La colla di fibrina nelle ernioplastiche tension-free: nostra esperienza

Scopo di questo studio è dimostrare la possibilità, nell’ernioplastica secondo Lichtenstein, di fissare la mesh alle strutture muscolo-fasciali con colla di fibrina, evitando l’uso di punti di sutura. La fissazione della rete di prolene con Tissucol è stata effettuata in 28 pazienti, mentre nello stesso periodo la tecnica tradizionale di Lichtenstein è stata eseguita in altri 28 pazienti. I vantaggi dell’uso della colla di fibrina sono: nessun trauma chirurgico, perfetta fissazione della mesh, riduzione del dolore e della morbilità, abbassamento dei costi. La metodica è sicura e facilmente riproducibile. I risultati sono promettenti anche se la verifica va effettuata con casistiche più consistenti e follow-up più lungo

DERMATOME MAPPING TEST IN THE ANALYSIS OF ANATOMO- CLINICAL CORRELATIONS AFTER INGUINAL HERNIA REPAIR

Background: Nerve identification is recommended in inguinal hernia repair to reduce or avoid postoperative pain. The aim of this prospective observational study was to identify nerve prevalence and find a correlation between neuroanatomy and chronic postoperative inguinal pain (CPIP) after 6 months Material: A total of 115 patients, who underwent inguinal hernia mesh repair between July 2018 and January 2019, were included in this prospective observational study. The mean Age and BMI respectively resulted 64 years and 25.8 with minimal inverse distribution of BMI with respect to age. Most of the hernias were direct (59.1%) and of medium dimension (47.8%). These patients were undergoing Dermatome Mapping Test in preoperatively and postoperatively 6 months evaluation. Results: Identification rates of the Iliohypogastric (IH), Ilioinguinal (II) And Genitofemoral (GF) nerves were 72.2%, 82.6% and 48.7% respectively. In the analysis of nerve prevalence according to BMI, the IH was statistically significant higher in patients with BMI<25 than BMI ≥25 P (<0.05). After inguinal hernia mesh repair, eighteen patients (17.47%) had chronic postoperative inguinal pain after 6 months. The CPIP prevailed at II/GF dermatome (14 patients, 13.59%). In eight patients’ pain was probably of neuropathic origin (33%). In the other ten patients (67%) pain was probably of neuropathic origin. The relation between the identification/neurectomy of the II nerve and chronic postoperative inguinal pain after 6 months was not significant (p=0.542). Conclusion:The anatomy of inguinal nerve is very heterogeneous and for this reason an accurate knowledge of these variations is needed during the open mesh repair of inguinal hernias. The new results of our analysis is the statistically significant higher IH nerve prevalence in patients with BMI<25; probably the identification of inguinal nerve is more complex in obese patients. In the chronic postoperative inguinal pain, the II nerve may have a predominant role in determining postoperative long-term symptoms. Dermatome Mapping Test in an easy and safe method for preoperative and postoperative 6 months evaluation of groin pain. The most important evidence of our analysis is that the prevalence of chronic pain is higher when the nerves were not identified

Dermatome mapping test in the analysis of anatomo-clinical correlations after inguinal hernia repair

