[The ideal length of hospital stay in the surgical treatment of colorectal cancer]. / La lunghezza ideale del ricovero per il trattamento chirurgico del cancro colo-rettale.

In order to verify the safety of an ideal length of hospital stay (5-6 days) after open colectomy, we reviewed complications after 371 consecutive, elective colorectal resections for cancer at our institution between April 1991 and December 1998. Specifically, age of the patient, length of hospital stay and when the complication was diagnosed were registered. The median postoperative hospital stay was 9 days (range, 4-34 days). No difference in length of hospital stay was detected in patients < or = 65 years old versus > 65 years old (P = NS). All major complications (anastomotic leak, intestinal bleeding, intestinal occlusion, pneumonia, pulmonary embolism, pulmonary edema, stroke, angina pectoris, and fascial dehiscence) were diagnosed before the fifth postoperative day (P < 0.05). Among the minor complications (vomiting, packed red blood cells transfusion, diarrhea, wound infection, urinary tract infection, and pleural effusion), none requiring hospitalization was detected later then 5 days after the operation. We conclude that postoperative length of stay after colorectal resection for cancer can be reduced safely to five to six days after the operation.

[Inguinal hernia prosthetic repair through the anterior approach]. / La riparazione protesica elettiva dell'ernia inguinale per via anteriore.

BACKGROUND: Aim of this study is to compare the Lichtenstein's, Rutkow's and PHS techniques of inguinal hernia repair in terms of therapeutical efficacy and grade of acceptability, expressed in function of the complications, compliance and performance status of the patients. METHODS: The preliminary results of an ongoing prospective non-randomized study on the most frequently used techniques of inguinal hernia repair (PHS, Rutkow's, and Lichtenstein's) are reported. Sixty patients with primary inguinal hernia were divided into three homogeneous groups for age, gender, Gilbert's type of hernia, type of anesthesia, ASA class. The three groups underwent PHS, Rutkow's and Lichtenstein's inguinal hernia repairs, respectively. The end-points of the study were: operative time, intra- and postoperative pain, intra- and postoperative complications, patients compliance and performance status. RESULTS: The mean operative time were 40', 41' and 36' minutes for the PHS, Rutkow's and Lichtenstein's procedures, respectively. One of patients of the PHS group, five of the Rutkow's and none of those undergoing Lichtenstein's repair needed mild intraoperative sedation. Mild postoperative pain was recorded in 5% of the patients undergoing PHS repair and 10% undergoing Rutkow's repair. No intraoperative complications, difference in compliance and performance status were detected in the three groups. CONCLUSIONS: The conclusion is drawn that the PHS, Rutkow's and Lichtenstein's procedures for inguinal hernia repair are safe (no complications), effective and well accepted by the patients (85% of the patients expressed a very good judgement) although the Rutkow's repair seems more invasive. The appearance of a better trend, in patient's compliance and performance status when operated with the PHS technique, need to be confirmed in the future but, if it will be, this could became our first choice technique of repair for the medium and large hernia defect.

High prevalence of nodular thyroid disease in patients with Cushing's disease.

