De Garengeot hernia with acute appendicitis.

AIM: The presence of the appendix within a femoral hernia sac is a rare condition known as De Garengeot hernia. We report a case of De Garengeot hernia with concomitant appendicitis and a brief review of the literature on the pathogenesis, diagnosis and treatment of this uncommon condition. CASE REPORT: A 33 year-old woman was admitted to our Surgical Unit with acute-onset pain and swelling in the right groin region. Clinical signs and ultrasound imaging suggested the presence of a strangulated femoral hernia and the patient was operated on in emergency setting. An inflamed appendix was discovered within the hernia sac. Appendectomy via McBurney incision and prosthetic repair of the femoral ring were performed. The postoperative course was uneventful and at the 2 week and 1 year follow-up no signs of wound infection and no hernia recurrence were found. CONCLUSION: Since clinical signs are non-specific and radiological findings may often be misinterpreted, appendicitis within a femoral hernia sac is often an incidental finding during an emergency operation for strangulated femoral hernia. Appendectomy-associated hernia repair may be performed with or without prosthesis depending on the extent of surgical field contamination.

Oligodendroglial gliomatosis cerebri. Case report.

Gliomatosis cerebri of oligodendroglial origin is very unusual. In the present article we illustrate a case of this pathology, outlining his severity and suggesting it seems to be more aggressive than the astroglial type. We give a short focus about the diagnosis and the therapy of this neoplastic disease.

[Ultrasonography of acute colonic diverticulitis. Effect on surgical treatment]. / Lo studio ecografico nella diverticolite acuta del colon. Influenza sul trattamento chirurgico.

The clinical diagnosis of acute colonic diverticulitis (ACD) is at times difficult and an early detection by a non-invasive method as ultrasonography (US) is required. The aim of this study is to evaluate the diagnostic sensibility of US performed on admission in patients with ACD, its value in monitoring assessment of severity and its influence on surgical decision. The Authors have carried out a retrospective study on 22 patients (8 men and 14 women, median age 58 years) admitted from January 1997 to June 1999 for ACD. In 21 cases the diagnosis was made on admission by US. The diagnostic sensibility was 95.5% (false-negative: 1 case). The true diagnosis in 2 false-positive patients was: ischemic colitis (1 case), aspecific thickening of colonic wall in patient with left renal carcinoma (1 case). The sensibility of clinical evaluation on admission was 68% (false-negative: 7 cases). The clinical diagnosis was unequivocal in only 36.4% of cases. In 14 patients, successfully treated conservatively, the US gave monitoring the reduction of hypoechogenic thickening of the colonic wall. Seven patients who underwent urgent surgery: in 3 cases for generalized peritonitis, but in 4 patients (18.2%) the immediate management was influenced by US detection of a clinical misdiagnosed abscess. The Authors conclude that, in the hands of an expert investigator, the extensive use of US in acute abdominal pain facilitate an accurate diagnosis of ACD and its appropriate management.

[Neuroendocrine carcinoma of the skin]. / Il carcinoma neuroendocrino della cute.

Merkel cell carcinoma is an unusual neuroendocrine tumour that arises in the derm. The case reported seemed to deserve the author's attention because of the clinical features, pathological findings and natural history (local recurrence, regional lymph node metachronous metastases, distant metastases). The authors believe that a differential diagnosis between Merkel cell carcinoma and other tumours located in the subcutaneous tissue is mandatory, in order to perform specific immunohistochemical and ultrastructural study.

[Ambulatory surgery: current status and prospects]. / Chirurgia ambulatoriale: stato attuale e prospettive.

Ambulatory Surgery (AS) was born some 20 years ago in USA pushed by economic requirements and rapidly spread over the European countries as one of the main factors of progress in health care. The Authors, after evaluating the actual situation of AS in the international literature, report their personal experience from January 1991 to December 1994. The series includes 810 surgical operations performed as outpatients procedures with immediate discharge. The following types of anaesthesia were used: local infiltration (86.6%), monolateral ultraselective spinal (10%), blended or general (3.4%). Hernias of the abdominal wall, varicose veins and anorectal diseases were the more frequent pathologies operated on. Results of surgery are satisfactory supporting the advantage of AS such as the absence of complications due to anaesthesia and hospital stay, the better relationship between patient and surgeon, the short return to working activities. AS proves its value on the clinical and socio-economic grounds provided that a well organised program and careful selection of patients are adopted. No extemporary organisation are advisable.

[Teicoplanin in the prevention of wound infections in major ambulatory surgery]. / La teicoplanina nella profilassi delle infezioni della ferita in chirurgia ambulatoriale maggiore.

Wound infection is a frequent complication and is related to various parameters: type of surgery, patient's age, nutritional status, associated diseases, length of surgery and hospital stay, use of prosthesis and drainage and finally surgeon's ability. The frequency of wound infection is reported between 1.5%-5.1% after "clean surgery" and the greatest source of microbial contamination is due to GRAM positive cocci either aerobic or anaerobic. The Authors present their experience of ultra short-term prophylaxis with Teicoplanin in 375 patients undergoing major ambulatory surgery. Median age was 49 years (15-87 ys); patients over 65 years were 22%. Hernias of the abdominal wall and varicose veins represent the diseases most commonly operated on. In 30% of the cases the patients selected for major ambulatory surgery were in II and III classes according to the standards of the American Society of Anaesthesiologists (A.S.A.). The ultra short-term prophylaxis with Teicoplanin was administered as follows: 400 mg, i.v., thirty minutes pre-operatively. The operations were performed under local or loco-regional anaesthesia. The choice of Teicoplanin was based on the strong bactericidal activity on GRAM positive cocci, including the methicillin-resistant Staphylococcus aureus infections, and on the long activity of the drug. The results were considered according to the American College of Surgeons scheme: no wound infection was observed and excellent local and general drug's tolerance were noticed. Ultra short-term prophylaxis in ambulatory surgery was chosen for the following reasons: large use of prosthesis, major risk of sepsis in older patients and at last for a badly accepted infective complications in outpatient surgery.