The use of biosynthetic mesh in giant hiatal hernia repair: is there a rationale? A 3-year single-center experience.

PURPOSE: Reinforced prosthetic crural repair is particularly indicated for giant hiatal hernias. The rationale is to reduce the recurrence rate in the long term. The aim of our study is to evaluate the outcomes of laparoscopic giant hiatal hernia repair using a biosynthetic mesh. METHODS: We retrospectively analyzed 44 patients who underwent laparoscopic mesh-reinforced hiatal closure and fundoplication using a biosynthetic material. Inclusion criterion was large hiatal defects (> 5 cm). Follow-up was scheduled at 6, 12 and 36 months after surgery. RESULTS: 44 patients (29F) with a mean age of 62 years (range 14-85) and mean of BMI 24.5 kg/m2 (range 21-29) underwent successful laparoscopic repair. Twenty-six (59.1%) patients had Nissen-Rossetti fundoplication, whereas 18 (40.9%) had Toupet fundoplication. Six-month questionnaire for the evaluation of symptoms was available for 43 patients (97.7%) and for 40 (90.9%) patients at 12 and 36 months. Mean preoperative symptoms score analysis was 1.68 ± 0.73. Mean scores at each follow-up time were significantly improved compared to baseline (p > 0.05). Barium swallow was available in 37 patients (84.1%) at 1 year after surgery. Radiologic recurrence was observed in two patients (4.5%). No patient had symptoms attributable to recurrence or required revisional surgery. There were no mesh-related complications at 3 years follow-up. CONCLUSIONS: The use of biosynthetic mesh for crural reinforcement is associated with a low incidence of mesh-related complications and with a reasonably low recurrence rate (4.5%) at 36 months. However, additional data with longer follow-up are needed to determine long-term safety and efficacy.

Single-layer versus double-layer closure of the enterotomy in laparoscopic right hemicolectomy with intracorporeal anastomosis: a single-center study.

BACKGROUND: The aim of our study was to evaluate the short-term outcomes of totally laparoscopic right colectomy, in particular to compare the incidence of leakage of the ileocolic anastomosis after either single-layer (SL) or double-layer (DL) enterotomy closure. METHODS: From March 2010 to July 2014, 162 patients underwent laparoscopic right colectomy with intracorporeal ileocolic anastomosis. The enterotomy was closed with either SL (77 patients) or DL technique (85 patients). Short-term outcomes in both groups were retrospectively analyzed. RESULTS: Median time to perform the ileocolic anastomosis was similar in the two groups (17 min in SL versus 20 min in DL, p = 0.109). DL closure was associated with a significantly lower incidence of anastomotic leakage (1.2 % in DL vs 7.8 % in SL, p = 0.044). Shorter hospital stay was also observed in the DL group. CONCLUSIONS: Adoption of DL closure of the enterotomy resulted in significantly improved outcome. We strongly recommend a double-layer closure technique when performing an intracorporeal enterocolic anastomosis.

[Giant atypical lipoma of the thigh. Case report and literature review]. / Lipoma atipico gigante della coscia. Caso clinico e revisione della letteratura.

Lipomas are benign tumors of mesenchymal origin which may localize in various sites, both superficial or deep. Among the benign tumors they have an incidence of around 10%; most of them have small size and low weight (about 30 g); huge masses (giants lipomas) are uncommon. The Authors report the case of a 73 years old woman, with a large swelling localized at the anterior-medial region of the left thigh, of about three years, completely asymptomatic, surgically excised, and by histological examination, proved to be a giant atypical lipoma.

[Solid pseudo papillary tumor of the pancreas: case report and literature review]. / Tumore solido pseudopapillare del pancreas. Caso clinico e revisione della letteratura.

Solid pseudopapillary neoplasm (SPT) of the pancreas is a rare exocrine tumor, for the first time described from Frantz et al. in 1959. Despite the increasing recognition of the tumor in this last year, its pathogenesis remain unclear. It occurs predominantly in young woman and behave in an indolent fashion, even when distant metastasis are present. The Authors report the case of a 24 years-old woman with an abdominal mass localized in retro-peritoneum, removed with body-tail of the pancreas and spleen, diagnosed as pancreatic SPT after histological examination.

Medicines for children licensed by the European Agency for the Evaluation of Medicinal Products.

OBJECTIVE: . The aim of this study was to evaluate the number and the characteristics of medicines approved for children in Europe by the European Agency for the Evaluation of Medicinal Products (EMEA) and whether the paediatric studies supporting the authorisation were in accordance with the Note for Guidance on the Clinical Investigation of Medicinal Products in children (CPMP/ICH/2711/99). We also considered any possible difference between the EMEA and the Food and Drug Administration (FDA) paediatric medicines evaluations. METHODS: . We examined the drugs authorised by the EMEA through the centralised procedure from January 1995 to September 2001 deriving information from the "European Medicines - Database" (EMD) set up in 1998 by the Italian Group for Pharmacoeconomic Studies (GISF) and sponsored by the Italian Ministry of Health. The analysis of paediatric data has been managed by experts belonging to the Clinical Pharmacology Working Group of the Italian Paediatric Society. The following parameters were assessed: active substance, year of approval, anatomical therapeutic and chemical (ATC) code, therapeutic indications, age for which the drug is authorised, interest to children and paediatric studies supporting a paediatric authorisation. European Public Assessment Reports (EPARs) were considered as reference sources. RESULTS: . The median percentage of drugs authorised for children from 1995 to 2001 (September) is 35% of the total of commercially available drugs; only 16 medicines have been approved for children under 2 years of age (11%), ten of these being vaccines. Medicines for children shared out 9 ATC classes, 24 belonging to the J- (anti-infective agents) -ATC class. Thirty-nine medicines were authorised on the basis of at least one clinical trial (27 phase III, 6 phase II, 6 phase I) while eight active substances have been licensed without any paediatric investigation. CONCLUSIONS: . Under the EMEA centralised procedure, several active substances have been licensed for children. Consequently serious and life-threatening diseases as AIDS and diabetes are now treatable, in a legal framework overcoming the orphan status of the past years. Despite the reported encouraging results, the number of drugs devoted to children remain low and important ATC classes, as L-(oncology) or N-(neurology), are still 'orphans' of innovative medicines. At the same time few medicinal products are specifically studied in children. Consequently, more efforts have to be made to increase the number of drugs assessed and licensed for the paediatric population, and manufacturers should be required to supply data on the effects of new drugs in children when the products are expected to offer a benefit over existing therapies.

