Laparoscopic versus open incisional hernia repair: a retrospective cohort study with costs analysis on 269 patients.

PURPOSE: To compare clinical outcomes and institutional costs of elective laparoscopic and open incisional hernia mesh repairs and to identify independent predictors of prolonged operative time and hospital length of stay (LOS). METHODS: Retrospective observational cohort study on 269 consecutive patients who underwent elective incisional hernia mesh repair, laparoscopic group (N = 94) and open group (N = 175), between May 2004 and July 2014. RESULTS: Operative time was shorter in the laparoscopic versus open group (p < 0.0001). Perioperative morbidity and mortality were similar in the two groups. Patients in the laparoscopic group were discharged a median of 2 days earlier (p < 0.0001). At a median follow-up over 50 months, no difference in hernia recurrence was detected between the groups. In laparoscopic group total institutional costs were lower (p = 0.02). At Cox regression analysis adjusted for potential confounders, large wall defect (W3) and higher operative risk (ASA score 3-4) were associated with prolonged operative time, while midline hernia site was associated with increased hospital LOS. Open surgical approach was associated with prolongation of both operative time and LOS. CONCLUSIONS: Laparoscopic approach may be considered safely to all patients for incisional hernia repair, regardless of patients' characteristics (age, gender, BMI, ASA score, comorbidities) and size of the wall defect (W2-3), with the advantage of shorter operating time and hospital LOS that yields reduced total institutional costs. Patients with higher ASA score and large hernia defects are at risk of prolonged operative time, while an open approach is associated with longer duration of surgical operation and hospital LOS.

A rare case of a double phytobezoar causing gastric and jejunum obstruction in an adult man: a case report.

BACKGROUND: Bezoars are an uncommon cause of mechanical intestinal occlusion. There are four different kinds of bezoars: phytobezoars, made of vegetables and fibers; trichobezoars, resulting from the ingestion of hair and frequently an expression of psychiatric disorders; lactobezoars, which are formed of milk curd; and pharmacobezoars, caused by drugs and medications. Symptoms are classically indistinguishable from one another and from more common causes of intestinal occlusion, so it can be difficult to establish a correct diagnosis in order to apply the correct treatment. We present a rare case of two different phytobezoars causing intestinal occlusion (gastric and jejunal). We also describe the correct techniques for making a correct and fast diagnosis of occlusion caused by phytobezoars, and the possible conservative and operative treatments. CASE PRESENTATION: We present the case of a double phytobezoar that was surgically treated with a double enterotomy. Our patient was a 68-year-old Caucasian man with a medical history of hypertension, a previous open appendectomy, and open repair of a perforated gastric ulcer. He was admitted with a 5-day history of abdominal pain located in his upper quadrants along with vomiting. After a preoperative examination, he was taken to the operating room. He was discharged in a good clinical condition 11 days after surgical intervention. A physical examination at 6 months demonstrated our patient was in good health. CONCLUSIONS: Diagnosing bezoars is difficult because of their rarity. However, they must be taken into consideration in a differential diagnosis because their treatment is not always surgical. In fact, it may be conservative in many cases and a correct diagnosis will guide towards the correct therapy.

Prophylactic Appendectomy during Laparoscopic Surgery for Other Conditions.

Acute appendicitis remains the most common surgical emergency. Laparoscopy has gained increasing favor as a method of both investigating right iliac fossa pain and treating the finding of appendicitis. A question arises: what to do with an apparent healthy appendix discovered during laparoscopic surgery for other pathology. We present a case of unilateral hydroureteronephrosis complicated with rupture of the renal pelvis, due to gangrenous appendicitis with abscess of the right iliopsoas muscle and periappendicular inflammation in a 67-year-old woman, who underwent laparoscopic right annessiectomy for right ovarian cyst few years earlier, in which a healthy appendix was left inside. There is a lack of consensus in the literature about what to do with a normal appendix. The main argument for removing an apparently normal appendix is that endoluminal appendicitis may not be recognized during surgery, leading to concern that an abnormal appendix is left in place. Because of a lack of evidence from randomized trials, it remains unclear whether the benefits of routine elective coincidental appendectomy outweigh the costs and risks of morbidity associated with this prophylactic procedure. Nevertheless, it appears, from limited data, that women aged 35 years and under benefit most from elective coincidental appendectomy.

