RESUMEN
BACKGROUND: To evaluate the hospital stay, morbidity, and patients' compliance for short stay inguinal hernia repair. METHODS: Retrospective analysis of 669 patients (594 men and 75 women) who underwent short stay inguinal hernia repair (706 inguinal and 45 femoral repairs) at the Institute of General Surgery, University of Ferrara. Mean age was 60.7 years (range, 18-84 years). The anesthesia was: loco-regional in 495 patients (74%) and general or epidural in 174 (26%). RESULTS: Mean hospital stay was 1.2 days. Postoperative complications were: three scrotal hematomas, two ischemic orchitis, three prosthetic infections, one local anesthetic intolerance, and three high fever. Eighty-five percent of patients were satisfied of the surgical procedure in short hospital stay. Mean follow-up was 36 months. CONCLUSIONS: Short hospital stay in inguinal hernia repair is safe, effective, and widely accepted by patients.
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Procedimientos Quirúrgicos Ambulatorios , Hernia Inguinal/cirugía , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios RetrospectivosRESUMEN
OBJECTIVE: Evaluation of long saphenous vein sparing surgical procedures alternative to high ligation and distal stab avulsion, in terms of effectiveness and suitability for eventual by-pass surgery. EXPERIMENTAL DESIGN: Prospective evaluation of 125 operations for primary varicose veins, 52 external valve-plasties of the sapheno-femoral junction (EV-SFJ) (42 performed using the hand sewing technique and 10 using the Veno-cuff device), mean follow-up 45 months, and 73 hemodynamic correction of varicose veins (French acronyms: CHIVA), mean follow-up 30 months. SETTING: Department of General Surgery, University of Ferrara. Institutional practice, one-day surgery. PATIENTS: Patients were selected using clinical, Doppler cw, and duplex scanning evaluations. Patients with early varices due to sapheno-femoral reflux with duplex scanning evidence of mobile valve leaflets underwent EV-SFJ. The other patients were operated on using the hemodynamic correction technique. Both groups underwent preoperative ambulatory venous pressure (AVP) and light reflection rheography-refilling time (LRR-RT) measurements. INTERVENTIONS: EV-SFJ restores valve function correcting vein wall dilitation by applying an external prosthesis. CHIVA consists of selected ligatures of the superficial veins that allow superficial blood aspiration in the deep veins through the perforators. MEASURES: The outcome was evaluated with clinical and ultrasonographic examinations, AVP and LRR-RT measurements. RESULTS: Long saphenous vein patency registered after EV-SFJ and CHIVA was 94.2% and 90.4%, respectively. Both treatments preserve the drainage function in the saphenous system. Varicose veins recurrence percentage rate was 9.6% and 10.9%, respectively. CONCLUSIONS: Following the proposed selection criteria, these two alternative procedures seem to be more effective in varices treatment than high ligation and have the advantage of preserving saphenous veins suitable for eventual by-pass surgery.
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Prótesis Vascular , Vena Safena , Várices/cirugía , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios ProspectivosRESUMEN
The Mirizzi syndrome is an unusual benign obstructive jaundice due to extrinsic mechanical compression of the common hepatic duct by gallstone impacted within the neck or cystic duct of the gallbladder. This syndrome is described either as an acute form due only to extrinsic compression of the common bile duct (type I) or as a chronic form resulting in an erosive cholecysto-choledochal fistula (type II). Up to date, the syndrome remains a clinically and surgically challenging problem. The anatomic basic of the syndrome (an anomalous relationship between the cystic duct and the common hepatic duct) when associated with inflammation and interbiliary fistula predisposes to a critical situation to be clearly detected and contributes to technical difficulties when surgical management is performed. The operative diagnosis of Mirizzi syndrome remains elusive and requires careful scrutiny of the biliary tract imaging to recognize the diseased duct system and to facilitate the following operative procedures. The surgical treatment requires a skill and careful operative dissection of the duct system, cholecystectomy and a safe biliary exploration and stone clearance, avoiding any iatrogenic damage to common hepatic duct. Laparotomy is commonly advocated as the safer approach to the diseased biliary tract and it is still employed by most authors. The laparoscopic surgery has not yet entered as the first-choice procedure for this syndrome due to jaundice and acute inflammation considered by some as contraindication to mini-invasive treatment. This paper describes successful surgical management by laparoscopic techniques in two patients affected by Mirizzi type I and type II syndrome treated by cholecystectomy alone and cholecystectomy with choledochal fistula flap repair, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)
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Colelitiasis/cirugía , Colestasis/cirugía , Laparoscopía , Anciano , Anciano de 80 o más Años , Fístula Biliar/cirugía , Colangiografía , Colelitiasis/complicaciones , Colestasis/etiología , Enfermedades del Conducto Colédoco/cirugía , Conducto Cístico , Femenino , Estudios de Seguimiento , Enfermedades de la Vesícula Biliar/cirugía , Conducto Hepático Común , Humanos , Masculino , Síndrome , Factores de TiempoRESUMEN
In order to verify the endogenous steroid influences on the myometrium, we compared the receptor status in 18 specimens of uterine leiomyomata and 31 specimens of pregnant myometrium. 17-beta-Estradiol and Progesterone receptors were assayed in the cytosol and nuclear extracts. In the uterine leiomyomata we observed the following mean values: PgR/c 279 fmol/mg, PgR/n 89 fmol/mg, ER/c 52.5 fmol/mg, ER/n 12.3 fmol/mg. In the pregnant myometrium we observed the following mean values: PgR/c 5.86 fmol/mg, PgR/n 166 fmol/mg, ER/c 0.76 fmol/mg, ER/n 1.65. It was concluded that direct correlation between estrogen power and progesterone receptor replenishment in the nucleus exists.
