RESUMO
BACKGROUND: The best surgical technique for sacrococcygeal pilonidal disease is still controversial. The aim of this randomized prospective trial was to compare both the results of Limberg flap procedure and primary closure. METHODS: A total of 260 patients with sacrococcygeal pilonidal disease were assigned randomly to undergo Limberg flap procedure or tension-free primary closure. RESULTS: Success of surgery was achieved in 84.62% of Limberg flap patients versus 77.69% of primary closure (P = .0793). Surgical time for primary closure was shorter. Wound infection was more frequent in the primary closure group (P = .0254), which experienced less postoperative pain (P < .0001). No significant difference was found in time off from work (P = .672) and wound dehiscence. Recurrence was observed in 3.84% versus 0% in the primary closure versus Limberg flap group (P = .153). CONCLUSIONS: Our results do not show a clear benefit for surgical management by Limberg flap or primary closure. Limberg flap showed less convalescence and wound infection; our technique of tension-free primary closure was a day case procedure, less painful, and shorter than Limberg flap.
Assuntos
Dor Pós-Operatória/prevenção & controle , Seio Pilonidal/cirurgia , Retalhos Cirúrgicos , Técnicas de Sutura , Adulto , Feminino , Seguimentos , Humanos , Tempo de Internação , Masculino , Dor Pós-Operatória/diagnóstico , Dor Pós-Operatória/etiologia , Seio Pilonidal/complicações , Seio Pilonidal/patologia , Recuperação de Função Fisiológica , Recidiva , Resultado do Tratamento , Cicatrização , Adulto JovemRESUMO
The liver is the most commonly injured intra-abdominal organ. Liver mass is the key factor in determining the extent of the inertial force and consequently of damage in the case of sudden deceleration. In this respect, high-speed accidents usually produce characteristic lesions where the III-IV segments tear at the level of the hepatic ligament causing grade I-III liver injuries. The pathophysiology of such traumas is the subject of the present contribution. All trauma patients who sustained a blunt abdominal injury from January 1 to December 31 2004 were identified by the trauma registry at the Policlinico di Tor Vergata In order to select high-speed and sudden deceleration traumas, clinical records were reviewed for demographics, severity of injury, severity of liver injury, associated concomitant injuries, and management scheme. The grade of liver injury was determined on the basis of the initial CT or the intraoperative findings. A total of 159 patients who incurred abdominal injuries due to blunt trauma were identified. In 14 (8.8 percent) one or more liver lesions were associated. Among the low-grade injuries, 3 were grade I, and 8 grade II. Forty percent were high-grade injuries consisting in 6 grade III and 1 grade IV. We observed no grade V or grade VI injuries in this series. The most frequent occurrence was a tear between hepatic segments III and IV caused by the acute impact of the liver on the hepatic ligament. A hepatic injury caused by the round ligament was diagnosed intraoperatively in 1 out of 5 liver trauma patients (20 percent) and preoperatively in 4 out of 5 (80 percent) in our one-year abdominal blunt trauma series. Our clinical contribution underlines the high frequency of such lesions that seems to be related to, and characteristic of, high-speed trauma. In these cases immediate deceleration due to the impact may be a relevant factor in the pathophysiology of the lesion.
Assuntos
Acidentes de Trânsito , Fígado/lesões , Fígado/patologia , Ferimentos não Penetrantes/patologia , Adolescente , Adulto , Idoso , Biofísica , Feminino , Humanos , Masculino , Adulto JovemRESUMO
BACKGROUND: The long-term prognosis of patients with colon cancer is dependent on many factors. To investigate the influence of a series of clinical, laboratory and morphological variables on prognosis of colon carcinoma we conducted a retrospective analysis of our data. METHODS: Ninety-two patients with colon cancer, who underwent surgical resection between January 1999 and December 2001, were analyzed. On survival analysis, demographics, clinical, laboratory and pathomorphological parameters were tested for their potential prognostic value. Furthermore, univariate and multivariate analysis of the above mentioned data were performed considering the depth of tumour invasion into the bowel wall as independent variable. RESULTS: On survival analysis we found that depth of tumour invasion (P < 0.001; F-ratio 2.11), type of operation (P < 0.001; F-ratio 3.51) and CT scanning (P < 0.001; F-ratio 5.21) were predictors of survival. Considering the degree of mural invasion as independent variable, on univariate analysis, we observed that mucorrhea, anismus, hematocrit, WBC count, fibrinogen value and CT scanning were significantly related to the degree of mural invasion of the cancer. On the multivariate analysis, fibrinogen value was the most statistically significant variable (P < 0.001) with the highest F-ratio (F-ratio 5.86). Finally, in the present study, the tumour site was significantly related neither to the survival nor to the mural invasion of the tumour. CONCLUSION: The various clinical, laboratory and patho-morphological parameters showed different prognostic value for colon carcinoma. In the future, preoperative prognostic markers will probably gain relevance in order to make a proper choice between surgery, chemotherapy and radiotherapy. Nevertheless, current data do not provide sufficient evidence for preoperative stratification of high and low risk patients. Further assessments in prospective large studies are warranted.