Hiperplasia adenomatoide de glândulas salivares menores: relato de dois casos / Adenomatoid hyperplasia of minor salivary glands: a report of two cases

A hiperplasia adenomatoide de glândulas salivares menores é uma lesão benigna rara que pode ser confundida com outras neoplasias de glândulas salivares. Apresenta-se como um pequeno nódulo firme ou como massa exofítica, geralmente indolor, com mucosa de aparência normal, levemente avermelhada ou azul. Histologicamente, observa-se a presença de agregados acinares relativamente normais e lóbulos da mucosa em maiores quantidades, causando aumento do volume e, por vezes, dor. Relato do caso: São relatatos dois casos de hiperplasia adenomatoide de glândula salivar menor, sendo um em menino de 12 anos de idade, em mucosa bucal esquerda, e o outro em mulher de 44 anos de idade em mucosa labial; uma revisão dos relatos anteriores já descritos na literatura também é apresentada. O aparecimento clínico do tumor é indistinguível em comparação com neoplasia da glândula salivar; assim, o exame patológico é essencial para o diagnóstico definitivo desta patologia. Nos dois casos descritos, o tratamento escolhido foi o acompanhamento clínico após diagnóstico; não foram observadas alterações no período de 2 anos desde a primeira consulta...

Adenomatoid hyperplasia of minor salivary glands is a rare benign lesion that can be mistakenly diagnosed as other types of salivary gland neoplasms. It presents as a small firm nodule or as an exophytic mass, usually painless with normal mucosa, and slightly red or blue. Histologically, aggregates of relatively normal acinar lobule mucosa can be seen in larger amounts than expected, causing increased volume and sometimes pain. Case report: This article describes two cases of adenomatoid hyperplasia of minor salivary glands, the first in the left buccal mucosa of a 12 year-old boy and the second in the labial mucosa of a 44 year-old woman, and a review of previous reports of this pathology in English literature. The clinical appearance of the tumor is indistinguishable from salivary gland neoplasms and pathological examination is therefore essential for definitive diagnosis of this pathology. In both cases the treatment chosen after diagnosis was follow up and no changes were observed over 2 years from the first appointment...

[Phenotypic relations with regard to pyocin sensitivity, of 191 strains of Pseudomonas aeruginosa isolated in a hospital environment]. / Relazioni fenetiche in rapporto alla sensibilità piocinica, tra 191 ceppi di Pseudomonas aeruginosa isolati in ambiente ospedaliero.

191 strains of Pseudomonas aeruginosa, isolated from clinical specimens, were tested by passive and active pyocin typing. The results of passive typing were computerized and a final dendrogram, with its peculiar similarity levels between the single strains, was obtains. This study will permit to build a system, to mark out the Pseudomonas strains, through active pyocin typing or through passive pyocin typing.

[Precursors of atherosclerosis in childhood: Pordenone study. Transverse and longitudinal study of arterial blood pressure (BP) in a group of boys and adolescents (author's transl)]. / Precursori dell'arteriosclerosi nell'infanzia: studio di Pordenone. Primi risultati concernenti il comportamento "trasversale" e "longitudinale" della pressione arteriosa in un gruppo di bambini ed adolescenti.

Mean systolic BP values gradually and significantly increase from the infancy to the adolescence. On the contrary, diastolic BP does not change significantly. No sex differences were found for mean values of both systolic and diastolic BP. The results of the longitudinal study (two years follow-up) have shown, for the two sexes, a significant increase in the systolic BP values, which parallels the ponderal growth. In particular, the greatest increment of the values was observed in the triennium 12-14 year, that is around the puberty.

[Study of the precursors of atherosclerosis in childhood: the Pordenone study. Longitudinal behaviour of total cholesterol and serum triglycerides in school children (author's transl)]. / Precursori dell'arteriosclerosi nell'infanzia: studio di Pordenone. Comportamento "longitudinale" ["two years follow-up"] del colesterolo totale e dei trigliceridi del siero in una casistica scolare di bambini ed adolescenti.

In a total number of approximately 500 school-children, belonging to a suburban area around Pordenone (Northern Italy), aged 6-9-12-15, we have performed a two years follow-up on serum TC and TG. As for serum TC, a progressive decrease of mean TC levels at the two rescreenings was observed. We cannot explain such trend, unless we admit that some dietary modification has been introduced in the families, although no dietary advices were given. However the observed decrease of the TC levels, makes clear that a single serum TC determination is not sufficient in order to define the lipid profile of a given subject. Unlike TC, serum TG tend to increase with the age. The "longitudinal" behavior of TC and TG is similar for both males and females.