[Surgical treatment of hemorrhoid disease. A comparison between techniques]. / Il trattamento chirurgico della malattia emorroidaria. Tecniche a confronto.

BACKGROUND: The past years have seen the development of outpatient treatment and surgical procedures for the treatment of hemorrhoid disease in an attempt to reduce postoperative pain on the one hand and execution and hospitalisation times on the other. METHODS: This retrospective study compares the results obtained in the treatment of hemorrhoid disease using three different METHODS. Three groups of 30 patients were selected from those operated during the past 10 years using Milligan-Morgan s technique (Group A), Parks technique (Group B) and radiosurgery (Group C). All patients were matched for sex (50% males and 50% females), age (ranging between 30 and 50 years old), diagnosis (4th degree hemorrhoids not associated with another proctologic pathology such as anal fissures, fistulas, etc.) and referred symptoms. RESULTS: The results obtained allow a positive evaluation to be made of all three surgical techniques, but indicate submucous hemorrhoidectomy using radiosurgery as the method of choice for the treatment of grade III and IV hemorrhoids. CONCLUSIONS: The excellent results achieved using this approach in the authors opinion amply justify the relatively difficult execution and longer operating times.

[Diabetic foot. Physiopathology, clinical aspects, and recent therapeutic approaches]. / Il piede diabetico. Fisiopatologia, clinica e recenti orientamenti terapeutici.

Diabetic foot is a complication of diabetes mellitus occurring in 15% of patients that is of specific surgical interest. Over the past few years, preventive measures and the use of new therapeutic resources has reduced the number of patients undergoing demolitive surgery. The authors present a concise but at the same time sufficiently detailed picture of modern knowledge of the physiopathology, clinical aspects and current therapeutic guidelines for diabetic foot. In particular, they analyse the validity of various forms of complementary treatment to surgery, including techniques to stimulate tissue repair processes, hyperbaric oxygen therapy and laser therapy, and they underline the importance of using a multidisciplinary approach to this pathology. To this end, they review all the articles on the subject reported on Medline from 1992 to June 1998, presenting and commenting on the most significant results.

[Observations concerning an unusual presentation in a case of intestinal duplication]. / Osservazioni su un'insolita presentazione di un caso di duplicazione intestinale.

Duplications of the alimentary canal are an infrequent pathology and may be localised in any part of the digestive tract. According to reports by several authors, the jejunoileal localisation is the most frequent. The authors report the case of a 13-year-old patient with a duplicate ileal tract which remained asymptomatic until hospitalisation was required, whose symptoms at onset resembled the clinical manifestations of acute appendicitis.

Cytomegalovirus encephalitis: diagnosis with clinical approach, EEG and PCR techniques.

Cytomegalovirus (CMV) encephalitis is particularly evident in immunodepressed patients. Often diagnosis is difficult and time-consuming because of the complex basic clinical picture of these patients. We describe the diagnostic steps taken in a case of cytomegalovirus encephalitis affecting an elderly patient, classified as immunodepressed and deceased on the thirty-fifth day of hospitalisation in the intensive care unit due to acute myocardial infarction. Treatment with ganciclovir, 30 mg/kg per day, begun at the time of diagnosis, appears to have had a positive effect on the neurologic symptoms.

[Cultured human urothelium. Possible application in reconstructive surgery of the urinary tract]. / L'urotelio umano coltivato. Possibilità applicative nella chirurgia ricostruttiva delle vie urinarie.

The authors focus on and analyse a number of problems linked to urinary tract reconstruction, with special reference to urethral surgery in patients suffering from hypospadias. After having examined a number of approaches used over this period, the authors underline the possible new applications and future lines of research offered by cell culture techniques in the fields of urology and plastic surgery.

Mechanisms of bone resorption: analysis of proinflammatory cytokines in peritoneal macrophages from titanium implant--an experimental design.

Cytokines, and interleukin-6 in particular, are inflammatory peptide mediators that are extensively studied as regulators of bone tissue homeostasis. They seem to be involved in osteoclast activation and bone resorption and probably play a role in osseointegrated implant rejection. In this study we investigate the ability of titanium implants to cause an imbalance in the homeostatic equilibrium of cytokines using the peritoneal cavity of DB-A2 mice as a model. The inflammatory response was evaluated as a messenger ribonucleic acid expression determined by the semiquantitative reverse transcriptase--polymerase chain reaction technique in peritoneal macrophages from titanium-implanted mice. Interleukin-6 release was detected by a specific quantitative enzyme-linked immunosorbent assay. Our results have shown that titanium implants do not significantly stimulate the proinflammatory cytokine system compared to the control group. The enzyme-linked immunosorbent assay test confirms, after a peak in secretion at day 1 compared with basal levels, a clear decrease in interleukin-6 at basal levels on following control at 6 and 9 days after implantation. The study of the interaction between implanted biomaterials and inflammatory mediators seems to be very promising. Perhaps a better understanding of the mechanisms of bone resorption could lead to finding a new clinical solution for patients with osseointegrated implant rejection.

