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In this paper, we describe a case of a 73-year old female with late skeletal muscle metastases from a clear-type renal cell carcinoma 8 years after total nephrectomy. The metastases were located in the right femoral quadriceps, in the... more
In this paper, we describe a case of a 73-year old female with late skeletal muscle metastases from a clear-type renal cell carcinoma 8 years after total nephrectomy. The metastases were located in the right femoral quadriceps, in the sartorius muscle and adductor magnus muscle. A full clinical work-up was performed with blood examinations, radiological and pathological assessment. A complete surgical resection with a wide margin was performed for all lesions, and the final pathological report deposed for metastatic renal carcinoma clear-type cells. In this case report, we discuss the crucial rule of accurate radiological and pathological assessment and aggressive surgical management.
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A Day Surgery unit can be defined as a service dedicated to those patients which are not eligible for a simple ambulatory treatment, though requiring a short hospital stay for less than 12 hours. The Italian regulation for Day Surgery has... more
A Day Surgery unit can be defined as a service dedicated to those patients which are not eligible for a simple ambulatory treatment, though requiring a short hospital stay for less than 12 hours. The Italian regulation for Day Surgery has been developed in the last 80's. Three models have been defined: 1) Autonomous unit; 2) Mono o multidisciplinary units: 3) Dedicated beds. Admission criteria are clinical data, age, familial support. The Tor Vergata University Hospital has an autonomous multidisciplinary Day Surgery unit, opened on November 22, 2002. Cost and clinical data are independently calculated and stored, allowing as to evaluate the activity of the first 14 months of its life (Nov 02-Dec 03). 5288 patients have been treated, with a preliminary access for lab and clinical evaluation, a surgical procedure and postoperative controls. The Author have calculate that treating as in patients would have needed a dept of 40 beds. DS offers both 1) economics, and 2) social advant...
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Minilaparoscopic appendectomy for appendicitis is not a well-established procedure. This approach provides less abdominal wall trauma, fewer complications, and excellent cosmetic results. Our aim was to show the feasibility and safety of... more
Minilaparoscopic appendectomy for appendicitis is not a well-established procedure. This approach provides less abdominal wall trauma, fewer complications, and excellent cosmetic results. Our aim was to show the feasibility and safety of the minilaparoscopic approach. Minilaparoscopic appendectomy was performed in 37 patients. Two 2.2-mm trocars were used to manipulate a 2.2-mm, 0-degree laparoscope and for grasper access. A 5-mm trocar was used for the ultrasonic scalpel. No deaths occurred. In 3 patients (8%), appendectomy was aborted due to pathology of the ovary. Conversion to the open approach occurred in 2.7% of patients. The average operating time was 34 minutes (range, 15 to 80), and the median length of hospital stay was 1.2 day (range, 1 to 5). The minilaparoscopic approach a) has the same advantages as the conventional laparoscopic approach in terms of better diagnostic accuracy and safety; b) a low incidence of complications; and c) yields excellent cosmetic results.
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Trocar-site incisional hernias and their complications are reported in 1% to 6% of patients. Such hernias are attributed to the difficulty of applying standard suturing techniques to wound closure. We report our experience with a simple... more
Trocar-site incisional hernias and their complications are reported in 1% to 6% of patients. Such hernias are attributed to the difficulty of applying standard suturing techniques to wound closure. We report our experience with a simple device, the Deschamps ligature needle. The Deschamps needle has a handle and a tip (sharp or blunt), with an opening to pass suture. The blunt tip is very effective for closing trocar sites. Disposable needles are obviously sharp, but can bend on the needle holder and break in a deep small incision. The Deschamps needle is a rigid, noncutting instrument that can be forced through fascia and peritoneum (around the surgeon's fingertip) avoiding loss of pneumoperitoneum. A full-thickness closure is accomplished. We perform closure under direct vision through the scope. Tactile sense is provided by the surgeon's finger. The last trocar site is closed in the same manner without the scope. We have used the Deschamps needle since 1992 in all (1400) ...
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The aim of the study was to evaluate the efficacy of parathyroid hormone 1-hour assay for the early prediction of hypoparathyroidism after thyroidectomy. Candidates for total, subtotal, completion thyroidectomy or lobectomy were entered... more
The aim of the study was to evaluate the efficacy of parathyroid hormone 1-hour assay for the early prediction of hypoparathyroidism after thyroidectomy. Candidates for total, subtotal, completion thyroidectomy or lobectomy were entered into the study. Pre- and postoperative calcium and parathyroid hormone (1 hour and postoperative day 1 after thyroidectomy) levels and clinical hypocalcaemia were recorded. Patients were divided into 3 groups and 2 subgroups: 1. patients who underwent lobectomy (control group); 2. patients who underwent total thyroidectomy with postoperative hypocalcaemia (2A: asymptomatic patients, 2B: symptomatic patients); 3. asymptomatic patients with normal calcium levels after total thyroidectomy. Of 119 patients, 109 underwent total thyroidectomy and 10 lobectomy. Of the 109 patients submitted to total thyroidectomy, 35 (32.11%) developed postoperative transient hypocalcaemia. Twenty-one patients (19.27%) were asymptomatic and 14 (12.84%) were symptomatic. Par...
