Cic edizioni internazionali
Il Giornale di Chirurgia

Overview on surgical management of papillary thyroid microcarcinoma

Mini-review, 81 - 87
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Particular interest is now being given to the best treatment of papillary thyroid microcarcinoma (PTMC) due to its significantly increased incidence. PTMC typically shows indolent organic behavior but, in a low percentage of cases, it can express a relative aggressive behavior.
Several risk factors have been shown to negatively influence the rate of regional recurrences and metastases such as tumor diameter, Romaage, sex, multifocality, capsular invasion, extracellular diffusion, lymph node metastases, histological variants, mutated Braf and incidentality. The identification of patients with aggressive PTMCs among the majority with low risk lesions is very important to plan an adequate clinical management, thus the most appropriate surgical treatment. The latter includes thyroid lobectomy and total thyroidectomy with central compartment lymphadenectomy, though several studies did not show statistically significant differences in terms of recurrence and mortality rates between the two techniques. At last, it seems crucial to better define those biological features able to improve selection making process of patients with PTMCs aiming to reserve more radical surgery to those patients carrying more aggressive clinicopathologic features and worse prognosis.

Can initial inflammatory markers predict length of stay in uncomplicated diverticulitis?

Original Article, 88 - 94
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Aim. To investigate the ability of White Cell Count (WCC), Neutrophil count & C-Reactive Protein (CRP) levels at admission to predict length of stay (LOS) in patients with uncomplicated diverticulitis.
Method. This study was performed as a retrospective review of all patients admitted with CT proven uncomplicated diverticulitis over a one-year period. WCC, Neutrophils and CRP levels where recorded at admission. Uniform discharge criteria where used and length of stay measured. A correlation analysis was performed between the inflammatory markers and LOS.
Results. A total of 84 admissions with uncomplicated diverticulitis was included in this study. Average LOS 3.06 (range 1-7 days). On Romaadmission average CRP was 55 (1-276), WCC 11.5 (4.5-35.6) and Neutrophils 8.37 (2.3-18.9). Peak inflammatory values were also measured with mean peak CRP 93.5 (3-325), WCC 11.6 (5.1-35.6) and neutrophils 8.47 (2.3-18.9). Inflammatory markers were correlated to LOS. Multivariate analysis and Fit Plots showed no correlation between any of the inflammatory markers and LOS. Using a modified Hinchey classification 8 patients were Hinchey 0, 60 Hinchey Ia and 16 Hinchey Ib. Hinchey classification was associated with longer LOS (Hinchey 0 mean LOS 2.63 days, Hinchey Ia 2.71 days, Hinchey Ib 4.4 days).
Conclusion. There was a high degree of variation in the inflammatory markers at admission, as well as the peak level of these inflammatory markers during the patients stay. The extent to which these markers were raised did not correlate with the patients’ length of stay. As such, the use of inflammatory markers has limited prognostic value in patients with uncomplicated diverticulitis.

Impact of cardiovascular/diabetic comorbidity on conversion rate during laparoscopic cholecystectomy for acute cholecystitis: a multi-center study on early versus very delayed approach

Original Article, 95 - 104
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Background. The impact of diabetes and cardiovascular comorbidity on laparoscopic cholecystectomy has been long debated, evaluating them as risk factors for conversion to an open procedure especially in patients with acute cholecystitis: an “early” procedure, as suggested by 2013 Tokyo guidelines, has been compared to a “very delayed” one in patients under anticoagulant/antiplatelet therapy or treated for diabetes and referred by medical wards to surgery after the acute period.
Methods. We selected 240 patients operated for acute cholecystitis by laparoscopy over the last 4 years at St. Orsola University Hospital-Bologna and Umberto I University Hospital-Rome, comparing 98 diabetic/cardiovascular patients versus 142 subjects as control group: the selection was based on operative timing, “early” (73 patients treated within 3 days) and “very delayed” (167 patients operated after 6 weeks).
Results. In the “early” subgroup there was no difference comparing diabetic/cardiovascular patients (31 pts) versus control group (42 pts) while in the “very delayed” subgroup among diabetic/cardiovascular patients (67 pts) there was significantly male predominance, ASA III/IV prevalence and less positive imaging findings versus control group (100 pts). In both subgroups, the conversion rate was significantly higher for diabetic/cardiovascular patients (“early”=25.8% and “very delayed”=8.95%) compared to control groups (“early”=4.76% and “very delayed”=1%), showing a trend (p=0.058) towards an increased conversion rate in the early approach among diabetic/cardiovascular group.
Conclusions. Our study showed a significantly increased conversion rate to an open cholecystectomy for diabetic/cardiovascular patients affected by cholecystitis, especially within 3 days by the acute episode.

