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ABSTRACT: AIM: To establish if the indication for different approaches for thyroidectomy and the incision length provided by means of pre-operative assessment of gland volume and size of nodules resulted in safe and effective outcomes and in any notable aesthetic or quality-of-life impact on patients. MATERIALS AND METHODS: Ninehundred eightytwo consecutive patients, undergoing total thyroidectomy, were enrolled. The thyroid volume and maximal nodule diameter were measured by means of ultrasounds. Based on ultrasounds findings, patients were divided into three groups: minimally invasive video assisted thyroidectomy (MIVAT), minimally invasive thyroidectomy (MIT) and conventional thyroidectomy (CT) groups. The data concerning the following parameters were collected: operative time, postoperative complications, postoperative pain and cosmetic results. RESULTS: The MIVAT group included 179 patients, MIT group included 592 patients and CT group included 211 patients. Incidence of complications did not differ significantly in each group. In MIVAT and MIT group, the perception of postoperative pain was less intense than CT group. The patients in the MIVAT (7±1.5) and MIT (8±2) groups were more satisfied with the cosmetic results than those in CT group (5±1.3) (p= <0.05). CONCLUSIONS: The MIT is a technique totally reproducible, and easily convertible to perform surgical procedures in respect of the patient, without additional complications, increased costs, and with better aesthetic results. KEY WORDS: Minimally Invasive Thyroidectomy, MIT, Minimally invasive video-assisted thyroidectomy, MIVAT, Thyroidectomy.
Annali italiani di chirurgia 10/2012; · 0.23 Impact Factor
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ABSTRACT: BACKGROUND: Axillary lymphadenectomy or sentinel biopsy is integral part of breast cancer treatment, yet seroma formation occurs in 15-85% of cases. Among methods employed to reduce seroma magnitude and duration, fibrin glue has been proposed in numerous studies with controversial results. METHODS: Eighty patients underwent quadrantectomy or mastectomy with level I/II axillary lymphadenectomy; a suction drain was fitted in all patients. Fibrin glue spray were applied to the axillary fossa in 40 patients; the other 40 patients were treated conventionally. RESULTS: Suction drainage was removed between post-operative Days 3 and 4. Seroma magnitude and duration were significantly reduced (p=0.004 and 0.02, respectively), and there were fewer evacuative punctures, in patients receiving fibrin glue compared with the conventional treatment group. CONCLUSIONS: Use of fibrin glue does not always prevent seroma formation, but does reduce seroma magnitude, duration and necessary evacuative punctures. KEY WORDS: Breast cancer, Fibrin glue, Seroma.
Annali italiani di chirurgia 10/2012; · 0.23 Impact Factor
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ABSTRACT: INTRODUCTION: The aim of this study was to verify the effectiveness of hyaluronic acid in preventing adhesion formation after endoperitoneal surgery in which prosthetic polypropylene mesh is placed directly on the viscera. Methods: Forty albino rats were included in this study and the animals were randomized to the following 4 groups each with 10 rats: polypropylene prosthesis (PP), PP+hyaluronic acid (HA), Hertra prosthesis (HP), HP+HA. A large defect was created in the anterior abdominal wall of each rat and repaired in different ways. In the first group a polypropylene mesh was placed intraperitoneally, while, in the second group the peritoneal surface of the mesh was impregnated with HA. In the third group a Hertra 0 polypropylene rigid mesh was placed intraperitoneally and, in the fourth group, the peritoneal surface of the Hertra 0 mesh was impregnated with HA. Clinical controls on the animals were carried out at 1 month. Each group was divided into two subgroups in which the controls and the prosthetic explantation were randomly carried out at 3 and 6 months. Explanted prostheses were subjected to histological and immunohistochemical analysis, and examined for shrinkage. An assessment of adhesion formation was performed, evaluating the quantity and tenacity of the adhesions. RESULTS: We demonstrated higher levels of adhesions in rats with PP than in those with HP and lower levels in rats with a protective layer of hyaluronic acid. The amount of fibronectin in the periprosthetic fibrotic tissue and the histological score confirmed the previous data. CONCLUSIONS: Hertra 0 mesh with HA provided the best results in terms of physical stability and resistance to adhesion formation. KEY WORDS: Hyaluronic acid, Peritoneal adhesions, Polypropylene, Shrinkage, Ventral hernia repair.
