[Esophageal diverticula today].
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Biomedical subjects
Publications and source records attributed to A Orio.
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There is still much discussion about the pharmacological treatment of certain symptoms caused by haemorrhoids and their complications. In 1986 topical treatment with Diosmina ointment was used on 50 patients (33 males, 17 females) with grade 1, 2, 3 or 4 haemorrhoids featuring strangulation and thrombosis. Patients who had previously been given other treatment were excluded from the study. The efficacy of the treatment was assessed by a simple method previously used by others which involves scoring (0-3) the major symptoms of the condition (bleeding, oedema, erythema, pain, itching) according to severity. The drug was most effective on oedema and erythema, producing 75% and 73% improvements as assessed in three consecutive weekly visits. These results confirm the value of Diosmina in the topical treatment of acute haemorrhoids. In particular the treatment is very well tolerated and produces no unwanted side effects if properly used.
Even today subphrenic abscesses constitute a major problem for the surgeons who are at times their involuntary cause. These abscesses are characterised by a high mortality rate and difficulty of treatment. A careful review of the literature and a fortunately modest experience form the basis for an assessment of what has been achieved and what problems still remain with particular reference to new diagnostic and therapeutic techniques.
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A comparison was made between 73 patients with colon-rectum neoplasia operated urgently due to occlusion and 85 electively operated in the absence of mechanical ileus. Six parameters were examined: 1) Duration of preoperative symptomatology; 2) Seriousness of preoperative symptomatology; 3) Extention of neoplasia at surgery; 4) Type of operation; 5) Postoperative mortality; 6) Long-term survival. It was found that obstruction often occurs within 5 months after the onset of symptoms and in cases where the tumour is still local (55%). It is attended by higher postoperative mortality (22%) and shorter survival (18 as opposed to 23 months).
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Spigelian hernia, or ventro-lateral hernia is a rare clinical condition, it represents about 1.5% of hernial formation cases of the abdominal wall. It is localised laterally to the rectus muscle and emerges from the semilunar arch. The line, which joins the IX rib to the pubic tubercle, defines the limit between muscular and aponeurotic portion of trasversus abdominis muscle. Diagnosis often results misunderstood. As a matter of fact, this hernia has typically an intraparietal localization and the clinical picture seldom presents characteristic signs. The hernial sac and its content can be appreciated subcutaneously in only 2% of cases. It is estimated that about 50% of patients affected by this condition have a certain diagnosis before surgery. The early clinical signs are generally aspecific and deceitful, represented by oppressive grief and rarely by an abdominal wall tumor; it occurs that it starts with a complication: intestinal occlusion (23%), subocclusion (8%), strangulation (20%, but some authors report percentage up to 50%). We report 5 cases who came to our observation during the last 7 years; all patients underwent elective surgery, and specifically 3 patients in day surgery. Starting from the discussion of these cases, we review anatomy, etiology, clinical nature, instrumental investigation and surgical technique of this rare kind of hernia, comparing our experience to literature reported case histories.
BACKGROUND/AIMS: Milligan-Morgan's hemorrhoidectomy has a high recurrence rate (> 10%) in patients with circular IV grade hemorrhoids. In such cases a circular hemorrhoidectomy with complete elimination of residual piles, and anoplasty might be more successful. The aim of this retrospective study was to compare the results of circular hemorrhoidectomy using the Hopital Leopold Bellan (HLB) technique (Paris) with the reported results of other techniques in patients with advanced hemorrhoidal disease. METHODOLOGY: From January 87 to December 96, 100 consecutive patients with circular IV grade hemorrhoids underwent radical hemorrhoidectomy. Mean hospital stay was 4 days (range 3-7). Patients were strictly controlled in the postoperative period and in cases of early fibrosis anal dilators were used. RESULTS: Eighty one percent of patients had a complete recovery. The recurrence rate was 4%. The cumulative rate of early and late complications was 34%. Early and late hemorrhages were more frequent than in traditional hemorrhoidectomy, while the incidence of anal stenosis was the same. CONCLUSIONS: The HLB operation is the best choice for patients with advanced circular hemorrhoids because of its radicality and good results. The postoperative morbidity of HLB hemorrhoidectomy is higher than traditional hemorrhoidectomy; nevertheless, all complications are tractable without extension of hospital stay.