Efficacy and safety of ultrasound-guided placement of central venous port systems via the right internal jugular vein in elderly oncologic patients: our single-center experience and protocol.

BACKGROUND: Ultrasound-guidance has become the routine method for internal jugular vein (IJV) catheterization reducing dramatically failure and complication rates for central venous port (CVP) placement. AIMS: The aim of this study was to determine the safety and efficacy of ultrasound-guided IJV CVP placement in elderly oncologic patients. METHODS: Between January 2013 and December 2015, 101 elderly oncological patients underwent right IJV CVP placement under ultrasound-guidance. The length of catheter introduction ranged from 18 to 21 cm. Intraoperative fluoroscopy (IF) was always performed intraoperatively. Chest X-ray (CXR) was always performed 30 min after the end of the procedure. RESULTS: The morbidity rate was 1.98%; two arterial punctures were reported with one self-limiting hematoma. Two patients (1.98%) had catheter misplacements, recognized by intraoperative IF. No patients (0%) experienced pneumothorax (PNX), confirmed at CXR. Patients were all discharged at maximum 6 h from the procedure. DISCUSSION: The risk of catheter misplacement, PNX, and arterial/nerve puncture remains present with this technique. Lower rates of catheter misplacement have been reported after right IJV puncture, probably for its straight vertical course. Our results are in accordance with literature (1 counter-lateral subclavian vein and 1 counter-lateral internal jugular vein misplacements). All misplacements were detected intraoperatively. The PNX rates after cannulation of the IJV vary between 0.0 and 0.5%. We had no PNX occurrence. CONCLUSION: Ultrasonography (US) has improved safety and effectiveness of port system placements. While routine post-procedural CXR seems avoidable, IF should be considered mandatory.

Early outcomes of colon laparoscopic resection in the elderly patients compared with the younger.

BACKGROUND: The aim of this study was to define any benefits in terms of early outcome for laparoscopic colectomy in patients over 75 years old (OP) compared with the outcomes of a younger populations (YP). METHODS: Forty elderly patients undergoing laparoscopic colectomy for colorectal cancer between 2007-2011 were studied, the patients are divided for gender, age, year of surgery, site of cancer, and comorbidity on admission and compared with 40 younger patients. RESULTS AND DISCUSSION: Mean (standard deviation) age was 81.3 in OP and 68.3 YP Conversion rate was the same between the two groups. There was no difference in operative mean time . The overall mortality rate was 0% percent. The surgical morbidity rate was the same but there was an increased in cardiologic e bronchopneumonia complications in older population. Patients treated with laparoscopic approach had a faster recovery of bowel function and a significant reduction of the mean length of hospital stay not age related. Laparoscopy allowed a better preservation of postoperative independence status. CONCLUSIONS: Laparoscopic colectomy for cancer in elderly patients is safe and beneficial including preservation of postoperative independence and a reduction of length of hospital stay.

Prevalencia de sobrepeso, obesidad e hipertensión arterial en adolescentes de una escuela de arte / Prevalence of overweight, obesity and hypertension in adolescents attending an art school

Se realizó un estudio analítico de corte transversal en la población de alumnos que concurren a una Escuela Pública Secundaria y de Arte (n=213, varones 24 por ciento, mujeres 76 por ciento) en sus dos trayectos vocacionales (No-físico: Artes Visuales/Música y Físico: Danzas). Se determinaron variables antropométricas, presión arterial y frecuencia cardíaca. Se aplicó una encuesta sobre antecedentes personales de enfermedades crónicas no-transmisibles; traumatismos; ciclo menstrual; actividad física extraescolar; sedentarismo y horas de sueño. La tasa de participación fue del 70 por ciento. En los varones (edad 15,6±1,8 años) las tasas de prevalencia de bajo peso, eutrofismo, sobrepeso y obesidad fueron de 0 por ciento, 87,5 por ciento, 12,5 por ciento y 0 por ciento, respectivamente. En las mujeres (edad 15,5±1,7) estas tasas fueron 1,1 por ciento, 86 por ciento, 8,6 por ciento y 4,3 por ciento. El índice de masa corporal se encontró significativamente asociado con los perímetros de cintura y braquial tanto en varones como en mujeres (p<0,001). En el grupo de alumnos con Sobrepeso/Obesidad se detectaron 2 adolescentes con PAS aislada, centilo 90. Un joven eutrófico con PAS/PAD centilo 90 fue confirmado como "borderline" por presurometría de 24h. En las mujeres con Sp/Ob se detectaron 2 alumnas con PAS aislada centilo 90, una con PAD aislada centilo 90 y dos con PAS/PAD centilo 90. El estado nutricional de los alumnos es satisfactorio, con alta proporción de jóvenes eutróficos en ambos sexos. Sin embargo, la aplicación de este protocolo permitió detectar jóvenes con valores elevados de PA así como jóvenes con sobrepeso/obesidad. Dada la actividad escolar realizada por estos alumnos, estos factores podrían constituir un riesgo para su salud.

