[Laparoscopic appendectomy and laparotomy appendectomy: comparison of methods]. / Appendicectomia laparoscopica ed appendicectomia laparotomica: metodiche a confronto.

The study compares the real advantages of laparoscopic appendicectomy using only a transumbilical trocar, with laparotomic appendicectomy in the management of acute and/or chronic pain in the lower right abdominal quadrant. From May 1997 to April 2000, 88 patients were treated: 27 (group I) with the laparoscopic approach, and 61 (group II) with laparotomy. We compared operating times, incidence of complications, hospital stay and cosmetic result. We also reviewed the literature on this subject over the past ten years. Average operating time was 45 minutes in group I and 30 minutes in group II; complications consisted in 2 cases of omphalitis in the laparoscopic group and 3 infections of the wound and 2 cases of lipolysis of the abdominal wall in the laparotomic group. The average hospital stay was 3.2 days in the laparoscopic group against 4.7 days in the laparotomic group. Resumption of work and sport occurred after 10 to 20 days and 15 to 45 days in groups I and II, respectively. The total cost was lower in the laparoscopic group. The laparoscopic approach appears to be an effective technique for the management of acute and chronic appendicitis, as it allows both treatment of the pathology and diagnosis and treatment of other unknown pathologies, with exploration of the abdominal cavity. In addition, it guarantees a good cosmetic result, a short hospital stay with a low incidence of complications and an advantageous cost/benefit ratio.

Totally Implantable Central Venous Access: 15 years' experience in a single unit.

The use of Totally Implantable Central Venous Access Systems (T.I.C.V.A.S.) has become an essential aid for those patients requiring extended intravenous infusion treatments or complete parenteral nutrition, and for whom the peripheral venous system may be or may become inadequate for infusions. This paper describes fifteen years of experience in the use of totally implantable systems. It examines the application methods as well as the different systems, complications, patient satisfaction, quality of life, and cost/benefit ratio. We examined 261 patients observed during a period of approximately 15 years. A surgical team carried out the operations for these patients in an operating room under the strictest asepsis conditions. The Port-a-Cath central venous access systems were used in 221 cases (84.6%) and the Pas-Port peripheral venous access systems were used in 40 cases (15.3%). We observed no particular differences between the different types of systems implanted. The total rate of complications was 11.7%, 0.7% of which were positioning complications, 4.2% stability complications, and 6.1% management complications. There were 2 cases (0.76%) of defective performance of the implanted system. We found patient satisfaction with the method average in 19.85% of the cases, good in 70.23% and excellent in 11.9%. Quality of life improved because of reduced total hospitalization time and more convenient treatment management. Regarding the cost/benefit ratio we also found that the benefits outnumbered costs. In connection with the cost of the system the possibility of home management leads to a marked decrease in hospitalization expenditure. Today these systems should be considered as being essential in the correct management of the patient requiring medium-to-long-term infusion treatment. On the whole these treatments are well accepted by the patient and the possibility of home or day hospital management allows a marked reduction in hospitalization, which affects both social life and costs. The incidence of complications was found to be relatively low considering that most of them are the result of poor management of the system by the paramedical personnel or by the relatives of the patients. In this sense, better education in the management of the system would further optimize results. (The Journal of Vascular Access 2001; 2: 161-167).

[Evaluation of the delayed hypersensitivity response by the Multitest-IMC. Multicenter study for the definition of reference values in a sample population]. / Valutazione della risposta di ipersensibilità ritardata mediante Multitest-IMC. Studio multicentrico per la definizione di valori di riferimento in una popolazione campione.

The latest investigations in the field of clinical immunology have proposed ways of assessing immunological efficiency that have also been used to identify patients most susceptible to infectious complications. The assessment of delayed hypersensitivity response (DHR) using anamnestic antigens is currently the most common method. The results of a polycentric study are presented. The study was conducted on a group of healthy subjects from various Italian regions divided into three age classes. Positive responses to the MT were noted in 96.4% of the population studied. The incidence of energy was statistically higher among females than males, while the mean response to the MT expressed in millimetres was statistically higher in males. Though 7 antigens were administered, the responsive population reacted on average to 3. The highest incidence of positive responses was to Candida, with Trichophyton responsible for the fewest.

Regional arterial chemotherapy of liver tumours. I. Performance comparison between a totally implantable pump and a conventional access system.

Thirty-nine patients with liver tumours have been submitted to regional arterial chemotherapy by means of either totally implantable Infusaid-400 pumps (22 c.) or implantable ports (17 c.). The latter were subsequently perfused with external pumps. There was one single major operative complication and no operative deaths. Most patients underwent continuous Fudr infusion. Access related complications occurred in both groups. Treatment was stopped for access related complications in 18.4% and 29.4% of cases out of the pump and port groups respectively. In most of those cases, however, several cycles of chemotherapy had already been performed. The Infusaid-400 pumps showed a 12-month functional duration of 57% with a 13-month median, the 10-month duration of ports being 67%. The difference was not significant. The new implantable systems give better results in comparison with traditional regional access methods, the functional performances of the port systems appearing very similar to the totally implantable pumps, with an obvious advantage for the pumps as far as quality of life is concerned.

[Comparison of the performance of a totally implantable pump and conventional access systems in regional arterial chemotherapy of liver tumors]. / Paragone di affidabilità tra pompa totalmente impiantabile e sistemi tradizionali di accesso per la chemioterapia arteriosa regionale dei tumori epatici.

Forty-nine patients with liver tumors have been submitted to regional arterial chemotherapy by means of either totally implantable Infusaid 400 pumps (29 casse) or implantable ports (20 cases). The latter were subsequently perfused with external pumps. There was one single major operative complication and no operative deaths. Most patients underwent continuous FUDR infusion. Access related complications in the Pump and Port groups respectively included 1 and 0 malfunctions, 7 and 2 seromas, 2 and 0 pocket necroses, 8 and 10 thromboses, 2 and 4 catheter dislocations, 0 and 2 portal breakages. Treatment was stopped for access related complications in 5 and 5 patients respectively. In most of those cases, however, more than 6 cycles of chemotherapy have been performed. The Infusaid 400 pumps showed a 12-month duration of 58.4% with a 13 month median versus 17% and 9 month median of the Ports. The difference was not significant. The new implantable systems give better results in comparison with traditional regional methods; the performance of the Port systems appear very similar to the totally implantable pumps, with an obvious advantage, however, for the pumps as far as quality of life is concerned.

Treatment of chronic cancer pain by means of continuous intrathecal low dose morphine administration with a totally implantable subcutaneous pump. Case report.

A 59 year old man suffering from intractable chronic pain from sacral coccygeal relapsing neoplasia with pelvic invasion, operated and irradiated more than once, after a first partial success with subarachnoid intermittent morphine infusion by means of a subcutaneous reservoir, refilled transcutaneously, has been treated with continuous intrathecal low-dose morphine infusion with a totally implantable pump. This device not only greatly resolves many of the problems connected to spinal administration of morphine, but it also allows to obtain constant concentrations of the drug, so that an efficacious therapeutic action is already present at low doses, reducing the risks of overdose and supraspinal redistribution as well as the development of tolerance. This case represents the first example in Italy of the use of a completely implantable pump for this purpose.