The use of Argentum-Quartz® solution in primary or recurrent perianal fistulas: first experience on three cases.

Primary perianal fistulous pathology represents a painful condition often noticeable in patients affected by Crohn's disease or Ulcerative colitis. It causes difficult defecation and can evolve in perianal abscess that should be urgently ascertained and drained. The present work aims to propose Argentum-Quartz® as valid non-surgical therapeutic treatment in order to reach a more comfortable perianal fistula healing. In fact, our preliminary data allow us to consider Argentum Quartz® ideally employable for treatment of perianal fistulas associated or not with IBDs, representing a reliable sphincter-sparing solution.

The saxophonist's hernia: a rare case report of anterior primary perineal hernia in a young male patient.

Perineal hernia is the protrusion of an intra-abdominal structure into the perineal area, that could be primitive or secondary to trauma or abdominoperineal resection. Main treatment could be transabdominal, transperineal or combined. Here is a rare case of anterior perineal hernia in a young saxophone male patient, treated with a mininvasive perineal approach. A 25-year-old Caucasian male patient referred 1-year history of perineal pain. The pain was more severe when he played his saxophone. Local exam was negative but a dynamic perineal ultrasonography revealed a small anterior perineal hernia. The defect was repaired with a polypropylene plug and the patient was discharged the day after. At one year, no signs of remission have been signalled. Perineal mesh hernioplasty of primary perineal hernia is technically feasible, is associated with rapid recovery and minimal complications, and has a good long-term outcome. The use of ultrasonography to detect the hernia could be considered the best choice whenever it is of small size. Ultrasonography allow to identify weakness areas, reducing diagnostic time and avoiding further costs.

[Infected pancreatic pseudocysts: technical notes]. / Pseudocisti pancreatiche infette: note di tecnica.

INTRODUCTION: Starting from the observation of 9 cases of giant infected pancreatic cysts, which occurred from 1994 to 2004 at the Department of Oncological and Surgical Studies, the Authors' aim has been to evaluate whether a more thorough necrosectomy, carried-out under video-endoscopic control, associated with a nose-gastro-cavity tube, which ensures a continuous cleansing of the newly-formed cavity, and an appropriate positioning of the drainages, could reduce the morbidity and allow a shorter recovery of the infected pseudocysts. PATIENTS AND METHODS: Of 73 cases of acute pancreatitis, observed from 1994 to 2004, 9 showed severe and acute pancreatitis, which included giant pseudocysts, as revealed by the abdomen angio-TC. Our nine septic patients underwent cysto-gastro-anastomosis, necrosectomy, intraoperative cleansing of the cavity with an antibiotic solution and positioning of multiple drainages. Three of these patients also underwent a thorough and targeted necrosectomy, assisted by a trans-anastomotic video-endoscopy. A nose-gastro-cavity tube has been placed in all the patients. RESULTS: The disappearance of the septic state in our three patients who underwent a targeted video-assisted necrosectomy occurred after three days of treatment; moreover, the abdomen angio-TC on the 5th postoperative day showed the disappearance of the necrotic areas. The recovery of these three patients was significantly shorter, compared to those undergoing traditional treatment (cysto-gastro-anastomosis, standard necrosectomy and positioning of abdominal drainages). CONCLUSIONS: Our surgical video-assisted technique demonstrated that, with a slight increase in the operative time, a better control over sepsis may be accomplished, as well as a reduction of the post-operative morbidity, which leads to shorter hospitalisation of patients with infected pancreatic pseudocysts.

[Observations about a case of giant splenic cyst]. / Osservazione a proposito di un caso di cisti gigante della milza.

The Authors, on the basis of a case of giant spleen cyst with positive tumoral markers, analyse some epidemiological and clinical aspects related to splenic non parasitic cysts. They affirm the priority of the conservative surgery, whenever possible, followed by an appropriate follow-up, although in this case their therapeutic choice was radical, due to the lack of residual parenchyma. In accordance with the data of several publications, as well as on the basis of the results obtained, the conservative approaches have been reevaluated, above all in view of the modern findings related to the function of the spleen. The conservative approach cannot be carried out in the following cases: neoplastic diseases, increase of the tumoral markers serum levels, total involvement of the splenic parenchyma by cysts.

