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Biomedical subjects

Gianlorenzo Dionigi

Publications and source records attributed to Gianlorenzo Dionigi.

At least 19 recordsLinked to original sources
PubMed2006

Postoperative infections after oesophageal resections: the role of blood transfusions.

BACKGROUND: Perioperative blood transfusion carries numerous potential risks concerning the transmission of infective diseases and immunodepression that can facilitate the occurrence of postoperative infectious complications. Explanation of connections between perioperative blood transfusion and postoperative septic complication worldwide is not well documented. Many studies have described a correlation between perioperative blood transfusions and postoperative infections. On the contrary, other studies indicate that factors influencing the need for blood transfusions during surgery have a greater bearing than blood transfusion per se on the occurrence of postoperative complications. PATIENTS AND METHODS: A prospective study was conducted in our Department on 110 consecutive patients undergoing oesophageal resection for primary cancer, in order to evaluate the incidence of postoperative infections related to perioperative allogenic blood transfusions. For each patient we preoperatively recorded in a computerized data-base several known risk-factors for postoperative infections; in detail we registered the administration of allogenic perioperative blood transfusions (period of administration, number of packages administered). RESULTS: Among the enrolled 110 patients, 53 (48%) received perioperative blood transfusions: in this group postoperative infections (overall infective complications) occurred in 27 patients. After a multivariate analysis we observed that perioperative blood transfusions significantly affected as an independent variable the development of wound infections (p = 0.02). CONCLUSION: Blood transfusions independently affected the incidence of wound infections in patients who underwent oesophageal resection for primary cancer.

Journal Article↗
PubMed2006

Multifocality and multicentricity are not contraindications for sentinel lymph node biopsy in breast cancer surgery.

BACKGROUND: After the availability of the results of validation studies, the sentinel lymph node biopsy (SLNB) has replaced routine axillary dissection (AD) as the new standard of care in early unifocal breast cancers. Multifocal (MF) and multicentric (MC) tumors have been considered a contraindication for this technique due to the possible incidence of a higher false-negative rate. This prospective study evaluates the lymphatic drainage from different tumoral foci of the breast and assesses the accuracy of SLNB in MF-MC breast cancer. PATIENTS AND METHODS: Patients with preoperative diagnosis of MF or MC infiltrating and clinically node-negative (cN0) breast carcinoma were enrolled in this study. Two consecutive groups of patients underwent SLN mapping using a different site of injection of the radioisotope tracer: a) "2ID" Group received two intradermal (i.d.) injections over the site of the two dominant neoplastic nodules. A lymphoscintigraphic study was performed after each injection to evaluate the route of lymphatic spreading from different sites of the breast. b) "A" Group had periareolar (A) injection followed by a conventional lymphoscintigraphy. At surgery, both radioguided SLNB (with frozen section exam) and subsequent AD were planned, regardless the SLN status. RESULTS: A total 31 patients with MF (n = 12) or MC (n = 19) invasive, cN0 cancer of the breast fulfil the selection criteria. In 2 i.d. Group (n = 15) the lymphoscintigraphic study showed the lymphatic pathways from two different sites of the breast which converged into one major lymphatic trunk affering to the same SLN(s) in 14 (93.3%) cases. In one (6.7%) MC cancer two different pathways were found, each of them affering to a different SLN. In A Group (n = 16) lymphoscintigraphy showed one (93.7%) or two (6.3%) lymphatic channels, each connecting areola with one or more SLN(s). Identification rate of SLN was 100% in both Groups. Accuracy of frozen section exam on SLN was 96.8% (1 case of micrometastasis was missed). SLN was positive in 13 (41.9%) of 31 patients, including 4 cases (30.7%) of micrometastasis. In 7 of 13 (53.8%) patients the SLN was the only site of axillary metastasis. SLNB accuracy was 96.8% (30 of 31), sensitivity 92.8 (13 of 14), and false-negative rate 7.1% (1 of 14). Since the case of skip metastasis was identified by the surgeon intraoperatively, it would have been no impact in the clinical practice. CONCLUSION: Our lymphoscintigraphic study shows that axillary SLN represents the whole breast regardless of tumor location within the parenchyma. The high accuracy of SLNB in MF and MC breast cancer demonstrates, according with the results of other series published in the literature, that both MF and MC tumors do not represent a contraindication for SLNB anymore.

Journal Article↗
PubMed2006

Bleeding after percutaneous radiofrequency ablation: Successful treatment with transcatheter embolization.

