Collagen tampons as aminoglycoside carriers to reduce postoperative infection rate in prosthetic repair of groin hernias.

OBJECTIVE: To find out whether collagen tampons treated with gentamicin would prevent postoperative infections in patients operated on for groin hernias by insertion of prostheses. SETTING: University hospital, Italy. DESIGN: Prospective randomised trial. PATIENTS: 595 patients who required prosthetic repair of a groin hernia. INTERVENTIONS: All repairs were by our standard surgical technique including prophylactic ceftriaxone, local anaesthesia, and insertion of a polypropylene mesh. 301 patients also had a gentamicin laced collagen tampon placed in front of the prosthetic mesh before the aponeurosis of external oblique muscle was sutured. RESULTS: 1/301 patients in the gentamicin group (0.3%) developed a postoperative wound infection compared with 6/294 in the control group (2.0%), (p = 0.04 Fisher exact test). CONCLUSIONS: Gentamicin-laced collagen tampons are effective in reducing the postoperative infection rate in patients operated on for groin hernia by insertion of a prosthesis.

Madelung's disease: case report and discussion of treatment options.

Madelung's disease was first described in 1846. Since then, approximately 200 patients have been reported in the literature. Its three main characteristics-typical location of the lesions, symmetry, and the diffusive nature of the fat-are more often found in men of Mediterranean descent. A clear association with alcohol abuse is reported, but the etiology remains uncertain. Patients usually complain of their cosmetic appearance, but treatment can be rendered for decreased neck motion and/or aerodigestive problems. Given the benign nature of the lesion, surgical debulking is the treatment of choice, with liposuction reserved for smaller lesions. A standard facelift pattern can be used for skin incisions and removal, with good cosmetic results.

[Fournier syndrome: multidisciplinary approach]. / Sindrome di Fournier: approccio multidisciplinare.

Fournier's gangrene, a form of necrotizing fasciitis, is an uncommon, fulminant, rapidly progressing subcutaneous infection of the scrotum and genito-perineal region, and may occur in all age groups. Most cases involve a mixed synergistic infection of aerobic and anaerobic bacteria, and occur as a result of one of this mechanisms: local trauma, extension from a perineal, periurethral or ischiorectal infection. It is associated with a high mortality rate. Predisposing factors included diabetes mellitus, steroids or chemotherapy, alcohol abuse, malignancy and radiation therapy. This disease requires prompt treatment: early diagnosis, antibiotic therapy, nutritional support, immediate extensive surgical debridement and hyperbaric oxygen therapy. The use of etherologue serum is a valuable adjunct in the therapy of Fournier's gangrene. We report a case of Fournier's syndrome treated with etherologue serum immuno-therapy, together with the conventional multidisciplinary approach. The postoperative course was uneventful and the patient was discharged on day 50 post intervention in good general conditions. The 3 years follow-up showed no recurrence of the disease. In conclusion we remark that the survival can be improved in patients with Fournier's gangrene by multidisciplinary approach.

[Chromoendoscopy in the diagnosis of precancerous lesions of the esophagus. Our experience]. / La cromoendoscopia nella diagnostica delle lesioni precancerose dell'esofago. Nostra esperienza.

The elements of an unfavourable prognosis for oesophageal cancer are frequent metastasis, high incidence of local recurrence and mainly the difficulty of an early diagnosis. Alcohol, tobacco and precancerous lesions are the most important risk factors of these tumours. According to literature, the authors suggest the method of chromoendoscopy, with vital staining by lugol or blue toluidine for endoscopic; guidance to biopsy in the aimed screening of patients, whose habits--alcohol, smoking--should cause, in time, the rising of lesions with neoplastic potentiality. Endoscopy with bioptic test is the best diagnostic investigation. In fact sensibility and specificity of these investigations increase using this method with vital staining.

[Post-traumatic diaphragmatic hernia with late diagnosis. Report of a clinical case]. / Ernia diaframmatica post-traumatica a diagnosi tardiva. Descrizione di un caso clinico.

Starting from the observation of a case of late diagnosed left-side hernia after traumatic rupture of diaphragma, the authors consider the increasing incidence of this pathology during the years. The increased frequency of thoraco-abdominal traumas and the more sophisticated diagnostic tools, permit an earlier diagnosis nowadays. In our patient the diagnosis was made late on the basis of the standard x-ray of the thorax. The CT scan of the thorax and of the abdomen gave more informations. Left thoracotomy enabled a wide exposure of the herniated viscera; the breakthrough of the diaphragm was repaired by means of interrupted suture and it was necessary to apply two prostheses of synthetic material.

Magnetic resonance imaging in evaluation of the common bile duct.

