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Biomedical subjects

M Bossotti

Publications and source records attributed to M Bossotti.

12 recordsLinked to original sources
PubMed2002

Structural alterations of prosthetic meshes in humans.

The use of prosthetic mesh in abdominal wall hernia surgery is a well-accepted practice. What is not settled, however, is the type of prosthesis that best suits the purpose. The narrow choice today means a prosthesis of polyester or polypropylene. These are available in many designs, configuration of weave, thickness of weave and strand, and size of pore. There has been a pervasive feeling that these materials "shrink". To what extent they do has not been accurately defined. This study was designed to measure such "shrinkage". Interestingly, our measurements revealed that prosthetic meshes could "expand" as well as "shrink". The extent to which they do varies between -40% and 58.5%. Whereas it was felt that fibrocyte activity and its eventual scar formation accounted for the "shrinkage" of the mesh, we have discovered that structural alterations in the size of the mesh pores can be affected by distilled water, saline, blood, formalin, bleach, as well as in vivo implantation. Prosthetic meshes are, therefore, not the inert materials they are claimed to be and can expand as well as shrink. We have, unfortunately, not been able to correlate the degree or direction of change to any known parameter.

Adult↗
PubMed2001

Gasless laparoscopic-assisted ileostomy or colostomy closure using an abdominal wall-lifting device.

BACKGROUND: Restoration of intestinal continuity in patients with ileostomy after total colectomy or with colostomy after Hartmann's procedure is a major operation. Herein we illustrate the validity of gasless laparoscopically assisted reversal using abdominal wall lifting. METHODS: The operation was performed on 10 patients from February 1997 to May 1999. Seven of them had a left iliac stoma after a Hartmann resection, and three had an ileostomy after total colectomy. RESULTS: The laparoscopic reversal was completed in eight patients; the two others were converted to an open procedure. Three major complications occurred (30%). There were no deaths. The average operation time was 192 min (range, 125-265). Time of discharge from surgery averaged 9.5 days. Mean follow-up of these patients was 12 months and negative. CONCLUSIONS: Laparoscopically assisted ileo- or colorectal anastomosis without pneumoperitoneum and using a laparotenser can be considered for the reversal of patients with ileostomy or colostomy. Even taking the high rate of intraoperative or postoperative complications into consideration, the advantages that make such a laparoscopic approach suitable include reduced trauma related to a second major abdominal operation, reduced postoperative pain, and fewer cutaneous tissues exposed to bacterial contamination. Moreover, the use of a laparotenser makes it possible to operate on elderly patients with cardiovascular diseases. In the absence of pneumoperitoneum, it becomes possible to use traditional instruments, with a consequent reduction in costs.

Abdominal Muscles↗
PubMed2000

Incisional hernia and fascial defect following laparoscopic surgery.

Complications involving the abdominal wall, particularly incisional hernias, were not expected when laparoscopic procedures were first introduced. With the increasing number of laparoscopies in abdominal surgery, more incisional hernias are observed. The authors report 13 cases of umbilical incisional hernia, which occurred late after laparoscopic cholecystectomy, and one case of omental procidentia through a lateral port, which occurred early after laparoscopic hernia repair with the transabdominal preperitoneal technique. There are 4 men and 10 women (mean age, 59.8 years; range, 40-74 years). Between March 1991 and December 1997, a total of 1,287 patients underwent laparoscopic operations at the Surgical Department of the Gradenigo Hospital in Turin, Italy. Incisional hernia incidence is 1%. Risk factors, such as chronic bronchitis or weight increase, which give rise to endoabdominal pressure, are present in some cases. Malnutrition may have a major role in many cases. Calculi larger than 15 mm are also seen frequently. Postlaparoscopy incisional hernia is generally a minor complication--only once did its occurrence cause a strangulated hernia. All precautions, including fascial suturing, must be taken to reduce the 1% incidence of postoperative incisional hernias.

Adult↗
PubMed1999

Incisional hernia and fascial defect following laparoscopic surgery.

Complications involving the abdominal wall, particularly incisional hernias, were not expected when laparoscopic procedures were first introduced. With the increasing number of laparoscopies in abdominal surgery, more incisional hernias are observed. The authors report 13 cases of umbilical incisional hernia, which occurred late after laparoscopic cholecystectomy, and one case of omental procidentia through a lateral port, which occurred early after laparoscopic hernia repair with the transabdominal preperitoneal technique. There are 4 men and 10 women (mean age, 59.8 years; range, 40-74 years). Between March 1991 and December 1997, a total of 1,287 patients underwent laparoscopic operations at the Surgical Department of the Gradenigo Hospital in Turin, Italy. Incisional hernia incidence is 1%. Risk factors, such as chronic bronchitis or weight increase, which give rise to endoabdominal pressure, are present in some cases. Malnutrition may have a major role in many cases. Calculi larger than 15 mm are also seen frequently. Postlaparoscopy incisional hernia is generally a minor complication--only once did its occurrence cause a strangulated hernia. All precautions, including fascial suturing, must be taken to reduce the 1% incidence of postoperative incisional hernias.

