[The general surgeon's experience in emergency gynaecological laparoscopy]. / L'esperienza videolaparoscopica del chirurgo generale di fronte alle urgenze rivelatesi ginecologiche.

BACKGROUND: Early laparoscopy plays a very important role in the diagnosis and treatment of uncertain surgical diseases. Its use is not very clear, in part because it is a very new technique and secondly because its application in emergency surgery is very recent. The aim of this study is to evaluate the efficacy of this surgical approach. METHODS: In the last six years, during emergency laparoscopy, we diagnosed various gynaecological diseases. We performed 4 ovarian cystectomies (25%), 2 salpingectomies (12.5%), 6 salpingo-oophorectomies (37.5%), 2 myomectomies (18.75%), 1 endocoagulation (6.25%). RESULTS: Neither conversion in open surgery, nor major postoperatory complications were noted. Intervention time was shorter than that of the open technique. Return to normal activity was earlier. CONCLUSIONS: The results of this study contribute to demonstrate that, in emergency surgery, laparoscopy constitute a valid and efficient diagnostic and therapeutic technique. It is indicated for the treatment of acute abdomen of unknown origin.

[Response of interleukin-6 in patients undergoing a laparoscopic or laparotomic cholecystectomy]. / Risposta della interleukina-6 in pazienti sottoposti a colecistectomia laparoscopica o laparotomica.

BACKGROUND: It is well known that surgery induces an acute inflammatory response associated with significant increase of interleukin-6 (IL-6) and C reactive protein (CRP). Laparoscopic cholecystectomy (LC) is a so called "mini-invasive" surgical intervention and on the basis of this consideration it has been investigated if and how serological markers of inflammation are modified in patients after laparoscopic cholecystectomy compared to patients undergoing open cholecystectomy. METHODS: The acute phase of inflammation (IL-6, CRP and body temperature) was evaluated in 53 patients one day before surgery and p.o. after 1, 3 and 6 days; 26 patients underwent "open" cholecystectomy and 27 LC. RESULTS: One day after surgery patients with open cholecystectomy showed significant increase (p < 0.05) of IL-6, CRP and body temperature, while these parameters were almost unchanged in patients with LC. In patients with "open" cholecystectomy, 2 p.o. complications (pneumonia) were observed. CONCLUSIONS: In conclusion, LC, although it requires longer operative time, strongly reduces p.o. pain, hospitalization, promotes earlier recovery and return to normal activity, avoiding the acute phase of p.o. inflammation with better p.o. morbidity compared to open surgery.

[Video laparoscopic cholecystectomy in acute cholecystitis: when,how and why?]. / La videolaparocolecistectomia nella colecistite acuta. Quando, come e perché?

Acute cholecystitis has been previously considered as contraindication for laparoscopic cholecystectomy (LC), but recently, several studies have demonstrated that the laparoscopic approach can also be effective in such cases, although iatrogenic lesions of the biliary tree have been increasingly reported. Aim of this study was to verify the effectiveness of LC in patients presenting with acute cholecystitis on the basis of preoperative and intraoperative findings, postoperative mortality and morbidity, in order to assess those conditions which still can be considered as contraindications for LC. From September 1992 to January 1995, 133 patients have been consecutively admitted and operated for LC. 46 cases (36.5%) had histologically proven acute cholecystitis. Moreover we have compared preoperative date (clinical history, laboratory findings, Rx and ultrasound evaluation) with intraoperative findings to assess a correlation with intraoperative difficult conditions evaluated according to De Manzini score. Our results demonstrate that clinical data significantly correlate with intraoperative difficult situations. Hepatobiliary ultrasound also has shown good correlation between the thickness of gallbladder wall and difficult operations (73.9 sensibility-70.1 specificity). Therefore, in patients with clinically severe acute cholecystitis, and thickened gallbladder demonstrated by ultrasound it is very likely that the surgeon will experience difficult in intraoperative situations. In these conditions laparoscopy may be considered mainly as a diagnostic procedure in order to evaluate the entity of inflammatory changes considering the possibility of an open conversion that must be done before any iatrogenic lesion occur. This policy has allowed us to avoid in our series postoperative complications such as lesions of the biliary tree. In conclusion we believe that LC for acute cholecystitis should be considered as a therapeutical option only for selected cases.