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ABSTRACT
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Trocar-site incisional hernias and their complications are reported in 1% to 6% of patients. Such hernias are attributed to the difficulty of applying standard suturing techniques to wound closure. We report our experience with a simple... more
Trocar-site incisional hernias and their complications are reported in 1% to 6% of patients. Such hernias are attributed to the difficulty of applying standard suturing techniques to wound closure. We report our experience with a simple device, the Deschamps ligature needle.
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In this retrospective study the functional results of microsurgical repair of iatrogenic recurrent nerve lesions (10 patients) faced during years 1983 through 1995 have been analysed. Different parameters were considered (thyroid disease,... more
In this retrospective study the functional results of microsurgical repair of iatrogenic recurrent nerve lesions (10 patients) faced during years 1983 through 1995 have been analysed. Different parameters were considered (thyroid disease, previous thyroid surgery, microsurgical reconstruction technique, time between surgical damage and microsurgery). Furthermore, a thorough review has been made on the medical literature on subjects such as surgical anatomy of the cervical region, microsurgical nerve repair techniques, and clinical results of microsurgery in different authors experiences.
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The Authors present a short review of the literature comparing transrectal ultrasound of the prostate (TRUS) and ultrasound guided biopsy and the results of 694 consecutive prostatic biopsies from their cohort. All the biopsies were US... more
The Authors present a short review of the literature comparing transrectal ultrasound of the prostate (TRUS) and ultrasound guided biopsy and the results of 694 consecutive prostatic biopsies from their cohort. All the biopsies were US guided with an endorectal biplanar 5 MHz probe and transperineal samples were carried out with an 18 G needle (cutting length 22 mm) over the last 4 years. The histological exam showed 187 prostates affected by cancer while 112 had only inflammation. The operator's opinion, based on ultrasonography and integrated with a digital rectal exam (DRE) and a prostate specific antigen (PSA) blood test, was correct in 80% of the cases, with 90% sensitivity and 70% specificity. The positive prediction rate was 74% and the negative prediction rate was 89%.
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Post-phlebitis syndrome of the lower limbs is a set of symptoms that follow a state of phlebostasis and phlebolymphostasis with consequent oedema and tissue distress. We submitted 36 patients with post-phlebitis syndrome of the lower... more
Post-phlebitis syndrome of the lower limbs is a set of symptoms that follow a state of phlebostasis and phlebolymphostasis with consequent oedema and tissue distress. We submitted 36 patients with post-phlebitis syndrome of the lower limbs to radioisotopic lymphoscintigraphy for the purposes of evaluating the vicariant function of the lymphatic system and the possible role of the lymphatic system in the genesis of dermo-epidermal abnormalities. The average age of the patients was 53.2 years (range: 43-69 years; M:F ratio: 0.50). The control group consisted of 6 healthy subjects. The average duration of the post-phlebitis syndrome in the patients studied was 8.5 years. We excluded from the study patients in whom a central cause was identified as being responsible for the pathogenisis of the oedema of the lower limbs. In addition, patients with obliterant arteriopathy were also excluded. Venous pathology was evaluated first clinically and then investigated by continuous-wave Doppler. ...
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Percutaneous biopsy is considered one of the most important diagnostic tools to evaluate diffuse liver diseases. The introduction and widespread diffusion of ultrasounds in medical practice has improved percutaneous bioptic technique,... more
Percutaneous biopsy is considered one of the most important diagnostic tools to evaluate diffuse liver diseases. The introduction and widespread diffusion of ultrasounds in medical practice has improved percutaneous bioptic technique, while reducing postoperative complications. Although ultrasonography has become almost ubiquitous in prebiopsy investigation, only one third of biopsies are performed under ultrasound control. Moreover, the one-day procedure, reported in several studies to be safe and cost effective, accounted for only 4% of biopsies done. We report our experience of 142 percutaneous US-guided biopsies performed on 140 patients affected by chronic diffuse liver disease over a four-year period. Liver biopsies were performed under US guidance at the patient's bed using an anterior subcostal route. We evaluated postoperative pain, modifications of blood pressure and red cell count, hospital stay, morbidity and mortality rates, and adequacy of specimens for histologic ...
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In this retrospective study the functional results of microsurgical repair of iatrogenic recurrent nerve lesions (10 patients) faced during years 1983 through 1995 have been analysed. Different parameters were considered (thyroid disease,... more
In this retrospective study the functional results of microsurgical repair of iatrogenic recurrent nerve lesions (10 patients) faced during years 1983 through 1995 have been analysed. Different parameters were considered (thyroid disease, previous thyroid surgery, microsurgical reconstruction technique, time between surgical damage and microsurgery). Furthermore, a thorough review has been made on the medical literature on subjects such as surgical anatomy of the cervical region, microsurgical nerve repair techniques, and clinical results of microsurgery in different authors experiences.