A cross-sectional analytical study involving the population of adolescent students attending the Nigelia Soria Public School and Art Institute (n=213, 24 percent boys, 76 percent girls) in the two career paths (non-physical: visual arts and music, and physical artistic activities: dance) was conducted. Anthropometric variables, blood pressure (systolic, SBP, and diastolic, DBP), and heart rate were measured. A semi-structured questionnaire collecting personal data regarding non-communicable chronic diseases, trauma, menstrual cycle, non-school physical activity, inactivity, and sleep duration was administered. The participation rate was 70 percent. In boys (age 15.6±1.8 years), the prevalence rates of low weight, eutrophy, overweight, and obesity were 0 percent, 87.5 percent, 12.5 percent and 0 percent, respectively. In girls (age 15.5±1.7 years), these rates were 1.1 percent, 86 percent, 8.6 percent, and 4.3 percent. Body mass index was significantly associated with waist circumference and brachial circumference in both genders (p<0.001). In the overweight/obesity group, two students were diagnosed with isolated systolic hypertension (SBP 90th percentile). A eutrophic male student with SBP/DBP 90th percentile was confirmed as borderline by 24-h blood pressure measurement. In the group of overweight/obese girls, two students were identified with isolated SBP 90th percentile, one with isolated DBP 90th percentile, and two with SBP/DBP 90th percentile. The nutritional status of students is satisfactory, with a high proportion of young healthy adolescents of both genders. However, the implementation of this protocol permitted to identify adolescents with high blood pressure, overweight, and obesity. These factors may pose a health risk considering the school activity of these students.

[Intestinal reconstruction after dehiscence of a jejunal suture in a patient submitted to aorto-enteric fistula repair: a case report]. / Ricostruzione intestinale dopo deiscenza di sutura digiunale in paziente sottoposto a riparazione di fistola aorto-enterica: case report.

Aorto-enteric fistulas are serious complications of aortic surgery that require swift, effective surgical intervention. We report a case of a secondary aortoenteric fistula treated with prosthesis replacement and an intestinal suture subsequently complicated by the dehiscence of the previously constructed anastomosis. We opted for reconstruction re-intervention, closing the intestinal lesion by means of a mechanical suture above the jejunal dehiscence, making a side-to-end jejuno-jejunal Roux anastomosis and an end-to-side anastomosis at the base of the loop. The operation was completed by performing a gastrostomy and transforming the fistula into a jejunostomy. This intervention enabled us to discharge the patient in good general condition after 30 days.

[Our experience in the management of patients with Mirizzi syndrome]. / Orlentamenti attuali nel trattamento della sindrome di Mirizzi. Nostra esperienza.

