Correlation between surgical intervention, adjuvant therapy, and long-term survival in patients operated on for breast neoplasia

Brest cancer is the most frequentl cancer among female sexabove all in rich countries where it occurrs ten times more than the others . The most incidence of breast cancer is in female over 45 years and over 70 years with a plateau during menopause.though a random and retrospective sthudy among all an female patients who had surgery for breast cancer in the last ten years we have related the kind of surgical treatment to overal survival to the therapies, and to any possible local recurrence od f disease, We analized 270 femolesurgical treatment used the simple quadrantectomy up to radical mastectomy. With the association linfoadenectomy survival was of 82,2%

Tecnica open versus TAPP nel trattamento dell’ernia inguinale. Nostra esperienza

Introduzione. L’utilizzo di nuovi tipi di protesi per la riparazione open e l’introduzione di tecniche laparoscopiche hanno apportato radicali cambiamenti nel trattamento delle ernie inguinali. Resta tuttavia controversa la scelta del tipo di approccio. Scopo di questo lavoro è stato quello di confrontare i risultati del trattamento dell’ernia inguinale con posizionamento di protesi per via open e quelli ottenuti con tecnica laparoscopica transaddominale preperitoneale (TAPP). Pazienti e metodi. Lo studio ha riguardato 584 pazienti, 532 uomini e 52 donne, di età compresa tra i 19 e gli 86 anni, dei quali 332 (56,8%) operati con tecnica open e 252 (43,2%) per via laparoscopica con tecnica TAPP. Sono stati analizzati nei due gruppi tempi operatori, complicanze, recidive e ripresa dell’attività lavorativa. Il follow-up era da 1 anno fino a 10 anni. Risultati. La durata media dell’intervento è stata di 71 minuti per il gruppo open e di 92 minuti per il gruppo TAPP. Non si sono avute complicanze intraoperatorie. Il 4,5% dei pazienti del gruppo open ha presentato complicanze postoperatorie rispetto al 3% del gruppo TAPP. Il tasso di recidive è risultato inferiore all’1% nei due gruppi (in particolare, 0,6% per la riparazione open e 0,4% per quella laparoscopica). Il tempo medio alla ripresa dell’attività lavorativa è risultata nettamente a favore del gruppo TAPP (9,8 giorni) rispetto a quello open (13,4 giorni). Conclusioni. Il nostro studio dimostra fattibilità, efficacia e sicurezza della tecnica laparoscopica TAPP nel trattamento delle ernie inguinali in alternativa alla chirurgia convenzionale. L’esperienza del chirurgo e la learning curve sono fattori determinanti nella riduzione dei tempi operatori e della percentuale di complicanze e recidive

Fine-needle aspiration of the thyroid gland: twelve years’ experience.

the thyroid FNA is considerated to be the only exam for nature diagnosis and it is used in order to discover neoplastic lesions as soon as possible. In our tsudy we have analised patients who underwent total thyroidectomy from 1994 to 2006. bening pathology for differentiated thyroid neoplasm. The Autors report the results of FNA compared with postoperative histological exams focusing on the indeterminate forms

Combined Burch urethropexy and anterior rectopexy in pelvic organ prolapse: skip the mesh

Pelvic organ prolapse (POP) is a common accompaniment of advancing age. Current repair techniques incorporate transvaginal and transabdominal approaches with or without prosthetic mesh insertion. In this paper, we present the short- and medium-term results of a unit policy directed at patients with POP of combined abdominal rectopexy and Burch retropubic urethropexy without the use of prosthetic mesh assessing its safety profile in selected cases. Between January 2009 and January 2011, 16 women with tri-compartmental prolapse who had all undergone prior hysterectomy underwent combined surgical pelvic floor repair. Preoperative symptom assessment by validated questionnaires and clinical examination were pre- and postoperatively recorded. Cures were defined as either optimal or satisfactory outcomes based on combined clinical, radiological examinations and reported patient satisfaction. The mean age of the 16 patients was 57.2 years, and their mean BMI was 28.6 (+/- 5 SD). Pelvic examination revealed a POP-Q stage III prolapse in 12 patients and stage IV in 4 patients. The mean operating time was 57.5 min (range 40-85), with a mean length of hospital stay of 4.5 days. Cystocele and enterocele resolution was noted in every case on dynamic magnetic resonance imaging (MRI). Our results in a small patient cohort employing a simple 'all-in-one' repair approach combining a retropubic colposuspension with an anterior rectopexy appear to be satisfactory. Further larger randomized studies are required, incorporating a laparoscopic arm in order to determine the longer-term effectiveness of this approach

Use of the circular compression stapler and circular mechanical stapler in the end-to-side transanal colorectal anastomosis after left colon and rectal resections A single center experience

