Intrathoracoscopic localization techniques. Review of literature.

BACKGROUND: Several techniques for localizing pulmonary nodules have been described, but the advantages and disadvantages of each method remain unclear. We reviewed ultrasound, endofinger, finger palpation and wait and watch, radioguided, vital dye, fluoroscopic, agar marking, and needle wire methods for localizing pulmonary nodules. METHODS: Original, peer-reviewed, and full-length articles in English were searched with PubMed and ISI Web of Sciences. Case reports and case series with less than 10 patients were excluded. RESULTS: All localization techniques showed good reliability, but some carry a high rate of major or minor complications and drawbacks. CONCLUSION: No ideal localization technique is available; thus, the choice still depends on surgeon's preference and local availability of both specialists and instruments.

Impact of laparoscopy and ultrasonography in gastrointestinal malignancies.

BACKGROUND/AIMS: An adequate preoperative disease staging is highly required before surgical treatment, even in gastrointestinal malignancies. Our study wants to give a contribution in order to define echolaparoscopy weight in gastrointestinal tumors and its impact in surgical therapy. METHODOLOGY: 33 patients were affected by pancreas, 22 by stomach, 16 by extrahepatic biliary tract and 18 by liver cancers; every patient was considered worthy of radical or palliative surgery according to preoperative staging (thorax-abdominal CT and percutaneous ultrasonography). Paired sample t-tests were used to analyze the results of each methodical and probability values of less than 0.05 were considered significant. RESULTS: Preoperative instrumental examinations gave correct evaluations only in 44 of 89 cases (49%) while echolaparoscopic gave correct evaluations in 82 on 89 cases (92%) (P<0.05). So after echolaparoscopic in only 7 cases we performed an explorative laparotomy. CONCLUSIONS: Laparoscopy and ultrasound impact on therapy is worthy of attention. It seems to be able to give advantages in staging gastrointestinal malignancies, except for pancreas cancers, in which some limits and negative aspects have been demonstrated, regarding the possibility of giving correct diagnosis of portal axis infiltration.

Single pulmonary nodules: localization with intrathoracoscopic ultrasound -- a prospective study.

This prospective study, based on 13 patients with single pulmonary nodules of width between 10 and 30 mm, was performed to verify the utility of intrathoracoscopic ultrasound to localize the single pulmonary nodule. In all 13 cases the ultrasound examination was able to localize the position of nodules, but the homogeneous hypoechoic pattern of nodules observed in ten of 13 cases did not prove whether the lesion was benign or malign. In conclusion, we can confirm that intrathoracoscopic ultrasound examination is a safe, risk-free and less expensive method of localizing the single pulmonary nodules.

Significance of a single pulmonary nodule in patients with previous history of malignancy.

OBJECTIVES: To determine the diagnosis, treatment and follow-up in patients with a solitary lung nodule and a previous primary extrapulmonary neoplasm. METHODS: The authors evaluated the charts of 45 patients with an extrapulmonary malignant neoplasm and a solitary pulmonary nodule. The histologic characteristics of the nodule were correlated with those of the extrapulmonary neoplasm. RESULTS: The histology of the nodule was not known preoperatively in 43 cases (93.5%); in the remaining three cases cytologic examination had shown the presence of atypical cells. The majority of pulmonary lesions (73.9%) were found during the follow-up of the previous tumour, but a significant percentage of nodules (17.4%) were found incidentally. Pre- or intraoperative localisation of the nodule was done in 19 cases (41.3%), and was successful in nine cases (47.4%). Thoracoscopy was performed in 44 patients (95.6%). The coincidence between the pathology of the previous tumour and that of the nodule was 41.3% (19/46). The coincidence rate was 100% for the tumours of ovary, prostate, and sarcomas. CONCLUSIONS: The advent of minimally invasive surgical techniques has made a definitive diagnosis likely, providing also therapy with a less painful engagement for the patient and a less cost for the community.

Primary lung epithelioid hemangio-endothelioma with multiple bilateral metachronous localizations: case report and review.

The authors report a case of primary epithelioid (EH) in a 73-year-old female.

[Cutaneous mechanical staplers. Our experience]. / Le suturatrici meccaniche cutanee. Nostra esperienza.

This paper reports the results of a trial, comparing the use of disposable skin staplers with conventional nylon or silk sutures in skin closure. This study began in 1986; 7274 patients undergoing elective and emergency operations were controlled during the postoperative period, 3 and 6 months after surgery. It was shown that skin clips instead of sutures decrease the operative time, produce wound healing with a good cosmetic results, and above all a significant lowering of the wound infection rate.

[Experimental study of postoperative lavage: standardization of the method]. / Studio sperimentale sul lavaggio postoperatorio: standardizzazione del metodo.