PURPOSE: This knowledge will provide an ability to earlier detect bleeding complications after radiofrequency ablation (RFA), to manage these complications appropriately with endovascular procedures and minimize the sequelae. MATERIALS AND METHODS: From 2002 to 2005, 96 patients with 150 hepatic tumours underwent 126 RFA sessions. Fifty-eight patients had HCC, 34 had liver colorectal metastases and 4 had cholangiocellular carcinoma. Sixty-one patients were men and 35 were women (mean age 69.82 years, age range 39-89). The lesions number ranged from 1 to 7 per patients (mean 1.6 nodules) with a mean diameter of 28.5 mm (range 80-10 mm). Seventy-seven patients underwent a single ablative session, 13 patients underwent 2 sessions, 4 patients underwent 3 sessions and 2 patients underwent 4 sessions. The number of tumours treated in each ablative session was 1 in 106, 2 in 18 and 4 in 2 patients. RESULTS: Two cases of serious haemorrhages occurred after the procedures in two patients treated for liver metastases. An endovascular embolization was proposed for both patients using polyvinyl-alcohol and micro-coils. The absence of bleeding was first confirmed during angiography and then by CT performed the day after the angiographic procedure. CONCLUSION: Transarterial embolization (TAE) represents the treatment of choice in the management of iatrogenic bleeding after RFA since it is minimally invasive, have a high success rate and a low incidence of complications compared to the more complex and dangerous surgical or laparoscopic options in patients who are often haemodynamically unstable and therefore at high anaesthetic and surgical risk.

Adult↗
PubMed2006

Surgical treatment of malignant involvement of the inferior vena cava.

BACKGROUND: Resection and replacement of the inferior vena cava to remove malignant disease is a formidable procedure. The purpose of this review is to describe our experience with regard to patient selection, operative technique, and early and late outcome. METHODS: The authors retrospectively reviewed a 12-year series of 11 patients; there were 10 males, with a mean age 57 +/- 13 years (range 27-72) who underwent caval thrombectomy and/or resection for primary (n = 9) or recurrent (n = 2) vena cava tumours. Tumour location and type, clinical presentation, the segment of vena cava treated, graft patency, and tumour recurrence and survival data were collected. Late follow-up data were available for all patients. Graft patency was determined before hospital discharge and in follow-up by CT scan or ultrasonography. More than 80% of patients had symptoms from their caval involvement. The most common pathologic diagnosis was renal cell carcinoma (n = 6), and hepatocarcinoma (n = 2). In all but 2 patients, inferior vena cava surgical treatment was associated with multivisceral resection, including extended nephrectomy (n = 5), resection of neoplastic mass (n = 3), major hepatic resection (n = 2), and adrenal gland resection (n = 1). Prosthetic repair was performed in 5 patients (45%). RESULTS: There were no early deaths. Major complications occurred in 1 patient (9%). Mean length of stay was 16 days. Late graft thrombosis or infection did not occur. The mean follow-up was 22.7 months (range 6-60). There have been no other late graft-related complications. All late deaths were caused by the progression of malignant disease and the actuarial survival rate was 100% at 1 year. Mean survival was 31 months (median 15). CONCLUSION: Aggressive surgical management may offer the only chance for cure or palliation for patients with primary or secondary caval tumours. Our experience confirms that vena cava surgery for tumours may be performed safely with low graft-related morbidity and good patency in carefully selected patients.

Journal Article↗
PubMed2006

Reconstruction after esophagectomy in patients with [partial] gastric resection. Case report and review of the literature of the use of remnant stomach.

BACKGROUND: Bowel reconstruction after subtotal esophagectomy represents a problem when a previous distal gastrectomy was performed: usually the colon or jejunum is used. METHODS: In a 10 year period 126 patients with primary esophageal cancer underwent esophageal resection in our Department. Surgical procedures were 57% two-phase subtotal oesophagectomy, 23% transhiatal, 9% stripping, 10 three-phase total esophagectomy and 2 endoscopic resections. RESULTS: In 112 patients alimentary tract reconstruction was achieved by means of esophago-gastric anastomosis. Reconstruction was performed using colon in 10 cases and jejunum in 2. We describe the technical aspects of esophagectomy and gastric reconstruction in a patient with previous antrectomy and Billroth II reconstruction. The procedure was performed via a combined laparotomy and thoracotomy with anastomosis at the level of the azygous vein using the remnant stomach. CONCLUSION: Few technical reports have been reported in literature about the use of remnant stomach in reconstruction for subtotal esophagectomy subsequent to distal gastrectomy. Several hypotheses are made to explain the maintenance of the gastric vascular integrity as its intramural network without micro-vascular anastomosis.

