21 research outputs found

    Local anesthesia for treatment of hernia in elder patients: Levobupicavaine or Bupivacaine?

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    BACKGROUND: Inguinal hernia is one of the most common diseases in the elderly. Treatment of this pathology is exclusively surgical and relies almost always on the use of local anesthesia. While in the past hernia surgery was carried out mainly by general anesthesia, in recent years there has been growing emphasis on the role of local anesthesia. METHODS: The aim of our study was to compare intra-and postoperative analgesia obtained by the use of levobupivacaine to the same obtained by bupivacaine. Bupivacaine is one of the main local anesthetics used in the intervention of inguinal hernioplasty. Levobupivacaine is an enantiomer of racemic bupivacaine with less cardiotoxicity and neurotoxicity. The study was conducted from March 2011 to March 2013. We collected data of eighty patients, male and female, aged between 65 and 86 years, who underwent inguinal hernioplasty with local anesthesia. RESULTS: Evaluation of intra-operatively pain shows that minimal pain is the same in both groups. Mild pain was more frequent in the group who used levobupivacaine. Moderate pain was slightly more frequent in the group who used bupivacaine. Only one reported intense pain. Two drugs seem to have the same effect at a distance of six, twelve, eighteen and twentyfour hours. Bupivacaine shows a significantly higher number of complications, as already demonstrated by previous studies. Degree of satisfaction expressed by patients has been the same in the two groups. Levobupivacaine group has shown a greater request for paracetamol while patients who experienced bupivacaine have showed a higher request of other analgesics. CONCLUSIONS: Clinical efficacy of levobupivacaine and racemic bupivacaine are actually similar, when used under local intervention of inguinal hernioplasty. In the field of ambulatorial surgery our working group prefers levobupivacaine for its fewer side effects and for its easy handling

    How the First Year of the COVID-19 Pandemic Impacted Patients’ Hospital Admission and Care in the Vascular Surgery Divisions of the Southern Regions of the Italian Peninsula

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    Background: To investigate the effects of the COVID-19 lockdowns on the vasculopathic population. Methods: The Divisions of Vascular Surgery of the southern Italian peninsula joined this multicenter retrospective study. Each received a 13-point questionnaire investigating the hospitalization rate of vascular patients in the first 11 months of the COVID-19 pandemic and in the preceding 11 months. Results: 27 out of 29 Centers were enrolled. April-December 2020 (7092 patients) vs. 2019 (9161 patients): post-EVAR surveillance, hospitalization for Rutherford category 3 peripheral arterial disease, and asymptomatic carotid stenosis revascularization significantly decreased (1484 (16.2%) vs. 1014 (14.3%), p = 0.0009; 1401 (15.29%) vs. 959 (13.52%), p = 0.0006; and 1558 (17.01%) vs. 934 (13.17%), p < 0.0001, respectively), while admissions for revascularization or major amputations for chronic limb-threatening ischemia and urgent revascularization for symptomatic carotid stenosis significantly increased (1204 (16.98%) vs. 1245 (13.59%), p < 0.0001; 355 (5.01%) vs. 358 (3.91%), p = 0.0007; and 153 (2.16%) vs. 140 (1.53%), p = 0.0009, respectively). Conclusions: The suspension of elective procedures during the COVID-19 pandemic caused a significant reduction in post-EVAR surveillance, and in the hospitalization of asymptomatic carotid stenosis revascularization and Rutherford 3 peripheral arterial disease. Consequentially, we observed a significant increase in admissions for urgent revascularization for symptomatic carotid stenosis, as well as for revascularization or major amputations for chronic limb-threatening ischemia

    Evoluzione cretacica di un settore della piattaforma apula da dati di sottosuolo e di affioramento (Appennino campano-molisano)