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The authors present two patients (mother and son) affected by cystadenolymphoma (Warthin's tumor) of the salivary glands, both surgically treated. A thorough review of the literature is conducted and the authors suggest that... more
The authors present two patients (mother and son) affected by cystadenolymphoma (Warthin's tumor) of the salivary glands, both surgically treated. A thorough review of the literature is conducted and the authors suggest that echographic screening of these neoplasia in first-degree relatives could be of value.
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The prognostic parameters most universally accepted as indicative for the assessment of 5 and 10 year survival in breast cancer are considered. The aims of this study were to elucidate the relationships among these parameters and to... more
The prognostic parameters most universally accepted as indicative for the assessment of 5 and 10 year survival in breast cancer are considered. The aims of this study were to elucidate the relationships among these parameters and to determine the specific interrelations of these prognostic factors. These parameters (age, grading, tumour size, lymphatic and vascular invasion, necrosis, lymph node status and number of nodes positive) are analysed by univariate and multivariate analysis on a series of 75 patients. The analysis performed confirms prognostic accuracy of age, tumor size, number of nodes positive (p < 0.05, p < 0.001, p < 0.003, respectively) when considered singularly but the impossibility of deriving any benefit from the study of their reciprocal interrelations. This is due to the importance of each parameter assumes independently from the other and to the reciprocal compensation that occurs when all possible interactions are considered.
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Among the late complications of high-dosage pelvic radiotherapy for cervical cancer, anorectal and bladder malignancies are sporadically reported in the literature. In this study the possible relationships of previous radiotherapy with... more
Among the late complications of high-dosage pelvic radiotherapy for cervical cancer, anorectal and bladder malignancies are sporadically reported in the literature. In this study the possible relationships of previous radiotherapy with late appearance of neoplasms are analyzed and in particular post-radiotherapy interval, dosage and type or irradiation to the cervical area. The mechanisms or neoplastic transformation or irradiated tissues are also studied. Three clinical cases or women irradiated in the past because or cervical cancer and recently treated at our surgical Division for the appearance or four new pelvic malignancies in the irradiated field (three rectal and one bladder cancer are presented. In conclusion, the possible cause-effect relationships between previous radiotherapy and subsequent appearance of neoplasms are analyzed as well as the potential therapeutical consequences or considering these women high-risk subjects. The usefulness or recruiting women with history...
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The difference in biologic behavior of Hürthle-cell neoplasms as reported in several series may be explained by the use of different diagnostic pathologic criteria, and the selection of patients with neoplasms of varying clinical stages... more
The difference in biologic behavior of Hürthle-cell neoplasms as reported in several series may be explained by the use of different diagnostic pathologic criteria, and the selection of patients with neoplasms of varying clinical stages (treatment at the time of initial diagnosis versus treatment for advanced disease, or initial diagnosis at an advanced stage). On the basis of all of the available evidence, it appears that Hürthle-cell neoplasms exhibit a biologic behavior similar to that of corresponding follicular neoplasms although these latter tumors may have a slightly higher propensity to metastasize. Survival and cure rates are lower than those for papillary cancer and are comparable to those for follicular carcinoma. DNA analysis may be of some help in predicting clinical behavior; aneuploid neoplasms are more often associated with the pathologic features of malignant tumors and may follow a more aggressive clinical course. At present, however, we are unaware of specific sur...
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The incidence of hemobilia following percutaneous liver biopsy ranges between 0 and 1%. It is an unpredictable complication and the lack of symptoms or delay in their presentation further complicates its diagnosis. We report a case of... more
The incidence of hemobilia following percutaneous liver biopsy ranges between 0 and 1%. It is an unpredictable complication and the lack of symptoms or delay in their presentation further complicates its diagnosis. We report a case of hemobilia after US-guided percutaneous liver biopsy for diffuse HCV-related liver disease. The diagnosis of hemobilia was established 6 days after the percutaneous liver biopsy by endoscopic retrograde cholangiopancreatography. After superselective catheterization of the feeding artery, vascular occlusion was successfully obtained with gel foam pledges and the patient was discharged 7 days after the procedure.
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Chronic abdominal pain syndrome is becoming increasingly important with regard to the quality of life of the patients and its social and economic impact, in terms of cost of hospitalization, income loss due to sick leave, and... more
Chronic abdominal pain syndrome is becoming increasingly important with regard to the quality of life of the patients and its social and economic impact, in terms of cost of hospitalization, income loss due to sick leave, and pharmaceutical costs for treatments which fail to offer either significant clinical improvement or resolution of the pain symptoms. The main symptom is chronic abdominal pain, which may vary in intensity and may be associated with constipation and episodes of vomiting, when the clinical picture evolves toward one of subocclusion or total occlusion of the bowel. We considered the following criteria in our selection of patients for this study: 1) quality of life, 2) constant use of antispastic and analgesic medications, 3) absence of any other diagnosticable pathology prior to the operation. From August 1992 to April 2000 we operated on 105 patients with this syndrome (16 males and 89 females). Among these 8 patients had never been subjected to a laparotomy, whil...