Surgical intervention for intestinal typhoid perforation

Original Article, 105 - 111
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Aim. Typhoid perforation is the most fatal complication of typhoid fever in developing countries and is most often caused by the bacteria Salmonella Typhi. There are conflicting views as to which type of surgical intervention gives the best outcome. The aim of this study was to determine the mortality associated with the different types of surgical interventions employed in patients with typhoid perforation.
Method. This was a retrospective review of the medical records of adult and paediatric surgical patients treated in the general and paediatric surgical units of the Korle Bu Teaching Hospital. Information was obtained from medical records at the Korle Bu Teaching Hospital in Accra, Ghana, between January 2009 and April 2012. The data was analysed using IBM SPSS Statistics version 20 and 22.
Results. 133 patients (median age of 21 years, 72.2% males) with typhoid perforation were included in the study. The typhoid perforation specific mortality rate was 12.8%. Males had a significantly lower mortality rate (7.3%) compared to females (27%). Simple bowel closure (85.7% of total) was the most common surgical intervention performed and patients operated upon with this method had a significantly lower mortality rate (9.6%) compared to patients with bowel resection (31.6%).
Conclusions. In this study, patients treated with intestinal resection were more likely to die from typhoid perforation and female gender was a risk factor for death. Simple bowel closure was the predominant surgical procedure.

Long-term steroid treatment: a potential risk factor for uterine rupture during pregnancy?

Original Article, 112 - 114
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Aim. Uterine rupture during pregnancy is a rare but life threatening event in Obstetrics, with potentially catastrophic consequences for both the fetus and the mother. There are few published case reports that investigate the possible association between long-term steroid treatment and uterine rupture during the antenatal period.
Case report. A 33-year-old G2P1 woman with obstetrical history of one previous transverse low-segment caesarean section presented at the 30th week of gestation with severe abdominal pain which started spontaneously one hour before. She had medical history of pemphigus under long-term treatment with prednisolone. Clinical examination showed acute abdomen while the fetus developed heart rate decelerations. Emergency caesarean section via Pfannenstiel incision under general anaesthesia was performed. Uterine rupture was recognised with localization not at the scar of the previous caesarean section but at the left posterolateral site of the uterine fundus. A healthy premature male infant with an excellent Apgar score and weight of 1510 gr. was delivered by a low-segment caesarean section. Surgical repair of the site of the rupture with isolated sutures followed. There was no need for hysterectomy as hemorrhage was controlled and hemodynamic stability of the woman was restored.
Discussion. Uterine rupture should be included in the differential diagnosis by all obstetricians not only during labour but in acute abdominal pain during the antenatal period as well.

Postoperative complications, pain and quality of life after thoracoscopic or thoracotomic lobectomy for lung cancer

Original Article, 115 - 119
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Aim. Thoracoscopic lobectomy is superior to thoracotomy, but the evidence for this assumption is low. We present a comparison between thoracotomy and thoracoscopy in term of postoperative complications, mortality, postoperative pain, hospital stay and quality of life.
Patients and methods. This is a retrospective analysis of 224 lobectomies in 24-months. 128 patients (57.1%) were operated by thoracotomy; 96 patients (42.9%) by videothoracoscopy.
Results. Major complications were observed in 4/128 (3.1%) in thoracotomy group and in 1/96 (1%) in thoracoscopy. Minor complications were observed in 38/128 patients (29.7%) in the thoracotomy, and in 16/96 (16.7%) thoracoscopy. Thoracoscopy patients had a shorter hospital stay.
Conclusion. Our study shows an advantage of thoracoscopy over thoracotomy but further studies are needed.