Assuntos
Neoplasias do Colo/diagnóstico , Adulto , Idoso , Idoso de 80 Anos ou mais , Neoplasias do Colo/cirurgia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Invasividade Neoplásica , Prognóstico , Estudos RetrospectivosRESUMO
Given the increasing incidence of colorectal cancer (CRC), performing new and cost-effective stool tests is of particular importance for early diagnosis and treatment. In the present review, we describe the main characteristics, and the performance of the most recently developed stool tests in the screening setting of colorectal tumoral diseases. Most of the studies reported high sensitivity both for adenomas and CRC diagnosis; less than half studies reported also high specificity with respect to stage and localization of the tumor. However, the performance of every single test was extremely variable, reaching >95% specificity for most of DNA-based markers, although lacking sensitivity even in case of invasive CRC. A new potential stool marker of colon cancer is clusterin, a protein of particular interest for its high sensitivity and positive predictive value in patients with highly aggressive CRC.
Assuntos
Neoplasias Colorretais/diagnóstico , Sangue Oculto , Neoplasias Colorretais/genética , DNA de Neoplasias/análise , Fezes/química , Humanos , Programas de Rastreamento , Sensibilidade e EspecificidadeRESUMO
AIM OF THIS STUDY: to report our results in a large series of patients with chronic pilonidal sinus (PS) at long term follow up. MATERIALS AND METHODS: Two hundred sixteen patients underwent excision and rhomboid flap transposition (RFT) from 1986 to 2004 for PS, and followed for more than two years. Clinical presentation includes: pilonidal abscess treated by drainage (33%), chronic discharge (48%) and simple infected sinus (19%). Mean follow-up was 74.4 months (range: 24-96). RESULTS: Minimal flap necrosis occurred in 5 pts (2.3%), post operative infection in 2 pts (0.9%), 4 pts (1.8%) had a seroma, 18 pts (8.3%) anesthesia or hypoesthesia on the upper portion of the flap. The mean hospitalization was 3.1 +/- 0.30 days and return to work was 10.8 +/- 2.4 days. Recurrences occurred in 5 pts (7.4%) in our initial 87 pts. Since we modified the technique no recurrences were seen. CONCLUSIONS: The Limberg's technique is a very effective procedure for chronic or recurrent PS with a low complications rate, a short hospital stay, a rapid return to normal activities and a low recurrence rate. Moreover with the modified technique the wound healing and the rate of recurrences have shown a significant decrease.
Assuntos
Seio Pilonidal/cirurgia , Retalhos Cirúrgicos , Adolescente , Adulto , Feminino , Seguimentos , Humanos , Masculino , Procedimentos Cirúrgicos Operatórios/métodos , Fatores de TempoAssuntos
Embolização Terapêutica , Linfoma de Células B/terapia , Glândula Tireoide/irrigação sanguínea , Neoplasias da Glândula Tireoide/terapia , Artérias , Biópsia por Agulha Fina , Humanos , Linfoma de Células B/cirurgia , Masculino , Pessoa de Meia-Idade , Glândula Tireoide/patologia , Neoplasias da Glândula Tireoide/cirurgia , TireoidectomiaRESUMO
BACKGROUND: The present paper describes a training method with objective evaluation to enhance video-assisted surgical skills in subfascial endoscopic perforator veins surgery (SEPS). Training was scheduled during a 2-day intensive course. METHODS: Hands-on exercises were performed (i) on a simulator to assess whether specific training exercises were helpful in attainment of skills; (ii) on a known animal model that uses the swine abdominal wall and which allows practice in endoscopic dissection and perforator veins (PV) using appropriate instrumentation in an environment that is a reasonable surrogate for the human calf; and (iii) assisting a senior surgeon performing SEPS. Thirty surgeons without experience in SEPS were trained to perform a sequence of standardized drills connected with the SEPS technique. The SEPS simulator consisted of an artificially constructed subfascial space of the leg in which false perforator veins had to be localized, and cut. The participants performed a sequence of drills three times in order to improve their dexterity. The same exercises were then performed on a swine model. The model consisted of the arteries and veins penetrating the rectus fascia and passing into the overlying cutaneous trunci muscle and hypodermis on either side of the midline between the arch of the ribs cranially and the umbilicus caudally. Trainees were required to achieve operative space in the animal subcutaneous fat, to reach and identify the "perforating" subcutaneous vessels, and to interrupt some of them with a 5-mm clamp coagulator ultrasonic scalpel. The time required to perform each dexterity drill was recorded in seconds. Finally, the day after, trainees were asked to drive the senior operator during clinical SEPS performed on eight patients, suggesting the following manoeuvres in order to: (i) enter the subfascial space of the leg; (ii) make operative space; (iii) identify the incompetent perforator vein(s); and (iv) coagulate and divide them with the ultrasonic scalpel. Each of these four steps scored 1 point. RESULTS: All the trainees showed a steady improvement in skill acquisition on the SEPS simulator (P < 0.001), and on the animal model with the single-port technique (P < 0.001). These results reflect positively on the animal model using the dual-port technique, and on the scores achieved in the operating theatre during clinical SEPS. CONCLUSIONS: The validity of the 2-day course was demonstrated by significant improvement in performance with increasing skill on the training models, and in clinical practice.
