Risultati del trattamento chirurgico del varicocele nella infertilità maschile

To evaluate the results of surgical treatment of varicocele on infertile men, especially regarding sperm count, 245 patients, surgically treated from 1993 to 2003, were evaluated. Patients underwent to ligature and section of the pampiniform plexus, throught the subinguinal approach and local anaesthesia. At the follow-up (3-6-12 months) an improvement of sperm count was relieved in 79.5% of patients and the incidence of complications and relapses was of 3.7% and 1.2%, respectively. The Authors stress the efficacy of surgical treatment of varicocele in male infertility and hold the subinguinal approach as an effective treatment, minimally invasive and low cost

Postpartum Ovarian Vein Thrombosis

Postpartum ovarian vein thrombosis carries a significant risk of morbidity and mortality if not recognized early and managed appropriately

Loco-regional relapses from rectal cancer

Background. Loco-regional relapses (LRRs) from rectal cancer still represent a major issue in colo-rectal surgery. With the introduction of Total Mesorectal Excision (TME), LRR incidence after curative resection for rectal cancer dramatically decreased from 20–40% of cases to 2–12%. Several factors are involved in predicting LRRs, the most important of these being Dukes stage. When no treatment is performed, median survival for these patients is about 8 months. In 50% of cases LRRs are confined to the pelvis; so, the recurrent tumour can be amenable to potentially curative surgical removal, with minimal mortality and a 5 year survival rate around 20–40%. Surgery is not recommended for patients with unresectable metastases and/or infiltration of sciatic nerve, sacrum above S2–S3, and pelvic bones. We hereby report our personal experience with management of LRRs from rectal cancer. Materials and methods. We retrospectively reviewed the clinical records of 289 rectal cancer patients, treated with curative resection between 1998 and 2007. Patients were divided in two groups: A (206 patients), younger than 74 y.o.; and B (83 patients), older than 75 years old. A total of 31 patients (10.7%) developed a LRR: 24 patients of group A (11.6%) and 7 of group B (8.4%). We also included in the study 11 patients (8 in group A, 3 in group B) treated elsewhere for the primary; we thus managed in total 42 LRR patients (26 males, 16 females; mean age 64 y.). LRR was anastomotic in 37.1% of cases, central-pelvic in 31.4%, presacral in 25.7% and perineal in 5.7%. In 88.5% of patients a R0 resection had been achieved at former surgery. Mean DFS was 13.4 months. We focused on the 35 patients assessed as metastases-free at the time of the first surgery. Results. Surgical management with curative intention was possible for 23 patients (65.7%), 17 of which in group A, and consisted either of exeresis of the recurrent neoplasm (10 cases), re-resection (7 cases) or Miles operation (6 cases). In18 of these patients (15 of group A) a R0 resection was achieved. Postoperative morbidity was 42.8%; perioperative mortality was 7.1%. 3 years – OS was 28%, but it was 60% for R0 patients. Conclusion. In selected patients, especially if younger than 75, LRRs may be amenable to a multimodal approach that, in a relevant rate of cases, can lead to a potentially curative R0 resection; for the other cases a palliative management is possible, to improve overall survival and quality of life

Un caso di faringocele bilaterale recidivato come mediano e rioperato con successo

l faringocele, nelle sue varianti congenita ed acquisita, rappresenta una patologia di raro riscontro. È caratterizzato da un’erniazione della mucosa faringea, in genere attraverso un “locus minoris resistentiae” localizzato a livello della parete laterale del faringe. I segni e i sintomi del faringocele sono generalmente scarsi e aspecifici per cui molto spesso la diagnosi è radiologica. La particolarità del caso di faringocele riportato è dovuta sia alla bilateralità sia alla recidiva unica e paramediana dopo otto anni. Il trattamento è stato chirurgico, con totale scomparsa della sintomatologia e delle formazioni previamente dimostrate dalle indagini strumentali

Characterization of turbulent flow behind a transcatheter aortic valve in different implantation positions

The development of turbulence after transcatheter aortic valve (TAV) implantation may have detrimental effects on the long-term performance and durability of the valves. The characterization of turbulent flow generated after TAV implantation can provide fundamental insights to enhance implantation techniques. A self-expandable TAV was tested in a pulse replicator and the three-dimensional flow field was extracted by means of tomographic particle image velocimetry. The valve was fixed inside a silicone phantom mimicking the aortic root and the flow field was studied for two different supra-annular axial positions at peak systole. Fluctuating velocities and turbulent kinetic energy were compared between the two implantations. Velocity spectra were derived at different spatial positions in the turbulent wakes to characterize the turbulent flow. The valve presented similar overall flow topology but approximately 8% higher turbulent intensity in the lower implantation. In this configuration, axial views of the valve revealed smaller opening area and more corrugated leaflets during systole, as well as more accentuated pinwheeling during diastole. The difference arose from a lower degree of expansion of the TAV's stent inside the aortic lumen. These results suggest that the degree of expansion of the TAV in-situ is related to the onset of turbulence and that a smaller and less regular opening area might introduce flow instabilities that could be detrimental for the long-term performance of the valve. The present study highlights how implantation mismatches may affect the structure and intensity of the turbulent flow in the aortic root

A case of relapsing secondary bladder adenocarcinoma after right colonic cancer

Periodic