[Digestive endometriosis: an isolated case localized in the ileum and occlusive course]. / L'endometriosi digestiva: su un caso a localizzazione ileale, isolata, ad evoluzione occlusiva.

The authors starting from the description of a clinical case of intestinal endometriosis, who underwent emergency surgery for acute intestinal obstruction, take into consideration the incidence, the pathogenesis and the pathological characteristics of intestinal endometriosis. They attempt to define it while accepting that the indications for resection should be extremely limited from both gynecological and intestinal points view.

[Acute cholecystitis: video-laparoscopic or laparotomic treatment? Role of the immune system]. / Colecistite acuta: trattamento videolaparoscopico o laparotomico? Ruolo del sistema immunitario.

Recent clinical studies suggest that laparoscopic cholecystectomy (LC) causes less depression of cell-mediated immunity than open cholecystectomy. LC is a so called "mini invasive" surgical presidia, and on the basis of this consideration we have investigated if and how the immune response is modified in patients with acute cholecystitis after laparoscopic cholecystectomy compare to patients undergone open cholecystectomy. Immune-activity (neutrophils, total lymphocytes count, lymphocytes subpopulations, HLA-DR, 6-Interleukin, skin multitests) was evaluated in 28 patients 24-36 hours before surgery and p.o. after 1, 3 and 6 days: 16 patients underwent "open" cholecystectomy and 12 LC. One day after surgery patients with open cholecystectomy showed significant increase (p < or = 0.05) of plasma neutrophils and 6-Interleukin, while these parameters were almost unchanged in patients with LC. Moreover, skin tests showed ipo or anergic response in the majority (81.8%) of patients with "open" surgery compare to patients with LC (10.5%): (p < or = 0.05). Finally monocyte antigen HLA-DR was also reduced in patients with "open" cholecystectomy: in this group we also recorded 2 cases (12.5%) of respiratory tract infection. In conclusion, LC for acute cholecystitis, avoids p.o. immunosuppression with better p.o. morbidity compare to open surgery.

[Chronic abdominal pain: role of video-laparoscopic adhesiolysis]. / Il dolore addominale cronico: ruolo della adesiolisi videolaparoscopica.

Adhesions have been suggested as a possible cause of chronic abdominal pain, but the reports of their etiological role conflict. Lysis of adhesions has been proposed as the therapeutic modality of choice, although the reports of success are controversial. The aim our prospective study was to determine whether laparoscopic adhesiolysis ameliorates chronic abdominal pain in patients with abdominal adhesions. Forty-one patients with chronic abdominal pain lasting for more than 6 months, but with no abnormal findings other than adhesions found at laparoscopy, underwent laparoscopic adhesiolysis. 37 patients (90.2%) were available for follow-up after a median time interval of 18 months (range: 12-41 months). Twenty-two patients (59.4%) were free from abdominal pain and 9 (24.3%) patients reported significant amelioration of their pain. Six (16.2%) patients had no amelioration. In conclusion the laparoscopy is an effective tool for the evaluation of patients with chronic abdominal pain, and laparoscopic adhesiolysis cures of ameliorates chronic abdominal pain in more than 80% of patients.

[Reduction modality of a dietary questionnaire]. / Modalità di riduzione di un questionario alimentare.

The data relative to the average daily intake of 7 nutrients and total energy obtained through the answers to a dietary questionnaire, consisting of 152 items and administered to 200 patients (admitted for acute pathologies) has been analysed. The aim has been to elaborate a questionnaire consisting of a more limited number of items but maintaining a great part of the informative contents from the original questionnaire. For this aim, a multiple regression model with a selection procedure for independent variables, of the stepwise type, has been used, where the dependent variable is the daily average intake of the nutrient and the independent variables are the consumption of each food included in the complete questionnaire (QC). By combining the results of the model with the 7 nutrients and total energy, 3 reduced questionnaires have been produced (QR): the first two are based on the sole criteria of the inter-individual variance of the intake of the nutrient, explained by the consumption of the foods included in the QR, the third by adding the foods that offer an adequate contribution in order to explain the supply of the nutrient under examination. The application potentials of the 3 QRs have been analysed both by evaluating the inter-class correlation coefficient, deduced by an concordance/discordance matrix relative to the quintilis values of the nutrient deduced by the QC and by each QR, and by simulating their use in a case-control study; for this aim, the attenuation of the odds ratio trend and the increase of the sample dimension has been calculated following the use of a QR instead of a complete one.(ABSTRACT TRUNCATED AT 250 WORDS)

A datalogger to identify vocalizing dolphins.

