[Complications due to mechanical sutures in laparoscopic surgery: bowel obstruction caused by staple. Case report and literature review]. / Complicanze da suture meccaniche in chirurgia laparoscopica: occlusione intestinale da clip. Segnalazione di un caso clinico e revisione della letteratura.

Bowel obstruction after laparoscopic surgical operation is reported only in few cases. The incarceration of bowel loop occurs into the port site more frequently. The case of a young woman, subjected to laparoscopic appendectomy is reported: bowel obstruction occurs on the third postoperative day caused by a staple of the mechanical suture on the caecum, hooked to bowel mesentery. This complication can occur for staples partially formed, spilled in the peritoneum or put to the extremity of mechanical sutures: they can hook to fixed structures and strangle a bowel loop. It may occur in 1.8% of surgical laparoscopic procedures. It can be solved by the simple laparoscopic lysis, above all if an early diagnosis and surgical operation are performed. It is recommendable to remove all the free spilled staples in the peritoneum and close or remove those partially formed to the extremities of the suture.

[A modified technique of gallbladder dissection from the liver during laparoscopic cholecystectomy. Personal technique]. / La dissociazione della colecisti dal letto epatico durante colecistectomia laparoscopica. Tecnica personale.

BACKGROUND: Gallbladder injures during cholecystectomy happens more frequently when surgical operation is conduced under laparoscopic (16%) rather than laparotomic (8%) access. A modification of the technique of dissection of the gallbladder from the liver is presented, suggesting a progression from the medium to the lateral side. This technique should facilitate the division of the organs and, above all, limit the gallbladder iatrogenic injures. METHODS: During 1995-2000 we have employed our technique in 637 patients, 89 (14%) affected by acute cholecystytis, subjected to laparoscopic cholecystectomy. RESULTS: Gallbladder injures occurred in 38 cases (6%), with stones liberation 12 (1,9%): 11 had been submitted to surgery in emergency. All patients have been subjected to follow-up from 12 to 30 months. No intraperitoneal abscess was observed, while suppuration of the umbilical port occurred in 12 patients (1,9%): 6 were affected by systemic illnesses. CONCLUSIONS: Our technique can limit the incidence of iatrogenic gallbladder injuries during laparoscopic cholecystectomies, reducing surgical times, antibiotics administration, incidence of perioperative complications. Besides, this technique may facilitate the gallbladder dissection from the liver in case of infundibular stones.

[The effectiveness of long-term treatment of severe secondary hyperparathyroidism with intravenous calcitriol]. / Efficacia della terapia a lungo termine con calcitriolo endovenoso nell'iperparatiroidismo secondario grave.

AIMS: To evaluate the efficacy of intravenous calcitriol as a means of significantly reducing plasma PTH in long-term hemodialysis with severe hyperparathyroidism. EXPERIMENTAL DESIGN: prospective study. FOLLOW-UP: 12 months. SETTING: hospital hemodialysis centre. PATIENTS: 14 chronic hemodialysis patients, 6 males and 8 females, mean dialytic age 6.3 +/- 2.7 years, mean age 65.3 +/- 10.5 years, PTH-I > 500 pg/ml; normal serum calcium, serum phosphate, serum aluminium; normal or increased alkaline phosphatase; signs of hyperparathyroidism on hand X-ray; non-responder to oral calcitriol; 12 patients completed the study. TREATMENT: intravenous calcitriol 6 micrograms/week post-dialysis, half dose during the study of 7 patients; preventive calcium salt suspension; reduced calcium in dialysis bath, low dose aluminium hydroxide and intravenous disodium clodronate to treat and prevent hyperphosohoremia and hypercalcemia. FINDINGS: in basal conditions: PTH-I, total serum calcium, serum phosphate, total alkaline phosphatase, serum aluminum, ultrasonography, neck scintigraphy; serum calcium, serum phosphate, alkaline phosphatase each week in the first 45 days, every 2 weeks up until the third month, every month until the twelfth month; PTH-I every 3 months, serum aluminium after 12 months. RESULTS: Reduction of PTH-I from 1006 + 363 to 303 + 136 pg/ml in 12 patients who completed the study, with occasional, controllable hypercalcemia and hyperphosphoremia; dropout 2/14 (14.2%). CONCLUSIONS: Intravenous calcitriol is an efficious and easily managed long-term treatment for hemodialysed patients who would otherwise undergo parathyroidectomy.

[Therapeutic use of heparan sulfate in nephrotic syndrome: rational use]. / Uso terapeutico dell'eparansolfato nella sindrome nefrosica: uso razionale.

We report the beneficial effects of heparan sulfate administration in nephrotic syndrome (NS) in reducing the degree of proteinuria, in ameliorating the chylomicron removal defect and the hypercoagulable state and, consequently, in slowing down the progression to uraemia.