[Short-term prophylaxis with erythromycin lactobionate in patients undergoing lung surgery]. / Short term prophylaxis con eritromicina lattobionato in pazienti sottoposti ad intervento di chirurgia polmonare.

The efficacy of short term prophylaxis with erythromycin lactobionate in the peri-operative treatment in patients undergoing pulmonary surgery is examined.

[Acute effects of a new type of lipidic emulsion in critical patients]. / Effetti acuti di un nuovo tipo di emulsione lipidica in pazienti critici.

A new type of 10% lipidic emulsion based on safflower oil and soya (Liposyn II, Abbott, Latina) characterised by a high linoleic/linolenic acid ratio was administered in random, double blind fashion with 10% Intralipid to 20 subjects submitted to major surgery of the digestive system. Dosage was 1.2 g/kg at an infusion rate of 2.6 ml/kg/h. In order to evidence possible in vivo inter-reactions between proteins of the acute post-aggressive phase and these emulsions, serial samples were used to measure haemogasanalytic parameters, plasma levels of triglycerides and serum levels of protein C-reactive and fourth complement factor. Both emulsions proved well tolerated and there was no evidence of general or administrative site reactions. The plasma levels of triglycerides underwent an increase during the test, with no significant differences between the two groups of patients. Notwithstanding the high serum levels of protein C-reactive of the subjects in question, there was no evidence of activation of the complement system nor alteration in haemogasanalytic parameters with the two lipidic emulsions adopted.

Queratoacantoma gigante / Giant keratoacanthoma

Presentamos dos casos de Q. A. G. caracterizados por presentar crecimiento exofítico hiperqueratósico similar a un cuerno cutáneo de gran tamaño. Uno de ellos se localizó en la sien derecha, midiendo 10 cm. x 5 cm., comprendiendo borde palpebral externo; regresando espontáneamente en 6 meses. El otro caso se encontraba en cuero cabelludo siendo sus dimensiones 7 x 5,5 x 3,5 cm., involucionando espontáneamente en 14 meses. Ambos dejaron cicatrices ligeramente deprimidas, lineales y estéticamente aceptables. En el segundo caso, apareció una recaída 2,5 meses después, la que fue extirpada. Efectuamos una revisión bibliográfica sobre Q.A.G. realizando consideraciones del aspecto clínico, evolución, antecedentes traumáticos y lesiones previas, recaídas, histopatología, diagnósticos diferenciales y terapéuticos

Epitelioma basocelular ulcerada: dos casos tratados como úlcera de pierna / Ulcerated basal cell carcinoma: 2 cases treated as leg ulcer

Se comunican dos pacientes con epitelioma basocelular ulcerado localizado en perna, tratados durante años como úlceras venosas. El primer caso es una mujer de 70 años de edad, con lesión ulcerada, localizada en cara antero-externa y posterior tercio inferior de pierna izquierda; 30 años de evolución; recibió múltiples tratamientos locales e incluso safenectomía e injerto, presentando metástasis ganglionares. Histológicamente es un epitelioma basocelular cordonado lobulado con áreas metatípicas. El segundo caso es un hombre de 60 años de edad, con una lesión ulcerada que asienta sobre terreno varicoso, en cara anterior de tercio inferior de pierna derecha; aspecto hipertrófico, tratada localmente como úlcera venosa. Histológicamente corresponde a un epitelioma basocelular cordonado. La localización y aspecto clínico infrecuente no deben hacernos olvidar la ocurrencia de un epitelioma basocelular, el que debe ser incluído en los diagnósticos diferenciales de úlceras crónicas de pierna

Epitelioma basocelular: localizaciones infrecuentes / Basal cell epithelioma: unfrequent localizations

Realizamos un estudio continuado, con pacientes registrados en los últimos seis años, sobre localizaciones infrecuentes, considerando como tales los tumores que no asientan en cabeza y cuello. De 602 epiteliomas basocelulares, 82,22 por ciento estaba localizado en cabeza y cuello, y 17.78 por ciento en otros sitios. El porcentaje de localizaciones infrecuentes correspondía a: tórax anterior (4,32%), tórax posterior (4,32%), abdomen (0,83%), región lumbo-sacra (3,32%), genitales (0,50%), miembros superiores (2,33%) y miembros inferiores (2,16%). El mayor porcentaje correspondió a la forma clínica e histopatológica superficial