Journal Article↗
PubMed2006

Solitary pulmonary metastasis from primary melanoma of the oesophagus 5 years after resection of the primary tumor.

BACKGROUND: Primary malignant melanoma of the oesophagus (PMME) is an uncommon tumor. PMME has an aggressive biological behavior, similar to melanomas developed elsewhere in the body. Most patients die from distant metastases, and the overall 5 year survival rate is approximately 4%. CASE PRESENTATION: We report a rare case of a solitary pulmonary metastasis found 5 years after curative resection of primary esophageal melanoma. No other sites of metastatic disease were identified. Video-assisted lung wedge resection of the lung nodule was carried out successfully. CONCLUSION: This supports the concept that patients with primary melanoma of the oesophagus treated should be carefully followed up.

Journal Article↗
PubMed2006

Multimodal approach to endovascular treatment of visceral artery aneurysms and pseudoaneurysms.

PURPOSE: To assess the feasibility and the effectiveness of endovascular treatment of visceral arteries aneurysms (VAAs) using a "multimodal approach". MATERIAL AND METHODS: Twenty-five patients (mean age 60.1 years) with 29 VAAs (13 splenic, 4 hepatic, 3 gastroduodenal, 6 renal, 2 pancreatic-duodenal, 1 superior mesenteric) were considered suitable for endovascular treatment; 8/29 were ruptured. Saccular aneurysms (9/29) were treated by sac embolization with coils (in 4 cases associated with cyanoacrylate or thrombin) with preservation of artery patency. Fusiform aneurysms (6/29), were treated by an "endovascular exclusion". In 10/29 cases, supplied by a terminal branch, we performed an embolization of the afferent artery, with coils and cyanoacrylate or thrombin. 2/29 cases were treated with a stent-graft and 2/29 cases with a percutaneous ultrasound-guided thrombin injection and coils embolization of the afferent artery. The follow-up was performed by ultrasonography and/or CT-angiography 1 week after the procedure and then after 1, 6, and 12 months and thereafter annually. RESULTS: In 29/29 cases we obtained an immediate exclusion. Two patient died for other reasons. Complication rate was 27.6% (7 spleen ischemia and 1 stent-graft occlusion). During the follow-up (range: 7 days-36 months, mean 18.7 months), we observed 3/29 (10.3%) cases of reperfusion in the first month, all treated successfully with a further endovascular procedure. Primary technical success was 89.7%; secondary technical success was 100%. CONCLUSION: Endovascular therapy can be considered a feasible and effective approach for VAAs with good primary and secondary success rates.

Adult↗
PubMed2006

Ten year survival after excision of squamous cell cancer in Zenker's diverticulum: report of a case.

BACKGROUND: Zenker's diverticulum (ZD) has been increasingly recognized as a site of primary epithelial malignancy. Pitt in 1896 described the first case. METHODS: Between 1990 and 2005, 30 patients affected of esophageal diverticulum were referred to our Department. RESULTS: The pathological results revealed one case of squamous cell carcinoma. On follow-up 10 years after diverticulectomy alone, the patient was alive and well without evidence of recurrence. CONCLUSION: Our case reported provides additional data on clinical decision when the tumor is well localized without full-thickness penetration or extension to the line of resection. In this patient, long-term survival and apparent disease control have been effected by diverticulectomy alone. A case of such long survival is very rare.

Journal Article↗
PubMed2006

Randomized controlled trial of harmonic scalpel use during thyroidectomy.

OBJECTIVE: To compare operative factors, postoperative outcomes, and surgical complications of thyroidectomy when using the harmonic scalpel (HS) vs conventional hemostasis (CH). DESIGN: Single-blind, randomized controlled trial. SETTING: Department of Surgery, S. Chiara Hospital, University of Pisa, Pisa, Italy. PATIENTS: One hundred patients undergoing thyroidectomy. MAIN OUTCOME MEASURES: Postoperative pain, drainage volume, hypocalcemia, nerve injury, and operative time. INTERVENTION: Patients underwent total thyroidectomy in which either the HS or CH was used. RESULTS: We found no significant differences between the HS and CH groups at baseline. Postoperative pain was reduced in the HS group at 24 hours (mean visual analog scale score, 3.90 vs 5.30; P<.001) and 36 hours (2.27 vs 3.95; P<.001). Drainage volume was significantly lower in the HS group (40.1 mL vs 75.4 mL; P<.001). Transient hypocalcemia was significantly lower in the HS group (5 patients [10%] vs 16 [32%]; P=.01). No patients experienced nerve injury or permanent hypocalcemia. Mean operative times were shorter in the HS group (40.0 vs 46.7 minutes, P<.001). CONCLUSIONS: Use of the HS may reduce postoperative pain, drainage volume, and transient hypocalcemia in patients undergoing thyroidectomy. Shorter operative times and improved outcomes might justify the cost of the HS compared with that of CH.