Abstract Background: Nerve identification is recommended in inguinal hernia repair to reduce or avoid postoperative pain. The aim of this prospective observational study was to identify nerve prevalence and find a correlation between neuroanatomy and chronic neuropathic postoperative inguinal pain (CPIP) after 6 months. Material: A total of 115 patients, who underwent inguinal hernia mesh repair (Lichtenstein tension-free mesh repair) between July 2018 and January 2019, were included in this prospective observational study. The mean age and BMI respectively resulted 64 years and 25.8 with minimal inverse distribution of BMI with respect to age. Most of the hernias were direct (59.1%) and of medium dimension (47.8%). Furthermore, these patients were undergoing Dermatome Mapping Test in preoperatively and postoperatively 6 months evaluation. Results: Identification rates of the iliohypogastric (IH), ilioinguinal (II) and genitofemoral (GF) nerves were 72.2%, 82.6% and 48.7% respectively. In the analysis of nerve prevalence according to BMI, the IH was statistically significant higher in patients with BMI < 25 than BMI ≥ 25 P (< 0.05). After inguinal hernia mesh repair, 8 patients (6.9%) had chronic postoperative neuropathic inguinal pain after 6 months. The CPIP prevailed at II/GF dermatome. The relation between the identification/neurectomy of the II nerve and chronic postoperative inguinal pain after 6 months was not significant (P = 0.542). Conclusion: The anatomy of inguinal nerve is very heterogeneous and for this reason an accurate knowledge of these variations is needed during the open mesh repair of inguinal hernias. The new results of our analysis is the statistically significant higher IH nerve prevalence in patients with BMI < 25; probably the identification of inguinal nerve is more complex in obese patients. In the chronic postoperative inguinal pain, the II nerve may have a predominant role in determining postoperative long-term symptoms. Dermatome Mapping Test in an easy and safe method for preoperative and postoperative 6 months evaluation of groin pain. The most important evidence of our analysis is that the prevalence of chronic pain is higher when the nerves were not identified. Keywords: Inguinal hernia, Inguinal nerves, Nerve identification, Pain, Follow-up © Th

RADIO-GUIDED SURGERY IN BREAST CANCER

According to current literature, sentinel lymph node identification technique is a simple procedure that allows predicting the location of the axillary lymph nodes without under-staging neoplastic disease. In clinical practice, the radio-guided surgery has been spreading also to diagnose the occult malignancy, giving space to the nuclear method for those injuries that, with a lot of difficulties for all the team's specialists, were detected using a guide-wire. Currently the Radio-guided Occult Lesion Localization (ROLL) has become the choice procedure for all small lesions. Therefore, dedicated centers for study and treatment of breast disease use ROLL and Sentinel Node and Occult Lesion Localization (SNOLL) to resolve in a single surgery both breast disease and axillary nodal spread. For this reason, the authors intend to prove, through this work, the idea that this method should be applied routinely in the current clinical practice of all operative units

COFFEE CONSUMPTION AND FEMALE CANCERS: A NARRATIVE REVIEW OF RECENT EVIDENCE

Coffee contains a wide variety of bioactive compounds including polyphenols, melanoidins, and diterpenes. Coffee consumption may have either neutral or beneficial effects toward human health. In this review, we summarize current evidence regarding the association between coffee consumption and breast, endometrial and ovarian cancer, as well as molecular mechanisms underlying the beneficial effects of coffee. The epidemiological evidence suggests a protective effect of coffee towards postmenopausal breast and endometrial cancer. However, no statistical association was found between coffee and ovarian cancer. The chemo-preventive effects of coffee phytochemicals may include activation of anti-oxidative and anti-inflammatory response. Finally, coffee bioactive components where shown to inhibit cancer cell proliferation and metastasis, as well as modulation of impaired angiogenesis

Tumori stromali del tratto gastrointestinale: descrizione di tre casi e revisione della letteratura

I tumori stromali gastrointestinali sono i tumori mesenchimali più comuni dell’apparato digerente. La loro diagnosi spesso non è agevole, poiché la sintomatologia è generalmente aspecifica e le tradizionali indagini strumentali non consentono una caratterizzazione istologica preoperatoria. Attualmente, la storia naturale rimane poco definibile e numerose sono le variabili a cui si è cercato di attribuire valore prognostico; tra queste, ad esempio, la sede di insorgenza del tumore è stata chiamata in causa da alcuni autori in quanto sembrava condizionare il comportamento clinico dei GIST. In realtà successivi studi non hanno confermato tali osservazioni e, oggi, le dimensioni del tumore primitivo, la conta mitotica e la possibilità di eseguireù una resezione chirurgica radicale sembrano essere ancora i principali fattori determinanti i risultati a distanza. L’intervento chirurgico rappresenta l’opzione terapeutica di scelta, considerata la scarsa responsività ai tradizionali protocolli radio-e chemioterapici; tuttavia l’utilizzo di una nuova sostanza, l’imatinib mesilato, sembra fornire risultati incoraggianti nei pazienti con malattia metastatica o non resecabile. Nel presente studio vengono presentati tre casi di GIST, complicati da emorragia e occlusione intestinale, e viene quindi eseguita una revisione della letteratura al riguardo