Annali italiani di chirurgia 10/2012; · 0.23 Impact Factor
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ABSTRACT: In consideration of the use of fibrin glue in a general surgery department, authors analyze their last two years series. Operations on liver and biliary ducts, bowel and proctologic surgery, thyroid and breast surgery, abdominal wall hernias, fistulas and difficult wounds are considered with a literary review on fibrin sealant. KEY WORDS: Biological glue, Fibrin sealant, General surgery.
Annali italiani di chirurgia 10/2012; · 0.23 Impact Factor
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ABSTRACT: A 62 y.o. male with tight fimosis, swelling, redness, pain on palpating and necrosis of the penis and scrotum was admitted in our clinic, (FGSI = 6) with periferic vasculopathy; and diabetes mellitus type II and he was in dialysis treatment before the hospitalization. The patient was HCV affected. In 24 hours he underwent radical surgical debridement with excision of all necrotic material from penis and scrotum up to the subdermal layer and tissue of doubtful viability for about 75% of the skin and circumcision. In third, fifth and seventh postoperative days he underwent to local infusion of autologous PLT growth factors. The patient was discharged in 9th postoperative day and FGSI was still 6; the skin and subdermal tissue was barely reskined, with low homogeneous granulation, edema was heavely reduced. In our case, deviation from homeostasis status at admission was the main worrying factor. We found that diabetes mellitus and renal dysfunction at admission was also important risk factor for FG. "E.Coli" was the most common organism isolated from patient wound cultures. The FGSI is an objective and easy to apply score method to quantify the metabolic status and can be used to evaluate therapeutic options and assess results. KEY WORDS: Fascitis, Fournier, Gangrene, Infection, Necrotizing, Syndrome, Tissue.
Annali italiani di chirurgia 08/2012; 84(1):111-5. · 0.23 Impact Factor
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ABSTRACT: Background: The widespread use of surgical lasers has found place in dermatologic and aesthetic surgery largely because they are well tolerated with a reduced incidence of postoperative haemorrhage and oedema, few associated adverse events and a high rate of patient satisfaction. Patients and methods: A retrospective analysis of 1232 consecutive patients was performed on patients undergoing a range of laser treatments between January 2005 and January 2010. A mixed variety of indications for laser use included dermatologic surgeries for the removal of fibromas, angiomas and naevi, aesthetic surgeries for acne, superficial vascular conditions, facial rejuvenations and remodelling and tattoo removals as well as many miscellaneous conditions. A range of lasers were employed including CO2, Erbium: Yttrium Aluminum Garnet (Er:YAG), diodes, Alexandrite, Ruby and Neodymium:Yttrium Aluminum Garnet (Nd:YAG) lasers with variable use for different indications in combination with a selective protocol of topical anaesthesia and local cooling systems. Results: Patient satisfaction was high overall (92.4%) with most reported failures amongst those treated for general surgical conditions where there were the highest recorded complication rates. The main failures occurred in those with small cutaneous telangiectases (36.2% incomplete treatment response and 31.9% dissatisfaction rate). In those patients where lasers were used for aesthetic reasons,(most notably in those undergoing tattoo or scar removal and in those with hypertrichosis and dermatofolliculitis), incomplete results occurred in 7.2% with an 11.8% dissatisfaction rate and rare complications (0.9%). In this group, the highest reported incomplete results occurred in patients undergoing tattoo removal (13.9%), followed by scar removal (12.5%) and then by those undergoing treatment for hypertrichosis and dermatofolliculitis (8.8%). Conclusions: Laser use in general surgery is associated with a high success rate for a wide variety of conditions with high patient satisfaction and a low incidence of adverse events in experienced hands. The advantages and disadvantages as well as the specific recommendations for different laser types are presented with clinical advances resulting from the development of non-ablative laser systems designed for dermal remodeling. Key words: Cross-disciplinary, General surgery, Laser, Outpatient.