Immediate TRAM flap breast reconstruction in an obese patient with relapsing benign phyllodes tumor: report of a case.

The authors present a case of relapsing benign phyllodes cystosarcoma of the breast in an obese female treated with a simple mastectomy and an immediate reconstruction using a bipedicled transverse rectus abdominis musculocutaneous (TRAM) flap. After a brief review of treatment options for phyllodes tumors, they discuss the advantages of TRAM flap breast reconstruction, suggesting that it may also be applied in obese patients.

[Plastic surgery of the abdominal wall in laparocele in a patient with previous kidney transplant]. / Plastica della parete addominale per laparocele in paziente con pregresso trapianto renale.

The authors report the case of a patient undergoing kidney transplant from a non-related but compatible living donor who subsequently developed a voluminous incisional hernia affecting almost the entire small intestine in the right iliac fossa, the site of earlier surgery. After having analysed the problems involved when a transplant patient requires further surgery owing to the chronic administration of drugs, the authors describe the case. The patient was treated using the insertion of a prolene graft and remodelling the abdominal wall in correspondence with the lower quadrants using abdominoplasty without repositioning the umbilicus.

[Plastic surgery by the Limberg-Dufourmentel method in the treatment of a pilonidal sinus. The anatomicosurgical considerations and an emblematic case]. / La plastica secondo Limberg-Dufourmentel nel trattamento del sinus pilonidalis. Considerazioni anatomo-chirurgiche e presentazione di un caso emblematico.

Limberg-Dufourmentel's cutaneous flap may be used to fill in the loss of residual substance after the radical excision of sinus pilonidalis in the sacrococcygeal region. According to the authors, this technique enables some aspects of the locoregional anatomic conformation typically linked to the onset of this pathology to be modified, as well as permitting more accurate radical surgery. By way of example, the authors report the case of a 20-year-old subject with sinus pilonidalis who was successfully treated using this surgical technique.

[Surgical treatment of rhinophyma using dermo-epidermal graft. A case report]. / Trattamento chirurgico del rinofima con innesto dermo-epidermico. Caso clinico.

Rhinophyma is a nosographical form that has always attracted attention, even among non-experts, owing to the marked aesthetic damage it often causes. Several types of surgery have been proposed for its treatment in an attempt to elaborate a technique that is easy to apply and guarantees satisfactory results in clinical and aesthetic terms. After a short review of the general aspects of the pathology, the authors illustrate the case of a patient with rhinophyma treated with a full thickness dermo-epidermic graft, and emphasise that this surgical solution, provided that the indications are correct, is still a valid alternative.

SPECT in the long-term evaluation of osteointegration in intraoral and extraoral implantology.

Scintigraphic methods used in intraoral and extraoral implantology allow the evaluation of bone metabolism in the peri-implant zones, providing anatomic images and functional dynamics information on the osteointegration process. Twenty-five patients who underwent implantation operations for the application of intra- and extraoral prostheses were studied using technetium 99 m single photon emission computed tomographic (SPECT) procedures to evaluate osteointegration dynamics at 3 weeks, and 3, 6, 12, and 24 months. The study demonstrates that radiation emission peaks 3 weeks after surgery with the maximal bone remodeling activity and 6 months after surgery after the functional loading of the implants only in intraoral fixtures. High uptake past the eighth month after surgery has never been detected and must be considered abnormal. SPECT offers the possibility of obtaining a three-dimensional reconstruction of the photon emission of selected structures. The use of these nuclear medicine methods in addition to traditional-type radiological procedures introduces new possibilities, although still in the clinical experimentation phase, for early diagnosis and inserted implant prognosis.

Titanium bone-integrated implants in extraoral facial prosthetic rehabilitation: surgical planning and long-term follow-up.

The authors report on their clinical experience in the reconstruction of complex facial deformities using titanium osseo-integrated implants for the retention of soft silicone prostheses. They also evaluate the importance of this surgical technique as a viable alternative to traditional reconstructive procedures using autologous grafts, both in patients with severe osteomuscular defects and corrective surgery of unsuccessful reconstruction operations. The patients who underwent implantation operations were studied by CT 3D and 99m Tc SPECT (Single Photon Emission Computerized Tomography) procedures to evaluate osseo-integration at 3 weeks, 3, 6, 12, 24 months. The study demonstrates that the radiation emission peaks three weeks after surgery with the maximum bone remodeling activity, and after the functional loading of the implants, 3 months after surgery. High uptake past the eight month after surgery has never been detected and must be considered abnormal. SPECT offers the possibility of obtaining a three dimensional reconstruction of the photon emission of selected structures. The use of these nuclear medicine methods in addition to traditional-type radiological procedures introduce new possibilities, although still in the clinical experimentation phase, for the long-term follow-up of the inserted implants in craniofacial rehabilitation.