A datalogger was developed to identify vocalizing dolphins within socially interacting captive groups. Every 50 ms the logger stores data on the level and frequency of detected sound. Dataloggers are temporarily attached to dolphins by suction cups for data collection sessions lasting up to 45 min. Later, computer analysis of data from the dataloggers reveals which dolphin produced each vocalization recorded during the session. Results from use of dataloggers with two captive bottlenose dolphins (Tursiops truncatus) at the New England Aquarium in Boston, MA are presented. The possible use of dataloggers with wild dolphins is discussed.

[Postoperative esophageal-visceral fistulae: their prevention and treatment]. / Fistole esofago-viscerali postoperatorie: prevenzione e trattamento.

A series of 12 cases of esophageal anastomotic leakage following esophageal surgery observed from 1969 to 1989 is retrospectively analyzed. In the period 1969-1975 6 patients were treated in emergency and the mortality rate was 66.6%, while the remaining 6 patients observed from 1975 to 1989 were treated conservatively with total parenteral nutrition (sometimes associating adequate surgical drainage): the mortality rate was 16.6%. In conclusion, not only in the treatment of anastomotic leakage, but also in its prevention, artificial nutrition has a crucial role. The outcome of thoracic and abdominal fistulas depends mainly on adequate drainage, not necessarily surgical. Cervical fistulas heal in 2-4 weeks, but strictures arise frequently and respond to endoscopic dilatation.

Diffusible sodium, potassium, magnesium, calcium and phosphorus in frog skeletal muscle.

A microvolumetric analytical method has been developed to measure the endogenous concentrations of diffusible elements in muscle cells. Single twitch fibres from frog muscle were skinned under oil and 0.2 nl drops of isosmotic sucrose solution, held in the tips of specially constructed pipettes, were placed in contact with the skinned fibres. After 0-10 min, the microdrops were removed and analysed with a wave-length dispersive X-ray spectrometer. The uptake of Na, K, Mg, and P into the microdrops was well fitted by a single exponential function, while the uptake of Ca was better represented by the sum of two exponential functions. All elements analysed except Ca reached diffusional equilibrium within 5 min of placing the microdrop on the fibre, while Ca was still not equilibrated at 10 min. For freshly isolated muscle fibres, diffusible element concentrations in the microdrops at equilibrium were (in mM, mean +/- S.D.): Na, 7.6 +/- 7.2; K, 82 +/- 36; Mg, 5.8 +/- 3.0; P, 51 +/- 19. Diffusible Ca concentration (at 10 min elapsed sampling time) was 0.7 +/- 0.4 mM. Results from experiments in which microdrops were equilibrated with skinned fibres pre-soaked in an artificial (Ca-free) solution support the notion that the exogenous solutes can replace the endogenous diffusible contents of a skinned fibre by soaking the skinned fibre in a relatively large volume of the artificial solution. Total Na, K, Mg, Ca, and P content of whole muscle was measured by electron probe analysis of muscle extracts. In freshly isolated muscle, whole muscle element content was (in mmol/kg wet weight, mean +/- S.D.): Na, 21 +/- 8; K, 120 +/- 26; Mg, 9.7 +/- 2.6; Ca, 2.2 +/- 0.5; P, 76 +/- 18. Extracellular fluid volumes of freshly isolated whole muscles were estimated by compartmental analysis of Na efflux. Extracellular element concentrations were measured by electron probe analysis of frog plasma. Using the extracellular fluid volume and concentration estimates, extracellular contributions were subtracted from measurements of the element content of whole muscle to yield estimates of total intracellular element concentration (in mmol/l myoplasmic water). Based on the values for the intracellular total and diffusible element concentrations, the diffusible/total content fraction in freshly isolated muscle is estimated to be: Na, 0.38; K, 0.48; Mg, 0.42; Ca, 0.22; and P, 0.47.