Effectiveness of a preventive bundle of measures for reducing surgical site infections in patients undergoing elective orthopedic procedures in a Hellenic Air Force Hospital

Original Article, 120 - 126
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Background. Bundles of preventive measures may improve patient outcomes. The aim of this study is to investigate if a surgical site infections (SSIs) preventive bundle in orthopedic surgery patients can result in reduction of such infections, hospitalization length and cost.
Methods. The present is a retrospective cohort study. A total of 1299 patients was admitted to hospital for an elective orthopedic procedure during 2012-2015. The patients were subjected to either an integrated three-stage SSIs preventive protocol or standard preventive measures. The two groups were compared for incidence of SSIs, median hospitalization length and median cost.
Results. The incidence of SSIs was lower in the new-protocol group, when compared to the old protocol one (p=0.102). Median (md) hospitalization length was significantly lower in the new protocol group (md = 2) compared to “old-protocol” group (md= 5) [U = 280520, p<0.001]. Regarding arthroscopies, the median cost in the new protocol patients (md= 1500) was significantly lower compared to “old-protocol” patients (md= 1585) [(U= 112660), p < 0.001]. Knee arthroplasties’ median costs did not differ (both mds= 4400, U = 2002, p > 0.05). For hip arthroplasties, the new protocol’s patient median cost (md= 3000) was significantly lower than that of “old-protocol” (md = 4000) [U = 19680, p < 0.001].
Conclusions. The use of a bundle of measures for the prevention of SSIs in a hospital’s orthopedic operations proved effective, since it resulted in substantial decrease of SSIs, statistically significant decreased hospitalization length, as well as cost.

Recurrent giant Brunner’s gland adenoma

Clinical practice, 127 - 131
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Benign duodenal tumours are extremely rare, with an incidence of 0.008% among general population; those originating from Brunner's Gland represent 11% of this neoplasms. Most cases remain asymptomatic and are often diagnosed during routine endoscopic procedures, however their clinical presentation may be variable making resection treatment of choice in order to prevent complications. Recurrence has not been reported previously on literature.
59-year-old male presented to the emergency department nine months following endoscopic resection of a 2x1.5cm Brunner’s gland adenoma complaining of bloating, weight loss and gastro intestinal bleeding, diagnostic approach revealed a 10x4cm mass occupying the duodenum. Tumour size did not allow for endoscopic resection and surgical removal was performed with excellent outcome and no further recurrence at 30 months.

Occasionally report of sacral chordoma; treatment and review of literature

Clinical practice, 132 - 136
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Introduction. Brain notochordal cell tumors (BTCN) are lesions arising from notochordal differentiation which affect the axial skeleton.
Presentation of case. We report a case of a patient treated in our General Surgery Unit of the University Hospital of Bari, Italy, with occasional finding of sacral chordoma at the histological examination.
Discussion. Because of their location, sacral chordomas can affect bowel and bladder with organ specific symptoms. Radiotherapy may be used as a palliative treatment or for recurrence in those patients who cannot be submitted to surgery.
Conclusions. Due to the high local recurrence rate radiation therapy should be considered mandatory after any type of chordoma resection. Multidisciplinary management of the disease is mandatory and improve patient outcomes. Patients should have maximal tumor debulking with adjuvant radiotherapy when possible.

Choroidal metastasis from lung adenocarcinoma: a rare case report

Clinical practice, 137 - 140
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The choroid is the most common site for intraocular metastatic di sease. Orbital metastasis as metastatic site of lung adenocarcinoma is very rare and in literature a very exiguous number of cases is present. This is a case report of a woman with history of lung adenocarcinoma and, after surgery, detection of a choroidal mass described as lung metastasis, responding to Gefinitib therapy. However a biopsy was not performed. After two years there was a great dimension decrement of the lung metastasis but she is still suffering from recurrent pleural effusion, with pleural thickenings biopsied and diagnosed as recurrences of disease.

Is the social status a new prognostic factor in the Fournier’s gangrene?