OBJECTIVES: In the recent past, we have noted a frequent occurrence of thyroid nodules in our patients with Cushing's disease. We therefore elected to evaluate thyroid structure and function in these patients and also in patients with Cushing's syndrome of primary adrenal origin. PATIENTS AND METHODS: In 33 of the 37 patients (30 women and 3 men aged 19-66 years) with endogenous hypercortisolism referred to our Institution during the last five years, measurement of T4, T3, FT4, FT3, TSH serum levels and thyroid ultrasonography were performed, at first admission in 15 cases and subsequently in the course of follow-up in 18 cases. At the time of the study, 16 of the 33 patients had active Cushing's disease while 9 were in remission after successful surgery, 6 patients had an adrenal tumour and 2 patients had previously undergone unilateral adrenalectomy for an adrenal adenoma. Thyroid function and ultrasonography were also evaluated in 55 normal subjects, 40 women and 15 men aged 20-73 years. RESULTS: In 25 patients with Cushing's disease, we found a significantly higher prevalence of thyroid nodular disease than that recorded in 55 control subjects (60.0 vs 20.0%, chi 2 = 10.779, P < 0.005) and comparable to that in patients with active disease (56.2%) and those in remission (66.6%). Multiple nodules were present in 8 Cushing's patients and in 4 normal subjects while a single nodule was detected in 7 patients and in 7 controls. A markedly lower occurrence of thyroid abnormality was found in the 8 patients with adrenal tumours (25.0%, NS vs controls). In 9/17 (52.9%) patients with ultrasonographic evidence of thyroid nodules, these were palpable. As expected, serum thyroid hormone and TSH levels were reduced in patients with active Cushing's syndrome compared to normal controls. CONCLUSIONS: We found a significantly higher prevalence of nodular thyroid disease in patients with Cushing's disease with respect to a group of controls in whom the prevalence of thyroid nodules was comparable to that reported for the general population in Europe. The possibility that glucocorticoid excess is responsible for the development of thyroid changes does not seem likely since in our small series of patients with adrenal tumours the prevalence was only slightly higher than that observed in control subjects. Other factors related to hyperactivity of the corticotrophic cell, or a growth factor stimulating both corticotroph and thyrocyte proliferation might be involved. Evaluation of a larger series of patients with adrenal tumours may help to distinguish between these possibilities.

[Indications for permanent electric electrostimulation in atrioventricular block]. / Indicazione all'elettrostimolazione elettrica permanente nei BAV.

Personal experience of pacemakers in patients suffering from (symptomatic and asymptomatic) 2nd degree AVB and 3rd degree AVB is reported.

[Postoperative hyperkinetic arrhythmias treated with amiodarone]. / Aritmie ipercinetiche insorte nel periodo postoperatorio trattate con amiodarone.

Twenty eight patients have been treated; 8 patients had atrial fibrillation (FA) and 20 supraventricular paroxysmal (SVPT) tachycardia. Both diseases followed interventions of major surgery. No patient had myocardial ischemia and/or damaged conduction system, took any heart-related drug, or showed any risk factor. The posologic plans was as follows: a) bolus i.v. (three minutes) with 2 Amiodarone vials and electrocardiographic monitoring, then b) 10-20 mg/kg/day for three days with electrocardiographic monitoring. Within 5 days, all patients attained the total recovery from SVPT; AF regressed during the bolus injection in 1 patient, on the first day in 5 patients, and on the third day in the remaining 2 patients. During the hospitalization no important side effects occurred, except for transient hypotension in three subjects. The 6 months follow up did not reveal signs of intolerance, either. Amiodarone thus showed to be useful and well tolerated in the treatment of post-surgical hyperkinetic arrhythmias in patients undergoing major surgery.

The use of nimodipine (Nimotop-Bayer) in patients with chronic ischemic cerebral vasculopathies. Twenty-eight case reports.

Nimodipine therapy (30 mg x 3/die) was commenced in twenty-eight patients affected by chronic ischemic cerebral vasculopathies and continued for the 90 days in order to evaluate drug efficacy. Clinical controls were carried out 4, 8 and 12 weeks after the start of therapy using Doppler, ultrasound and neurological tests (the letter based on the SCAG neurological scale). Hemodynamic and hematochemical parameters were also monitored and controlled.

Ambroxol for prophylaxis and treatment of bronchopulmonary complications after chest surgery.

A double-blind clinical trial has been carried out with 40 patients hospitalized for thoracic pathology requiring surgery (cancer of the lungs, hamartoma, pleural mesothelioma, bullous dystrophy or emphysema of the lung). The purpose was to determine the effectiveness of the drug in preventing and in treating postoperative bronchopulmonary complications. The results showed that the patients treated with 1g of ambroxol for three days before surgery, on the day of the operation and for five days afterwards had a more rapid turnover of intra-alveolar surface tension and better re-expansion of the pulmonary parenchyma after surgery. They also had better mucociliary clearance of the respiratory tract. These improvements are indispensable for limiting bronchopulmonary complications after chest surgery.