[Nutritional dynamic monitoring during pregnancy: a personalized intervention of prevention]. / Monitoraggio nutrizionale dinamico in gravidanza: intervento di prevenzione personalizzato.

Obesity is an increasing condition spreading out in all of the world, independently by race, sex and age. Obesity in pregnancy represent a risk condition for both mother and her offspring. All of the studies are observational and show intervention strategies on weight gain improvement during gestational period, a current topic, but still controversial. Our study is based on nutritional dynamic monitoring during pregnancy in order to improve health and wellbeing status of both mother and her offspring, through an early and efficacy prevention.

Laparoscopic colectomy: indications, standardized technique and results after 6 years experience.

BACKGROUND/AIMS: The aim of the present study was to perform a retrospective study of our experience in performing laparoscopic colon surgery after 6 years experience. METHODOLOGY: From April 1992 to April 1998, 215 patients underwent colon laparoscopic surgery. There were 121 females and 94 males, whose average age was 66.7 (range: 31-92). RESULTS: 170 laparoscopic procedures were completed out of 215 (79%): 151 resections (22 for a benign lesion and 129 for a malignant one), 4 reversal of Hartmann's procedures, 6 rectopexy, 3 ileotransverstomies and 6 suture of traumatic colon perforation. There were 3 mortalities out of 215 (1.9%). The conversions were 45 out of 215 (20.9%); 22 (10.2%) cases were, however, converted to a laparoscopic facilitated procedure. The most common causes for conversion were the presence of bulky tumors and/or tumors that contaminated the adjacent structures (16/215), adhesions due to previous operations (9/215) and the patient's obesity (8/215). There were 39 complications (18.1%), 10 (4.6%) out of which required reoperation (2 anastomotic fistula, 2 anastomotic leak, 2 anastomotic stenosis, 2 hemorrhage, 1 colic iatrogenic perforation and 1 occlusion to rotation of anastomosis). There were only 2 recurrences (1.3%), 15 months (C2) and 8 months (B2) after the operation for intraoperative technical error. The average number of lymph nodes harvested in resected specimens was 12.8 (range: 1-41), whereas the mean distance of the tumor from the proximal margin of resection was 11.5 cm (range: 5-35), and from the distal margin 7.5 cm (range: 1-25). The average operative time was 165 min (range: 40-360), and the mean hospital stay was 9.2 days (range: 6-40). CONCLUSIONS: A colon resection for a malignant lesion, if performed with the highest respect for the oncologic principles, proves that it is impossible to develop a wall and intraluminal recurrence, which, in our opinion, may be caused by an improper surgical technique. Therefore, neoplastic colon laparoscopic surgery must be the perogative of a few selected and specialized centers.