[Bowel injuries after port insertion in laparoscopy. Gynerisq's database analysis]. / Plaies digestives à l'insertion des trocarts en cœlioscopie. Analyse de la base de données de retour d'expérience de Gynerisq.

INTRODUCTION: Port insertion is a high-risk period during laparoscopy. The French Gynecologist and Obstetricians College (CNGOF) published recommendations in 2010 to minimize those risks. The aim of our analysis was to establish the accidents' circumstances and consequences and to determine if those incidents could have been depending on whether recommendations had been respected or not. MATERIAL AND METHODS: Gynerisq is an approved organism by the Haute Autorité de santé (HAS). Its mission is to evaluate and improve practices by a risk management centered approach. We analysed incidents reported by Gynerisq's adherents in an experience report database. RESULTS: Above 114 incidents analysed in the Gynerisq's database, we reported 31 bowel injuries. Those injuries occurred for 77.4% (24/31) during planned interventions. For 32.3% of the cases (10/31), interventions were judged complex by the surgeons. A total of 54.8% (17/31) of the patients had a history of laparotomy. Above 27 injuries occurred during Veress needle or open laparoscopy, 17 could have been avoided regarding to the surgeon. The causes reported were in 10 cases that the recommendations had not been respected, in 2 cases another cause and in 5 cases no causes were given to explain the incident. CONCLUSION: Our analysis shows that bowel injuries after port insertion, in open laparoscopy or Veress needle use, do not seem to occur only in an emergency context or during complicated interventions. However, most of the incidents occurred for patients with risk factors.

[Nutritional habits and colon-rectal tumours]. / Abitudini dietetiche e tumori del colon-retto.

Following a review of the literature, the relationship between diet and the onset of colorectal cancer is analysed starting from the consideration that in Italy about 20,000 people every year from carcinoma of the colon and 50% of these do not survive. The authors proceed to analyse the epidemiological data which point to diet as an aetiological factor in the cancerogenesis of a variety of tumours in spite of the fact that none of the individual nutritional components has been specifically identified as a triggering and/or protective agent, with the exception perhaps of alcohol in the cancer-cirrhosis sequence. They conclude by stating that, while continuing to give the correct importance to integrated surgical, chemo and radio treatment, to prevent the onset of tumours of the large intestine it is useful to associate the support of a complete nutritional education, which should be begun as soon as possible, with the canonical screening techniques. This educational programme should stress the importance of diet as a contributor of protective principles such as fruit, vegetables, vitamins and non-absorbable fibres which reduce contact time between the carcinogenic substances derived from a prevalently meat diet (cholesterol stimulates the production of biliary salts by increasing the quota of taurodesoxycolic and lithocolic acid and other carcinogenic factors represented by conservants and chemical additives such as nitrates and nitrites which can have a carcinogenetic activity) and the intestinal mucosa.

[Anal carcinoma]. / Il carcinoma anale.

The authors, want to demonstrate the operation of abdominal perianal rectum amputation, and it is considered absolute, even 80 years, in the treatment of the anal neoplasia, it is superseded by alternative methods represented by protocols radio-chemo-therapeutic associated or less to the surgery treatment. They make then a retrospective valuation since 1963 till our days on 54 patients. In the 6 patients (stadium I-II) treated after 1982 with protocols of freemall, it is was obtained disappearance of the neoplasia about 50% the cases. On overcoming of the results there was in a second group of 8 patients (1987) treated always with protocol of Greenall, in 5 of these (62.5%) could observe absence of remaining of disease. In the third group (1993) on 8 patients treated with therapy fixed radio-chemo, it was registered the absence of the residual of illness in 6 patients(75.5%). Finally, from the analysis of patients observed in the last seven years, 5 of which suffered by Ca squamous in different evolutive stadium (one I stadium, three II stadium and one stadium III-B), the stadium I and II were treated with the protocol radio-chemotherapeutic obtaining total remission of the disease in the 100% of the cases. In the follow-up of 45 patients, 12 of whose were treated with the therapy combined radio-chemo and of these 10 were valuable for survival to 5 years which was about 70% superior to patients treated with only surgery therapy.