Liver abscess and pseudotumoral gastric lesion caused by chicken bone perforation: laparoscopic management.

The accidental ingestion of a foreign body into the gastrointestinal tract is not uncommon, but the vast majority of foreign bodies pass through the gastrointestinal tract uneventfully within a week. Less than 1% of patients with foreign body ingestion develop complications such as perforation of the gastrointestinal tract. The migration of an ingested foreign body may result in chronic inflammation, a silent clinical course, and radiological features suggestive of a neoplasm. The authors report a case of chicken bone perforation of the gastric wall that leads to hepatic abscess formation and thereafter to submucosal pseudotumor of the gastric wall treated with totally laparoscopic management. Usefulness of endoscopic ultrasonography for a correct diagnosis is also stressed.

Facial nerve function after parotidectomy for neoplasms with deep localization.

PURPOSE: To determine whether the deep location of a parotid gland neoplasm is specific risk factor for facial nerve paralysis after parotidectomy. METHODS: We retrospectively reviewed 88 patients, including 59 with a benign superficial neoplasm of the parotid treated by superficial parotidectomy (group 1); 5 with a benign deep neoplasm treated by total parotidectomy (group 2); 20 with a malignant superficial neoplasm treated by total parotidectomy (group 3); and 4 with a malignant deep neoplasm treated by total parotidectomy (group 4). RESULTS: Temporary facial nerve paralysis developed in 10.3%, 20%, 10%, and 50% of groups, 1, 2, 3, and 4, respectively. Permanent facial nerve paralysis developed in 0%, 0%, 10% and 50% of groups 1, 2, 3, and 4, respectively. CONCLUSION: The risk factor associated with nerve damage resulting from surgery for parotid neoplasms were malignancy and deep localization. However, the deep location of a benign tumor was not a major risk factor for permanent paralysis.

[Lymphectomy for well differentiated or "aggressive" thyroid malignancies. Indications, complications and results of our experience]. / La linfectomia per neoplasie maligne ben differenziate o "aggressive" della tiroide. Indicazioni, complicanze e risultati nella nostra esperienza.

The aim of this retrospective study was to assess the role of lymphectomy in the treatment of well differentiated and aggressive carcinomas of the thyroid gland. From 1987 to 2002, 231 patients were operated on in our Division; 97 were male (42%) and 134 female (58%), with a mean age of 48 years (range 17-45). One hundred and ninety-four patients had well differentiated thyroid carcinomas, and 37 aggressive thyroid cancer. We performed a follow-up on 171/231 patients (74%) who underwent surgery from 1997 to 1998. Among the 143 patients with well differentiated neoplasms, 93 were treated with total thyroidectomy (65%), and 50 with total thyroidectomy with simultaneous or subsequent lymphectomy (35%); 92 patients underwent postsurgical radiomethabolic therapy (64%). Two patients developed non-functional metastases and died because of disease progression. Of the 28 patients affected by aggressive tumours, 8 underwent total thyroidectomy (29%) and 20 total thyroidectomy with simultaneous or subsequent central lymphectomy (71 %). All 28 patients with aggressive malignancies underwent postsurgical radiomethabolic therapy (100%). Three patients developed diffuse non-functional metastases and died because of disease progression.

[Pancreaticojejunostomy by simple introduction after pancreaticoduodenectomy]. / Pancreatodigiunostomia per introduzione semplice dopo duodenocefalopancreatectomia.

The method which most surgeons still prefer in the treatment of the pancreatic stump after pancreaticoduodenectomy is pancreaticojejunostomy. In this article, we describe our preliminary experience with a fast, effective method, consisting in an end-to-end pancreaticojejunostomy by simple introduction, in 11 cases operated on without morbidity or mortality. From 1998 to 2002, 11 patients with pancreatic head or distal bile duct neoplasms underwent pancreaticoduodenectomy. After removal of the specimen, the residual pancreatic stump was prepared towards the left for about two centimetres, mobilizing the posterior surface from the porto-meseraic axis. A single layer of interrupted suture, consisting only in two posterior stitches, was enough in all cases; each stitch was done taking the stump full-thickness at about one centimetre from the transection margin (so as to introduce a corresponding portion of parenchyma into the jejunal lumen), and from the superior and inferior margin, respectively, of the pancreas. On the intestinal side, the stitches were passed full-thickness from the inner surface to the outside, 6 to 7 millimetres from the transection margin. After introducing the stump completely into the intestinal lumen, three anterior stitches were always done and knotted between the pancreatic capsule and the jejunum. All the anastomoses proved to be perfectly sealed.

Complications in total thyroidectomy: our experience and a number of considerations.

The authors review 1,636 cases of total thyroidectomy with reference to specific complications, classifying them under the headings: major-minor, early-late, transitory-definitive. They report 19 cases of postsurgical haemorrhage, all within 12 hours of the operation, 31 transitory and 15 definitive cases of recurrent laryngeal nerve paralysis, and 14 cases of definitive hypoparathyroidism. As far as the minor complications were concerned, there was a greater incidence of seroma following the use of the harmonic scalpel. The risk factors and physiopathological mechanisms associated with each type of complication are analysed here, above all those responsible for the major and definitive complications. The need for routine preparation of the recurrent nerve, in order to prevent occurrence of postsurgical paralysis is stressed, as is the efficacy of vitamin D in preventing symptomatic postsurgical hypocalcaemia.

[Ultrasonic scalpel in thyroid surgery]. / Il dissettore ad ultrasuoni in chirurgia tiroidea.

In order to evaluate the harmonic scalpel during "open" thyroid surgery, a prospective randomized study was performed using the device versus the traditional procedure. One hundred and forty-two multinodular goiter patients were selected for total thyroidectomy and subdivided into two gender- and age-matched groups. In the first group of 72 patients, the surgical procedure was performed with the US scalpel without using any electrical device or vascular ligatures; in the second group of 70 patients, the traditional technique was employed. No statistically significant differences were recorded with regard to permanent inferior laryngeal nerve palsy or hypoparathyroidism rates. Use of the harmonic scalpel was associated with a higher incidence of transient nerve injury (P < or = 0.005, 9.7% vs 1.4%), but this difference disappeared with increasing experience with the harmonic scalpel. Using the US device significantly improves surgical duration (87.5% < 1 h) and blood loss (P < or = 0.005).