The authors report their experience in the management of patients with Mirizzi Syndrome (MS) admitted, over a period of 15 years, at the General Surgery of Emergency Department of Cardarelli Hospital, Naples, Italy. All patients were admitted and surgically treated in emergency save for one. Out of 12 patients, cholecystectomy was performed in 7 cases. In others 5 patients, with cholecystocholedochal fistula, cholecystectomy with positionig of T-Tube was performed in 4 cases (MS-II); finally, 1 patient with MS type III undewrwent choledochojejunostomy. According to literature, the diagnostic protocol included abdominal ultrasonography and CT scan of the abdomen for all patients; in one case, a cholangio-MRI was performed to clarify the diagnosis. The preoperative diagnosis is essential to reduce risk of iatrogenic injuries. The cholangio-MRI, used to this extent, clarifies the site of obstruction, shows the anatomy of the biliary tree and allows to make all the possible differential diagnoses in order to exclude the presence of biliary tumors before surgery. The intraoperative cholangiography remains mandatory to clarify the anatomy of the biliary tree. In the cases we have treated, ERCP was never performed. We believe that ERCP has limited indications and unsatisfactory outcomes for both diagnosis and treatment of MS. Pathological examination of the fresh-frozen surgical specimens was always performed intraoperatively to exclude the presence of concomitant cancer of the gallbladder. The traditional treatment of patients with MS is surgery, as confirmed by our experience. We perform cholecystectomy for MS type I and cholecystectomy with direct repair of the biliary fistula over aT tube for MS type II. Patients with MS type III usually undergo a tailored operation based on the intraoperative findings, while choledochojejunostomy is mandatory for patients with MS type IV. Laparoscopic surgery is indicated only for MS type I and II. It seems to carry a higher risk for the patient and we do not use this approach in the emergency settings.

Endoscopic management of intragastric penetrated adjustable gastric band for morbid obesity.

This report describes a case of successful endoscopic management of intragastric penetrated adjustable gastric band in a patient with morbid obesity. The favorable course of the case described here demonstrates that adjustable gastric bands in the process of migration need not be removed surgically in patients who are asymptomatic.

[Conservative treatment of the digestive fistulas: personal experience]. / Trattamento conservativo delle fistole digestive: nostra esperienza.

OBJECTIVE: The authors, thanks to experience obtained in an Unit for the treatment of digestive fistulas, discuss the possibility of a conservative treatment for the anastomotic fistulas. MATERIAL AND METHODS: From 2000 to 2003 were treated thirty-five patients with post-anastomotic gastroenteric fistulas marked according to their localization, way end output (51.5% high, 42.8% moderate and 5.7% low). The treatment is based on an aspiration system, sometimes integrated with an irrigation system. A semi-permeable barrier was created over the fistula by vacuum packing a synthetic, hydrophobic, polymer covered with a self-adherent surgical sheet. This system create a vacuum chamber equipped with a subathmospheric pressures between 262.2 and 337.5 mmHg (350-450 mmbar), integrated with a continuous irrigation using antibiotic solutions or 3% lactic acid. RESULTS: The AA. obtained the resolution in 30 patients (85.7%), 3 patients needs the surgery (8.6%), 2 died, one for sepsis and the other one for malnutrition. The mean time for the closure was 45 days (from 20 to 90). A part of digestive external fistulas goes to spontaneous resolution so comes the idea that the creation of particular condition is the basis of their closure.

[The congenital cystic dilatation of the liver and bile ducts (CDB): our experience]. / La dilatazione congenita delle vie biliari: la nostra esperienza.

The congenital cystic dilatation of the liver and bile ducts (CDB) is a very uncommon disease. It often appears in females and most frequently in paediatric patients. Its etiopathogenesis is not yet completely defined. Its evolution includes, together with several complications, the malignant transformation. The Authors present the outcomes of their experience based on a series of 5 patients observed from 1991 till today. Apart from the rarity of this disease, their series is so interesting because 4 out of 5 are adult patients and the fifth one is over 15. In addition, differentiating from the literature trend, the group included only male patients. Are also discussed the most important aspects referring to nosology, epidemiology, etiopathogenesis, clinical pattern and its evolution of CDB, looking over a wide review too. The Authors extensively examine the diagnostic problems; owing to that the patients were observed in the period 1991-1999 it is necessary to clarify that some imaging methods, i.e. CSTscan and the bile duct MNR, were not yet introduced. The surgical treatment has been investigated as well, developed during its historical evolution until nowadays and our solutions for the 5 cases have been presented and discussed. In their series the Authors haven't ever observed during hospitalisation a malignant transformation.