Annali italiani di chirurgia 06/2012; · 0.23 Impact Factor
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ABSTRACT: Objective: The ultrasonic scalpel is a surgical shear that uses high-frequency mechanical energy to enable simultaneous vessel sealing and tissue coagulation at the same time. We conducted a prospective randomized study to compare the outcome of total thyroidectomy using the ultrasonic scalpel versus standard clamp and tie (CT) procedure in terms of safety, operative time, overall drainage volume, complications, hospital stay. Methods: Between January 2008 and December 2010, 200 patients (130 women, 70 men; mean age 46 years) undergoing thyroidectomy were randomized into two groups: group A, where CT technique were used, and group B, where the ultrasonic device was used. Results: There was no significant differences between the two groups in terms of age, gender, indication for thyroidectomy, thyroid gland weight and diameter, histopathologic diagnosis, preoperative and postoperative serum calcium levels, postoperative complications and reoperative thyroid surgery. In group B there is a statistically significant reduction of the operative times (63 ± 9' vs 85 ± 15', P<0.001) and overall drainage volume (50 ± 20cc vs 70 ± 25cc, P<0.001) . Conclusions: The ultrasonic scalpel is safe, effective, useful, and time-saving alternative to the traditional suture ligation technique for thyroid surgery. They simplified total thyroidectomy, eliminating the need for clamp-and-tie maneuvers while achieving efficient hemostasis. Our study shows that the use of ultrasound in thyroid surgery reduces significantly surgical time and overall drainage volume. Furthermore, we also verified a decrease in hospitalization time, postoperative pain and blood loss, without increasing complication rates, for patients who underwent total thyroidectomy with the ultrasonically activated shear. Key words: Hemostasis, Thyroidectomy, Ultrasonic device.
Annali italiani di chirurgia 05/2012; · 0.23 Impact Factor
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ABSTRACT: The "PIP problem", in the field of the breast augmentation, represents today a surgical epidemiological emergency. The massive media coverage produced a kind of mass fear and many women are asking for explantations. A 47 y.o. female, breasts implanted with PIP devices for breast augmentation in 1998, came to our clinic asking for explantation and excisional biopsy of a 2.5 cm nodule adjacent to the upper side of the breast implant capsule. The outcome of the pathologic examination of the excised nodule was: ductal infiltrating carcinoma of the breast, medium degree of differentiation. After 7 days from the first operation the patient underwent a skin-sparing mastectomy with axillary limphadenectomy and immediate reconstruction by a submuscular placement of implant. The surgical specimen sent for pathologic examination revealed: "granulomatous inflammation by giant cells around extraneous material, lymph nodes, negative for cancer, showed extensive accumulation of foamy macrofages containing extraneous material". The findings of foreign material in granulomas and macrophages that are the primary inflammation body defense, suggest that the chronic inflammation, coming from mammary implants subject to leakage or/and osmotic shift, increase the risk of breast cancer. We therefore suggest improving the explantation/replacement of old implants. KEY WORDS: Breast cancer, Extraneous material, Immediate breast reconstruction, Inflammation, Pip Implant.
Annali italiani di chirurgia 01/2012; 83. · 0.23 Impact Factor
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Rodolfo Nasti,
Ornella Carbonara,
Maria L Mangoni di Santo Stefano,
Roberta Auriemma,
Sabato Esposito,
Giuseppe Picardi,
Nadia Lascar,
Antonio Pagano, Roberto Ruggiero,
Roberto Torella,
Ferdinando C Sasso
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ABSTRACT: Non-invasive testing often does not identify coronary artery disease (CAD) in diabetic subjects. This study was designed in order to examine the prevalence of CAD in a cohort of asymptomatic type 2 diabetic patients at high cardiovascular risk and negative nuclear imaging, using multi-slice computed tomography (MSCT) angiography.
In total, 770 type 2 diabetic patients were screened from January 2008 through July 2010. Of these, 132 Caucasians with diabetic nephropathy and asymptomatic for angina were eligible for a cross-sectional study. Patients underwent MSCT after ischaemia was excluded by myocardial Single Photon Emission Computed Tomography (SPECT) at rest and after dynamic exercise. When obstructive plaques were found (≥ 50% lumen narrowing), patients were sent to conventional coronary angiography (CCA).
Six subjects were not included in the analysis because of motion artefacts. MSCT was positive for CAD in 114 patients (90%). Within patients with positive MSCT, 60 (48% of all) showed one or more obstructive plaques. CCA confirmed significant stenosis (≥ 50%) in 48 of these 60 patients (80%). Some 21 (35%) showed stenosis ≥ 75% and were submitted to the revascularisation procedure.
