Biomedical subjects
Publications and source records attributed to M R Bosco.
The nature of polypoid lesions of the gallbladder is difficult to define. Surgical indication still remains controversial but in some cases mandatory. In this clinical study data were retrospectively evaluated in 25 patients with polypoid lesions who underwent laparoscopic surgery to elucidate the ultrasonic findings and to establish criteria for the best treatment.
The Authors conducted a study on 780 patients who underwent surgery. Fourteen patients developed operative table-induced pressure ulcers of different gravity. This paper is a description of these 14 cases. From the literature and from experience we know that the major exogenous risk factor for intraoperative pressure ulcers is the operation time. Therefore, special attention should be paid to preoperative, intraoperative and postoperative prevention. The knowledge of the pathology, specialized personnel and the use of appropriate facilities can reduce the risks of complication that are important sanitary and economic issue.
Incisional hernia is one of the commonest long-term complications of open abdominal surgery. Especially in old patients (over 70 years), the incisional hernias represent an invalidating pathology whose treatment, for the high incidence of associated respiratory and cardiovascular disease, offers difficulties related to the preoperative and postoperative management as well as to the surgical treatment. This paper reports the Author's experience about the surgical treatment of large incisional hernia (> 10 cm) with open prosthetic mesh repair in geriatric patients.
It's shown by literature and confirmed by Author's experience that, on account of the excellent results, prosthetic repair of inguinal hernia is more effective than "conventional" (Bassini, Mc Vay, Shouldice). Between January 1993 and December 2000 were observed 875 patients with inguinal hernia (814 monolateral, 61 bilateral); all patients underwent a Lichtenstein repair both in the primary version and in its variations (internal ring plastic, trasversalis plicate, plug repair). The patients were discharged from hospital within 24 hours after surgery in 90% of cases. No important intraoperative complications were observed; the patients restarting work varied from 3 to 15 days after the discharging in relation to patient anxiety, onset of complications and to the type of work. The complications observed were: urine retention (1.6%), superficial haematoma (1.3%), superficial infection (1%), wound suppuration (0.5%), serous effusion (0.7%), postsurgery pain (2.1%), scrotal edema (1.7%), persistent inguinal neuralgia (0.6), local hypoesthesia (4.3%), ischemical orchitis (0.1%), recurrence (0.2%). In conclusion Authors assert that "tension free" repair allows optimal results both for the surgery point (easiness of the technique, repeatability, less invasivity, scanty incident of recurrences, low frequency of postoperative complications) and in economic terms, allowing an early mobilization of the patients. A further improvement would be obtained with more care in surgical and patient management, with more excellent results.
The Authors report the outcomes of an epidemiology study concerning the external genital pathologies, carried out on 2400 young males, ranging between 18 and 22 years who underwent the medical inspection for admission to the Air Force Academy. Basing on an andrologic clinical and anamnestic protocol, 229 cases with genital abnormalities, and among them 171 cases of varicocele (8.16%), were detected. The presence of varicocele in all the selected cases was confirmed with proper instrumental investigations (CW Doppler, ecocolorDoppler, telethermography). A randomized sample of 240 out of the 2400 young males, underwent the same investigations as a routine. These investigations enhanced the accuracy in detecting the varicocele, and allowed to identify 3 new cases, all classified as 1st type, in addition to the 19 previously correctly detected by the clinical and anamnestic examination.
The Authors report in this paper the outcomes of a post-operative study based on echo and echo-color imaging in 10 patients who underwent surgery for bilateral groin hernia. On both sides the operation was performed with a "patch and plug" implantation, according to the Rutkow technique. On right sides the polypropilene mesh was fixed to the inguinal orifice with cardinal stitches, while on left sides the mesh was shaped and spreaded on the orifice without any fixation. The U.S. postoperative pictures, performed up to 30 th p.o. day, showed a better stretching of the unfixed meshs, probably owed to a better adapting capability of the free mesh inside the tissues in standing position. The Authors consider significative the correlation between images showing in 7 patient's right sides little irregularities in mesh display, with presence of thin liquid filled spaces, and the moderate postoperative pain, that occurred in the same side in 6 of them.
The aim of this work was to clearly illustrate that the haemodynamic pathogenesis of the varicocele can be a consequence of a retrograde flux along the internal spermatic vein. The reflux is due to the use of a different path of drainage along the internal spermatic vein, which uses some collateral routes of the vessel, and mainly the nephrogenital branch. The diminishing pressure in the final segment of the internal spermatic vein is the focal points of the pathogenesis of the disease. The ontogenetic processes that lead to the formation of the left renal vein help in explaining the almost general one-sidedness of the disorder, its frequency and the fact that it is mostly the young who are affected by it. In fact, the variability of the timing and of the extension of the involution of the primitive venous system and of the processes of evolution which lead to the morphological definition of the tracts of the genital flow down, lead to the various manifestations of the idiopathic varicocele. This theory which also takes into account the physiological mechanisms of the venous drainage to the testicle in an anti-gravitation sense is part of the patterns that, under the diaphragm, rule the entire venous return of the blood toward to the heart.
Bronchogenic carcinoma is one of the tumors with the statistically most markedly rising incidence, at least in western countries. For many years both the resectability and the long-term results have remained invariable due to the serious delay with which the disease is usually diagnosed. In addition, the success of treatment appears to be closely correlated with disease stage; in particular lymph node involvement has a major influence on the long-term survival following adequate treatment. As a consequence, a strong conviction has established itself in recent years, that radical removal of all mediastinal lymph node stations ipsilateral to the operated lung represents not only a necessary staging procedure, but also a useful measure to improve the prognosis of these patients. However, the real utility of radical lymphadenectomy is questioned by a number of groups: on the one hand the supporters of lymph node "sampling", inasmuch as the usefulness of radical lymphadenectomy has not been demonstrated by randomized clinical trials; on the other hand those workers, in particular from Japan, who on the basis of observations of the lymphatic flow in the mediastinum stress the necessity to extend lymph node clearance to the nodal station contralateral to the tumor. The current opinion is changing under the influence of recent developments, for instance the possible use of the sentinel technique also in lung cancer, and the possibility of "reasonable" or targeted lymphadenectomies, planned in relation to the lobar location of individual tumor. Whichever of these approaches is chosen--and this choice is still a matter of debate--many agree about the importance of neoadjuvant treatment not only to render patients eligible for surgery but also to improve the prognosis for patients at the most advanced stages of the disease.
The external biliary drainage in severe jaundice secondary to pancreatic carcinoma acts differently in pre, intra, and postoperative period. In the preoperative period the drainage enables to lower the direct bilirubinemia and the intrahepatic biliary stasis and consequently the complications linked to the impaired hepatic and renal function. During the operation the catheter acts as a guide in performing the biliodigestive anastomosis. In the postoperative period the external drainage of most of daily biliary secretion protects the biliodigestive anastomosis during the postoperative paralytic ileus, and prevents the fistula development along the pancreatic jejunal anastomosis.
The Meckels divetriculum has a prevalence of the 0.3-3%. It is surgically removed only when arise a complication or a neoplasia. The Meckels diverticulum tumors are unfrequent and observed in only the 0.5-3.2% of the Meckels diverticula. The 12% of these tumors are a GIST. We report a case of a gastrointestinal stromal tumor with neural immunophenotype, observed in a patient presenting a deep venous thrombosis perhaps with a paraneoplastic origin. We also report some observations about the state of the art about the GIST management and particularly of all of them arising in a Meckels diverticulum.