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    Dati sismici e di sottosuolo suggeriscono che le successioni carbonatiche mesozoiche affioranti in alcuni settori dell’Appennino centro-meridionale costituiscano una parte affiorante della Piattaforma Apula Interna (PAI). Sono state studiate in dettaglio alcune successioni cretaciche affioranti nei rilievi del Gruppo del Matese e del Taburno-Camposauro, confrontandole con coevi sedimenti carbonatici della unità Apula interna raggiunta in perforazione nel Campo Benevento e dal pozzo Morcone 1bis. I dati di sottosuolo evidenziano come a partire dal tardo Aptiano vengano ad individuarsi piccoli bacini o solchi intrapiattaforma, in alcuni casi fortemente subsidenti. Anche i dati raccolti in superficie documentano una tendenza simile e, confrontati con quelli del sottosuolo, permettono di riconoscere 3 fasi principali di strutturazione riferibili all’Aptiano medio, all’Aptiano superiore- Albiano e al Cenomaniano inferiore-medio. I principali lineamenti tettonici, individuatisi a seguito della prima fase di strutturazione, sono stati ripetutamente riattivati nelle fasi successive condizionando l’evoluzione paleo-ambientale dei differenti subdomini. L’analisi delle facies sia dei corpi affioranti che di quelli raggiunti nel sottosuolo mostrano trend deposizionali confrontabili e soprattutto evidenziano come, a partire dall’Aptiano medio-superiore, le aree a sedimentazione carbonatica mostrino una netta variazione: da uniformi sistemi lagunari pre-aptiani a complessi sistemi di produzione e accumulo di sedimenti, creatisi in relazione con le fasi di strutturazione tettonica. Infine, lo studio delle sezioni sismiche permette di effettuare una correlazione tra il massiccio del Matese, il pozzo Morcone 1 e il Campo di Benevento, mostrando una struttura costituita da una serie di thrust in cui i piani di scollamento portano unità più antiche (Piattaforma Apula) su terreni più giovani (Avanfossa miocenica). Un elemento di conferma di tale interpretazione è rappresentato dalla polarità temporale dei sedimenti silico-clastici cui evolvono le facies neritiche mioceniche, in un trend di annegamento passante per depositi relitti, palinsesto ed emipelagici, spostandoci dal Matese orientale verso i pozzi Morcone 1 e Benevento. Tale polarità temporale permette, infatti, di ricostruire il timing deformativo di questo settore della catena

    Comparative study between Levobupivacaine and Bupivacaine for hernia surgery in the elderly

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    Background: The inguinal hernia is one of the most common diseases in the elderly. Treatment of this type of pathology is exclusively surgical and relies almost always on the use of local anesthesia. While in the past hernia surgery was carried out mainly by general anesthesia, in recent years there has been growing emphasis on the role of local anesthesia. Methods. The aim of our study was to compare intra-and postoperative analgesia obtained by the use of levobupivacaine compared with that of bupivacaine. Bupivacaine is one of the main local anesthetics used in the intervention of inguinal hernioplasty. Levobupivacaine is an enantiomer of racemic bupivacaine with less cardiotoxicity and neurotoxicity. The study was conducted from April 2010 to May 2012. We collected data of forty male patients, aged between 73 and 85 years, who underwent inguinal hernioplasty with local anesthesia for the first time. Results: Minimal pain is the same in both groups. Mild pain was more frequent in the group who used bupivacaine, moderate pain was slightly more frequent in the group who used levobupivacaine, and the same for intense pain. It is therefore evident how Bupivacaine is slightly less preferred after four and twenty four hours, while the two drugs seem to have the same effect at a distance of twelve and forty-eight hours. Bupivacaine shows a significantly higher number of complications, as already demonstrated by previous studies. The request for an analgesic was slightly higher in patients receiving levobupivacaine. Conclusions: After considering all these elements, we can conclude that the clinical efficacy of levobupivacaine and racemic bupivacaine are essentially similar, when used under local intervention of inguinal hernioplast

    Comparative Study between Levobupivacaine and Bupivacaine for Hernia Surgery in the Elderly