MSCT seems to better identify CAD than myocardial SPECT in asymptomatic patients with type 2 diabetes and diabetic nephropathy.
Diabetes & Vascular Disease Research 11/2011; 9(1):10-7. · 2.12 Impact Factor
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ABSTRACT: Intra abdominal hypertension (IAH) is defined as an intra-abdominal pressure (IAP) >12 mmHg. Abdominal compartment syndrome (ACS) is defined as an IAP above 20 mmHg with evidence of organ dysfunction/failure. The real incidence of the ACS is not clear, because there are few perspective studies. The origin of ACS can be divided into retroperitoneal, intraperitoneal, parietal and intestinal, and the diagnostic algorithm includes base and toxicological laboratory examinations, thorax X-ray, abdomen X-ray, abdomen TC, peritoneal washing, abdomen ultrasonography, diagnostic laparoscopy, and measurement of IAP. To allow a suitable decompression and avoid the damages to the abdominal organs, abdominal wall normally is not sutured primarily but secondarily and there are many methods of temporary closing: absorbable net, non-absorbable nets, 'Bogota bag', 'vacuum pack ice', gradual approximation of side cutaneous edges on the half-way line with permanence of an ample ventral hernia that could be subsequently repaired, and the use of 'skin expanders'. Since January 2000, until December 2008, eight patients were submitted to laparostomy, four of them for re-laparotomy, with mortality incidence of 37.5%. The defective size to fill was on the average 300 cm as reported by Bradley and Bradley (J Clin Invest 26:1010-1015, 1947). The abdominal wall reconstruction was performed using ample muscle edges derived from the slip in medial sense of the rectus muscle of the abdomen 'unmoored' through an incision 1 cm distant from semi-lunar line, and using absorbable prosthesis to cover the solution of continuity, thus allowing the closing of defects over 30 cm. We have found median post surgical hernia in one patient corrected in accordance with the time using polypropylene prosthesis. In one patient with parietal disaster and multiple traumatic splanchnic ruptures, we have used a pure pork-derived acellular collagen mesh (Permacol(®)) to close the wound, leaving enough space between fascia extremities, to solve the IAP. The employment of ample muscle edges represents the ideal solution in the reconstruction of the abdominal walls after laparotomic operations, offering a valid dynamic support preferable in comparison with the employment of alloplastic material. In consideration of the limits of this technique in the enormous parietal disaster-ACS treatment, we describe a new kind of innovative mesh application (Permacol(®)), most often used for parietal disaster or enormous incisional hernias, which can easily be preferred to dual mesh prosthesis, having a better biological profile and no capacity to produce intestinal adherences.
Updates in surgery. 06/2011; 63(4):271-5.
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Angela Pezzolla,
Giovanni Docimo, Roberto Ruggiero,
Massimo Monacelli,
Roberto Cirocchi,
Domenico Parmeggiani,
Giovanni Conzo,
Adelmo Gubitosi,
Serafina Lattarulo,
Anna Ciampolillo,
Nicola Avenia,
Ludovico Docimo,
Nicola Palasciano
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ABSTRACT: In recent years it has seen an increase of incidental thyroid carcinomas (ICs), most of the ICs are any microcarcinoma (MC). The term refers to a CT, predominantly papillary, and smaller than or equal to 1 cm. The MC is characterized by a papillary heterogeneous clinical behavior ranging from small outbreak discovered accidentally after surgery than the cancer that manifests clinically with lymph node metastases in the neck or rarely systemic.
From January 2007 to June 2009, 1507 patients for benign disease were subjected to surgery.
Histological examination confirmed the diagnosis of benignity in 1339 cases. In 168, however, we detected unexpected, incidental carcinoma (CI). In patients with CI receiving total surgery (TT), the next iteration we agree with the endocrinologist. In cases of lobectomia, was run TT and was heading endocrinology. Of the 168 patients with incidental CT, 147 had papillary carcinomas, 12 follicular carcinomas, 5 follicular variant papillary carcinomas, 2 oncocytic carcinomas, 1 uncertain malignancy.
