[A new conservative approach in the treatment of postoperative digestive-tract fistulas. Mechanical closure by a balloon-catheter]. / Nuova metodica conservativa nel trattamento delle fistole digestive postoperatorie. Chiusura meccanica con catetere con palloncino.

BACKGROUND: Digestive fistulas represent troublesome complication in patients operated in modern surgical wards where the improved surgical procedures and better intensive care enhance the surgeon to perform more aggressive approaches with a high surgical risk index. The management of a patient presenting a digestive-tract fistula is never easy, being its approach either conservative (TPN) or surgical. We applied an alternative surgical procedure consisting in a mechanical closure of the fistula using a balloon-catheter so as to improve outcome in those patients in whom medical tratment did not show satisfactory RESULTS. METHODS: We treated 7 patients presenting a postoperative fistula following several surgical procedures for neoplasms of the digestive system. These fistulas were closed using a Foley or Fogarthy balloon catheter preceeded by radiological and/or endoscopy controls. Once the catheter was placed, oral nutrition was started and some patients were discharged. A progressive deflation of the balloon was performed until complete removal of the catheter upon approx 10 days. RESULTS: We obtained a complete healing of the fistula in 6 patients, within 10 days since catheter placement. Only one patient required another operation. CONCLUSIONS: Our case-series may seem statistically not significant, but varied concerning location and type of fistulas. We observed an excellent outcome using this procedure which allows very short healing period thanks to an early oral nutrition uptake and a decrease in costs mainly due to a short hospital stay and a minor use of expensive drugs (TPN).

[Therapeutic trends in adrenal incidentaloma]. / Orientamento terapeutico nell'incidentaloma surrenalico.

The term incidentally discovered adrenal mass or incidentaloma includes several tumors, mainly benign, involving the adrenal space. From 1983 to 1990, at the 1st Surgical Department of the Careggi Hospital of Florence, 10 patients (8 females and 2 males), with age ranging from 31 to 66 years, were found to have an incidentaloma. The size of the mass ranged from 2 to 10 cms; the left side was interested in 2 cases and the right one in 8 cases. The first diagnostic approach was abdominal ultrasound scanning in 8 out of 10 patients, whereas computerized tomography was the first used in the remaining 2 patients. Overall, all patients underwent CT scanning, while abdominal ultrasound scanning was performed in 9, urography in 2, and MNR in 1. Fine needle aspiration was performed in one case of adrenal cyst both for diagnostic and therapeutic purposes. The Authors suggest a therapeutic-diagnostic program in which cytology, obtained through fine needle aspiration, may have a prominent role in reducing the need for surgical interventions, as it recently happened for thyroid disorders. Although technically more complex compared to thyroid fine needle aspiration, adrenal ultrasound-guided FNA may bring to a better classification of the different adrenal disorders reducing at the same time the need for surgery, which at present has a prevalent diagnostic intent.