Clinical practice, 141 - 144
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Fournier’s gangrene is a life-threatening acute necrotizing fasciitis of perianal, genitourinary and perineal areas. Local symptoms are scrotal swelling, erythema of scrotal skin and pain with generalized constitutional symptoms. The gangrene may extends to abdominal wall, intra-abdominal structures, and even in the retroperitoneal tissues. Urgent surgical debridement is crucial to warrant a good outcome since delayed intervention carries a poor prognosis. We report the case of a not diabetic patient with Fournier’s disease presented with severe sepsis and successfully treated with urgent deep debridement and reconstructive surgery. We propose the social status of the patient as a prognostic factor with high impact for survival rate.

Benign multicystic mesothelioma: a case report of recurrent disease in a young adult with familiarity for renal cell carcinoma

Clinical Article, 145 - 148
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Benign multi-cystic peritoneal mesothelioma (BMCM) is a very rare disease (about 150 cases observed). The aetiology is currently little-known, and the data collected, without having achieved conclusive re sults, identify two possible causes: neoplastic and reactive inflammatory. This case report refers to a recidivism of BCMC in a patient whose brother, few months before, underwent a left nephrectomy and right renal Radio Frequency Termo Ablation (RFTA) for bilateral papillary renal cell carcinoma. For the recurring trend, the onset in a male young patient without chronic inflammatory diseases evidence, the presence of a first degree relative with a rare carcinoma we supposed a neoplastic aetiology. The available literature suggests that both tumours (BCMC and renal cell carcinoma) are susceptible to oestrogens. This biomolecular mechanism could represent a valid antipathogenic hypothesis.

Antibiogram in the biopsy of chronic venous ulcers related to sudden changes in the pain profile

Methods, Techniques, Drugs, 149 - 152
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Introduction. Chronic venous insufficiency (CVI) has an important impact on the public health system in particular due to the occurrence of chronic venous ulcers (UCV) and infections.
Objective. To evaluate cultures of biopsies of chronic venous ulcers of patients who suffered an acute change in the intensity of pain of the lesion.
Method. Antibiograms of the cultures of chronic venous ulcer biopsies of patients who suffered an acute change in the lesion with significant pain for 24 hours were evaluated. All patients were treated between 2011 and 2015 in the Vascular Surgery Outpatient Clinic of the Medical School in São José do Rio Preto. Other causes of pain such as chronic arterial insufficiency and problems with the dressings were ruled out.
Results. Positive cultures were detected in 34 of the 35 patients whose pain was resolved by antibiotic therapy.
Conclusion. Acute changes in the intensity of pain associated with chronic venous ulcers seem to be related to local infectious disease.

An enhanced outpatient modality for the treatment of hemorrhoidal disease: preliminary results

Methods, Techniques, Drugs, 153 - 157
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Surgical treatment of haemorrhoids is, primarily, performed on an outpatient basis, and as so, the reduction of the operative time and the hospitalization duration is necessary. In order to achieve these results, both the surgical procedure and the anaesthesia modality should be optimized. Therefore, in this randomized controlled trial, we proposed the hemorrhoidal arteries ligation under pudendal nerve block, as an enhanced outpatient modality, versus the standard of doppler guided hemorrhoidal arteries ligation under spinal anaesthesia. Preliminary results showed that the experimental group was characterized by a similar to the control arm, symptoms remission rate, a lower operation duration and an improved postoperative recovery.

Una vita a strati uniti. Il nutrimento e l’esercizio fisico per stare meglio oggi e domani

Books, 158
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Vol. XL (No. 2) 2019 March - April

