1,720,987 research outputs found
A new device for sutureless skin closure "the zipper"
No full textBACKGROUND: We have done a prospective, controlled, randomized study to investigate the role of the "zipper", a new device for skin closure. We have also analysed morbility and advantages with the use of the "zipper" compared with sutures.
METHODS: 610 consecutive patients underwent surgery for abdominal thoracic endocrinologic and post traumatic pathologies. In 203 cases we used the zipper a new device for skin closure.
RESULTS: 6/203 Morbility: in six cases it was necessary to substitute the zipper with sutures or leave the wound healing by second intention. The patients were operated for inguinal hernioplasty, axillary lymphadenectomy, appendicectomy and cholecystectomy. These patients developed complications after surgery as hematoma, lymphorrhea, wound infection and a reintervention. The correction has been done removing the zipper and positioning sutures or leaving the wound healing by second intention.
CONCLUSIONS: The use of the zipper permits to achieve an efficient seal, a simple application, an aesthetic comfort; it can be applied in local anaesthesia and for its painless, application it is indicated in pediatric surgery
A new device for sutureless skin closure "The Zipper"
No full textBACKGROUND: We have done a prospective, controlled, randomized study to investigate the role of the "zipper", a new device for skin closure. We have also analysed morbility and advantages with the use of the "zipper" compared with sutures.
METHODS: 610 consecutive patients underwent surgery for abdominal thoracic endocrinologic and post traumatic pathologies. In 203 cases we used the zipper a new device for skin closure.
RESULTS: 6/203 Morbility: in six cases it was necessary to substitute the zipper with sutures or leave the wound healing by second intention. The patients were operated for inguinal hernioplasty, axillary lymphadenectomy, appendicectomy and cholecystectomy. These patients developed complications after surgery as hematoma, lymphorrhea, wound infection and a reintervention. The correction has been done removing the zipper and positioning sutures or leaving the wound healing by second intention.
CONCLUSIONS: The use of the zipper permits to achieve an efficient seal, a simple application, an aesthetic comfort; it can be applied in local anaesthesia and for its painless, application it is indicated in pediatric surgery
Relationship between octreotide and breast surgery.
No full textTo the Editor:
We would like to express our opinion about the article by Gonzalez et al. (1). We congratulate them on the well-performed study and the large number of patients included. We know that seroma formation is the most common complication of breast cancer surgery (2). We noted a few things in the article.
First, the authors do not describe the amount of lymphorrhea aspirated and the number of aspirations during the postoperative medications. There is a big difference between an aspiration of 10 cc of seroma and an aspiration of 100 cc of lymphorrhea, but they describe only the mean number of aspirations. We believe the amount of aspiration and number of aspirations for every postoperative medication will be helpful in understanding the results.
Second, we noted the absence of any information about the mean quantity of lymph loss with drains during the first postoperative days. The authors described only the removal of suction drains after 5 or 7 days, depending on the type of surgery performed. We would also like to know if the authors used some compressive medication with suction drains or if they placed only suction drains without compressive medication? We think that Gonzalez et al. could test compressive medication or other ways of preventing seroma formation.
In our experience (3,4), the use of compressive medication is helpful, but not resolutive, in the treatment of seroma or lymphorrhea, where other authors tested axillary padding with encouraging results (5). We know that external axillary compression is not universally accepted to reduce seroma (6) formation, but we think that this kind of medication combined with suction drains will be useful, even if today some authors do not encourage the use of suction drains in breast surgery (7).
Finally, we would like to remind readers that today in breast surgery we can take advantage of octreotide. In fact, octreotide can be used successfully for the treatment of postaxillary dissection lymphorrhea, and potentially in the prevention of postaxillary lymph node dissection lymphosarcoma, since the amount and duration of lymphorrhea in this setting are known to be important risk factors for its development. In fact, in our experience, the mean quantity (± standard deviation) of lymphorrhea was 94.6 ± 19 cc/day and the average duration was 16.7 ± 3.0 days. In comparison, the mean quantity of lymphorrhea in the treatment group was 65.4 ± 21.1 cc/day and the average duration was 7.1 ± 2.9 days. Potentially octreotide might be used in similar situations where lymphorrhea is detrimental, such as peripheral vascular surgery and regional lymph node dissection for melanoma. So we encourage the authors of this article to use octeotride in the treatment of lymphorrhea
A new approach to the cure of the Ogilvie's syndrome.