Prognostic factors of cirrhotic patients in extra-hepatic surgery.

BACKGROUND: The surgical approach to a cirrhotic patient is conditioned by a number of variables depending on the emergency and kind of the intervention. It is also related to the evolutionary stage of the liver pathology (evaluated following Child-Pugh score). The present study will explore the physiopathologic mechanisms which should be correlated with the preoperative risk factors responsible for the variation of morbidity and mortality of the hepatopathic patient addressed to an extrahepatic surgical intervention. METHODS: This study includes a retrospective analysis (from 1992 to 1999) of 40 patients with cirrhosis (80% HCV correlated cirrhosis, 15.5% alcoholic cirrhosis, 2.5% cryptogenic cirrhosis), who underwent such procedures as: colon resection (5), gastrectomy (4), hernioplasty (11), cholecystectomy (14), ulcorraphy (3), laparotomy (3). Patients with hepatic resection and portal shunt are excluded from this study. A pre- and postoperative evaluation of ascites, PT, APTT, albumin, bilirubin and protein value, number of leukocytes and Child-Pugh score was performed on all patients. Their follow-up was 30 days. RESULTS: The presence of tensive ascites, low albumin value, PT, APTT, together with the emergency of the operation, proved to be significant (p<0.001), in correlation with a mortality of 7.1% in Child's class A, of 23% in class B, and of 84% in class C. CONCLUSIONS: Cirrhotic patients undergoing elective or emergency surgery can incur significant preoperative risks and postoperative complications, increasing their mortality rate. An accurate preoperative predictive factor is Child's class.

Role of color flow Doppler sonography in pre-operative diagnostics of the thyroid pathology.

BACKGROUND: The aim of this work is to demonstrate the high effectiveness of preoperative diagnosis by echotomographic study of thyroid nodules through color-Doppler sonography integrated by B-mode. The authors performed both B-mode ultrasonography and color-Doppler sonography on 125 patients expecting total thyroidectomy surgical intervention, without a previous evaluation of a number of other already performed clinical and instrumental tests. After the intervention, we compared the histologic test with the data drawn from the ultrasound scan, in order to demonstrate that color-Doppler sonography is able to provide for additional diagnostic information in the preoperative period. METHODS: One hundred and twenty five patients with thyroid pathologies were examined by both B-mode and color-Doppler sonography. Two diagnoses were made for each clinical case: the first supported by B-mode data, the second based on vascularity. Our aim was to check color-Doppler's ability to provide new information in the ultrasound diagnosis. All patients underwent a total thyroidectomy surgical intervention. The data were examined by K concordance test. RESULTS: Ultrasound data were compared with the histologic test, which showed 118 (97.4%) benign and 7 (5.6%) malignant lesions. B-mode ultrasound test gave a correct diagnosis in 115 (97%) out of 118 benign lesions and in 4 (57%) out of 7 malignant lesions, while 3 (2.5%) out of 118 cases were false positive and 3 (42.8%) out of 7 were false negative. In those cases showing a wrong conventional ultrasound diagnosis, after the integration of B-mode with color-Doppler results, a decrease was recorded in both false negative and false positive. CONCLUSIONS: Even if no correspondence was found between the different aspects of blood flow and the histologic types of lesions, this experience proves that the color-Doppler test has a high predictive value of benignity in cases with pattern I II and IV, while lesions with pattern III should be more carefully examined, since both malignant and benign lesions belong to this group. From the data drawn from this study, we are able to infer that color-Doppler sonography is undoubtedly an advantage not only in terms of cutting the false negatives, but also in the aim of obtaining a higher effectiveness in the screening of goitrogenic pathology.