The outcome of conservative treatment of fifth metatarsal diaphyseal fractures.

INTRODUCTION: The fifth metatarsal diaphyseal fracture is a common fracture. However, clear consensus about the treatment is lacking. Unlike the avulsion fracture or Jones' fracture, literature available on the treatment and long-term outcome of the diaphyseal fracture is scarce.The purpose of this study is to demonstrate a substantial number of conservatively treated patients with persistent pain and to evaluate metatarsal shortening and displacement within this group. METHODS: In this retrospective study, 106 patients who had experienced a fifth metatarsal diaphyseal fracture were included and evaluated. The minimum follow-up period was three months. FAAM, AOFAS and NRS scores were used as outcome measurements for function and pain. Length and displacement were analysed on plain X-rays. RESULTS: At least 11% of the patients who received conservative treatment for their fifth metatarsal diaphyseal fracture had persistent pain at least 3 months after initiation of conservative treatment. No relationship has been found between the length of the fifth metatarsal and the FAAM (r( Petrisor et al., 2006) 2 = 0,051), AOFAS (r( Petrisor et al., 2006) 2 = 0,009) and NRS (r( Petrisor et al., 2006) 2 = 0,001). Furthermore, there was no association between patients with a shorter fifth metatarsal and FAAM, AOFAS, NRS, displacement and BMI. DISCUSSION AND CONCLUSION: The finding of persistent pain in at least 11% of all patients at long-term follow-up confirms our hypothesis on long-term symptoms. However, the results suggest that these persistent symptoms are not related to metatarsal shortening or displacement.

Intraperitoneal mitoxantrone: a feasibility and pharmacokinetic study.

Fractionated doses have been advocated to prevent chemoperitonitis after intraperitoneal infusion of mitoxantrone. Patients with peritoneal carcinomatosis of various origin underwent surgery, including intestinal resections, with minimal residual disease. Peritoneal mitoxantrone in 1000 ml/m(2) saline was planned on the first post-operative day in groups of four patients (5 mg/m(2) for 3 and 5 days, 7.5 mg/m(2) for 3 and 4 days, 10 mg/m(2) for 2-4 days, if possible). Due to dose-limiting myelosuppression, only one and three patients received the 7.5-mg 4-day and 10-mg 3-day regimens, respectively. A total of 20 patients were consequently treated. Neither major complications nor severe pain were observed. Pharmacokinetics were completed on the 1st day in five 5-mg and five 10-mg patients, on the 5th day in three 5-mg patients, and on the 3rd day in one 10-mg patient. On the 1st day, mean peritoneal peak concentrations of mitoxantrone resulted 1.45 +/-0.56 (range 0.48-1.9) and 1.9+/-0.85 (range 1.27-3.13) microg/ml in the 5-mg and 10-mg patients, respectively. Mean dialysate/plasma exposure (AUC) ratio was 115. Even in patients with sutures, early post-operative fractionated intraperitoneal mitoxantrone appears feasible and safe, with a high local advantage, for up to 5 days of treatment and a maximum tolerated total dose of 20-25 mg/m(2).

[6 years of experience in inguinal and femoral hernioplasty in patients over 65 years of age]. / Sei anni di esperienza di ernioplastica inguinale e femorale nei soggetti con oltre 65 anni di età.