La day-surgery del carcinoma della mammella senile

La possibilità di una diagnosi sempre più precoce per il tumore della mammella e il perfezionamento delle tecniche per l?individuazione e l?analisi del linfonodo sentinella permettono oggi approcci chirurgici più conservativi, grazie ai quali è possibile garantire anche alla paziente anziana un buon controllo della patologia mammaria, con il rispetto, nello stesso tempo, delle sue condizioni generali e della sua qualità di vita. Il nostro studio si basa sulla revisione di una casistica comprendente 28 pazienti di sesso femminile di età superiore a 70 anni che presentavano lesioni mammarie maligne. Tali pazienti sono state sottoposte a terapia chirurgica conservativa (tumorectomia o quadrantectomia, con o senza dissezione ascellare) in regime di day-surgery, con buoni risultati in termini di efficacia e di controllo del rischio perioperatorio. Possiamo dunque concludere che il trattamento chirurgico ambulatoriale del carcinoma della mammella senile è praticabile nella maggior parte dei casi, si associa a una bassa morbilità e presenta notevoli vantaggi sia clinici sia socio-economici. English version: Early diagnosis of breast cancer and improvement of new technologies for identification and analysis of sentinel node allow more conservative surgical approaches, which guarantee both excellent local control and a good quality of life, also in elderly patients. We have studied a series of 28 women aged 70 years or older and affected by breast cancer. They underwent breast-preserving surgery either alone or in association with axillary lymphadenectomy and all of them had early discharge from hospital. This approach demonstrated to be safe and effective, so we may conclude that day-surgery treatment of breast cancer in these patients is possible in the majority of cases, is associated with low morbidity and is profitable for clinical, social and economic issues

Dynamic self-regulating prosthesis in inguinal hernia repair

Inguinal hernia repair is one of the most common surgical procedure performed in Western countries and it consumes a lot of healthcare resources. Several types of different mesh are now disposable and tension-free techniques represent the “golden standard”. In our study, fifty male patients were operated on for inguinal hernia and a PAD (i.e., dynamic self-regulating prosthesis) used for the repair of the inguinal defect: this technique demonstrated to be safe, effective and easy to perform

Ernioplastica inguinale con PHS: nostra esperienza

Dal gennaio 2003 al dicembre 2004 nella nostra Unità Operativa sono stati sottoposti ad intervento chirurgico per ernia inguinale 300 pazienti; in 40 pazienti, selezionati in modo random, abbiamo impiegato la protesi PHS (Prolene Hernia System). L?intervento è stato eseguito nell?80% dei casi in anestesia loco-regionale, mentre il 20% è stato sottoposto a rachianalgesia. Di questi 40 pazienti, 29 erano di sesso maschile e 11 di sesso femminile (età media 58,5 anni, range 39-78). Il dolore postoperatorio è stato lieve e non ha compromesso comunque la mobilizzazione precoce. Anche la morbilità è stata trascurabile e abbiamo comunque riscontrato una netta distinzione fra pazienti con lavoro autonomo e pazienti con lavoro dipendente. Tra le complicanze relative alla ferita chirurgica abbiamo osservato in 3 pazienti (1%) la presenza di un sieroma ed in altri 3 (1%) un?ecchimosi in corrispondenza della ferita; queste complicanze sono regredite spontaneamente entro 15- 20 giorni dall? intervento. Ad oggi non abbiamo osservato recidive. English version Three hundred patients underwent inguinal hernia repair from January 2003 to December 2004; 40 patients were randomized to receive the PHS (Prolene Hernia System) mesh. Surgery was performed under local anesthesia in 80% of cases and under rachianesthesia in the remaining 20%. There were 29 men and 11 women; mean age was 58,5 years (range 39-78). Postoperative pain was light and morbidity was low; all patients had early return to normal activities. Particularly, there were differences between autonomous workers and employees: the former began work again 2-4 days after surgery in 85% of cases, while the latter began after 15-20 days. Immediate complications were rare and always minor: they included seroma (1%) and ecchymosis (1%). Follow-up examinations did not show any recurrences