In our study has highlighted the lack of data (medical history, ultrasound, scintigraphic), they may portend the presence of a tumor in the specimen CI. In all patients with CI, the surgical indication was given for symptomatic disease, for impairment of thyroid function, for failure to respond to medical therapy or unable to continue. The IC is almost always a microcarcinoma, predominantly papillary, and smaller than or equal to 1 cm, has little biological aggressiveness and is susceptible to metabolic radioiodine therapy. On the basis of these data we feel reasonably acceptable to a close follow-up endocrine surgery, particularly in patients with multinodular disease and stress the need for a multi-specialized team.
Recenti progressi in medicina 05/2010; 101(5):194-8.
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ABSTRACT: OBJECTIVE: We evaluated the efficacy of malabsorptive bariatric surgery on daily blood glucose fluctuations and oxidative stress in type 2 diabetic obese patients. RESEARCH DESIGN AND METHODS: The 48-h continuous subcutaneous glucose monitoring was assessed in type 2 diabetic patients before and 1 month after biliopancreatic diversion (BPD) (n = 36), or after diet-induced equivalent weight loss (n = 20). The mean amplitude of glycemic excursions and oxidative stress (nitrotyrosine) were evaluated during continuous subcutaneous glucose monitoring. During a standardized meal, glucagon-like peptide (GLP)-1, glucagon, and insulin were measured. RESULTS: Fasting and postprandial glucose decreased equally in surgical and diet groups. A marked increase in GLP-1 occurred during the interprandial period in surgical patients toward the diet group (P < 0.01). Glucagon was more suppressed during the interprandial period in surgical patients compared with the diet group (P < 0.01). Mean amplitude of glycemic excursions and nitrotyrosine levels decreased more after BPD than after diet (P < 0.01). CONCLUSIONS: Oxidative stress reduction after biliopancreatic diversion seems to be related to the regulation of glucose fluctuations resulting from intestinal bypass.
Diabetes care. 02/2010; 33(2):287-289.
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ABSTRACT: We evaluated the efficacy of malabsorptive bariatric surgery on daily blood glucose fluctuations and oxidative stress in type 2 diabetic obese patients.
The 48-h continuous subcutaneous glucose monitoring was assessed in type 2 diabetic patients before and 1 month after biliopancreatic diversion (BPD) (n = 36), or after diet-induced equivalent weight loss (n = 20). The mean amplitude of glycemic excursions and oxidative stress (nitrotyrosine) were evaluated during continuous subcutaneous glucose monitoring. During a standardized meal, glucagon-like peptide (GLP)-1, glucagon, and insulin were measured.
Fasting and postprandial glucose decreased equally in surgical and diet groups. A marked increase in GLP-1 occurred during the interprandial period in surgical patients toward the diet group (P < 0.01). Glucagon was more suppressed during the interprandial period in surgical patients compared with the diet group (P < 0.01). Mean amplitude of glycemic excursions and nitrotyrosine levels decreased more after BPD than after diet (P < 0.01).
Oxidative stress reduction after biliopancreatic diversion seems to be related to the regulation of glucose fluctuations resulting from intestinal bypass.
Diabetes care 11/2009; 33(2):287-9. · 8.09 Impact Factor
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Raffaele Marfella,
Carlo Luongo,
Antonino Coppola,
Margherita Luongo,
Paola Capodanno, Roberto Ruggiero,
Luigi Mascolo,
Immacolata Ambrosino,
Celestino Sardu,
Virginia Boccardi,
Biagio Lettieri,
Giuseppe Paolisso
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ABSTRACT: Inflammatory mediators contribute to the impairment of vasculogenesis by reducing endothelial progenitor cells (EPCs) mobilization in atherosclerotic vasculopathy. We tested the hypothesis that administration of an oxygen/ozone mixture (IMT) might counteract this pathophysiological mechanism and enhance limb tissue perfusion in patients with critical limb ischemia (CLI).
Randomized patients with rest pain or ischemic ulcers and transcutaneous oxygen tension (TcPO(2)) <40 mmHg and/or toe pressure <50 mmHg received placebo (n=74) or a non-specific immunomodulation therapy (IMT) (n=77), autologous blood exposed to oxygen/ozone gas mixture by intragluteal injection, on day 1, 2, 7, and once a week thereafter for at least 22 weeks. Patients were evaluated for changes in TcPO(2), levels of circulating EPCs (CD34/KDR-positive cells) and inflammation (tumor necrosis factor-alpha-TNF-alpha).
