Il trattamento topico delle ulcere vascolari infette degli arti inferiori nel paziente anziano con spray a base di ac. ialuronico e argento colloidale

Introduzione. Gli Autori riportano la propria esperienza svolta presso l’ambulatorio di Vulnologia del Dipartimento di Chirurgia “F. Durante” nel periodo che va dal 2008 al 2010 nel trattamento delle ulcere infette degli arti inferiori nei pazienti ultrasettantenni. A causa dell’aumento della vita media è sempre maggiore il numero dei casi di portatori di ulcera cronica degli arti inferiori che giungono all’osservazione degli operatori nell’ambiente chirurgico. Lo scopo del nostro lavoro è stato quello di analizzare i fattori alla base della cronicizzazione delle lesioni e studiare la terapia più idonea alla guarigione delle ferite

Outpatient repair for inguinal hernia in elderly patients: still a challenge?

Bacground:Elective inguinal hernia repair as a day case is a safe and suitable procedure, with well-recognized feasibility. The increasing number of elderly patients requiring inguinal hernia repairleads clinicians to admit a growing number of outpatients. The aim of the current study was to analyze the outcomes (feasibility and safety) of day case treatment in elderly patients. Methods: Eighty patients > 80 years of age and 80 patients < 55 years of age underwent elective inguinal hernia repairs under local anesthesia. Results: There were no mortalities or major complications in elderly undergoing inguinal hernirraphies as outpatients, and only one unanticipated admission occurred in the younger age group. Conclusions: Elective inguinal hernia repair in the elderly has a good outcome, and age alone should not be a drwback to day case treatment

Measurement of intra-abdominal pressure in large incisional hernia repair to prevent abdominal compartmental syndrome

Introduction. The repair of large incisional hernias may occasionally lead to a substantial increase in intra-abdominal pressure (IAP), and rarely to abdominal compartmental syndrome (ACS) with subsequent respiratory, vascular, and visceral complications. Measurement of the IAP has recently become a common practice in monitoring critical patients, even though such measurements were obtained in the early 1900s. Patients and Methods. A prospective study involving 54 patients undergoing elective abdominal wall gap repair (mean length, 17.4 cm) with a tension-free technique after incisional hernia was conducted. The purpose of the study was to determine whether or not urinary pressure for indirect IAP measurement is a reliable method for the early identification of patients with a higher risk of developing ACS. IAP measurements were performed using a Foley catheter connected to a HOLTECH® medical manometer. IAP values were determined preoperatively, after anesthetic induction, upon patient awakening, upon patient arrival in the ward after surgery, and 24 h after surgery before removing the catheter. All patients were treated by the same surgical team using a prosthetic composite mesh (PARIETEX®). Results. Incisional hernia repair caused an increase in the mean IAP score of 2.68 mmHg in 47 of 54 patients (87.04%); the IAP was decreased in two patients (3.7%) and remained equal in five patients before and 24 h after surgery (9.26%). FEV-1, measured 24 h after surgery, increased in 50 patients (92.6%), remained stable in two patients (3.7%), and decreased in two patients (3.7%). The mean increase in FEV-1 was 0.0676 L (maximum increase = 0.42 L and minimum increase = 0.01 L) in any patient who developed ACS. Conclusions. Measurement of urinary bladder pressure has been shown to be easy to perform and free of complications. Measurement of urinary bladder pressure can also be a useful tool to identify patients with a higher risk of developing ACS