Training resident anesthesiologists in adult challenging intubation comparing Truview EVO2 and Macintosh laryngoscope: a preliminary study.

AIM: Teaching airway management continues to be of high importance to the anesthesiologist, since the care of each individual patient depends on the expertise, training and knowledge of the anesthetist with different airway devices, techniques and algorithms. The aim of our study was to compare intubation performed by resident anesthesiologists in training, under senior supervision, using Truview EVO2 (Group 1) or Macintosh blade (Group 2) in a group of adult patients undergoing elective surgery. METHODS: This was a pilot prospective study. Thirty patients who were scheduled for surgery under general anesthesia were randomized into two groups. In Group 1, intubation was performed by using the Truview EVO2, and in Group 2 intubation was performed by using the Macintosh blade. Mallampati score, thyromental distance and neck mobility were recorded for each patient. The exclusion criteria included a Mallampati score =or<2 and a Patil distance >6 cm. The time of intubation and any occurrence of complications were recorded. RESULTS: Intubation was always successful on the first attempt in Group 1, while it failed for 46.7% of patients in Group 2 (P=0.006). The time of intubation was not different between the two groups. No complications were recorded for Group 1 (Truview), while seven were reported in Group 2 (Macintosh) (P=0.003). CONCLUSIONS: The resident managed to intubate all patients on the first attempt with the Truview, which led to a lower incidence of complications. Despite the exiguity of the population in the study, Truview EVO2 and other videolaryngoscopes can be considered to be useful tools in training resident anesthesiologists in elective intubation.

Intraoperative radiofrequency ablation: intraductal cooling of the main bile ducts for the prevention of heat damage. A case report.

Intraoperative radiofrequency (RF) ablation has recently become a valid procedure in the treatment of liver primary or secondary malignancies in selected cases. This procedure can be used alone or in association with surgery in treating lesions not considered for curative surgery. Heat damage of the main bile ducts represents nowadays a limitation in the use of radiofrequency ablation of hepatic lesions. Up to now, in tumors proximal to a main bile duct or to the biliary bifurcation this procedure has been contraindicated. In order to preserve these structures from heat damage, a new technique consisting of intraductal cooling of the bile ducts has recently been introduced. We report a case of successful experience with this technique.

Performance evaluation of tests used for tuberculin screening in adults: randomised comparison between Tine and Mono.

Between February 1993 and December 1994, 875 adults underwent tuberculin screening by the Public Health Service of Parma. The adults were randomly assigned to a multipuncture test, Tine or Mono, and contemporarily, as a reference test, received the intradermal Mantoux (IM) in the opposite arm. The tests were then read 72 hours later by two different trained nurses. The error quota due to IM was estimated by repeating both the tests done initially in patients with discordant results. The Mono test revealed a sensitivity of 95%, which was the same as that observed for the Mantoux test. As an 'operative index' of the screening, the number of false positives subsequently tested for every 10 correctly identified was used. The authors retain that the results obtained indicate the validity of the Mono test for screening in the adult population with a prevalence of tuberculous infection above 10%.

[Combined outpatient surgical-cryotherapeutic treatment of anal fissures. Our experience]. / Il trattamento combinato chirurgico-crioterapico ambulatoriale della ragade anale. Nostra esperienza.

The authors describe their technique and their experience of ambulatory surgical-cryotherapeutic combined, treatment of anal fissure. The data were observed in 35 patients (medium age 37.5); in 16 cases, previous treatments gave no benefit. The surgical treatment was the lateral internal close sphincterotomy according to Notaras, with local anesthesia (personal technique), followed by a fissure curettage with a N protosside cryosound. The results confirm the well known effectiveness of lateral internal sphincterotomy and the validity of ambulatory treatment and of cryotherapy.

[Surgical treatment of extrahepatic biliary lithiasis and Kehr's tube. Indications]. / Terapia chirurgica della litiasi biliare extraepatica e tubo di Kehr. Indicazioni.

The paper outlines the indications for the use of Kehr's tube in the surgical management of extra-hepatic biliary lithiasis by reporting the authors' personal experience relating to the period 1988-1992. In line with data reported in the literature the paper emphasizes the value of Kehr's tube not only in those cases where it is necessary to prevent choledochotomy and radiological control, but above all were the postoperative possibility of removing any residual calculi using litholytic, endoscopic or lithotripsic methods, is of prime importance.

[Video laparoscopic cholecystectomy. An analysis of our initial experience]. / La colecistectomia videolaparoscopica. Analisi della nostra esperienza iniziale.

The paper analyses the authors' initial experience of video laparoscopic cholecystectomy, outing the difficulties and incidence of morbidity in the preliminary group of 38 patients. The details of complications and their pathogenesis are also reported.

[Inguinal hernia repair with marlex mesh in a preperitoneal site using the classical inguinal access]. / La riparazione delle ernie inguinali con rete di marlex in sede preperitoneale mediante accesso inguinale classico.

Following a brief review of the main method of prosthetic repair used for inguinal hernia: Lichtenstein, Stoppa, Rives, etc, the authors propose an original technique consisting in the placement of a marlex patch below the trasversalis fascia, in a pre-peritoneal site, using a classical inguinal access route. The prosthesis is fitted round the spermatic funicle and fixed with a single stitch to the pubis and with a few others, in resorbable material, to the posterior face of the trasversalis fascia. Above it, plastic surgery is performed to bring the triple stratum closer to the reflexio of the inguinal ligament. The prosthesis is kept in place by positive abdominal pressure. The method outlined here has been used in 71 cases of primary or recurrent inguinal hernia. Follow-up lasted for 1-24 months and showed the low morbidity (4.5%) due to sepsis of the surgical wound, which did not require reoperation, and only 1 case of recurrent hernia which was probably caused by the incorrect positioning of the prosthesis.

[Non-palpable lesions of the breast. Analysis of 111 cases]. / Lesioni non palpabili della mammella. Analisi di 111 casi.

The authors report a series of 111 cases of non-palpable breast tumours. Radiological examinations showed the following mammographic patterns: microcalcification (63%); irregular opacity and/or denseness (26%); opacity and low density microcalcifications (12%), to which 3 progressive risk rates were assigned (high, medium, low). Histological controls of the tumours showed a positive predictive value of 73% for mammographic patterns defined as "high-risk". Localisation using a metal probe proved to be a simple and efficacious method which was well tolerated by patients.

[Two cases of adrenal myelolipoma]. / A proposito di due casi di mielolipoma del surrene.

The paper reports two rare cases of adrenal myelolipoma which were referred to the authors' attention. This is a functionally inactive benign tumour made up of fatty tissue and foci of hemopoietic cells. It is often diagnosed due to the compression disorders caused to adjacent structures, whereas at other times it is identified by chance during the course of diagnostic tests carried out for other pathologies.