TcPO(2) and CD34/CD133-positive cells increased at 22 weeks in IMT group (P<0.01) whereas no changes were observed in placebo group. TNF-alpha levels decreased at 6 months in IMT group (P<0.001) whereas no changes were observed in placebo group. There was a strong positive correlation between CD34/KDR-positive cells and TcPO(2) (r=0.56, P<0.01). Moreover, there was an inverse correlation between CD34/KDR-positive cells and TNF-alpha (r=-0.51, P<0.01).
Intramuscular injection of IMT may improve wound healing and limb salvage in patients with CLI.
Atherosclerosis 09/2009; 208(2):473-9. · 3.79 Impact Factor
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Nicola Avenia,
Alessandro Sanguinetti,
Roberto Cirocchi,
Giovanni Docimo,
Mark Ragusa, Roberto Ruggiero,
Eugenio Procaccini,
Carlo Boselli,
Fabio D'Ajello,
Francesco Barberini,
Domenico Parmeggiani,
Lodovico Rosato,
Francesco Sciannameo,
Giorgio De Toma,
Giuseppe Noya
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ABSTRACT: Post-operatory wound infections are a very uncommon finding after thyroidectomy. For these reasons international guidelines do not routinely recommend systemic antibiotic prophylaxis. The benefits of this antibiotic prophylaxis is not supported by clinical evidence in the literature. We have conducted a multicentric randomized double-blind trial on 500 patients who had undergone thyroidectomy for goitre or thyroid carcinoma. The 500 patients enrolled in the study (mean age 47 years) were randomized in two subgroups of 250 patients. 250 patients were treated with standard antibiotic prophylaxis with sulbactam/ampicillin 1 fl (3 gr.) 30 min before surgery. No antibiotic prophylaxis was instituted in the remainder 250 patients. Our RCT showed that prophylactic antibiotic treatment is not beneficial in patients younger than eighty years old, with no concomitant metabolic, infective and hematologic disease, with no cardiac valvulopathies, not under steroidal or immunosuppressive treatment, and not severely obese. Our study should be regarded only as a preliminary RCT, and should be followed by a study in which a larger number of patients should be enrolled so that statistically significant data can be obtained.
Annals of Surgical Innovation and Research 09/2009; 3:10.
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Adelmo Gubitosi,
Giancarlo Moccia,
Francesca Antonella Malinconico,
Francesco Gilio,
Giovanni Iside,
Umberto G A Califano,
Fabrizio Foroni, Roberto Ruggiero,
Giovanni Docimo,
Domenico Parmeggiani,
Massimo Agresti
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ABSTRACT: Usually, left colon cancer metastasis concerns liver, abdominal lymph nodes and lungs. Other localizations are quite rare occurrences. In spite of this, some uncommon metastasis sites are reported in literature, such as: peritoneum, ovaries, uterus, kidney testis, bones, thyroid, oral cavity and central nervous system. We report two cases of unusual localizations of left colon cancer metastasis localization, one into the retroperitoneal space and the other at the left axillary lynphnodes and between liver and pancreas. In the first reported case the diffusion pathway may have been the lymphatic mesocolic vessels, partially left in place from the previous surgery. In the second case the alleged metastatic lane may have been through the periumbilical lymph nodes to the parasternal lymph nodes and then to the internal mammary ones, finally reaching the axillary limph nodes.
Acta bio-medica: Atenei Parmensis 05/2009; 80(1):80-2.
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ABSTRACT: Axillary lymphadenectomy remains an integral part of breast cancer treatment, yet seroma formation occurs in 15% to 85% of cases. Among methods employed to reduce seroma magnitude and duration, fibrin glue has been proposed in numerous studies, with controversial results.
Fifty patients underwent quadrantectomy or mastectomy with level I/II axillary lymphadenectomy; a suction drain was fitted in all patients. Fibrin glue spray and a collagen patch were applied to the axillary fossa in 25 patients; the other 25 patients were treated conventionally.
Suction drainage was removed between postoperative days 3 and 4. Seroma magnitude and duration were significantly reduced (P = .004 and .02, respectively) and there were fewer evacuative punctures in patients receiving fibrin glue and collagen patches compared with the conventional treatment group.
Use of fibrin glue with collagen patches does not always prevent seroma formation, but it does reduce seroma magnitude and duration, as well as necessary evacuative punctures.