Adult↗
PubMed2006

Infective complications in laparoscopic surgery.

BACKGROUND AND PURPOSE: One of the main benefits of minimally invasive surgery compared with open surgery is the significant reduction in the incidence of postoperative infections. Possible explanations include the smaller incision, minimal use of central venous catheters for parenteral nutrition, faster mobilization, reduction in postoperative pain, and better preservation of immune system function with a limited inflammatory response to tissue injury. We compare the incidence of postoperative infections after the most common laparoscopic surgical procedures with that after the corresponding open operation, and review the possible mechanisms behind these results. METHOD: Review of the pertinent literature. RESULTS: Several randomized controlled trials (RCTs), as well as most retrospective studies, show a significant reduction in incisional complications with laparoscopic cholecystectomy in comparison with open surgery (mean 1.1% vs. 4%), as well as in urinary tract and pulmonary infections. In colorectal resection, laparoscopic surgery was characterized by a significant reduction in surgical site infections (mean 5% vs. 9.5%), and the infections that did occur tended to be less severe. Again, there were fewer urinary and pulmonary infections postoperatively. Acute appendicitis represents an interesting setting to study the effect of minimally invasive surgery on infections, as it involves a potentially contaminated field. Most of the results confirm that the rates of surgical site (mean 2% versus 8%) and respiratory (mean 0.3% versus 3%) infections favor laparoscopic surgery, but minimally invasive surgery seems to be characterized by a higher incidence of postoperative intra-abdominal abscess. The laparoscopic approach to splenectomy is clearly superior to standard laparotomy in terms of postoperative complications, including infections, although the rate of overwhelming postsplenectomy infection (OPSI) remains similar because this complication is related more to spleen removal than to the surgical approach. CONCLUSIONS: Most of the literature is in agreement that laparoscopic surgery is associated with better preservation of immune function and a reduction of the inflammatory response compared with open surgery. The rate of postoperative infections seems to be significantly lower.

Humans↗
PubMed2006

Long-term results and quality of life of patients undergoing sequential surgical treatment for severe acute pancreatitis complicated by infected pancreatic necrosis.

BACKGROUND: Infected pancreatic necrosis (IPN) is one of the most severe complications of acute pancreatitis (AP). Sequential surgical debridement represents one of the most effective treatments in terms of morbidity and mortality. The aim of this paper is to describe the quality of life and long-term results (e.g., nutritional, muscular, and pancreatic function) of patients treated by sequential necrosectomy at the Department of Surgery of the University of Insubria (Varese, Italy). METHODS: Data were collected on patients undergoing sequential surgical debridement as treatment for IPN. The severity of AP was evaluated using the Ranson criteria, the Acute Physiology and Chronic Health Evaluation (APACHE II) Score, and the Sepsis Score, as well as the extent of necrosis. The surgical approach was through a midline or subcostal laparotomy, followed by exploration of the peritoneal cavity, wide debridement, and peritoneal lavage. The abdomen was either left open or closed partially with a surgical zipper, with multiple re-laparotomies scheduled until debridement of necrotic tissue was complete. The long-term evaluation focused on late morbidity, performance status, and abdominal wall function. RESULTS: In the majority of patients (68%), mixed flora were isolated. Pseudomonas aeruginosa was the microorganism identified most commonly (59%), often associated with Candida albicans or C. glabrata. The mean total hospital stay was 71+/-38 days (range 13-146 days), of which 24+/-19 days (range 0-66 days) were in the intensive care unit. Eight patients died, the deaths being caused by multiple organ dysfunction syndrome in seven patients and hemorrhage from the splenic artery in one. Normal exocrine and endocrine pancreatic function was observed in 28 patients (88%). At discharge, four patients had steatorrhea, which was temporary. Eight patients (23%) developed pancreatic pseudocysts, and in six, cystogastostomy was performed. Most patients (29/32, 91%) developed a post-operative hernia, but only five required surgical repair. All patients had a Short Form (SF)-36 score>60%, and 20 of the 32 patients (68%) had scores>70-80% (good quality of life). The worst scores were related to alcoholic pancreatitis. CONCLUSIONS: The degree of pancreatic failure (exocrine and endocrine function) is not related to the amount of pancreatic necrosis. Even with a need for repeated laparotomy and multiple surgical procedures, the abdominal wall capacity as well as long-term quality of life remain excellent.

