289 research outputs found
Laparoscopic treatment of colo-colic intussusception secondary to a lipomatous polyp
No full textINTRODUCTION:
Colo-colic intussusception is extremely rare in adults and few cases have been described secondary to a lypomatous polyp.
CASE REPORT:
We present the case of a 50-year old man with chronic abdominal pain who was diagnosed a colo-colic intussusception secondary to a lipoma of the left colon. The patient underwent laparoscopic resection of the splenic flexure without reduction, which occurred spontaneously after induction of the pneumoperitoneum, and final histology confirmed a submucosal lipoma with no evidence of malignancy.
CONCLUSION:
The traditional treatment of choice for adult intussusception is bowel resection without reduction. More recently, however, preoperative reduction of the invaginated bowel segment has been reconsidered in order to: 1) avoid emergency surgery, 2) allow radical surgery for cancer, and 3) reduce the extent of the intestinal resection. To the best of our knowledge, this is the first case of adult colonic intussusception secondary to a lipoma treated by laparoscopy
Ernie della parete addominale.
No full textGli autori descrivono l'eziologia, patogenesi, presentazione clinica, diagnostica e trattamento chirurgico delle ernie della parete addominale
Patologie della tiroide e paratiroidi.
No full textGli autori descrivono l'eziologia, patogenesi, presentazione clinica, diagnostica e trattamento chirurgico delle patologie della tiroide e paratiroidi sia benigne che maligne
Patologie dei surreni.
No full textGli autori descrivono l'eziologia, patogenesi, presentazione clinica, diagnostica e trattamento chirurgico delle paologie surrenaliche benigne e maligne
Should esophageal resections for cancer be performed in high-volume centers only?
No full textEsophageal resection remains the only curative option for esophageal cancer, and therefore, improving the outcome of surgery is the best method of reducing mortality. Several studies have evaluated the postoperative morbidity and mortality after esophageal resection, analyzing the relationship between volume or surgical experience and operative mortality. In this article, the evidence supporting the referral of esophageal surgery to centers with a greater experience (i.e., high-volume centers) is reviewed in order to establish the best practice
Privatization in oligopoly : the impact of the shadow cost of public funds
No full textThe aim of this paper is to investigate the welfare effect of privatization in oligopoly when the government takes into account the distortionary effect of raising funds by taxation (shadow cost of public funds). We analyze the impact of the change in ownership not only on the objective function of the firms, but also on the timing of competition by endogenizing the determination of simultaneous (Nash-Cournot) versus sequential (Stackelberg) games. We show that, absent efficiency gains, privatization never increases welfare. Moreover, even when large efficiency gains are realized, an inefficient public firm may be preferred
Adrenal cavernous hemangioma: a case report
No full textAbstract Background Adrenal cavernous hemangiomas are very rare benign tumors that usually present as incidental findings on abdominal imaging. Preoperative differential diagnosis from other benign or malignant adrenal neoplasms may be challenging. Case presentation A 70-year old man was referred for an 8-cm abdominal mass incidentally discovered on a contrast-enhanced computed tomography (CT) performed to investigate a pulmonary nodule. Biochemical tests ruled out any endocrine dysfunction and iodine 123 metaiodobenzylguanidine whole body scintiscan single-photon emission CT excluded a pheocromocitoma. Findings on magnetic resonance imaging were non-specific and the patient was elected for a left adrenalectomy. Histopathological diagnosis revealed a cavernous hemangioma. A portion of the resected tissue was tested for drug sensitivity to mitotane, doxorubicin, and sunitinib. Conclusions Adrenal hemangioma is a rare disease but should be included in the differential diagnosis of adrenal tumors. The surgical resection is generally required to exclude malignant disease, resolve pressure-related symptoms, and prevent retroperitoneal hemorrhage. Although specific features in diagnostic imaging are often lacking, if the diagnosis is established preoperatively a laparoscopic adrenalectomy can be performed due to the benign nature of the lesion. Doxorubicin and sunitinib were both capable of reducing primary culture cell viability, this suggest that similar drugs may be useful in the medical treatment of adrenal hemangiomas
Importance of a multidisciplinary approach for the treatment of Barrett’s esophagus
No full textBarrett's esophagus is a consequence of gastroesophageal reflux disease. Today, it is the most common cause of esophageal adenocarcinoma. Cancer is usually the end results of a cascade of events whereby metaplasia changes into low- and high-grade dysplasia and eventually cancer. Today, we have the unique opportunity to block this cascade and avoid the development of esophageal cancer. A multidisciplinary approach with a team composed of radiologists, gastroenterologists, pathologists, and surgeons allows individualization of care and the best results
Laparoscopic versus open transverse‐incision right hemicolectomy: a retrospective comparison study
No full textBackground: The optimal surgical approach to right colon cancer is still under debate. The aim of the present study was to compare the short- and long-term outcomes of lapa-roscopic and transverse-incision open approaches to right hemicolectomy for colon can-cer.