The aim of our study was to compare the efficacy of the circular compression stapler and the circular mechanical stapler in transanal colorectal anastomosis after left colectomy or anterior rectal resection. We performed a retrospective analysis of 10 patients with disease of the, sigmoid colon or rectum (carcinoma or diverticular disease) who underwent left colectomy or anterior rectal resection with end-to-side transanal colorectal anastomosis. A follow-up was planned for all patients at 1, 3 and 6 months after surgery and the anastomosis was evaluated by colonoscopy at 1 year. In all patients an end-to-side transanal colorectal anastomosis was performed using a circular compression stapler (CCS group) or circular mechanical staplers with titanium staples (CMS group). The mean distance of the anastomosis from the anal margin was 6.4 ± 1.5 cm in the CCS group and 18.2 ± 11.2 cm in the CMS group. All patients in the CCS group expelled the ring after a mean time of 8.2 postoperative days. At 12 months colonoscopy revealed that all CCS patients had a satisfactory anastomosis with mean size of the colic lumen at the level of anastomotic line of 26.3 mm. In our experience the circular compression stapler a valuable alternative to the circular mechanical stapler for the creation of transanal colorectal anastomosis, in line with the relevant literature

Stapled and conventional Milligan Morgan haemorrhoidectomy: different solutions for different targets.

Purpose: Haemorrhoidal disease is one of the most common anorectal disorders. The aim of this study is to compare the results, over the last ten years, of stapled haemorrhoidopexy (SH) with those of standard Milligan Morgan haemorrhoidectomy (M&M). Furthermore, we discuss the proper indications for each technique in terms of the lowest rate of complications and long-term results. Methods: Three hundred forty-three patients with different degrees of symptomatic haemorrhoids underwent SH or M&M from January 2005 to December 2007. Patients were divided in two groups age and sex matched. The administration of painkillers drugs, antibiotics and laxatives, complication symptoms and hospital stay in all the patients were recorded after surgical treatment. Results: The mean operative time was shorter in the stapled group compared to that in the open group (31 minutes versus 40 minutes). Postoperative pain, hospital stay and return to full activity were shorter in the stapled group. There was a significant difference in the wound healing time between the two groups. We noticed a bigger rate of recurrence in patients, treated with stapled haemorrhoidectomy for fourth degree haemorrhoids. Conclusions: According to our experience, the Longo technique is indicated for the treatment of hemorrhoids of II and III degree. In the latter grades of prolapse, however, the Milligan Morgan haemorrhoidectomy can also be applied with good results. We believe, however, that in case of irreducible prolapse the M&M is to be preferred. However, operative management varies according to surgeon’s interest and is tailored to meet the individual patients’ need

Prevention of complications during reoperative thyroid surgery.

BACKGROUND: Thyroidectomy performed by an experienced surgeon is associated with a low incidence of recurrent laryngeal nerve injury and permanent hypoparathyroidism. During reoperative thyroid surgery there is a higher technical risk because detection and preservation of the recurrent laryngeal nerves and parathyroid glands are more difficult than in the primary surgery. AIM: Our retrospective cohort study was to assess short- and long-term complications associated with reoperative thyroid surgery in order to suggest a technical approach to lower the morbidity rate. MATERIALS AND METHODS: From January 2005 to September 2013, 745 patients underwent surgery for thyroid disease. Before surgery all patients underwent clinical examination, laboratory blood tests, hormonal assays, neck ultrasound, chest radiography and indirect laryngoscopy. Patients were followed up at 1, 3, 6 months and then annually after operation with hormonal assays, blood tests and neck ultrasound. RESULTS: Eighty (10.7%) out of 745 patients (mean-age= 52.5 years; age-range 18-80) underwent reoperative surgery for recurrent thyroid disease. The primary treatments were enucleoresection (11.2%), thyroid lobectomy(56,3%), thyroid lobectomy with isthmectomy(10%) and subtotal thyroidectomy (22,5%). In the reoperative surgery group (Group Re) the transient RLN complications were 1.3% compared to 0.2% in the primary surgery group (Group P) (p= 0.51). The incidence of temporary hypocalcemia was 45% in the reoperative surgery group vs. 42.7% in the primary surgery group (p=0.72). CONCLUSIONS: Reoperative surgery should be reserved to experienced surgeons. However, even in this case, when surgical maneuvers reserved for primary surgery are applied, then this surgery is associated with a low complications rate

A case of symptomatic mass in the right iliac fossa a Bermuda Triangle which often lies the right diagnosis.

Disease of the iliac fossa can often be accompanied by non-specific symptoms and some of these are exclusively caused by the compression of bulky masses of other neighboring structures. In young women a differential diagnosis is a non trivial task as several possible causes have to be taken into account. Thus, intraligamentary tumors, which are extremely rare finding, are frequently confused with uterus, ovary or intestinal tumors. Even if myomas are the most benign tumors of the female genital tract, broad ligament leiomyomas are an unusual finding in women of reproductive age. These tumors are often asymptomatic until they reach a volume likely to cause symptoms related to the mass pressure. An accurate patient's anamnesis and examination serve as a guide to further examinations. Ultrasound is the first line imaging as it can show ovarian or other pelvic mass and doesn't involve exposure to radiations in young patients, who can be pregnant. We describe the clinical presentation and imaging features of a broad ligament leiomyoma, which presented as an inguinal mass in a patient with a right iliac fossa pain. We also report our diagnostic process performing the differential diagnosis with other potential pathologies of RIF. In these cases, a preoperative disease classification discriminating the benign or malignant tumor nature is closely linked to the proper patient management