Laparoscopic treatment of blunt splenic injuries: initial experience with 11 patients.

BACKGROUND: Nonoperative treatment of splenic injuries is the current standard of care for hemodynamically stable patients. However, uncertainty exists about its efficacy for patients with major polytrauma, a high Injury Severity Score (ISS), a high grade of splenic injury, a low Glasgow Coma Score (GCS), and important hemoperitoneum. In these cases, the videolaparoscopic approach could allow full abdominal cavity investigation, hemoperitoneum evacuation with autotransfusion, and spleen removal or repair. METHODS: This study investigated 11 hemodynamically stable patients with severe polytrauma who underwent emergency laparoscopy. The mean ISS was 29.0 +/- 3.9, and the mean GCS was 12.1 +/- 1.6. A laparoscopic splenectomy was performed for six patients, whereas splenic hemostasis was achieved for five patients, involving one electrocoagulation, one polar resection, and three polyglycolic mesh wrappings. RESULTS: The average length of the operation was 121.4 +/- 41.6 min. There were two complications (18.2%), with one conversion to open surgery (9.1%), and no mortality. CONCLUSIONS: Laparoscopy is a safe, feasible, and effective procedure for evaluation and treatment of hemodynamically stable patients with splenic injuries for whom nonoperative treatment is controversial.

Squamous and adenosquamous cell carcinomas of the gallbladder.

Squamous and adenosquamous cell carcinomas (ASC and SCC) are rare subtypes of gallbladder cancer, traditionally considered more aggressive and with a poorer prognosis than adenocarcinoma. We report about two patients affected by an advanced squamous cell carcinoma of the gallbladder. Both had a large tumour in the gallbladder fossa region with infiltration of the liver. Surgical resection was radical in one, but palliative in the other. pTNM was T3 N0 M0, G3, R0 in the former and T3 N0 M0, G2 R1 in the latter. Patients died for local recurrence after 12 and 5 months, respectively. Natural history, clinical findings, prognosis and outcome of this rare gallbladder tumour are discussed on the basis of a review of the English literature. In conclusion, an aggressive and radical surgical treatment of advanced squamous and adenosquamous cell gallbladder carcinomas seems to be indicated for their low proclivity to distant spreading.

Large extrapleural hematoma in an anticoagulated patient after a thoracic blunt trauma.

We report the 7th case of a traumatic extrapleural hematoma that developed in an anticoagulated patient with a thoracic blunt trauma and rib fractures, and required an emergency surgical treatment. Extrapleural hematoma is a rare and life-threatening condition characterized by a collection of blood between the pleura parietalis and the endothoracic fascia. Related symptoms and chest x-ray findings are not characteristic and may present several hours after the injury, leading to delayed diagnosis and treatment. Etiological, surgical and prognostic implications of this finding are briefly discussed.

["Strawberry" gallbladder: review of the literature and our experience]. / Colecisti "a fragola": revisione della letteratura e nostra esperienza.

The term "strawberry gallbladder" refers to an anatomo-pathological aspect which is included in the wider chapter of gallbladder cholesterolosis. Introducing their experience, the Authors summarize the hypotheses through the years proposed about the etiopathogenesis of this condition the clinical symptoms that it can produce and the diagnostic strategies used to identify it. Moreover the Authors underline that the "strawberry gallbladder" continues to be reported with a significant frequency. They also confirm the opportunity of surgical treatment of symptomatic patients as a valid alternative to medical therapy which is not always effective, it is long lasting, often complex and not completely side effects lacking.

[Prognostic criteria in ruptured aneurysm of the abdominal aorta]. / Criteri prognostici associati negli aneurismi dell'aorta addominale rotti.

A logistic regression analysis of risk factors affecting the mortality on 69 cases of ruptured abdominal aortic aneurysm (RAAA), treated between 1988-1996, has been carried out. Mortality was 33.3%. No single risk factor significantly influenced mortality except the shock (p = 0.0016). The presence of two o less risk factors in the same patient was associated with 24% mortality, whereas three o more risk factors were associated with 92.4% mortality.

[Surgical methods in the management of urinary incontinence caused by genital prolapse: a review]. / Tecniche chirurgiche per l'incontinenza urinaria da prolasso genitale: contributo originale.

The authors, after of the different techniques mostly used in surgery to correct the urinary incontinence, illustrate their original technique adapted for UI caused by genital prolapse. At present, the Marchall-Marchetti-Krantz's and Goebell-Stoeckel's techniques are commonly used in this field. Since uterus lowering is the main cause of cystocele and subsequent urinary incontinence, their new technique has the principal purpose of holding the uterus permanently in it natural position. The authors limited experience is actually of only five cases; all the patients underwent an intervention of cystopexy according to their new technique described. The results obtained encourage and promote the usage of such a method, consenting them to go on with their experience.