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Acalasia esofagea in età pediatrica: descrizione di due casi clinici trattati con tecnica videolaparoscopica
No full textACHALASIA IN PAEDIATRIC AGE: TWO CASES REPORT TREATED
WITH MINIMALLY INVASIVE SURGERY: the Authors provide a study about 2 cases with achalasia treated with laparoscopic Heller myotomy and anterior fundoplication according to Thall, at the University of Siena. The preoperative exams included clinical examination, a barium x-ray of the upper digestive tract and a
esophageal-gastric-scopy. One patient had a Rett's syndrome. Postoperatively, the patients showed a normal weight curve and complete resolution of symptoms. Ali patients showed complete regression of digestive and respiratory symptoms from the very first
examination, with a normal oral meal intake and an improvement of weight and height parameters, In conclusion, the Authors suggest that modified extramucosal Heller cardiomyotomy associated to 180° anterior antireflux plastic surgery (according to both Thal and Dor 's procedures) is a usefull and safe procedure in the treatment of oesophageal achalasia in paediatric patients. Our data - which are supported by a long term follow up - also stress the relevance of the anterior fundoplication in preventing postoperative gastroesophageal reflux
LAPAROSCOPIC APPENDECTOMY AS A CARE MODEL OF "FAST TRACK SURGERY"
No full textIntroduction: "Fast track surgery" is a model of care pathway that is gradually replacing and incorporating all the other models so far applied
in surgery. In particular, this is possible thanks to minimally invasive procedures widely disseminated for the several benefits they offer.
The authors present a preliminary study of laparoscopic appendectomy using endo-GIA as a model of fast track surgery. Material and methods:
At the Department of Pediatric Surgery of the University of Siena, from December 2008 to May 2009 were carried out 10 surgery procedures
of laparoscopic appendectomy. Patients were subjected to emergency surgery for acute appendicitis diagnosed by clinical examination, laboratory
tests and ultrasound study. The mean age was 10.8 years (range 7-14 years). All procedures were performed under general anesthesia
with the patient in supine decubitus and using three trocars. The first 12 mm, was introduced through the umbilical incision with "open"
approach, the second, 12 mm in the left iliac fossa and the third, 5 mm, in sovrapubic seat. In each patient the appendectomy was carried out
with endo-GIA (a linear stapling device) that can be used for the section of appendix and vessels. Results: Any patient needed to convert to
“open surgery”. The duration of surgery procedure was in mean 80 minutes (range 60-90 minutes). In any case intraoperative complications
were observed. In 1 patient (10%) further surgery procedure with technique "open" was necessary due to presence of purulent exudate in
peritoneal cavity, depending to severity of endo-abdominal infection. The hospitalization was in mean 4.3 days (range 3-10 days) with intestinal
canalization on the 1st post-operative day. Conclusion: Laparoscopic appendectomy is a feasible and safe method with advantages
for patients such as lower incidence of septic complications (better toilet of peritoneal cavity and possible placement of drainage), reduced
time of hospitalization and convalescence, better control of postoperative pain, and better aesthetic results. Binder/section of appendix with
endo-GIA appears more secure in severe peritonitis compared to other systems of ligation, preventing the spread of faecal material, as the
apyretic trend in postoperative shows. In conclusion, beyond the known advantages of VLS, the use of Stapler allows further decrease of
hospitalization that amortizes the modest increase in cost of instruments and the comfort for the surgeon
Neonatal laryngeal saccular cyst: A case report
No full textNeonatal laryngeal saccular cysts are rare and manifest themselves as diverticulum departing from the laryngeal ventricle and extending to the thyroid cartilage. Male, born at 41+5 week in an eutocic delivery, birth weight 3,550 g, Apgar 6, 8 to 1′ and 10′. Due to respiratory distress the patient was intubated and transferred to the Intensive Care Unit. A chest X-ray showed pneumomediastinum and pneumothorax, which were resolved with pleural drainage. On the second day, a laryngoscopy did not allow for the visualization of the larynx because passage of the instrument was impossible. On the third day, ECT and the NMR showed a left-sided polylobed cystic formation of approximately 25 x 12 mm that required surgery using a cervical lateral approach. The postoperative course was normal with spontaneous breathing on the third day and discharge on the fifteenth. The short and long-term follow-up was normal. The incidence of congenital laryngeal cysts is 1.87:100.000. Their presence can be serious and fatal. Striking symptoms at birth are rare. Our patient presented respiratory distress immediately following birth. The standard diagnostic procedure requires an ECT and a laringoscopy. The CT and NMR remain indispensable in determining the location and extension of the mass. Therapeutic action, endoscopic or traditional, is still controversial. In our case, because of the size of the cysts and clinical conditions, we considered the traditional approach to be appropriate. We believe that early detection and timely surgical treatment are necessary. Lack of complications and the excellent results of the follow-up support the traditional approach which was undertaken
Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Intrauterine volvulus with malrotation: prenatal diagnosis
No full textVolvulus is a very rare condition which consists of the rotation of the small intestine and the proximal colon around the superior mesenteric artery, leading to complete intestinal obstruction and ischemic vascular damage. The frequency of this condition is 1 in 6000 live births. We report a case of midgut vovulus with malrotation with a prenatal diagnosis at the end of the week 33. We describe the importance of prenatal echotomographic diagnosis which offers the possibility of performing differential diagnosis. Additionally, it is important to remember that the prognoses of these patients depend on the length of remaining intestine, the location of the intestinal obstruction, the presence of meconium peritonitis, the possibility of associated malformations, but above all, on birth weight and level of prematurit
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