1,720,965 research outputs found
L'impraticabilità del triangolo di Calot. Colecistectomia laparoscopica retrograda. Analisi preliminare dei dati
No full textA rare case of intestinal carcinoid tumour. Clinical considerations and therapeutic approach
No full textI tumori carcinoidi sono un gruppo di neoplasie prevalentemente a basso grado di malignità per l’aspetto eterogeneo delle cellule tumorali, a lenta crescita e con scarsa tendenza a metastatizzare a livello linfonodale e alla diffusione sistemica (fegato, ossa, polmone), ma il meccanismo neoplastico risulta irreversibile e progressivo. Tendono a manifestarsi nei due sessi con uguale frequenza, con un intervallo tra l’inizio dei sintomi e la dia- gnosi che è in media di 4-5 anni, con prognosi buona per le localizzazioni appendicolari e colo-rettali (sopravvivenza a 5 anni del 85-95%), peggiore a lungo termine per le altre localizzazioni tipo ileale e linfonodale (soprav- vivenza a 5 anni del 40-65%) e pessima in corso di secondarietà epatiche (sopravvivenza a 5 anni del 18%). La localizzazione gastrointestinale costituisce la maggioranza di tale tipo di neoplasie (55-60%), con localizzazioni più frequenti a livello dell’appendice, dell’ileo distale a par- tenza mesenteriale e del colon-retto; in rarissimi casi può originare da un diverticolo di Meckel. Con un caso clinico particolare di carcinoide dell’ultima ansa ileale con metastasi linfonodale marginale peritumorale, riscontro occasionale durante una colecistectomia tradizionale, gli Autori hanno voluto riportarne sia le caratteristiche fisiopatologiche e cliniche, sia quelle di trattamento
Use of Tachosil in splenectomy in patients with clotting and blood composition disorders
No full textSplenectomy in patients suffering from onco-haematological conditions presents clotting-related problems which make correct haemostasis more difficult. Using operative haemostasis during splenectomy for onco-haematological conditions as a starting point, the authors report their personal clinical experience of the use of Tachosil, comparing it with other similar products and drawing some personal CONCLUSIONS: To complete their reflexions on clotting problems during splenectomy in the course of onco-haematological diseases, the comparison with its use in oncological pathologies in other parenchymas, such as the kidney and liver, which also present operative haemostatic difficulties of a technical nature, is pointed out and the soundness of the results indicated. The cases of 3 patients suffering from severe clotting disturbances and treated with splenectomy and 1 patient suffering from clear cell renal carcinoma and subjected to nephrectomy in which Tachosil was used as an aid to haemostasis are reported. In the light of these cases, it can be stated that, albeit with the persistence of difficulties related to the changed clotting capacities resulting from the basic disease, the use of Tachosil has proved effective as an aid in haemostasis and suggests the validity of its use in elective and emergency splenectomy, in these types of patien
Le Complicanze Chirurgiche della Malattia Diverticolare
No full textThe Authors report on a rare case of diverticular disease complicated by a sigmoid- vaginal fistula with personal considerations based on a review of literature. A 75 year old patient becomes to our observation suffering the lost of smelly vaginal secretions without fever or abdominalgia. In anamnesis hysterectomy cholecystectomy appendectomy and visceral adhesions lysis. Colonoscopy RX barium enema, gynaecological examination, vaginal buffer show diverticulis of colon sigma with sigmoid-vaginal fistula. After laparotomy, visceral adhesions lysis, it was done sigmoid- vaginal fistula resection with healing. Diverticular disease is a XX century pathology with incidence (for some authors) of 50% of population. Symptomatic forms affect 30-50% of patients (variable percentage based on age); the 1% of these need surgery. The colonic anatomical-functional disorder is the principal cause of diverticular disease that recognize the main localization in colon-sigma. Diverticulitis with pericolic inflammation are frequent complications; possible evolutions are local tamponed peritonitis, mechanical intestinal occlusion, hemorrhage from colonic wall and fistulas. Sigmoid-vaginal fistula is the most frequent in women previously treated with laparohysterectomy. The colonoscopy and RX barium enema are gold standard for instrumental diagnosis; the vaginography is diriment, urography excludes urological diseases. The surgical treatment is the fistula resection, with or without colonic resection. In consideration of the necessity of conservative surgery and on the basis of this case, the authors suggest, if it's possible, the simple fistula resection, although the literature report an high number of relapses
Splenectomia in pazienti con disordini della coagulazione e della crasi ematica: nostra esperienza con impiego di Tachosi r
No full textNasogastric tubes: a lot of bother
No full textThe insertion of the nasogastric tube is one of the procedure that produces the most discomfort for the patients and practitioners. The AA, with the make use of their clinical experience and the data of the literature, report some personal reflections about the management of the nasogastric tube. The AA also analyse some variables (choice of the tube, approach to the patient, insertion of the tube, examination of the position, fixation and removal) that can influence on discomfort of the patient. The choice of the most right SNG is an important moment for the correct insertion; an effect we need to adjust the material and diameter of the tube to the prearranged use. The common practice demonstrates that the collaboration with the patient, obtained by "direct" and "indirect" strategies, gives more possibilities to immediately success of this procedure. The literature explains that it is possible to decrease the discomfort with topical anesthesia; still there are some points of view to clarify. From analyse of the different methods to check the position of SNG, the pH test of the aspirating fluid is the best solution. Once examination of right placement, we need to fix in different points (at least two). From personal experience the removal of SNG is better tolerate that the insertion because the patient is more conscious to be on the mend. The principal recommendation is to abstain from insertion of SNG if it is not closely necessary
Colecistectomia Videolaparoscopica ad Ultrasuoni: Evoluzione di una Metodica Rivoluzionaria
No full text
[A surgical emergency: iatrogenic lesion of the spleen. Case report and review of the literature].
No full textSplenectomy is very frequently used to manage splenic lesions. Nevertheless, spleen-injured patients who have undergone splenectomy are exposed to hyposplenism. Authors report two patients with splenic lesions treated by conservative surgery (with fibrin glue) using the videolaparoscopic method. In both cases the preservation of the spleen was achieved. The conservative treatment allows one to avoid the risk of hyposplenism and provides the possibility to treat the patient with minimal surgical stress
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