosis of these subjects depend on early diagnosis.

[Colorectal carcinoma in young patients: review of 10-year experience]. / Il carcinoma del colon-retto in pazienti giovani: revisione di 10 anni di attività.

The authors, in reaffirming the high incidence of the mucin-producing type of colo-rectal adenocarcinoma in young patients, underline the considerable aggressiveness of this tumor. After a brief note on the etiopathogenetic hypothesis which could explain such behavior, the factors usually contributing to a worsening of the prognosis are reviewed. Thus, the Authors report their series and conclude affirming as indispensable to arrive to an early diagnosis.

[Clinico-statistical findings in Fournier's gangrene]. / Rilievi clinico-statistici sulla gangrena di Fournier.

Pathophysiological mechanisms of Fournier's gangrene are reported. Variety and progression of clinical manifestations are stressed as well. The importance of an accurate therapeutic protocol in the treatment of this peculiar and serious disease is therefore underlined.

[Tumors of the testicle]. / I tumori del testicolo.

The authors describe, in the light of the current literature, the clinical, diagnostic, and therapeutic characteristic of testicular cancer. They remark the good results of adjuvant therapy in this type of tumor.

[Autologous dermal graft in the treatment of hernia of the abdominal wall. A clinical contribution]. / L'innesto di derma autologo nel trattamento delle ernie della parete addominale. Contributo clinico.

The A.A. after reporting the different methods of treatment of the abdomen wall herniation relate about the advantages of autologous dermis graft. Pointing out their experience they conclude that dermis for its perfect tolerability and absence of complications gives considerable probabilities of success.

Beta-endorphin-like and alpha-MSH-like immunoreactivities in human milk.

We measured with radioimmunoassay the beta-endorphin-like and alpha-MSH-like immunoreactivities in milk and plasma of 8 lactating women. Mean beta-endorphin concentrations ( +/- SD) were 16.6 +/- 6.7 fmol/ml in milk and 9.9 +/- 4.1 fmol/ml in plasma. alpha-MSH concentrations (mean +/- SD) were 39.4 +/- 15.5 pg/ml in milk and 18.2 +/- 8.4 pg/ml in plasma. The concentrations of both peptides in milk were significantly (p less than 0.05) higher than in plasma. No significant correlation between milk and plasma concentrations of these peptides was found.