From April 1990 to November 1996, 313 inguinal and 14 femoral hernias were repaired in 295 subjects with a mean age of 74 years (66 to 97). Concomitant diseases increasing the operative risk were present in 206 subjects (70 per cent). A mesh repair was performed with "tension-free" or "plug" techniques in all but 23 inguinal and 2 femoral herniorrhaphies where the Bassini or the Shouldice procedures were adopted. Fifty-two inguinal hernias were recurrent, 11 emergency herniorrhaphies were performed for strangulation. Almost all operations (305), including 9 emergency herniorrhaphies, were carried out under local anaesthesia. There was no perioperative mortality. Acute intestinal bleeding occurred after surgery in a subject with colon diverticulosis. One urinary retention following emergency hernia repair under general anaesthesia and 2 following elective hernia repair under local anaesthesia in 2 subjects with hypertrophy of the prostate were observed. Some episodes of hypotension and/or bradycardia were observed either during or after surgery. Local complications following inguinal hernioplasty were 5 (1.5%) scrotal hematomas, 3 (0.9%) wound infections and 1 case (0.4%) of orchitis with atrophy after repair of a recurrent hernia. There were 1 recurrence after Bassini, 1 after Shouldice, and 1 (0.4%) after mesh inguinal hernioplasty. Using local anaesthesia and a mesh repair elective surgery of inguinal and femoral hernias can be safely and effectively performed in elderly patients. Consequently, early elective surgery should be recommended to avoid the risk of an emergency operation.

[Pregnancy after surgical therapy of obesity. Bibliographic review and our experience with biliopancreatic diversion]. / Gravidanza dopo terapia chirurgica dell'obesità. Revisione bibliografica e nostra esperienza con la diversione biliopancreatica.

BACKGROUND: An increasing number of women in childbearing age are submitted to surgical treatment of obesity; for this reason pregnancy represents a frequent event in operated patients. METHODS: In this study pregnancy in patients with morbid obesity submitted to jejunoileal bypass (JIB) and gastric bypass (GB) are reviewed from the literature and the analysis of our experience with biliopancreatic diversion (BPD) is reported. RESULTS: In 113 pregnancies after JIB reviewed from the literature, the results seem to be debated either about the course of pregnancy or about maternal and neonatal status. The data of literature concerning the pregnancies following GB are less debated but rather slight. One hundred and fifty-two pregnancies after BPD have a complete documentation concerning maternal conditions, modality of outcome and neonatal situation. CONCLUSIONS: Pregnancy occurred in the obese women represents an increased maternal-fetal risk. The excess weight loss, the weight maintenance and the reduced weight changes during pregnancy are an advantage in the operate women who, in any case, need accurate controls of the nutritional status during the whole gestational period. Keeping these cautions pregnancy following surgical treatment of obesity represents an event not only possible but even with less problems than in pregnancy in obese women.

Our experience in pancreatic trauma.

The authors, with this works, call fellow members attention, how is complicate the diagnosis and the following surgical treatment of the associated lesions caused by pancreatic trauma. The pancreatic traumas are today object of discussion for the surgical treatment, and for the lesions associated. In this work is described the experience of some years accumulated in the Emergency Department of the Liguria Region.

[Value of the use of tissue adhesive (Braun Histoacryl) and its importance as a safety measure in difficult anastomoses]. / La validità nell'uso dell'adesive tissue (Histoacryl Braun) e sua importanza come elemento di sicurezza nelle anastomosi difficili.

In an experimental and then clinical investigation, the intention has been to demonstrate that tissue adhesive (Histoacryl Braun) is a useful safety factor in a wide variety of difficult intestinal sutures, in both emergency surgery and in that of choice. Experiments were carried out on about a hundred rabbits which received colic anastomosis, after clean, complete section, anastomosis of the viscera, with four cardinal sutures in 000 silk and the remaining suture of a diameter of about 3 cm with adhesive. This stage having been surmounted with excellent results, work continued with the experiment in emergency surgery and surgery of choice, on the basis of the criterion of greater safety as a complement of the traditional high dehiscence risk suture technique. The clinical results obtained thus far have been encouraging enough to suggest its experiments.

[Experimental study of the use of tissue adhesives in colonic surgery]. / Studio sperimentale sull'impiego degli adesivi tissutali nella chirurgia colica.

The authors report the own experience about the experimental use of tissue adhesive in the colonic surgery, on 14 rabbits, with quite satisfactory result. Therefore they evince that this tissue adhesive, althought it can't replace the surgical suture, yet it can help the surgeon out of a hard colonic anastomosis.