APACHE↗
PubMed2006

Surgical site infections after thyroidectomy.

BACKGROUND: The history of thyroid surgery starts with Billroth, Kocher, and Halsted, who developed techniques for thyroidectomy between 1873 and 1910. Before 1950, the operative mortality rate approached 50%. The advent of general anesthesia and antisepsis and the development of fine hemostatic instruments rendered thyroid surgery safer, but the potential persists for life-threatening complications. This study was designed to identify specific risk factors for the development of surgical site infections (SSIs); to define high-risk patients; to determine the causative organisms; to illustrate the clinical presentation, treatment, and outcome; and to establish management guidelines. METHODS: A prospective analysis was carried out of complications affecting 241 consecutive patients (mean age 65+/-19 years; 76% female) undergoing cervical exploration for thyroid disease from 2000 to 2005, with particular attention to infection, and the pertinent literature was reviewed. RESULTS: Surgical site infections (SSI) affected 2% of patients. The risk of infection depended mainly on the quality of pre-operative and post-operative care and on whether there was a break in sterile technique. The use of drains and pre-operative antibiotics did not affect the incidence of SSI. No pre-operative factor foreshadowed this complication, and the definition of a high-risk population remains obscure. Surgical site infections lengthened the hospital stay. CONCLUSIONS: Effort should be made to improve sterile technique. Appropriate antibiotic coverage is indicated when infection develops post-operatively. The most important element in the management of SSI is adequate drainage of the incision once infection develops.

Aged↗
PubMed2006

Surgical site infections in day surgery settings.

BACKGROUND: Because major complications are rare in day surgery, minor morbidities such as surgical site infections, which become evident only after patient discharge, have a major impact on the perceived quality of care. We performed an audit of such infections over a oneyear period. METHODS: All procedures were performed in a multidisciplinary day surgery setting. There were 155 inguinal hernia repairs, 44 excisions of lipomas, and 27 excisions of pilonidal cysts. All patients received antibiotic prophylaxis according to a rotation protocol. RESULTS: One patient (0.65%) operated on for inguinal hernia developed a deep incisional infection caused by Staphylococcus schleiferi. The patient was treated using selective antibiotics, and complete recovery ensued. One patient (2.27%) who underwent excision of a lipoma revealed developed a deep incisional infection associated with fever (39 degrees C) caused by Staphylococcus aureus. He was treated by daily antibiotics and application of dressings for two weeks and recovered. One patient (3.7%) treated for pilonidal cyst developed a deep incisional surgical site infection. A group A Streptococcus was isolated, and he received an intravenous antibiotic for ten days. In the seven patients treated for pilonidal cyst with the wound left open, swab specimens were taken because of persisting local pain, and the following bacteria were found: Pseudomonas aeruginosa, Escherichia coli, Staphylococcus epidermidis, Proteus vulgaris, and Streptococcus constellatus. No antibiotic therapy was given, and local wound care led to complete recovery. CONCLUSION: In our day surgery unit, the rates of surgical site infection are similar to those described in the literature. Continuing audit is essential to maintain and improve the quality and standard of the surgery provided. Prevention of surgical site infection is very much the responsibility of the persons working in the operating theater. Therefore, it is vital not only to apply strict regulations concerning everyday management but also to maintain a high degree of motivation among the personnel.

Ambulatory Surgical Procedures↗
PubMed2006

Postoperative fever.