[The use of Holmstrom's flap in breast reconstruction]. / Utilizzo del lembo di Holmstrom nella ricostruzione mammaria.

The authors consider 12 cases of breast-reconstruction after mastectomy, made with the Holmstrom's flap, to verify the validity and the real utility of this way of reconstruction. It has been made a follow-up of 4 years, to verify, in course of time, the characteristics of the reconstructed breasts. All the patients have been operated in a general surgery department. The Holmstrom's flap has been prevalently used in patients, during immediate reconstruction. The breast reconstruction, made with this fascio-cutaneous transposition flap, requires the use of prosthesis. The operating time has a very short duration. The breast reconstruction, made with this method, requires a very short staying in hospital. The nipple-areola complex reconstruction has been made in a second time, few months later. The patients have been examined periodically, to verify, immediately, the result of the flap and, later, the quality of the new breast's shape and the occurrence of capsular contracture. The results achieved with this reconstructive method are a good shape and ptosis as to confer great naturalness to the new breast. The authors conclude that, even if they use the TRAM-flap as first choice in breast-reconstruction, the Holmstrom's flap is a reconstructive technique of great utility in immediate breast reconstruction, that is able to give very good aesthetic results.

[The use of osteointegrated implants in plastic surgery. Ear reconstruction]. / L'impiego degli impianti osteointegrati in chirurgia plastica. Ricostruzione del padiglione auricolare.

The authors present the case of a 14-year-old patient suffering from first branchial arch syndrome with agenesia of the auricle in which the auricle was reconstructed using osteointegrated implants. The patient had previously undergone numerous attempts at reconstruction using traditional methods, all of which had failed. In order to ensure an accurate preoperative evaluation, the patient was studied using CT with a standard technique and three-dimensional image reconstruction for a qualitative and quantitative evaluation of bone thickness so as to allow the optimal positioning of fixtures. This test also revealed the existence and good degree of development of the middle and internal ear. The Authors then proceeded to implant 4 titanium fixtures into the mastoid process of the temporal bone, three of which were used for fixing the auricle prosthesis and one for the insertion of a bone anchored hearing aid. The epithesis, in soft silicon, was modelled to match the contralateral ear with excellent aesthetic results.

[Primary hydatid cyst of the coracobrachial muscle. A clinical case]. / Cisti da echinococco primaria del muscolo coracobrachiale. Caso clinico.

Primary localization of hydatidosis in the musculoskeletal system is a quite rare occurrence. We report a case of a 67 year old man with an infestation of the coracobrachialis muscle. We discuss several instrumental and serologic diagnosis methods and the hypothesis of a primary muscular localization.

Papillary-like bladder calcifications following intravescical mitomycin C. A case report.

We report a case of bladder calcifications after intravescical mitomycin C in patient with recurrent superficial multifocal transitional cell carcinoma (TCC) of the bladder. The endoscopic appearance was particularly interesting since these calcifications occurred only in the areas of previous transurethral resection (TUR).

[Obstruction of the Le Veen shunt: a new surgical solution]. / L'ostruzione dello shunt di Le Veen: nuova soluzione chirurgica.

The authors propose an alternative which has been proved valid in four cases of peritoneovenous shunt with an occluded Le Veen valve for venous thrombosis implanted in cirrhotic patients with refractory ascites. After having explored the various possibilities using the vessels adjacent to the superior cava branch, the authors resolved the problem of reimplanting the valve by using an access route through the saphenous vein and inferior vena cava. Using this technique it was possible to reactivate the shunt with a marked improvement in the recurrent ascitic state and above all shunt functionality, and consequently in the clinical conditions and quality of life of these patients.

[Darier-Ferrand dermatofibrosarcoma. General aspects and personal experience]. / Il dermatofibrosarcoma di Darier-Ferrand. Aspetti generali ed esperienza personale.

The Darier-Ferrand dermatofibrosarcoma is a cutaneous lesion with a clinic and recidivant progress that appears in both sexes in the same measure. The metastasis are rare. The authors describe a kind of treatment effected in 13 cases arrived to their observation.

[The optimal implantation of the peritoneal-jugular shunt with LeVeen valve]. / Impianto ottimale dello shunt peritoneo-giugulare con valvola di LeVeen.

The authors underline the efficacy of peritoneovenous shunting with LeVeen's valve in the treatment of refractory ascites in cirrhotic patients. Selection and appropriate preoperative management of patients are essential to assure good immediate and long-term results.