COLECISTECTOMIA LAPAROSCOPICA CON UNA SOLA INCISIONE CHIRURGICA

none4------noneNAVARRA G.; OCCHIONORELLI S.; POZZA E.; DONINI I.Navarra, Giuseppe; Occhionorelli, Savino; Pozza, Enzo; Donini, Ippolito Giusepp

One-wound laparoscopic cholecystectomy

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Significance of a single pulmonary nodule in patients with previous history of malignancy.

none5OBJECTIVES: To determine the diagnosis, treatment and follow-up in patients with a solitary lung nodule and a previous primary extrapulmonary neoplasm. METHODS: The authors evaluated the charts of 45 patients with an extrapulmonary malignant neoplasm and a solitary pulmonary nodule. The histologic characteristics of the nodule were correlated with those of the extrapulmonary neoplasm. RESULTS: The histology of the nodule was not known preoperatively in 43 cases (93.5%); in the remaining three cases cytologic examination had shown the presence of atypical cells. The majority of pulmonary lesions (73.9%) were found during the follow-up of the previous tumour, but a significant percentage of nodules (17.4%) were found incidentally. Pre- or intraoperative localisation of the nodule was done in 19 cases (41.3%), and was successful in nine cases (47.4%). Thoracoscopy was performed in 44 patients (95.6%). The coincidence between the pathology of the previous tumour and that of the nodule was 41.3% (19/46). The coincidence rate was 100% for the tumours of ovary, prostate, and sarcomas. CONCLUSIONS: The advent of minimally invasive surgical techniques has made a definitive diagnosis likely, providing also therapy with a less painful engagement for the patient and a less cost for the community.noneSORTINI A.; CARCOFORO P; ASCANELLI S; SORTINI D; POZZA ESortini, Andrea; Carcoforo, Paolo; Ascanelli, Simona; Sortini, Davide; Pozza, Enz

Sonographic evaluation for peripheral pulmonary nodules during video-assisted thoracoscopic surgery.

We express our opinion about the article of Yamamoto and associates. First, we congratulate them for the results they obtained in their study. We agree with author of the article [4] about the utility of intraoperative sonographic for locating peripheral pulmonary nodules. In our department, we have performed intrathoracoscopic localization of solitary pulmonary nodules. We think that intrathoracoscopic ultrasound is useful for locating not only pulmonary nodules, but also study structures around the nodule-like vessels, bronchi, and limphonodes. Moreover, we think intrathoracoscopic ultrasound also is useful for detecting resection margins. We think that intrathoracoscopic cannot play a role in the histology of the nodule [2, 3]. We have observed a frequent association between the final histology of the nodule and its ultrasound pattern. In fact, malignant pulmonary lesions have appeared as a homogeneous hypoechoic pattern with the sonographic disappearance of the hyperechoic pulmonary surface. Benign lesions often are associated with heterogeneous echogenicity. This sonographic pattern may be attributable to air bronchograms, the presence of different tissue, or hamartoma. However, we think this ultrasound pattern was not able to distinguish between benign and malign lesions. The Doppler can add something to the ultrasound pattern in defining the histology of the pulmonary nodule, but we are not sure it can determine intraoperative or final histology. We think it is impossible to base surgical treatment on the ultrasound or Doppler pattern alone because for us, only the intraoperative or final histology is sure and reliable. Ultrasound and Doppler patterns are only radiologic patterns, and although they give statistically significant results, they are not reliable for qualitative diagnosis of pulmonary lesions. Moreover, they are operator dependent [1]. We think that it currently is not ethically defensible to submit patients with a solitary pulmonary nodule to explorative thoracoscopy alone. Because the grade of intratumoral blood flow signal, as shown by Doppler, is low, we think that pulmonary resection with a frozen section of the specimen is mandatory. The Doppler pattern would play a role if this method is applied in the preoperative diagnosis, but it is impossible to perform a qualitative– quantitative study of a pulmonary nodule with percutaneous Doppler. We think, therefore, that it would be more correct to use ultrasound or Doppler only to locate and not to obtain a qualitative diagnosis of pulmonary nodules

Drawbacks to videothoracoscopic management of solitary pulmonary nodules.

Drawbacks to videothoracoscopic management of solitary pulmonary nodule

ONE WOUND "MUPPETS SHOW_MAN TECHNIQUE" LAPAROSCOPIC CHOLECYSTECTOMY

none6------openNAVARRA G.; CARCOFORO P.; OCCHIONORELLI S.; ASCANELLI S.; POLEDRELLI M.; POZZA E.Navarra, Giuseppe; Carcoforo, Paolo; Occhionorelli, Savino; Ascanelli, Simona; Poledrelli, M.; Pozza, Enz

A new approach to the cure of the Ogilvie's syndrome.

The Authors describe a their own observation of 25 cases of acute colonic pseudo obstruction, better known as "Ogilvie Syndrome" with the objective to demonstrate that an early recognition and prompt appropriate therapy, better if conservative, can reduce the morbidity and the mortality of the Syndrome. The surgical therapy is reserved only to that cases in which the risk of perforation of the cecum represent an absolute indication to intervention

Aorto-mesenteric compression syndrome. Description of clinical case and critical review of the literature

Aorto-mesenteric duodenal compression syndrome is a rare disease in which superior mesenteric artery causes a substenosis of the duodenum. Pathogenesis of this syndrome is due to congenital or acquired factors. Symptomatology is usually non specific and intermittent. Diagnosis is given by selective superior mesenteric artery angiography. Therapy is only surgery