American journal of surgery 08/2008; 196(2):170-4. · 2.36 Impact Factor
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Alessandro Sanguinetti,
Lodovico Rosato,
Roberto Cirocchi,
Francesco Barberini,
Angela Pezzolla,
Giuseppe Cavallaro,
Domenico Parmeggiani, Roberto Ruggiero,
Giovanni Docimo,
Eugenio Procaccini, [......],
Silvestro Canonico,
Mario Taffurelli,
Francesco Sciannameo,
Alfonso Barbarisi,
Ludovico Docimo,
Massimo Agresti,
Giorgio De Toma,
Giuseppe Noya,
Umberto Parmeggiani,
Nicola Avenia
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ABSTRACT: Breast surgery is classified among the procedures performed in clean surgery and is associated with a low incidence of wound infection (3-15%). The objective of this study was to evaluate the advantages antibiotic prophylaxis in patients undergoing breast surgery. A multicenter randomized controlled study was performed between January 2008 and November 2008. One thousand four hundred patients were enrolled in prospective randomized study; surgical wound infection was found in 41 patients (2.93%). In our RCT we have shown that in breast surgery antibiotic prophylaxis does not present significant advantages in patients with potential risk of infection (17 patients, 2.42%, subjected to antibiotic prophylaxis vs 24 patients, 3.43%, without antibiotic prophylaxis) (P = 0.27). In patients with drainage there is a significant minor incidence of wound infections in patients receiving antibiotic prophylaxis (5 patients, 0.92%, subjected to antibiotic prophylaxis vs 14 patients, 3.09%, without antibiotic prophylaxis) (P = 0.02). CONCLUSION: This study is only a preliminary RCT to be followed by a study which should be enrolled more patients in order to get the results as statistically significant.
Annali italiani di chirurgia 80(4):275-9. · 0.23 Impact Factor
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ABSTRACT: The RET gene codes for a tyrosine kinase receptor, expressed in neural crest derived cells playing a central role during embryogenesis. The RET proto-oncogene is responsible for medullary thyroid cancer and multiple endocrine neoplasia type 2. To date, more than 50 germline point mutations have been described. A specific correlation between genotype and phenotype is well recognized. Genetic testing is predictive of cancer onset, age at onset and biological aggressiveness. In recent years, the concept of codon-oriented prophylactic surgery has been introduced and three levels of risk have been identified on the basis of specific mutations. A review of the literature shows the excellent results of laboratory, genetic and clinical research that have made it possible to reduce medullary thyroid cancer-related mortality.
Chirurgia italiana 61(5-6):531-8.
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ABSTRACT: There are a number of reports in the literature which describe the association of venous thrombosis with oral contraceptives. Venous thrombosis is a rare form of mesenteric ischemia which may be lethal if not diagnosed and treated quickly. Although the non specificity of clinical signs do not always permit an early diagnosis.
The patient, aged 52, with a case history characterized by alteration of the alvus with occasional emission of blood, and abdominal pain. She referred with metrorrhagia of about one year, and was being treated with Ethynylestradiol/Gestodene. A CAT scan with contrast showed the signs of thrombosis in the superior mesenteric vein. The patient underwent surgical laparotomy. On opening the peritoneum we found a large tumefaction formed of conglobate iliac loops together with intense inflammation. A resection of the tumefaction was performed "en bloc".
Pharmacological contraception remains in various cases as the only identified risk factor and there are reports which also censure a relationship of greater risk with increased hormonal doses and even reports of mesenteric venous thrombosis in patients taking triphasic drugs. Thus, we may state with near certainty, that a relationship between pharmacological contraceptives and mesenteric venous thrombosis exists and is probably more than a simple risk factor in contrast to that which exists for tobacco smoking and obesity.
Before the prescription of contraceptive therapy the examination of risk factors is necessary, compiled preferably by hematochemical screening to exclude haematological and/or coagulative pathologies, and not deriding the use of non-pharmalogical methods of contraception when possible. Considering the technological advancement of instrumentation (CAT scan, angiogram), even a diagnosis aimed at a suspected clinical history; starting from less invasive screening by ultrasonographic Doppler, might induce to a rapid intervention and thereby avoid sacrificing too much intestinal tissue if it is the case.
Annali italiani di chirurgia 82(1):69-74. · 0.23 Impact Factor