Assuntos
Currículo , Perna (Membro)/irrigação sanguínea , Perna (Membro)/cirurgia , Procedimentos Cirúrgicos Vasculares/educação , Cirurgia Vídeoassistida/educação , Animais , Competência Clínica , Humanos , Modelos Animais , Modelos Biológicos , Suínos , Veias/cirurgiaRESUMO
BACKGROUND: Common bile duct stones (CBDS) are present in 3-20% of patients with cholelithiasis. Intraoperative cholangiography has high sensitivity in detecting CBDS but its routine use is associated with increased costs and operating room time. The aim of our study was to define an accurate and simple model for the prediction of CBDS using preoperative variables. METHODS: The study consisted of a retrospective analysis followed by a prospective study. Multivariate analysis of the retrospective data was used to create a predictive model for the presence of concurrent CBDS in patients undergoing cholecystectomy. The predictive model was then validated in a prospective series of 160 patients undergoing laparoscopic cholecystectomy. RESULTS: Among the 19 potentially predictive variables for CBDS, only four were found to be statistically significant and independent: X1-alkaline phosphatase levels (UI/L); X2-number of gallbladder stones; X3-total serum bilirubin (mg/dL); and X4-CBD diameter (mm). Using these four variables, the multivariate analysis created the equation: score = 0.002 x X1 + 0.485 x X2 + 0.232 x X3 + 0.220 x X4 - 4.167 to define the risk of CBDS in each patient. The predictive model, tested prospectively in 160 patients undergoing laparoscopic cholecystectomy (LC), showed an elevated index of correlation (r = 0.75) among the predicted and the observed frequencies (chi2 = 126.6; P < 0.0001). The predictive model sensitivity and specificity were 92.9% and 99.3%, respectively. CONCLUSIONS: In patients undergoing cholecystectomy, accurate prediction of the risk for concurrent CBDS can be achieved using four preoperative variables. The use of this predictive model can contribute to reducing the number of unnecessary common bile duct explorations.
Assuntos
Colecistectomia Laparoscópica , Colecistolitíase/diagnóstico , Coledocolitíase/diagnóstico , Adulto , Idoso , Colangiografia , Colecistolitíase/cirurgia , Coledocolitíase/cirurgia , Coledocostomia , Ducto Colédoco/cirurgia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Modelos Estatísticos , Análise Multivariada , Valor Preditivo dos Testes , Estudos Prospectivos , Estudos Retrospectivos , Fatores de RiscoRESUMO
We herein present a case of primary malignant lymphoma of the saphenous vein. A 72-year-old man suffered from tumor and pain of the anteromedial aspect of the left upper thigh. Local thigh ultrasound scanning and computed tomography revealed a mass within the superior third of the internal saphenous vein. The patient underwent surgical exploration and removal of the saphenous vein between the groin and the upper third of the leg. The resected vessel was surrounded and infiltrated by a whitish, rubbery tissue all along its course. The histologic findings were consistent with high-grade, diffuse, large-cell lymphoma of peripheral B lymphocyte origin, primarily arising in the saphenous vein. Antiactin monoclonal antibodies depicted the venous vascular wall infiltrated by tumor cells, confirming the lymphomatous localization within the saphenous vein. The patient is now alive and free of tumor 10 months after the operation.