BACKGROUND: Fever is common in surgical patients. The list of potential causes is long and includes many noninfective etiologies. CAUSES: Only about 40% of fever episodes in hospitalized patients are caused by infection. Any fever in a surgical patient is a cause for concern. New or continuing fever more than three days after surgery should raise a strong suspicion of persistent illness or a new complication. On rare occasions, these fevers can be attributed to potentially life-threatening occult infections, including acute cholecystitis, antibiotic-related pseudomembranous colitis, systemic candidiasis, or transfusion-related cytomegalovirus disease. A change in the microbiology of postoperative infections has also been noticed, characterized by a greater incidence of infections caused by methicillin-resistant Staphylococcus aureus, by polymicrobial flora, and by fungi. TREATMENT: Control of nosocomial infections has become more challenging recently because of widespread bacterial resistance to antibiotics and to more frequent surgical indications in elderly patients at higher risk. Early recognition and appropriate treatment of these infections relieves anxiety, reduces hospital costs, and increases patient survival rates. CONCLUSIONS: The workup and therapy for the individual patient may differ, depending on the underlying disease and clinical appearance and the clinician's suspicion for infection. Subsequent testing should be based on the clinical findings. Perhaps more money is wasted in the evaluation of early postoperative fever than on any other aspect of postoperative care.

Cross Infection↗
PubMed2006

Infected pancreatic necrosis.

BACKGROUND: Infected pancreatic necrosis is a late infective complication of acute necrotizing pancreatitis in which infection tends to spread from the pancreas to the peripancreatic tissues, retroperitoneum, and, more rarely, the peritoneal cavity. Severe and rapid deterioration of the clinical condition may lead to septic shock and multiple organ dysfunction syndrome. CAUSATIVE ORGANISMS: The microorganisms most frequently isolated in cases of acute bacterial pancreatitis have been historically gram-negative bacteria of enteric origin. However, gram-positive cocci are isolated with increasing frequency. Enterococci are the single most commonly isolated species. TREATMENT: Aggressive multimodal therapy in the early stage of severe necrotizing pancreatitis improves survival; patients with infective complications tend to die later from multiple organ dysfunction syndrome. Initially, the treatment consists of fluids, analgesics, and oxygen supplementation. Surgical debridement should be limited to proved infections and delayed as long as possible to allow necrotic tissue to become demarcated. When surgery is necessary, blunt debridement of necrotic tissues is the procedure largely utilized and usually is not accompanied by excessive bleeding. Pancreatic resection should be reserved for massive necrosis of the gland substance. In many situations, the abdominal incision can be closed primarily. Treatment by the "open abdomen" technique should be reserved for those patients in whom further laparotomies are planned, mainly because of incomplete unsatisfactory debridement or uncontrolled bleeding that necessitates packing of the lesser sac. CONCLUSION: Modern management techniques have reduced the mortality of infected pancreatic necrosis to 15-20% from historical rates that were twice as high. Aggressive resuscitation and surveillance of infection are crucial for successful outcomes, although fewer patients are undergoing surgical debridement.

Bacterial Infections↗
PubMed2006

Mechanical bowel preparation for colorectal surgery.

BACKGROUND: Nosocomial infections are the most frequent complications of surgical patients. Most surgical site infections (SSI) are acquired intraoperatively and arise from the flora of the patient's skin, gastrointestinal tract, or mucous membranes. Although preoperative mechanical cleansing of the bowel is considered by many surgeons a cornerstone of modern elective colorectal surgery and, in association with antibiotic prophylaxis, a fundamental component of an intestinal antisepsis program, many surgeons do not perform preoperative mechanical preparation routinely. METHODS: Review of the pertinent literature. RESULTS: Some recent randomized trials and a Cochrane review found no proof that mechanical bowel preparation reduces the risk of complications after elective colorectal surgery. Indeed, there is some evidence that this intervention is associated with a higher rate of anastomotic leakage and wound complications. CONCLUSIONS: The dogma that mechanical bowel preparation is necessary before elective colorectal surgery may need to be reconsidered. On the other hand, such preparation decreases operating time by improving bowel handling during construction of the anastomosis. Moreover, it is helpful when intestinal palpation will be necessary for identification of a lesion.

Antibiotic Prophylaxis↗
PubMed2006

Treatment of secondary hyperparathyroidism with ultrasonographically guided percutaneous radiofrequency thermoablation.

We present a case of a 63-year-old woman with a recurrent secondary hyperparathyroidism hyperplasia with absolute contraindication for surgery, treated in 2 sessions with percutaneous ultrasonographically guided radiofrequency tissue ablation. The complete pathologic tissue ablation was confirmed by contrast-enhanced ultrasonography performed before and after the treatment and by clinical and laboratory follow-up. Furthermore in work progress, the percutaneous ultrasonographically guided radiofrequency tissue ablation can be considered a feasible and effective nonsurgical alternative treatment for symptomatic secondary hyperparathyroidism in high-risk patients.

Catheter Ablation↗