BACKGROUND: The ideal method for evaluation of the common bile duct (CBD) before or during cholecystectomy remains controversial. Magnetic resonance cholangiography (MRC) is a new, promising technique. A prospective evaluation is reported. METHOD: Sixty-one patients (45 women) were studied by MRC. There were 29 patients with symptomatic gallstone disease and without clinical, biochemical or ultrasonographic evidence of CBD stones (group 1); 28 of them also underwent intraoperative cholangiography (IOC). In addition, there were 21 patients with symptomatic gallstone disease, with mild biochemical and ultrasonographic signs of CBD involvement (group 2), of whom 19 underwent IOC, and 11 patients with symptomatic CBD stones (group 3), nine of whom had preoperative endoscopic retrograde cholangiopancreatography (ERCP) following MRC. RESULTS: MRC showed that no patient in group 1 and three patients in group 2 had CBD stones. Three patients (one in group 1, two in group 2) did not undergo IOC because of technical or clinical problems. In group 3, ERCP confirmed the results of MRC in nine patients. Two patients underwent open surgery because of ultrasonographic, MRC and radiographic signs of pancreatic malignancy. CONCLUSION: MRC could replace IOC and ERCP for identification of asymptomatic CBD stones. In symptomatic patients MRC combined with other non-invasive imaging techniques can direct the surgeon to appropriate management.

10-year experience of total thyroidectomy with special reference to 85 thyroid cancers in one Italian centre.

The ideal surgical approach for differentiated thyroid carcinomas (DTC) is a matter for debate. Total (TT) or near total (NT) thyroidectomy on one side, and lobectomy (LL) or lobo-isthmusectomy (LI) on the other side are the options. Extended (TT, NT) resections are preferable for several reasons, and LL or LI are preferred by some groups. Our 10-year experience indicates that the post-operative complications percentage may be low enough to make TT the preferred surgical option.

[Clinical manifestations in benign breast diseases. The surgeon's role in the evaluation of signs and diagnostic work-up]. / Manifestazioni cliniche in corso di patologia mammaria benigna. Ruolo del chirurgo nella valutazione dei segni della malattia e nella programmazione diagnostica.

From January 1988 through December 1995, 1022 patients having a breast disease have been operated on in our center. Of them 342 had a breast malignancies whereas 680 beared a benign breast disease. Benign breast pathology presents to the physician two main problems, they are: i) the need to rule out a breast cancer, which often may be simulated by special clinical presentation ii) the need to determine if eventually such a benign lesion can degenerate into a malignancy. We conclude according to our experience and following several authors that although a very careful diagnostic evaluation must be performed for every breast lesion, only few benign lesions arising with particular patterns can change into a breast cancer.

[Intestinal bleeding from an ulcerated diverticulum of the small intestine. A clinical case]. / Emorragia intestinale da diverticolo ulcerato del tenue. Descrizione di un caso clinico.

A case of occult bleeding of the upper intestinal tract in a patient with secondary polycythaemia and aortic valve stenosis is described. Routine tests failed to disclose the origin of the bleeding and the patient's condition continued to deteriorate. On the 23rd day after admission, laparotomy was performed, and an ulcerated diverticulum diagnosed. Resection of the diverticulum was done immediately. The patient had an uneventful post-operative recovery and was dismissed from the hospital 15 days later. Our experience underscores the necessity for early laparotomy in cases of gastrointestinal bleeding of obscure origin.

[Laparoscopic surgery in varicocele: description of the technique and preliminary data]. / Intervento di varicocele per via laparoscopica: descrizione della tecnica e dati preliminari.

UNLABELLED: The aim of this work is to remark the scientific worth of the laparoscopic approach in patients with varicocele. PATIENTS AND METHODS: From March 1993 to December of the same year 15 patients suffering from varicocele have been treated with a laparoscopic procedure. The technique is widely described in the next pages. RESULTS: Twelve patients have completed the 3 months follow-up whereas five among them have reached the 6 months control. The results are really interesting specially under a functional point of view. DISCUSSION: The noninvasive advantages provided by laparoscopy are always important, but is the worth of the results we have obtained under a functional point of view and the success in inducing pregnancy in some patients that lead us to remark the utility of this procedure comparing it, with the therapeutic proposals nowadays performed. They are: traditional surgery according to Ivanissevich or Palomo procedures percutaneous transvenous embolization under radiological guide varicocele vein ligation under local anesthesia. CONCLUSIONS: Laparoscopic varicocelectomy represents according to us and some other authors a proposal with a better response if compared to traditional surgery, specially under a functional aspect. Under a costs-benefits evaluation it may be considered more convenient than the radiological approach.

Brush border peptidases and arylamidases in the experimental blind loop syndrome of the rat.

Peptidase and arylamidase activities were assessed in purified brush borders from jejunum of rats with surgically created blind loops. The blind loop segment and the jejunum proximal and distal to the blind loop were studied. Comparable jejunal segments from control rats were also studied. The blind loop syndrome was documented by presence of macrocytic anemia. Enzyme activities were determined on purified brush borders. In rats with the blind loop syndromes enzymatic activities hydrolizing sucrose, L-Leucyl-beta-naphthylamide, L-lysyl-beta-naphthylamide, alpha-L-glutamyl-beta-naphthylamide, L-phenylalanyl-alanine and L-leucyl-glycine were significantly reduced as compared to controls (P less than 0.001). After a short course of antibiotic therapy enzymatic activities returned to normal. Our findings suggest a reversible intestinal mucosa damage in the rat with blind loop syndrome.