[Bilio-intestinal bypass in the treatment of metabolic syndrome in obese patient]. / Il by-pass bilio-intestinale nel trattamento della sindrome metabolica nel paziente obeso.

INTRODUCTION: obesity (O) is a chronic patologic condition, evolutive and relapsing, with multifactorial etiopathogenesis, consisting in an alteration of the body's composition characterized by a relative and absolute excess of fat, that gets worse the life quality and causes complications that can lead to death. PATIENTS AND METHODS: experience concerns twenty-five diabetic obese patients underwent bilio-intestinal by-pass between January 2006-December 2007. All these patients, before the surgical operation, underwent a rigorous clinical and laboratory examination. Besides, a precise rate control of laboratory, overlap with those performed in the pre-operative period of operation, was required for each patient: the first after one month, the second after six months and the third after twelve months. RESULTS: the average weight loss was about 40 kg and, more important, these data show that the BMI is reduced, until to become stable, after 12 months from surgical operation, about values 34-31 Kg/m², obtaining, in this way, an improvement of values in the development metabolic syndrome and, above all, heart rate and ventricular repolarization. CONCLUSIONS: the data obtained by our study support the hypothesis to suggest the operations of bariatric malassorbing surgery, in particular bilio-intestinal by-pass, as prophylactic methods for dismetabolics diseases, with reduction of cardiovascular risk in obese patient.

[Non recurrent inferior laryngeal nerve: our surgical experience]. / Il Nervo Laringeo Inferiore Non Ricorrente. Nostra esperienza chirurgica.

AIM: Iatrogenic damage to the recurrent laringeal nerve is the most feared complication in thyroid surgery and the main cause for vocal cord palsy. Prevention of such a lesion is based upon the thorough search for the nerve along its anatomic pathway. In the present study the Authors discuss an important anatomic variation: non-recurrent inferior laryngeal nerve, emphasizing the aspects of surgical anatomy, on the basis of their own experience in neck surgery. MATERIALS AND METHODS: The study takes into conideration 301 surgical interventions on the thyroid gland, in 268 women and 33 men; consisting in 256 total thyroidectomies and 45 loboisthmectomies, as follows: 186 for nodular goiter, 48 for follicular nodule, 34 for papillifer carcinoma, 33 for toxic goiter. The identification and exposure of inferior laryngeal nerve was performed according to the principles and technique by Lahey. RESULTS: The overall prevalence of non recurrent inferior laryngeal nerve was equal to 0.33% (1/301 operations). The anomaly is prevailing on the right side, being due by an anomalous reabsorption of the IV ventral arch. This is the cause of the formation of a subclavian artery that is responsible for dysphagia lusoria. CONCLUSIONS: The rationale for the preservation of recurrent nerve is its systematic identification and exposure along all its course from its laryngeal entry. Diagnosis of non recurrent inferior laryngeal nerve is exclusively intra-operative. The anomaly is clinically asymptomatic and its suspicion can be posed in case of vascular anomalies or dysphagia. In such a circumstance the golden diagnostic tool is the angio Tc-RMN, while both the EGDS and baritate esophagous can be of some diagnostic help.

New trends on fibrin glue in seroma after axillary lymphadenectomy for breast cancer.

BACKGROUND: Axillary lymphadenectomy remains an integral part of breast cancer treatment, yet seroma formation occurs in 15-85% of cases. Among methods to reduce seroma magnitude and duration, fibrin glue has been proposed in several studies with controversial results. PATIENTS AND METHODS: Ninety patients underwent quadrantectomy or mastectomy with level I/II axillary lymphadenectomy; a suction drain was fitted in all patients. Fibrin glue spray were applied to the axillary fossa in 45 patients; the other 45 patients were treated conventionally. RESULTS: Suction drainage was removed between post-operative (p.o.) days 3 and 4. Seroma magnitude and duration were significantly reduced (p 0.004 and 0.02, respectively), and there were fewer evacuative punctures, in patients receiving fibrin glue compared with the conventional treatment group. CONCLUSIONS: Use of fibrin glue does not always prevent seroma formation, but does reduce seroma magnitude, duration and evacuative punctures.

Ductal carcinoma in situ of the breast: our experience.

AIM: The ductal carcinoma in situ (DCIS) is a more and more frequent neoplasia, representing over 25% of diagnosed breast cancer in recent surveys.It is particularly interesting as concerns several aspects of which the most important are issues linked to clinical diagnosis and the difficulties of histopathological classification, with evident and important therapeutic implications. PATIENTS AND METHODS: The authors report their experience about 161 ductal carcinoma in situ of the breast. Guidelines for surgical treatment are: radiological or clinical diagnosis, tumor's extension, histological classification, grading and margin status. At the present the authors prefer breast conserving surgery with tumor margin's study. They report their experience in the last seven years about sentinel lymph node biopsy. RESULTS: The most frequent histotype resulted comedocarcinoma (61,8%) followed by non comedo (38,2%). Local recurrence after DCIS therapy is 6,1%. CONCLUSIONS: 80-90% of the patients currently treated for DCIS present non-palpable breast lesions at diagnosis. Breast conserving surgery is the first choice and radiotherapy and endocrine therapy are indicated for selected patients.

[Conservative anal fistula treatment with collagenic plug and human fibrin sealant. Preliminary results]. / Trattamento conservativo delle fistole perianali con plug in matrice extracellulare biologica e colla di fibrina umana: esperienza preliminare.