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    Background: The inguinal hernia is one of the most common diseases in the elderly. Treatment of this type of pathology is exclusively surgical and relies almost always on the use of local anesthesia. While in the past hernia surgery was carried out mainly by general anesthesia, in recent years there has been growing emphasis on the role of local anesthesia. Methods: The aim of our study was to compare intra-and postoperative analgesia obtained by the use of levobupivacaine compared with that of bupivacaine. Bupivacaine is one of the main local anesthetics used in the intervention of inguinal hernioplasty. Levobupivacaine is an enantiomer of racemic bupivacaine with less cardiotoxicity and neurotoxicity. The study was conducted from April 2010 to May 2012. We collected data of forty male patients, aged between 73 and 85 years, who underwent inguinal hernioplasty with local anesthesia for the first time. Results: Minimal pain is the same in both groups. Mild pain was more frequent in the group who used bupivacaine, moderate pain was slightly more frequent in the group who used levobupivacaine, and the same for intense pain. It is therefore evident how Bupivacaine is slightly less preferred after four and twenty four hours, while the two drugs seem to have the same effect at a distance of twelve and forty-eight hours. Bupivacaine shows a significantly higher number of complications, as already demonstrated by previous studies. The request for an analgesic was slightly higher in patients receiving levobupivacaine. Conclusions: After considering all these elements, we can conclude that the clinical efficacy of levobupivacaine and racemic bupivacaine are essentially similar, when used under local intervention of inguinal hernioplasty

    One-step mini-invasive treatment of abdominal aortic-iliac aneurysm associated with colo-rectal cancer

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    Endovascular aneurysm repair (EVAR) is still now a controversial technique, which remains the subject of a number of prospective randomised trials. Although questions remain regarding its long-term durability, objective evidence exists which demonstrates its reduced physiological impact compared with conventional open repair, especially for older population and for the concomitant treatment of aortic abdominal aneurysm (AAA) and abdominal neoplas, such as colo-rectal cancer (CRC). In these patients it may reduce the high perioperative mortality

    Adrenocortical carcinoma: What the surgeon needs to know. Case report and literature review

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    AbstractAdrenocortical carcinoma is a rare and aggressive cancer and its prognosis is frequently unsatisfactory. Due to its rarity there's a lack of prospective randomized studies. Without experience in the approach of this kind of tumor, managing becomes challenging and, moreover, we have only few recommendations, based on weak evidence. We report a case that has some peculiarities and is an excellent food for thought. Then we deal with a literature review to highlight and summarize most significant aspects of epidemiology, clinic, diagnosis, therapy and prognosis in an exquisitely surgical point of view

    Carotid screening with duplex ultrasound in elderly asymptomatic patientscandidate

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    Asymptomatic internal carotid artery steno-occlusion can be identified in different ways: the presence of a carotid bruit on physical examination, an asymptomatic stenosis contralateral to a symptomatic lesion and the presence of risk factors for atherosclerosis. The preferred screening test for hemodynamically significant stenosis of the internal carotid artery is the echo-color-doppler. We studied with carotid echo-color-doppler 252 asymptomatic patients candidate for general surgery, with a mean age of 66 years. The results indicated that it was detected the presence of stenosis> 70% in 25% of cases, moderate stenoses ranging from 30-69% in 70% of cases and complete thrombosis in 5% of cases. The multivariate statistical analysis of the data showed that age, cigarette smoking and the presence of carotid bruit are independent risk factors for carotid stenosis hemodynamically significant, while there is no association between hemodynamically significant stenosis of the internal carotid and the concomitant surgical pathology. In addition there was nocorrelation between hypertension, diabetes, chronic coronary syndrome, weight and dyslipidemia with the presence of severe asymptomatic carotid stenosis. In conclusion, we recommend the routine use of echo-color-doppler carotid artery survey in elderly patients and smokers, candidates for general surgery
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