Endoscopic repair of an abdominal intercostal hernia.

Abdominal viscera herniation through the chest wall is a rare condition. A case is presented of an abdominal intercostal hernia of the seventh right intercostal space; its pathogenesis and clinical features are described, and also the combined endoscopic and percutaneous surgical approach employed for its repair.

[Validity of the study of sentinel lymph nodes in the treatment of breast carcinoma]. / Validità dello studio del linfonodo sentinella nel trattamento del carcinoma della mammella.

Since it was introduced in the 1990s, axillary sentinel lymph-node biopsy has been rapidly and widely adopted to avoid complete axillary dissection (though this is still the standard procedure). The aims of the study were two-fold: (i) to determine the value of different techniques of sentinel lymph-node identification and (ii) to verify the predictive value of such procedures through histological examination of the sentinel lymph node and axillary dissection in the same patients. Both sentinel lymph-node biopsy and axillary dissection were performed in 230 patients with T1 and T2 (< 3 cm) carcinoma of the breast. Preoperative lymphoscintigraphy was able to identify the sentinel lymph node in 97.4% of cases, but, with an intraoperative hand-held probe, it was possible to find the sentinel lymph node in 98.2% of cases (226/230 patients). The sentinel lymph node was metastatic in 49.1% of cases (111/226 patients) and negative in 50.9% (115/226). The incidence of false-negative cases was 2.6% (2/115 patients). The predictive value of the sentinel lymph node was 98.7%. Finally, lymph-mode mapping is possible is a very high percentage of patients and therefore it is always advisable to use all three methods of identification together. The diagnostic reliability of sentinel lymph-node status is equally high. At present there no studies are available with a long-term follow-up to confirm these findings, and therefore axillary dissection is still the standard surgical treatment for breast cancer.

[Bipolar electrothermic coagulation (ligasure bipolar vessel sealing system) in thyroid surgery]. / La coagulazione elettrotermica bipolare (ligasure bipolar vessel sealing system) in chirurgia della tiroide.

Over the past few years different methods of achieving haemostasis in surgery have been developed. Among these methods, bipolar electrothermal coagulation carried out with the "LigaSure Bipolar Vessel Sealing System" has found numerous applications in some types of abdominal and pelvic surgery, especially when performed laparoscopically, where traditional methods of haemostasis sometimes prove more difficult to perform and are often unsafe. The authors also experimented with the use of electrothermal cautery in thyroid surgery, evaluating its efficacy in achieving haemostasis, as well as in reducing a number of complications such as hypoparathyroidism and recurrent palsy, which can be obtained utilizing the ability of the procedure to produce haemostasis without heat dispersion in the adjacent tissues. Analysing their experience with 67 cases of total thyroidectomy performed with the help of bipolar electrothermal cautery, the authors report a 4.5% incidence of transient hypoparathyroidism and a 1.5% incidence of transient monolateral recurrent lesions. These incidences proved significantly inferior to those reported by the same authors in a recent analysis of 579 total thyroidectomies carried out since 1994. The results, however, were similar to those reported in literature. The authors conclude by confirming the importance of the LigaSure system for haemostasis in thyroid surgery, stressing the fact that the routine use of this method may be limited due to the high cost of the equipment.