No full textThe Authors describe a their own observation of 25 cases of acute colonic pseudo obstruction, better known as "Ogilvie Syndrome" with the objective to demonstrate that an early recognition and prompt appropriate therapy, better if conservative, can reduce the morbidity and the mortality of the Syndrome. The surgical therapy is reserved only to that cases in which the risk of perforation of the cecum represent an absolute indication to intervention
Relationship between octeotride and breast surgery [1]
No full textTo the Editor:
We would like to express our opinion about the article by Gonzalez et al. (1). We congratulate them on the well-performed study and the large number of patients included. We know that seroma formation is the most common complication of breast cancer surgery (2). We noted a few things in the article.
First, the authors do not describe the amount of lymphorrhea aspirated and the number of aspirations during the postoperative medications. There is a big difference between an aspiration of 10 cc of seroma and an aspiration of 100 cc of lymphorrhea, but they describe only the mean number of aspirations. We believe the amount of aspiration and number of aspirations for every postoperative medication will be helpful in understanding the results.
Second, we noted the absence of any information about the mean quantity of lymph loss with drains during the first postoperative days. The authors described only the removal of suction drains after 5 or 7 days, depending on the type of surgery performed. We would also like to know if the authors used some compressive medication with suction drains or if they placed only suction drains without compressive medication? We think that Gonzalez et al. could test compressive medication or other ways of preventing seroma formation.
In our experience (3,4), the use of compressive medication is helpful, but not resolutive, in the treatment of seroma or lymphorrhea, where other authors tested axillary padding with encouraging results (5). We know that external axillary compression is not universally accepted to reduce seroma (6) formation, but we think that this kind of medication combined with suction drains will be useful, even if today some authors do not encourage the use of suction drains in breast surgery (7).
Finally, we would like to remind readers that today in breast surgery we can take advantage of octreotide. In fact, octreotide can be used successfully for the treatment of postaxillary dissection lymphorrhea, and potentially in the prevention of postaxillary lymph node dissection lymphosarcoma, since the amount and duration of lymphorrhea in this setting are known to be important risk factors for its development. In fact, in our experience, the mean quantity (± standard deviation) of lymphorrhea was 94.6 ± 19 cc/day and the average duration was 16.7 ± 3.0 days. In comparison, the mean quantity of lymphorrhea in the treatment group was 65.4 ± 21.1 cc/day and the average duration was 7.1 ± 2.9 days. Potentially octreotide might be used in similar situations where lymphorrhea is detrimental, such as peripheral vascular surgery and regional lymph node dissection for melanoma. So we encourage the authors of this article to use octeotride in the treatment of lymphorrhea
FOLLOW-UP OF 300 MELANOMA PATIENTS SUBMITTED TO SENTINEL NODE BIOPSY
No full textAIMS: Information of prognosis for patients with cutaneous melanoma is sparse and controversial. An understanding of the pattern of recurrence after melanoma’s surgical treatments is helpful in coordinating a rational plan of follow-up in these patients.
METHODS: From January 1999 to December 2007, 300 consecutive patients with primary cutaneous malignant melanoma stage I or II (AJCC) were enrolled. Patients were divided into three groups according to Breslow thickness: 4 mm (32 pts). All patients underwent regular follow-up with clinical examination, US, chest x-ray and PET.
RESULT: The median follow-up time from the date of primary melanoma diagnosis was 60 months (range, 12 – 108 months). The rate of development of skin recurrence was respectively in the three groups 1.2 % (1 pts/82), 7.5 % (14pts/186) and 18.8 % (6pts/32). With regard to nodal recurrence rates were 1.2 % (1 pts/82), 2.7 % (5 pts/186), 9.3 % (3 pts/ 32) and the percentage of distant metastases had the following distribution 1.2 % (1 pts/82), 5.9 % (11 pts/186) and 18.8 % (6 pts/32).
