Laparoscopic trans-peritoneal hernioplasty (TAPP) for the acute management of strangulated inguino-crural hernias: a report of nine cases.

BACKGROUND: Inguinal hernioplasty has always been one of the most commonly performed operations in clinical practice. In the last 15 years, thanks to the development of mini-invasive surgery, new video-endoscopic techniques for the treatment of inguinal hernia using trans-peritoneal (TAPP) and extraperitoneal (TEP) access have emerged. Both have a definite role in the treatment of bilateral and recurrent hernias, while the debate is still open about the treatment of primary mono-lateral hernias. In acute incarcerated hernia requiring an emergency operation, the endoscopic approach is uncommon and controversial, and even considered contraindicated. The aim of this publication is to verify the efficacy and the technical feasibility of TAPP operation by analyzing a consecutive series of patients operated on for incarcerated inguino-crural hernia associated with suspected visceral ischemic lesion in an emergency setting. MATERIALS AND METHODS: From September 2004 to October 2005, 13 patients were operated on acutely for inguino-crural incarcerated hernia associated with suspected visceral ischemic damage. Four were excluded from the endoscopic treatment due to anesthesiologic contraindications or huge hernia dimensions. Nine patients were operated on using a trans-peritoneal approach (TAPP). Visceral mobilization and hernia reduction were obtained by incision and opening of the hernia ring. Visceral resection was performed in one case with intestinal ischemia following a prolonged observation time or "test time." RESULTS: One case was associated with intestinal resection and incisional hernia repair, one with obturator hernia repair, and one with hepiployc appendix repair. None of the cases were converted to open technique, and no intra- or postoperative complications were recorded. Mean operative time was 72 min (35-180); mean hospital stay was 2.7 days (1-8). No recurrences were observed after a mean follow-up time of 18 months (8-24). CONCLUSIONS: The TAPP procedure can be proposed for emergency treatment of inguino-crural incarcerated hernias, allowing not only hernia correction, but also visual control and the contestual treatment of the hernia content. TAPP is a more challenging procedure compared to the traditional open anterior approach and therefore requires an adequate laparoscopic training. Exclusion criteria are constituted by anesthesiologic contraindications or dimensional criteria of the hernia.

Cervicofacial and pulmonary actinomycosis associated with non-Hodgkin's lymphoma.

A case of cervicofacial and pulmonary actinomycosis associated with non-Hodgkin's lymphoma (NHL) is reported. The patient underwent antimicrobial treatment and surgical debridement of a palatine lesion. Complete clinical recovery was achieved. The presence of actinomycosis may obscure and delay the diagnosis of NHL.

Venous aneurysm of extremities: a case report and literature review.

A case of venous aneurysm of the short saphenous vein is described in a young woman. The aetiology, diagnosis and treatment of this rare anomaly is reviewed.

[Acute pseudo-obstruction of the colon (Ogilvie syndrome). Apropos of a case]. / La pseudo-obstruction aiguë du côlon (syndrome d'Ogilvie). A propos d'une observation.

An additional case of acute colonic pseudo-obstruction (Ogilvie's syndrome) is reported. Conservative management was successful. Etiology of this syndrome is still uncertain. The aim of the treatment is to stop natural evolution to ischemia or perforation. Medical therapy, colonoscopic decompression and surgery are employed following prognostic criteria (age, cecal diameter, therapeutical delay). Mortality rate remains high, especially if complications occur. Colonoscopic decompression is a safe and efficacious first line of treatment when cecum is less than diameter 12 cm. Surgery is mandatory when perforation or ischemia are suspected and colonoscopy failed or is contraindicated.

Prolactin secretion in chronic schizophrenia.

Basal prolactin secretion and its response to various stimuli have been studied in 20 chronic hebephrenic schizophrenics, 10 males and 10 females, aged 20-54 years. The duration of the disease varied between 4 and 30 years. Eight normal subjects from the hospital staff, four males and four females, matched for age, were used as controls. The patients had been off medication for 10 days in 17 cases, for 3 months in one case and for 1 year in two cases. The TRH stimulation test was done by giving 500 mug of TRH i.v., both to schizophrenics and controls. Schizophrenics and controls. Schizophrenics only were subjected to a 2-day therapy with chlorpromazine (4 mg/kg body weight per day orally), and therafter for 8 days to a combined therapy with chlorpromazine at the same dose plus 2-BRalpha-ergokryptine-mesilate (500 mg per day orally). Prolactin levels were assayed radioimmunologically in the basal condition, during the TRH stimulation test, after 2 days of chlorpromazine alone, and after 4 and 8 days of combined therapy with chlorpromazine plus 2-Br-alpha-ergokryptine-mesilate. The results obtained showed normal basal prolactin levels, significantly enhanced responses to TRH, normal increases after chlorpromazine alone, and substantial decreases after 2-Br-alpha-ergokryptine-mesilate. A possible relative catecholamine deficiency, related to the mental disease, is suggested to explain the results.