Postoperative infections are an outstanding problem in a surgical department. We have been studying them from a clinical and experimental point of view has a long time. In this study we present a method standardisation of postoperative peritoneal lavage as prevention of surgical infections. Winstar mice, infected with intra peritoneal E. coli cultures, underwent peritoneal lavage with saline solution or sterile water. The results showed the right amount of solution and the exact administration of lavage according to grade of infection. Encouraged by this result we are going to test the efficacy of anti microbial agents for the postoperative peritoneal lavage.

[Emergency laparoscopic surgery]. / Chirurgia laparoscopica d'urgenza.

The acute abdomen continues to be a large part of the general surgeon's workload. The continuing advances in laparoscopic surgery have already permitted many emergency procedures to be performed by this route. Since 1993 the Authors perform an explorative laparoscopy in patients with acute abdomen. Once the diagnosis is verified, the endoscopic view suggests to continue the intervention laparoscopically or to convert the procedure. 70 acute cholecystitis, 57 acute appendicitis, 15 perforated peptic ulcers, 6 gynaecological emergencies, 8 intestinal occlusions and 2 splenic traumas were treated according to this approach. The results obtained testify that laparoscopy is a valuable diagnostic tool for the surgeon in case of acute abdomen and an interesting therapeutic alternative in selected cases. However, it requires extensive experience in laparoscopic techniques.

[Treatment of spontaneous pneumothorax with video-assisted mini-invasive thoracic surgery. First long-term results]. / Trattamento del pneumotorace spontaneo con toracochirurgia miniinvasiva videoassistita. Primi risultati a distanza.

The spontaneous pneumothorax (pnx. s.) is a type of pathology with a high per cent of relapse so its aetiological treatment can't be done only with a pleural drainage. With the resection of the bubble (that is the cause of it) instead, the problem will be resolved without possibilities of relapses. In the past, this was possible only with a thoracotomy, now with the new techniques of video-thoracoscopy, the therapeutical approach to this pathology has been revolutionized. In fact, this methodology resolves definitively the pulmonary lesion, can avoid the relapses, can guarantee a short stay in hospital and a very good restarting of the working and social activity.

[Atraumatic skin closure with Fasterzip]. / La sintesi cutanea atraumatica con Fasterzip.

The Authors report their experience of skin closure using a new device, a surgical "zipper", without applying any sort of sutures. The application of this device, the functional and aesthetic advantages and the results obtained are described.

Peritoneal cystic mesothelioma treated with minimally invasive approach.

A case of peritoneal cystic mesothelioma in a young woman was treated with a minimally invasive approach. The technique and a review of the literature are presented.

[Pleural drainage vs video-assisted minimally invasive surgery in the treatment of spontaneous pneumothorax. A retrospective study]. / Drenaggio pleurico vs chirurgia mini-invasiva videoassistita nel trattamento del pneumotorace spontaneo. Studio retrospettivo.

The most frequent cause of spontaneous pneumothorax is bleb's disease of the lung. Considering that, pnx s. has a remarkable bent for relapsing, we think that it's necessary an aggressive treatment to resolve it. That's because pleural drainage is useful for a symptomatic resolution, VATS for an etiologycal one. To value the real efficacy of the treatment of VATS, we have effected a retrospective research between two classes of patients suffering from pnx s. admitted in our Institute from 1987 until 1991, one treated with pleural drainage (class A, 11 patients) and the other with VATS (class B, 13 patients). 1) Patients treated with pleural drainage were nearly double compared to class B. 2) In class A, the mean value of drainages were nearly double compared to class B. 3) Class A had a number of relapses 10 times more compared to B. 4) Considering the period of hospitalization, class A had a value nearly triple compared to B. 5) We've noticed that the mean value of the cost for episode of pnx s. in class A was more than 15% compared to class B and the cost for patient in class A was nearly double than in class B. We can affirm that, for the treatment of pnx s., the method of VATS rappresents a real success. We're passed from the "symptomatological treatment" of it to an aetiological one, joined to the prophylaxis of the relapse.

[Epidemiological analysis of nosocomial infections at the "Arcispedale St. Anna" in Ferrara between 1989 and 1991]. / Analisi epidemiologica delle infezioni nosocomiali verificatesi presso l'"Arcispedale S. Anna" di Ferrara tra il 1989 ed il 1991.

The Authors describe the results of an epidemiology project on nosocomial infection performed from 1989 through 1991 at the "Arcispedale S. Anna", Ferrara, Italy. Data are considered from 4.183 patients who were hospitalized for surgical treatment and intensive care: 301 patients (7.2%) developed 402 episodes of infection, namely 1.34 infections per patient. 8.2% of the patients who underwent surgery had at least one infection, while 3.9% of the those who did not have surgery showed at least one infection. The majority of infections came out higher among those submitted (11.4%) than among those not submitted (4.4%) to antibiotic prophylaxis. Infections were caused by both Gram+ and Gram- bacteria, and often the infections were polimicrobial.