Biomedical subjects
Publications and source records attributed to L Rosato.
The authors affirm that plastic surgery using graft materials is a feasible technique also in case of recurrent inguinal hernia. They follow with interest the evolution of laparoscopic techniques which are still the cause of some perplexity. The paper reports a series of nine recurrent inguinal hernias out of 447 inguinal hernias operated during the period May 1994-May 1996.
A case of a symptomatic colonic lipoma causing recurrent abdominal pain and intestinal obstruction, not treated is reported. Lipomas are the most common mesenchymal benign tumors that can be found in the colon and are second as frequence only to the adenomatous polyps. In 65% of cases the lipomas are located in the large bowel and represent the most common cause of intestinal intussusception in the adult. Lipomas are most frequent in the right colon (40%-68%) an opposite distribution in comparison with adenocarcinomas and adenomatous polyps. When their diameter is more than 3 cm, lipomas become symtomatic. In lipomas less then 2 cm in diameter it is possible an endoscopic removal while for bigger sizes the surgical laparoscopic approach is recommended.
Non-palpable breast lesions may be defined as suspected lesions for "occult" tumours and diagnosed during the course of screening or, occasionally, in asymptomatic women. Mammography is the main diagnostic instrument owing to its high sensitivity and specificity, although an increasingly important complementary role is played by ultrasound scan. The comparison of findings obtained provides elements for further evaluation. Moreover, mammography can be used to make a dynamic study of the breast over time in order to evaluate doubtful lesions that might change, especially in women of a child-bearing age and during the various phases of the menstrual cycle. The use of the metal repere allows the lesion to be identified and surgically removed. A total of 135 operations for breast pathologies were examined from 1 January 1994 to 30 April 1996, subdivided into 26 operations for benign pathologies and 109 for malignant pathologies. Of the latter 52 (47.7%) were modified radical mastectomies, 50 (45.9%) were quadrantectomies with axillary lymphadenectomy, 1 (0.9%) quadrantectomy, and 5 (5.5%) simple mastectomies. A total of 16 needle biopsies were performed of which 8 were benign and 8 malignant. The latter were treated using 2 modified radical mastectomies owing to the presence of an extensive intraductal component, 5 quadrantectomies with lymphadenectomy, and 1 simple quadrantectomy for a lobular carcinoma in situ. Kopans needle was also used as a repere and the stiffening cannula was used for an accurate, effective but economical exeresis. One of the 8 benign cases was complicated by an hematoma (12.5%). Neither the mammary gland nor the subcutis were sutured to avoid unsightly scars and uncertain images at later mammographic controls.
Carcinoid tumors are infrequent but not exceptional neoplasias. The gastroenteric tract is affected in 80% of cases and almost half of these involve the appendix where they almost always represent an occasional finding after appendicectomy due to acute or subacute appendicitis. Although they have a low malignancy potential in this site, with a reduced index of metastasization and scant capacity to determine clinical symptoms, they are of considerable clinical importance in view of the prognostic and therapeutic type problems that their diagnosis entails. The authors report the case of a female 14-years-old patient, operated for acute appendicitis, and the finding of a yellowish hard tumefaction with a diameter of around 2 cm near the appendicular cone which histological tests showed was a relatively benign classic carcinoid.
Sacrococcygeal pilonidal disease may take a variety of forms: a silent chronic form, acute with abscess and a chronic or acute form with fistula. In the acute form surgery consists of the incision and evacuation of the purulent matter, postponing definitive surgery to a second phase, which is not always necessary, considering that in 60% of cases patients do not manifest any further symptoms. The final operation may be performed using a closed, semi-closed and open technique. The authors performed a retrospective review of 64 patients, including 44 males and 20 females. 75% of operations were performed using an open method, 22% with a closed method and 3% with a semi-closed method. Recidivations using the open method amounted to 8% (6% with a single recidivation, 2% with two recidivations), and 14% with the closed method. Average hospital stay was 5.8 days with the open method and 7.3 with the closed method. Patients operated using the open method were discharged after two or three days and dressings were applied using gauze soaked in Betadine solution after cleaning with hydrogen peroxide. The scar was fully formed in around 45 days.
Chyloperitoneum following traumatic rupture of the subdiaphragmatic thoracic duct is a very rare lesion and in fact no case was found when reviewing the last five years of international literature. The authors report a case of traumatic chyloperitoneum caused by a penetrating sidearm wound in a young 19-year-old woman. Emergency exploratory laparotomy enabled the precise identification of the site of the thoracic duct lesion and to proceed to its immediate suture. At one year after the operation the patient is in good health.