  1. Overview on surgical management of papillary thyroid microcarcinoma
    Ruggiero R., Pirozzi R., Gualtieri G., Terracciano G., Parisi S., Nesta G., Gazaneo L., Lanza Volpe M., Rinaldi S., Docimo L.
  2. Can initial inflammatory markers predict length of stay in uncomplicated diverticulitis?
    Parys S., Eranki A., Khamhing S.
  3. Impact of cardiovascular/diabetic comorbidity on conversion rate during laparoscopic cholecystectomy for acute cholecystitis: a multi-center study on early versus very delayed approach
    Lauro A., Cervellera M., D'Andrea V., Casella G., Di Matteo F.M., Di Matteo F.M., Santoro A., Panarese A., Palazzini G., Cirocchi R., AGastra E., Falvo L., Talarico E., Cicia S., Tonini V.
  4. Surgical intervention for intestinal typhoid perforation
    Nilsson E., Olsson S., Regner S., Polistena A., Ali A., Dedey F., Avenia N., Wu L., Banka Johnson L.
  5. Long-term steroid treatment: a potential risk factor for uterine rupture during pregnancy?
    Grigoriadis C., Tympa A., Delivoria V., Baka S., Theodoraki K.
  6. Postoperative complications, pain and quality of life after thoracoscopic or thoracotomic lobectomy for lung cancer
    Porrello C., Scerrino G., Vaglica A., Palazzolo M., Gagliardo C.M., Giangregorio F., Iadicola D., Tomasello G., Lo Faso F., Kawamukai K., Lacava N., Carini F., Cocorullo G., Gullo R.
  7. Effectiveness of a preventive bundle of measures for reducing surgical site infections in patients undergoing elective orthopedic procedures in a Hellenic Air Force Hospital
    Kritikou G., Avgerinos K.I., Koutserimpas C., Sourri F., Hatzigeorgiou D., Kottaridi C., Bountouris I.
  8. Recurrent giant Brunner’s gland adenoma
    Rodriguez-Quintero J.H., Santes O., Morales-Maza J., Clemente-Gutierrez U., Sanchez-Garcia Ramos E., Cortés-Gonzalez R.
  9. Occasionally report of sacral chordoma; treatment and review of literature
    Sallustio P., Minafra M., Laforgia R., Riccelli U., Lobascio P., Carbotta G., Balducci G., Palasciano N.
  10. Choroidal metastasis from lung adenocarcinoma: a rare case report
    Porrello C., Gullo R., Gagliardo C.M., Vaglica A., Palazzolo M., Giangregorio F., Iadicola D., Profita G., Lo Faso F., Tomasello G., Carini F., Cocorullo G.
  11. Is the social status a new prognostic factor in the Fournier’s gangrene?
    Capasso B., Pezzatini M., Cinquepalmi M., Antonelli M.S., Caraceni G., Rampini A., Cardella S., Castagnola G., Maggi S., Brescia A.
  12. Benign multicystic mesothelioma: a case report of recurrent disease in a young adult with familiarity for renal cell carcinoma
    Falco N., Colli F., Tutino R., Fontana T., Licari L., Rotolo G., Scerrino G., Salamone G., Gulotta G.
  13. Antibiogram in the biopsy of chronic venous ulcers related to sudden changes in the pain profile
    Pereira De Godoy J.M.
  14. An enhanced outpatient modality for the treatment of hemorrhoidal disease: preliminary results
    Perivoliotis K., Spyridakis M., Zintzaras E., Arnaoutoglou E., Pramateftakis M.G., Tepetes K.
  15. Una vita a strati uniti. Il nutrimento e l’esercizio fisico per stare meglio oggi e domani
    Pulcini A.
Last Viewed articles: la lista degli ultimi x visitati.
  1. Una vita a strati uniti. Il nutrimento e l’esercizio fisico per stare meglio oggi e domani
    Pulcini A.
  2. An enhanced outpatient modality for the treatment of hemorrhoidal disease: preliminary results
    Perivoliotis K., Spyridakis M., Zintzaras E., Arnaoutoglou E., Pramateftakis M.G., Tepetes K.
  3. Antibiogram in the biopsy of chronic venous ulcers related to sudden changes in the pain profile
    Pereira De Godoy J.M.
  4. Benign multicystic mesothelioma: a case report of recurrent disease in a young adult with familiarity for renal cell carcinoma
    Falco N., Colli F., Tutino R., Fontana T., Licari L., Rotolo G., Scerrino G., Salamone G., Gulotta G.
  5. Is the social status a new prognostic factor in the Fournier’s gangrene?
    Capasso B., Pezzatini M., Cinquepalmi M., Antonelli M.S., Caraceni G., Rampini A., Cardella S., Castagnola G., Maggi S., Brescia A.
  6. Choroidal metastasis from lung adenocarcinoma: a rare case report
    Porrello C., Gullo R., Gagliardo C.M., Vaglica A., Palazzolo M., Giangregorio F., Iadicola D., Profita G., Lo Faso F., Tomasello G., Carini F., Cocorullo G.
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