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Estradiol/metabolismo , Leiomioma/patología , Complicaciones del Embarazo/patología , Progesterona/metabolismo , Receptores de Estradiol/metabolismo , Receptores de Estrógenos/metabolismo , Receptores de Progesterona/metabolismo , Neoplasias Uterinas/patología , Núcleo Celular/ultraestructura , Cesárea , Citoplasma/ultraestructura , Citosol/ultraestructura , Femenino , Humanos , Histerectomía , Embarazo , Útero/patologíaRESUMEN
Primary surgical treatment in cervical carcinoma offers an unrepeatable chance to assess the biologic characteristics of the neoplasia by surgical staging and pathologic examination of the surgical specimen. The detection of factors of risk for locoregional diffusion, clinical staging being equal, can guide a subsequent target radio-treatment by identifying a group of patients at higher risk for relapses. The analysis of 155 cases of cervical carcinoma treated with radical primary surgery and pelvic lymphadenectomy at the Gynecologic Institute of Padua University has stressed the statistically significant correlation (P less than 0.05) existing between lymphatic diffusion and presence of neoplastic cells in capillaro-like spaces, degree of neoplastic cervical infiltration and parametrial diffusion. According to the Authors the presence of these features is a reliable basis to select patients eligible for post-surgery radiotreatment.
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Carcinoma/diagnóstico , Neoplasias del Cuello Uterino/diagnóstico , Carcinoma/patología , Carcinoma/cirugía , Femenino , Humanos , Invasividad Neoplásica , Estadificación de Neoplasias , Pronóstico , Neoplasias del Cuello Uterino/patología , Neoplasias del Cuello Uterino/cirugíaRESUMEN
The AA. considered 58 pregnant women affected by asymptomatic bacteriuria of pregnancy and 20 pregnant women with sterile urine during the first trimester of pregnancy as control group. Despite a constant treatment suggested by antibiogram the incidence of infective relapses was high but no patients were affected by important infections as acute haemorrhagic cystitis and acute pyelonephritis. In control group only 15% of patients had an asymptomatic urinary infection. These patients received the same treatment of the first group. In AA. opinion, a constant and careful screening of asymptomatic urinary infections is necessary in all pregnant women to prevent acute pyelonephritis.
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Tamizaje Masivo , Complicaciones Infecciosas del Embarazo/prevención & control , Infecciones Urinarias/prevención & control , Adulto , Antiinfecciosos Urinarios/uso terapéutico , Femenino , Humanos , Embarazo , Complicaciones Infecciosas del Embarazo/tratamiento farmacológico , Estudios Prospectivos , Infecciones Urinarias/tratamiento farmacológicoRESUMEN
85 high risk pregnant women were evaluated by RIA of total estriol, unconjugated estriol and HPL by ultrasonic measurement of foetal BPD and by NST and Fischer's score. In all, 277 evaluations were made. The Authors found a good correlation between results of the cardiotocographic tests and levels of HPL and measurements of foetal BPD. A low correlation was noticed between the levels of total and unconjugated estriol and the characteristics of cardiotocography. The evaluation of the cardiotocographic tests, according to Lee and Coll., resulted better than according to Fischer's score. The contemporary qualitative and quantitative evaluation of the cardiotocograms seems to reduce significantly the false-positive results and to half the false-negative results of the other tests for foeto-placental function. Result were analysed.
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Corazón Fetal , Monitoreo Fetal , Pruebas de Función Placentaria , Complicaciones del Embarazo/diagnóstico , Estradiol/sangre , Reacciones Falso Negativas , Reacciones Falso Positivas , Femenino , Humanos , Embarazo , Radioinmunoensayo , Riesgo , Ultrasonografía , Contracción UterinaRESUMEN
The administration of betamethasone to the mother in order to accelerate maturation of foetal lungs induces significant modifications in the foeto-placental hormonal secretion. Both the total estriol and unconjugated estriol present a sharp fall in the days immediately following the administration and a rise 10-12 days later, depending on a rebound effect. The HPL levels do not variate except for a progressive and constant rising due probably to better cardiocirculatory maternal condition with, consequently, a higher utero-placental blood-flow. All these phenomena increase when the administration of betamethasone to the mother is repeated more then once. The AA. believe that the sharp fall of the estriol doesn't represent a danger for the foetus being only an effect of maternal and fetal adrenal depression. Consequently the AA. suggest to drive the management during and after the administration of betamethasone to the mother on the basis of other foeto-placental functional tests, as cardiotocography. The results were analysed.