INTRODUCTION: Alloplasty with prosthetic graft (marlex net, dacron, mersilene, etc.) represents an undoubted progress in the surgical treatment of inguinal hernia. Having completed the isolation and possible resection of the hernial sac, the posterior wall of the inguinal canal is no longer reconstructed using musculo-aponeurotic plastic surgery (Bassini, Postemski, etc.), but by encouraging a granulomatous reaction using a prosthetic graft which provides a solid posterior wall to the inguinal canal. METHODS: A total of 447 cases were examined of patients undergoing alloplastic surgery with the use of a prosthetic polypropylene graft who were controlled at one week, one month and one year after surgery. RESULTS: Mortality was zero whereas morbidity was 21 cases: 7 hematoma, 5 funicular edema, 8 seroma. A total of 9 recidivations were recorded (2%).
The authors report their experience in the treatment of perforated peptic ulcer. From August 1992 to December 1995 a total of 23 patients (14 cases of gastric ulcer and 9 cases of duodenal ulcer), mean age 67.5 years, underwent emergency surgery for perforated peptic ulcer. The operations performed included: simple gastrorrhaphy in 19 cases (11 for gastric ulcer, 8 for duodenal ulcer); gastrorrhaphy with pyloroplasty + GEA in 1 case of gastric ulcer; gastrorrhaphy with pyloroplasty in 2 cases (1 for gastric ulcer, 1 for duodenal ulcer); gastric resection in 1 case of gastric ulcer. One case of perioperative mortality occurred, equivalent to 4.3%, whereas the percentage of complications observed was 13% (2 cases of IRA, 1 case of wound infection). The mean age of patients (67.5 years) and the high percentage of associated major pathologies (39.1%) oriented the choice of therapy towards ulcerorrhaphy. In the authors' opinion this rapid and easy to perform method represents the best treatment of perforated peptic ulcer; the validity of ulcerorrhaphy is confirmed by the reduced mortality (4.3%) and the low percentage of morbidity (13%) found in this series.
The pancreatic pseudocysts are a serious complication of acute or chronic pancreatitis. Personal experience in the treatment of 5 cases of pancreatic pseudocysts observed in the last six years is reported. In elective surgery the operation of choice in the treatment of the typical postnecrotic pseudocysts and which gives the best results in cystojejunostomy with a Roux-en-Y loop. The external bypass is indicated in the cases of infected or ruptured pseudocysts. Pancreatic resection is considered useful in the rare cases of multiple pseudocysts affecting the body and the tail of the pancreas.
Lumbar hernias are very rare and no more than 300 are reported in literature. They can be classified as congenital and acquired. The latter are in turn subdivided into primary and secondary. Secondary traumatic lumbar hernias account for 25% of all cases. The site of the formation of this hernia is mainly Grynfelt's triangle and, to a lesser extent, Petit's triangle. Traumatic lumbar hernia have very moderate symptoms and may be corrected surgically relatively easily, in particular with the use of Marlex nets. Recidivations can be easily identified owing to the lack of aponeurotic support structures in this anatomic site. Owing to their traumatic etiopathogenesis these hernias are of particular medicolegal importance for the purposes of indemnity. The case reported refers to a 46-years-old man involved in a road accident who sustained an injury caused by the explosion of hollow viscera in the abdomen and the subsequent onset of a hernia swelling through Petit's triangle in the right lumbar region. Owing to the width of the breach, plastic surgery was carried out using a Marlex graft. A large recidivation was observed around one year later.
The paper reviews past published work and evaluates various clinical aspects and surgical complications relating to the pathology of Yersinia enterocolitica, an increasingly frequent non-pathognomonic enteric infection in the western world. Despite this only ten instances have been documented of surgical complications arising from abscess and perforation of the intestinal wall requiring laparotomic intervention. It is concluded that, in any case of acute pathology of the right hand ileum cavity it would seem essential to undertake a more precise diagnosis so as to separate inflammatory or neoplastic pathologies of the intestine and mesentery from yersiniosis. This would allow more appropriate surgical and therapeutic treatment.
A case of Mondor's disease is described. They remark etiopathogenesis and clinical signs of this rare disease that affects thoraco-epigastric vein or one of its confluents. They point to the benignity of the disease that tends to evolve to a spontaneous healing in a few weeks. Authors confirm the advisability of performing appropriate exams to exclude malignancies of the breast.
The paper reports a case of extraosseous plasmacytic lymphoma in an ileal localisation in a patient with multiple myeloma. After having underlined the relative rarity of tumours of the small intestine and their diagnostic and clinical characteristics, the paper describes the case in question. The unique nature of the case depends on the extreme rarity of cases of isolated secondary forms in patients with active systemic pathologies reported in the literature.
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Personal experience of 58 portal hypertension patients monitored for a period of 30 months is presented. Biliary lithiasis was encountered in 34.4% of these patients. The almost symptom-free course of the biliary pathology is highlighted and the surgical problems arising including those related to portal by-pass operations are examined.