The authors, on the basis of a long clinical experience with human fibrin glue in general surgery, compared two different extracellular matrix (collagen), Surgisis and TissueDura, with human fibrin glue, applied during the operation, and sometimes in postoperative, to obtain the healing of perianal fistulas. The collagenic extracellular matrix provides, according to the rationale suggested, an optimal three-dimensional structure for the fibroblastic implant and neoangiogenesis, hence for the fistula "fibrotizzation" and closure. The encouraging results for transphincteric fistulas and a simple and easy technique push to researchers on samples statistically significant.

Plurifocal breast cancer and double lymphatic spread.

BACKGROUND: Sentinel node (SN) has been proved to be a reliable technique in predicting the lymph nodes state of the axilla in breast cancer. For the majority of the authors the intradermal and peritumoral injection is the best way. PATIENTS AND METHODS: Our experience, from 1997, includes 587 cases of SN in women with resectable breast cancer less than 3 cm of diameter. We performed the lymphoscintigraphy after a peritumoral injection of radioactive tracer and, if the lesion was superficial, we associated an intradermal injection on the skin above the lesion itself. Two patients had multifocal right breast cancer. We did two separate injections around each tumor. RESULTS: The radioactive tracer spread towards the internal mammary chain and homolateral axillary nodes. CONCLUSIONS: We consider the peritumoral injection as essential in tumors located deeply in the breast (under ultrasound guide if not palpable) together with intradermal injection in superficial ones. Using this technique the possibility of a mis-identification of the SN is reduced.

Fibrin glue to reduce seroma after axillary lymphadenectomy for breast cancer.

UNLABELLED: Axillary lymphadenectomy remains an integral part of breast cancer treatment, yet seroma formation occurs in 15-85% of cases. Among the methods employed to reduce seroma magnitude and duration, fibrin glue has been proposed in numerous studies with controversial RESULTS: Sixty patients underwent quadrantectomy or mastectomy with level I/II axillary lymphadenectomy; a suction drain was fitted in all patients. Fibrin glue spray was applied to the axillary fossa in 30 patients; the other 30 patients were treated conventionally. Suction drainage was removed between postoperative days III and IV. Seroma magnitude and duration were significantly reduced (P=0.004 and 0.02, respectively), and there were fewer evacuative punctures, in patients receiving fibrin glue compared with the conventional treatment group. The authors conclude that the use of fibrin glue does not always prevent seroma formation, but does reduce seroma magnitude, duration and necessary evacuative punctures.

Case report: laparoscopic cholecystectomy in situs viscerum inversus.

Situs viscerum inversus is a rare condition, in which the organs are transposed from their normal location in the opposite side of the body. The inversion of L-R asymmetry may be complete (SVI totalis) or partial (SVI partialis), whereby transposition is confined to either the abdominal or thoracic viscera. The authors report a case of videolaparocholecystectomy for cholelithiasis successfully performed on a 41-year-old Caucasian woman with situs viscerum inversus totalis. The patient was discharged on the 2nd postoperative day. The symptomatology disappeared right after the intervention, and still now, after a follow-up of six months, is absent. The procedure was safely performed on the patient with no particular difficulties, except for the reverse position of the angle between the operating and exposing trocars, which led to a difficult approach to the Calot triangle when using the right hand of the surgeon.

[Meckel's diverticulum. Our experience]. / Il diverticolo di Meckel. Nostra esperienza.

BACKGROUND: The paper aimed to highlight the percentage presence of Meckel's diverticulum compared to appendiceal pathology in a retrospective study and whether its surgical removal is always useful, even if asymptomatic. METHODS: The study was performed at the Institute of Emergency Surgery at the Second University of Naples (Head: Prof. R. Docimo) in 1211 patients affected by appendiceal-like pathology, reported to the authors' attention for both elective and emergency surgery from 1973 to today. The presence of Meckel's diverticulum was rarely diagnosed in preoperative patients; it was occasionally found in both elective surgery in patients with other abdominal pathologies, above all appendicitis, and in patients undergoing emergency surgery for acute pathologies (occlusion, peritonitis) caused by the former. The diverticulum was always totally removed (diverticulectomy or intestinal resection) even when it was asymptomatic. RESULTS: The results were satisfactory in all patients and at the one-year follow-up none complained of discomfort. CONCLUSIONS: We are convinced that Meckel's diverticulum should be investigated as a matter of course during appendectomy and, where present, it should be removed even if asymptomatic because the problems arising secondary to complications are undoubtedly more severe compared to any discomfort following its surgical removal.

[Evolution of the surgical treatment of rectal cancer. Our experience]. / L'evoluzione nel trattamento chirurgico del cancro del retto. Nostra esperienza.

In this study we have reviewed our data from 1973 to 1998 and we have compared three intervals. In each of these periods we have performed the same type of surgery which enables the comparison of adopted techniques with obtained results. During the first period (1973-1980) we have treated 65 cases of rectum cancer staging between B2 and D, which were mainly localised in the medium rectum (41.2%). During the second period (1981-1990) we have treated 44 cases with a majority of patients staging B2. The localisation was again mainly in the medium rectum (38.5%). During the third period (1981-1998) we have treated 37 cases of rectum cancer staging between A2 and B1. Again the most frequent site was the medium rectum (48.9%). Consequently, we compared the staging, the type of surgery and the complications for the three periods. Our results show that the survival time was 5 years, in 70% of the cases where an anterior resection was performed, but this percentage decreased substantially if we also considered patients presenting with an advanced staging (C2-D), in which the only type of surgery that could be performed was colostomy or the simple explorative laparotomy.