The relationship between the number of deaths related to disease and sentinel lymph node (SLN) status was respectively in the three groups: two deaths both (100 %) with negative SLN, 19 of which 11 (57.9 %) with negative SLN and 7 of which 3 (42.9 %) with negative SLN.
CONCLUSION: Further data will better clarify the role of prognostic factors to identify cases with a more aggressive biological behaviour of the disease. Has confirmed the importance of Breslow thickness as a prognostic factor, remains doubtful the prognostic value of sentinel lymph node biopsy. Therefore, regardless of the tumor-positive sentinel lymph node, is needful a close clinical and instrumental follow-up
RELIABILITY AND ACCURACY OF SENTINEL NODE BIOPSY IN CUTANEOUS MALIGNANT MELANOMA
No full textAIMS: In cutaneous melanoma, biopsy of the first tumour-draining lymph-node (sentinel node, SLN) is became the procedure of choice in regional staging of melanoma patients. A tumour-negative SLN excludes lymphatic metastases and obviates the need for lymph-node dissection.
METHODS: From January 1999 to December 2007, 300 consecutive patients with primary cutaneous malignant melanoma stage I or II (AJCC) were enrolled. The median age was 55 years old (range, 24 – 85); the Breslow thickness range was 0.15-15 mm; the most of patients were Clark levels of invasion III (43.3 %). All patients underwent regular follow-up.
RESULTS: The SLN identification rate was 99.7%. The mean number of SLNs was 2.0 (range, 1-17) and only 1 node was removed in 45.4%. The SLN was positive for metastases in 57 of the 300 patients (19 %): 46 patients (15.3 %) had SLN macro metastases, 11 (3.7 %) had micro metastases. The completion lymph node was performed in all of them with the exception of eight micro metastatic patients who did not accept the procedure. The distribution of positive SLNs by primary lesion thickness was as follows: ≤ 1 mm, two positive SLNs/82 patients (2.4 %); between 1 mm and 4 mm, 38 positive SLNs/186 patients (20.4%); > 4 mm, seventeen positive SLNs/32 patients (53.1%). The patients in our study underwent follow-up visits every four months. The median follow-up was 60 months (range, 12 – 108 months).
CONCLUSIONS: In patients with primary cutaneous melanoma the histological status of the SLN accurately reflects the presence or absence of metastatic disease in the relevant regional lymph node basin. Complete lymph node dissection should only be performed in patients with positive SLNs. The sentinel node mapping is a rational approach for the selection of patients who might benefit from early lymph node dissection of the affected basin
CLINICAL AND TERAPEUTIC IMPORTANCE OF SENTINEL NODE BIOPSY OF THE INTERNAL MAMMARY CHAIN IN PAZIENTS WITH BREAST CANCER: A SINGLE-CENTER STUDY WITH LONG TERM FOLLOW-UP
No full textBACKGROUND: We evaluated the incidence of sentinel lymph nodes (SLNs) in the internal mammary chain, calculated the lymphoscintigraphy and surgical detection rates, and evaluated the clinical effect on staging and the therapeutic approach in patients with breast cancer. METHODS: The study involved 741 women diagnosed with breast cancer eligible for the SLN technique. Lymphoscintigraphy was performed on the day before the operation by peritumoral injection of (99m)Tc-labeled nanocolloid. During the operation, a gamma probe was used to detect the SLN, which was then removed. RESULTS: A total of 719 SLNs were found in the axillary chain and 72 in the internal mammary chain. Preoperative lymphoscintigraphy showed 107 hot spots in the internal mammary chain, but only 72 SLNs in 65 patients were identified by the gamma probe and then removed with no complications. Of these 65 patients, 10 had a positive internal mammary chain SLN on final pathologic examination, whereas 55 patients had >or=1 negative SLNs on final pathologic analysis. Thirty-five (53%) of 65 patients had also an axillary SLN, but only 5 patients (8%) had a positive SLN on pathologic analysis. CONCLUSIONS: Evaluation of the SLNs in the internal mammary chain may provide more accurate staging in breast cancer patients. If an internal mammary sampling is not performed, patients may be understaged. This technique may allow better selection of those patients who will be submitted to adjuvant locoregional radiotherapy
The main problem in treating non palpable breast lesion is the need accurate localization during surgery
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