Cathamenial pneumothorax.

Cathamenial pneumothorax is a relatively low-frequency pathology (approximately 100 cases cited in the literature) characterized by recurrent pneumothorax episodes during the menstruation period. We report on a 34-year-old female patient who had recurrent pneumothorax that did not respond to chest drainage and whose presentation was directly related to the menstruation period. Our patient also had a significant clinical record for pelvic endometriosis. She underwent video-assisted thoracoscopic exploration (VATS) of the pleural cavity and dystrophic parenchymal blebs of the middle lobe were found. An atypical resection of the bollous tissue was performed and pleurodesis completed the intervention. During VATS no ectopic endometriosis foci or diaphragmatic fenestrations (widely considered as a possible cause of this clinical picture) were evidenced.

Is the loss of gallstones during laparoscopic cholecystectomy an underestimated complication?

Laparoscopic cholecystectomy entails an increased risk of gallbladder rupture and consequent loss of stones in the abdominal cavity. Herein we report the case of a 51-year-old male patient, who underwent laparoscopic cholecystectomy 2 years before presentation to our hospital. He had experienced tension sensation and epigastric pain since 4 months postoperatively. A well-defined epigastric mass, which was hard and painful on palpation, was detected and later confirmed by ultrasonography and CT scan. Explorative laparotomy revealed a mass in the area of the gastrocolic ligament,resulting from biliary gallstones in conjunction with a perimetral inflammatory reaction. A review of the literature showed that the incidence of gallbladder lesions during laparoscopy is 13-40%. In order to prevent this complication, meticulous isolation of the gallbladder, proper dissection of the cystic duct and artery, and careful extraction through the umbilical access are required. Ligation after the rupture or use of an endo-bag may be helpful. The loss of gallstones and their retention in the abdominal cavity should be noted in the description of the surgical procedure.

Impact of the introduction of laparoscopic cholecystectomy on the population aged 70 and over.

BACKGROUND/AIMS: Laparoscopic cholecystectomy is reported to be better tolerated than open cholecystectomy by patients aged 70 and over. We evaluate its impact on patients aged 70 and over, from one single center. METHODOLOGY: We review 427 cholecystectomies performed in one single centre, from November 1992 through November 1999. We consider 23 patients, 70 years old or older at the time of surgery. The following objective parameters were considered and compared with the younger population: length of stay in the hospital; mean preoperative stay; mean postoperative stay; incidence of risk factors; postoperative complications. A questionnaire was also mailed to all individual 427 patients. RESULTS: Length of stay in the hospital declined in both population, during the time interval considered. The incidence of risk factors, both major and minor, increases consistently with age from less than 1% below the age of 30 to about 62% in the eighth decade and over. Major postoperative complications were 4.34% in patients > or = 70 vs. 2.8% in patients < 70 years of age. Mortality was nil in both groups. Ninety percent reported complete disappearance of preoperative symptoms. CONCLUSIONS: Laparoscopic cholecystectomy in geriatric patients is safe and risks are reasonably low. Selection of patients must be done on strict indications.

[Surgical treatment of ulcerative rectocolitis: technical aspects of total restorative proctocolitis with S pouch]. / Il trattamento chirurgico della rettocolite ulcerosa: aspetti tecnici della proctocolectomia totale restaurativa con pouch a S.

Restorative proctocolectomy with an ileal-pouch-anal anastomosis seems to be the treatment of choice for ulcerative colitis. The aim of this study was to discuss a number of technical and functional aspects of the procedure that still appear to be controversial such as the shape of the pouch, the mucosectomy and the type of anastomosis. The authors report on their experience with the surgical treatment of ulcerative colitis with an "S" pouch. The technique reported, however, differs from the original method proposed by Parks and Nicholls in 1978 and the reasons for this surgical choice are discussed. A six-year experience (1993-1999) regarding 35 patients undergoing this approach is reported. No perioperative deaths were observed. The early and long-term complication rates were 8.5% and 11.4%, respectively. The average number of daily evacuations was 4. Mucosectomy affords complete resolution of the disease, while the particular shape of the pouch guarantees good functional results.