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Laparoscopic treatment of paraesophageal and mixed diaphragmatic hernias report of two cases
No full textHiatal hernias are classified into 3 types: sliding hernia (type I), paraesophageal hernia (type II) and mixed hernia (type III), that is a combination of type I and II. The paraesophageal and mixed hernias represent about 5-10% of the surgically treated hiatal hernias. The surgical treatment of the paraesophageal and mixed hernias is unavoidable because of the high risk of severe complications and it has to be considered in a high percentage of cases. The most important technical difficulty in the video-laparoscopic treatment is represented by the hugeness of the hernial defect and by the challenging reduction of the stomach into the abdomen. A cautious dissection of hernial sac and diaphragmatic cruses as well as a careful crural repair make the videolaparoscopic procedure feasible. The operative times are not prolonged and the results are similar to the open technique ones. In literature, the incidence of both intra and postoperative complications doesn't exhibit statistically significant differences between laparoscopic and open techniques. Because of the complexity of the laparoscopic procedure, the minimally invasive access has to be reserved to surgeons who are well trained in those techniques. In this paper we describe 2 cases: one of paraesophageal hernia and the other of mixed hernia which were videolaparoscopicaUy treated with the help, in the second case, of a Gore-Tex mesh. In both cases the technical results were positive. Intra and postoperative complications didn't occur and, one year after the surgical procedure, both patients were in good health and recurrence-free
Laser cleaning of works of art: evaluation of the thermal stress induced by Er:YAG laser
Get PDFThe Er:YAG laser has proven particularly efficient in cleaning procedures of works of art. The removal of the superficial deposits is achieved through melting, thermal decomposition and evaporation. However, the energy absorbed by vibrational modes is dissipated as heat, increasing the temperature of the surface coating that could cause damage on the object. The aim of this study was to evaluate the temperature increase induced by a Er:YAG MonaLaser (LLC., Orlando, FL, USA). To that purpose, we designed a dedicated device to perform the tests in an inert atmosphere or with a wetting agent, to measure the radiant energy per laser pulse. Tests were carried out both on graphite, which absorbs IR radiation and showed a very intense flash emission, and on different kind of samples representative of materials with different levels of conductivity and thermal diffusivity. Results obtained showed that the temperature increase in the irradiated surface depends on the substrate but never causes the damage of the organic and inorganic material. The use of a solvent as wetting agent has been also tested
Er:YAG laser cleaning of a marble Roman urn
No full textThere are very few documented instances of the use of an Er:YAG laser in the cleaning of stone artefacts; however, the cases reported in the literature have shown its effectiveness in the removal of surface organic patinas and lichens. A Roman marble funerary urn (67–100 AD) of archaeological importance was covered with an intractable surface layer that obscured its delicate decorative carving. Chromatographic mass spectrometric and Raman spectroscopic techniques allowed the characterisation of those inorganic and organic materials that had undergone photo-oxidation and biological changes, resulting in the thick encrustation. An Er:YAG laser at 2940nm, with a pulse length of 300μsec, was used for cleaning the urn. Preliminary tests were performed with fluences ranging from 0.7 to 6.4J/cm2 and in the presence of a variety of wetting agents. The laser cleaning resulted in a sufficiently clean marble surface with the thick deposit of unwanted material removed. Finally, the sensitivity of the method allowed for a compact layer of calcium oxalate to be retained on the marble’s surface to help protect it
Caratterizzazione dei materiali organici naturali nel dipinto su tavola Pala di San Zeno del Mantegna
No full text
Clipless laparoscopic cholecystectomy
No full textBackground: Laparoscopic cholecystectomy is the gold standard treatment of gallstones. The ultrasonically activated scalpel (Harmonic Scalpel - Ethicon) may be used as sole instrument for both gallbladder dissection and section of cystic artery and duct with no need of further ligatures.
Methods: In a series of 40 consecutive patients, laparoscopic cholecystectomy was performed with Harmonic. In 8 patients an additional cystic duct ligature with clips was performed because of the large size of the duct (5 cases of associated common bile duct stones, 1 case of acute cholecystitis and 2 of gallbladder empyema). There were 31 females and 9 males. Indications were: 27 simple gallstones, associated in 5 cases to common bile duct stones, 12 acute cholecystitis and 2 gallbladder empyema. In 11 cases associated procedures were performed.
Results: The mean operative time was of 62 minutes, intraoperative cholangiography was performed in 5 cases and common bile duct exploration in 3. A drainage was left in 17 patients. There were no conversions. No patients developed postoperative complications and the mean postoperative hospital stay was of 2,1 days.
Conclusions: Laparoscopic cholecystectomy performed with ultrasonically activated scalpel is feasible and effective. The advantages are represented by using a unique instrument both for dissection of the gallbladder and division of artery and duct. Furthermore, because of the minimal thermal dispersion, the use of Harmonic reduces the risk of injuries. The main limit of the procedure is represented by the cystic duct size: if more than 5 mm in diameter an additional ligature is necessary
Retospective analysis of resectability, prognostic factors and outcome of cholangiocellular carcinoma (CCC)
No full textretrospective study to evaluate resecability rate, prognosdtic factors and outcome of both central and peripheal cholangiocarcinom
A novel approach for high selective microsampling of organic painting materials by Er:YAG laser ablation
No full textLa Medusa by Caravaggio: characterization of the painting technique and evaluation of the state of conservation
No full textLaparoscopic cholecystectomy using harmonic: not only clipless
No full textBackground: Laparoscopic cholecystectomy is the gold
standard treatment of gallstones. The ultrasonically acti-
vated scalpel (Harmonic scalpel, Ethicon) may be used as
the sole instrument for both gallbladder dissection and
section of the cystic artery and duct with no need of further
ligatures.
Methods: In a series of 40 consecutive patients, laparo-
scopic cholecystectomy was performed with the Harmonic
scalpel. In 8 patients, an additional cystic duct ligature
with clips was performed because of the large size of the
duct (5 cases of associated common bile duct stones, 1 of
acute cholecystitis, and 2 of gallbladder empyema). There
were 31 females and 9 males. Indications were 27 sim-
ple gallstones, associated in 5 cases with common bile
duct stones; 12 acute cases of cholecystitis; and 2 cases
of gallbladder empyema. Associated procedures were
performed in 11 cases.
Results: The mean operative time was 62 minutes. Intraop-
erative cholangiography was performed in 5 cases and
common bile duct exploration in 3. A drain was left in 17
patients. No conversions were necessary. No patients
developed postoperative complications, and the mean
postoperative hospital stay was 2.1 days.
Conclusions: Laparoscopic cholecystectomy performed
with an ultrasonically activated scalpel is feasible and
effective. The advantages are represented by using a
unique instrument both for dissection of the gallbladder
and division of the artery and duct. Furthermore, because
of the minimal thermal dispersion, the use of the Harmonic
scalpel reduces the risk of injuries. The main limit of the
procedure is represented by the cystic duct size: if more
than 5mm in diameter an additional ligature is necessary
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