1,721,165 research outputs found
Elevata incidenza di infezione da Helicobacter pylori e lesioni gastriche precancerose in una popolazione a presunto basso rischio di cancri dieta-correlati.
No full textElevata incidenza di infezione da Helicobacter pylori e lesioni gastriche precancerose in una popolazione a presunto basso rischio di cancri dieta-correlati.
No full textLaparoscopic trans-abdominal pre-peritoneal (TAPP) surgery for incarcerated inguinal hernia repair
No full textPurpose: This series was aimed to analyze feasibility, safety and postoperative quality of life of trans-abdominal pre-peritoneal repair in incarcerated hernia; the rationale was a safe hernia reduction, more accurate abdomen exploration, diagnosis and treatment of contralateral unknown hernia. Methods: With a minimum follow-up of 30 months, 20 urgent incarcerated inguinal hernia patients were submitted to TAPP. Signs of strangulation, peritonitis and major comorbidity were exclusion criteria. Feasibility and safety were evaluated by ability to hernia reduction, conversion rate, operative time, perioperative mortality, morbidity, hospital stay, prosthesis infection and recurrence. Finally, quality of life was assessed by acute and chronic pain score, recovery of normal activities, return to work and patients’ satisfaction survey. Results: Under vision sac reduction was always achieved, incision of internal ring during the reduction manoeuvre was necessary in 40% of pts, intraoperative complications, conversions or perioperative mortality were not observed. In one case (5%) partial omentectomy was necessary. Contralateral hernia was diagnosed and repaired in 20%. Median operative time was 81.3 min, postoperative minor complications were recorded in 5 patients (25%), median in hospital stay was 2 days. After a median follow-up of 39 months, 1 patient recurred (5%). Acute pain, was scored 3 as median value (range 1–5), only one patient scored 2 as chronic pain during follow-up. Conclusions: Laparoscopic approach for incarcerated inguinal hernia repair is not the standard treatment. In our experience, with the limit of a single-surgeon series, selected patients showed satisfactory results in terms of feasibility, safety, postoperative quality of life and patients’ satisfaction were observed. Few series about this topic were published. More prospective trials are needed
Praecox postoperative enteral nutrition: preliminary experience
No full textStress reaction is known to result from major surgery, which causes the release of macrophages, monocytes, eicosanoids and cytokines. These, in turn, activate the adrenal gland, hypothalamus and so that this reaction is provoked, coupled with fever and anorexia. Such a reaction leads to rapid muscle tissue loss due to neoglucogenetic protein catabolism, acute phase protein synthesis, edema and constriction of the splanchnic blood vessels. Reduced blood-flow in the digestive system allows the passage of bacteria and endotoxins from the intestinal lumen, thus penetrating the mucous membrane through blood circulation. This latter phenomenon, "bacteria translocation", if not adequately treated can develop into multivisceral insufficiency, MOFS (Multi-Organ Failure Syndrome) or (Whole Body Inflammation). We can effectively prevent "bacteria translocation" by two methods: Praecox Post Operative Enteral Nutrition (PPOEN) and Immune Enteral Nutrition the administration of a semi-elemental formula containing immunonutrients.
METHOD. Between June 1999 and May 2001, we treated 10 patients at the General Surgery Department "Paride Stefanini" and wards of the Emergency Department of the University Hospital "Policlinico Umberto I" in Rome, according to the following criteria: access to the digestive tract by means of the Dobbhoff tube and the immune nutritional dosage conveyed by a peristaltic pump, according to the Harris-Benedict formula increased by 50%. The hydroelectrolite balance was ensured by the administration of polyelectrolite, saline and glucose solution via a peripheral vein on 12-hour schedule. It began with of fluid therapy and no IEN. After the first 12 hours IEN was started at with a corresponding reduction in fluid volume. This procedure continued until IEN reached the maximum calorie/volume regimen between the 72nd and 84th hour. This group was matched with another 10 patient group with the same age, sex and submitted to the same operation, treated with conventional therapy. Total proteinemia (TP), Albuminemia (Alb), Transferrinemia (TRF) and weight were considered for nutritional evaluation. For the assessment of patients' immune system, lymphatic squaring, CD3, CD4, CD8, CD8a were studied.
RESULTS. We show the average variations expressed as a percentage: PT = +4,19; Alb= +17,6; TRF = +46,11;
Weight = +1,98; CD3 = +17,06; CD4 = +16,47; CD8 =+ 19,83; CD8a = +6,66.
DISCUSSION. Data analysis shows a moderate improvement in nutritional parameters with a favourable reaction in the lymphatic squaring without either surgical or metabolic complications. Although preliminary, our results are encouraging. While waiting for more consistent statistics, our data confirm the currently accepted concept on the role played by immunonutrients. In conclusion, we think that PPONE integrated with IEN can provide a positive approach in the prevention of MOFS and WBI as well as a reduction in antibiotic consumption, recovery time and, perhaps above all, in the amount of money to spend -whatever the outcome
Metastasis from Renal Cell Carcinoma Presenting as Skeletal Muscle Mass: a Case Report
No full textRenal cell carcinoma can metastasize to virtually any site. Skeletal muscle metastasis is not common. The correct diagnosis of metastatic renal cell carcinoma to skeletal muscle is difficult in comparison with soft-tissue metastasis diagnosis. We report the case of a 58-year-old man with skeletal muscle metastasis from a clear-type renal cell carcinoma 5 years after total nephrectomy. The tumour was located in the proximal left tight at the level of the great adductor muscle. Clinical work-up included both 18 fluorodeoxyglucose positron emission tomography combined with non-contrast computed tomography and magnetic resonance imaging. The mass was widely excised and was confirmed to be a metastasis from renal cell carcinoma. Maintaining a high degree of suspicion of metastatic renal cell carcinoma is required for patients with a history of renal cell carcinoma. Positron emission tomography, combined with computed tomography, appears to be an effective surveillance tool. Magnetic resonance imaging is helpful in the differential diagnosis from primary soft-tissue tumours
Complete mesh migration into the small bowel after incisional hernia repair. A case report and literature review
No full textINTRODUCTION: Mesh migration into the intestine is very rare after incisional hernia repair. CASE REPORT: We report the case of transmural mesh migration from the abdominal wall into the small bowel presenting as recurrent small bowel obstruction 18 years after repeated surgical repair of an incisional ventral hernia. At surgery, a mesh was found inside the resected ileal loop. DISCUSSION: Mesh migration into the intestine is a possible, although very rare, complication after incisional hernia repair with nonabsorbable meshes. It tends to occur late with obstructive symptoms, especially if the small intestine is involved. Avoiding the direct contact between the mesh and the intestinal wall may help to reduce this complication
- …