Methods: Data on 99 adult patients with right side colon cancer undergoing either laparo-scopic or open transverse-incision right hemicolectomy at two different university hospi-tals, between January 2013 and December 2016, were retrospectively reviewed. Data con-cerning patients’ characteristics, operative details, functional recovery, and postoperative length of hospital stay were retrieved from prospective databases and analyzed.
Results: Forty-nine subjects were operated on laparoscopically while 50 through an open transverse incision. Operating time was significantly longer in the laparoscopic group compared with the open group (182 vs. 105 min; p<0.01). Patients treated laparoscopically had a shorter time to first bowel movement, while time to resume a normal diet and post-operative length of hospital stay were comparable in between groups. The median number of lymph nodes harvested was higher in the laparoscopic group (25.6 vs. 18.6; p<0.01), but no significant difference in overall survival between groups was detected. At long term follow up, the incidence of incisional hernia was higher in the laparoscopic group as com-pared to the open group (24.5% vs. 0%; p=0.0002).
Conclusion: Our results show that laparoscopic right hemicolectomy when compared to the transverse-incision open procedure may guarantee the same oncological radicality, but short-term functional benefits are still unclear. Randomized control studies are warranted to better clarify the comparison of these two approaches for right-sided colon cancers
Preoperative endoscopic tattooing to mark the tumour site does not improve lymph node retrieval in colorectal cancer: a retrospective cohort study
No full textBackground: A direct correlation between number of lymph nodes retrieved and evaluated after a colectomy for
colorectal cancer and survival of the patient has been reported, and consensus guidelines recommend to assess at
least 12 lymph nodes for adequate staging. Many factors (i.e., patients’ and tumour characteristics, surgeon, and
pathologist) may influence the evaluation of the presence of neoplastic disease in lymph nodes as well as the total
number of lymph nodes examined. Preoperative endoscopic tattooing to mark the site of the tumour has recently
been suggested to facilitate the retrieval of lymph nodes in colorectal specimens. The aim of this study was to
investigate its association with adequate lymphadenectomy (≥12 nodes) after colorectal resection for cancer.
Results: All patients undergoing elective colorectal resection for cancer between 2009 and 2011 at the S. Anna
University Hospital in Ferrara, Italy (N = 250) were retrospectively divided into two cohorts according to whether ink
tattooing to mark the tumour site was performed during preoperative colonoscopy. The two cohorts were
comparable regarding age, gender, body mass index, tumour location and size, TNM staging, and DNA microsatellite
instability-high status. No difference between the tattoo (N = 107) and control (N = 143) groups could be detected in
the rate of adequate lymphadenectomies performed (78% vs. 79%, p = 0.40). All factors known to influence lymph
nodes retrieval from colorectal specimen were specifically evaluated. Rectal and colonic cancers were analysed together
and separately. Full adjusted logistic regression analysis in patients who underwent colonic resection showed that
right hemicolectomy (OR 4.72; CI95% 1.09-20.36) was the only factor associated to adequate lymphadenectomy.
No association between ink tattooing performed preoperatively to mark the site of the tumour and adequate
lymphadenectomy after colorectal resection was found with logistic regression analysis.
Conclusion: This study shows that preoperative ink tattooing utilized to mark the site of the tumour does not improve
adequate lymphadenectomy and lymph nodes yield from colorectal cancer specimens. Further studies are therefore
needed to determine if preoperative colonoscopic tattooing to mark the tumour site can refine staging
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