Adult↗
PubMed1997

[Squamous carcinoma of the gallbladder. Anatomo-clinical study of a case with reference to oncogene expression].

Squamous cell carcinoma of the gallbladder is a rare tumor with an ill-defined clinical course. We report a case of pure squamous carcinoma of the gallbladder with a rapidly fatal outcome. The tumor cells were positive for oncogenes P53, c-Erb B2 and Ki 67. This feature has no comparison with other reported cases of squamous carcinoma of the gallbladder but it is in accordance with oncogene expression in adenocarcinomas.

Carcinoma, Squamous Cell↗
PubMed1994

[Inguinal hernia: technics compared in our experience. Hernioplasties compared].

The authors describe their survey carried out on 875 patients operated on for inguinal hernia between 1984 and 1989. 412 of these patients were checked in the out-patients' department after a minimum 2 year period. The regular check-up parameters were assessed, paying particular attention to the problem of recurrence. This occurred in 47 patients, which is equal to 11% of the total for the Bassini and Postempski techniques, and 8.9% for the Shouldice method. On first observation, statistical data analysis carried out on the results obtained, do not show any significant differences. However, notwithstanding the fact that the authors are at the initial stages with chances of varying results, important data have emerged in favour of the canadian technique.

Adolescent↗
PubMed1992

[Antibiotic prophylaxis with aztreonam in general surgery].

Personal experience in peroperative antibiotic prophylaxis with aztreonam (Azactam) in 81 patients undergoing abdominal surgery of choice is reported. The usefulness, handiness and lack of side-effects of this parenteral drug are reiterated. The incidence of surgical wound infections was 2.5%, while that of associated infections was 6.1%. Considering these results, the use of aztreonam (Azctam) is recommended in peroperative prophylaxis as a drug of choice.

Adult↗
PubMed1990

Immunologic conditions and infectious complications in colon and rectal surgery for neoplasms.

The authors evaluated the peroperative immunologic state of patients with colorectal tumors and controlled the postoperative incidence of infections. Twenty-one patients were studied, and delayed type hypersensitivity reactivity determined by the CMI multitest (Merieux) eight days before and eight days after surgery. A lymphocytogram was performed using monoclonal antibodies. A significant percentage of patients were anergic preoperatively. Immunologic analysis revealed lymphocytosis in the first postoperative period. The largest absolute quantitative increase was shown by NK CD16+ cells. It is possible that the results, obtained by dynamic monitoring of the main parameters of cellular immunity, will offer a new way for prognostic evaluation of surgical risk.

Adult↗
PubMed1985

[Infusion and transfusion therapy in polytraumatized patients].

Considerations of a physiopathological nature are expressed with regard to haemorrhagic multiple-injury patients in the light of the experience acquired in first-aid practice at the University of Turin department of emergency surgery. While treatment of the basic injury is the key to therapy, sufficient infusion management and careful monitoring of coagulation parameters before and during transfusion may be of fundamental importance in survival. By the same token, not all blood products available can be used indiscriminately. A treatment and monitoring protocol for the reinstatement of volaemia and corpuscle mass, and for the correction of coagulopathy due to loss, consumption and wash-out is proposed.

Blood Transfusion↗
PubMedDate not supplied

Ileal perforation due to ileocecal endometriosis: a case with an unusual clinical and pathological presentation.

A 34-year-old woman, was admitted to the emergency room of our hospital with a history of symptoms of abdominal pain dating back several years and transitorily related to the menstrual cycle. These had worsened in the days prior to admission. Radiological and clinical examinations detected no signs of peritonitis. During exploratory operative laparoscopy, opted for because of persistence and intensification of the abdominal pain, diffuse peritonitis was found due to an ileal perforation immediately upstream of an ileocaecal mass causing a precaecal stenosis. Laparoscopy enabled us to diagnose the preoperatively undetected complication, to perform a through peritoneal lavage and, following minimal conversion by laparotomy, to perform ileocaecal resection, thereby limiting the severity of the surgical trauma. The definitive pathological diagnosis was ileocaecal endometriosis with signs of transmural fistulisation and the presence of endometrial glandular structures in one of the lymph nodes around the lesion. Perforation is a rare complication on those segments of the intestine most often affected by endometriosis, such as the colon and appendix. However, it is even more unusual when it affects the ileum and no other cases have been reported in the literature. Its genesis is attributed to late diagnosis. The pathological findings highlight the particular characteristics of this case. We would stress the pre-, intra- and postoperative diagnostic difficulties encountered and the importance of a thorough anamnestic assessment when making differential diagnoses in women of child-bearing age with abdominal or pelvic pain and perimenstrual symptoms.

Adult↗