Laparoscopic adrenalectomy by the anterior transperitoneal approach: results of 108 operations in unselected cases.

BACKGROUND: The feasibility, safety, and results of 108 laparoscopic anterior transperitoneal adrenalectomies (six bilateral) were evaluated in a series of 105 patients. Three patients with a preoperative diagnosis of primary adrenal carcinoma were excluded from the study. METHODS: A total of 102 patients were included in the study based on exhaustive endocrinological and imaging assessment. Twenty-nine patients with nonsecreting adenoma, 34 with aldosterone-producing adenoma, 27 with cortisol-producing adenoma (five bilateral), 13 with pheochromocytoma (one bilateral), two with androgen-secreting adenoma, and three with metastases were considered eligible for adrenalectomy. Lesion size ranged from 3.5 to 12 cm. Concurrent surgical procedures were performed in 10 patients (9.8%). RESULTS: One (0.9%) intraoperative complication, a colon tear in a bilateral adrenalectomy, required conversion. There were two (1.9%) postoperative complications: one patient with thrombocytopenia developed hemoperitoneum and required a second laparoscopic procedure, and an intraabdominal abscess was treated medically. Mean postoperative hospital stay was 2.5 days (range, 1-7 days). Postoperative mortality was 0.9%; the patient with the colon tear died of sepsis 60 days after the operation. At a mean follow-up of 30 months (range, 1-62), normalization or improvement in hormone levels was observed in all patients with secreting adenomas, and significant improvement or cure was achieved in all patients with hypertension. CONCLUSION: Patients with secreting and nonsecreting adrenal lesions can be treated safety and effectively by laparoscopy with the anterior transperitoneal approach.

[Anesthesia-analgesia with remifentanil. Instrumental, laboratory and clinical evaluations]. / Anestesia analgesica con remifentanil. Valutazioni clinico-laboratoristiche-strumentali.

The option of analgesic anaesthesia without hypnotic was investigated in 13 patients, submitted to general, orthopedic or urologic surgery. Induction and maintenance of anaesthesia was performed with syringe-pump infusion of remifentanil 1-->2.2 mcg/kg/m and cisatrecurium, 0.2/air with FIO2 0.3; ecg monitoring, sieric level of ACTH were studied. "Slipping 8 channels patterns" were observed without spindless and K complexes; only in 2 patients N2O 50% can be used for increasing the depth of narcosys; ACTH levels increases only after remifentanil infusion stop.

[Our experience in the surgical treatment of cysts and fistulas of the thyroglossal duct]. / La nostra esperienza nel trattamento chirurgico delle cisti e delle fistole del dotto tireoglosso.

A clinical series of cysts and fistulas of the thyroglossal tract has been examined. Clinical aspects of this pathology and the results obtained with surgical treatment are compared with reported data.

Electrocardiomultigraphimeter using a home computer.

The drop in hardware costs has fostered the widespread use of home-computer systems. Because of this situation, the home computer can be profitably employed in some highly specialized fields. We believe electrocardiographic instrumentation to be one such field. We have built an electrocardiomultigraphimeter (ECXGM), which can be considered as a development of the traditional electrocardiograph that performs some additional functions. Our prototype features vectorcardiography, polar coordinate tracing, automatic measurements between fiducial points selected by the user with a joystick and screen cursor and trace filing by patient on labelled floppy disks. The standard hardware consists of a Commodore 64 console, a monitor, two floppy disk drives and an Epson HI-80 plotter, all of which are readily available. The special hardware consists of an A/D converter, which receives the electrocardiographic signal downstream of the amplifying stage, which is a standard feature of any electrocardiograph. Prototype development mostly involved the software. Difficulties were posed by the limited resources available on home computers, an important point in view of the problem to be tackled. The solutions adopted are based on the use of assembler language and overloading techniques and minimizing the interconnections among the software modules defined in a compactly built program. The result is an instrument with significantly advanced clinico-scientific capabilities as compared to current electrocardiographic instruments. This fact, and the class of the hardware used and special software built, confer originality to this work. The new instrument ought to be especially suitable for the offices of cardiologists who have an interest in such capabilities, and for schools of electrocardiography.

[The electrocardiomultigraphimeter and the Commodore-64. How to use the home computer with great skill]. / Elettrocardiomultigrafimetro in ambiente Commodore-64. Come usare con alta professionalità il calcolatore di casa.

The drop in hardware costs has fostered the widespread use of home-computing systems. Because of this situation, the home-computer can be profitably employed in some highly specialized fields. We believe electrocardiographic instrumentation to be one of such fields. We have built an electrocardiomultigraphimeter (ECXGM), which can be considered as a development of the traditional electrocardiograph that fulfills some additional functions. Our prototype features vectorcardiography, polar coordinate tracing, automatic measurements between fiducial points selected by the user with a joystick and cursor on the screen and trace filing by patient, on labelled floppy disks. The conventional hardware consists of a Commodore 64 console, a monitor, two floppy disk drives and an Epson HI-80 plotter, all of them readily available. The special hardware consists of an A/D converter, which receives the electrocardiographic signal downstream of the amplifying stage which is a standard feature of any electrocardiograph. Prototype development mostly involved the software. Difficulties were posed by the limited resources available on home-computers, an important point in view of the problem to be tackled. The solutions adopted are based on the use of the ASSEMBLER language, overloading techniques and on minimizing the interconnections among the software modules defined in a compactly built program. The result is an instrument having significantly advanced clinico-scientific capabilities as compared to current electrocardiographic instruments. This factor, and the class of the hardware used and special software built confer originality to this work.(ABSTRACT TRUNCATED AT 250 WORDS)

Parenting, protecting, preserving: mission of the adolescent female runaway.

This paper presents a systemic framework for therapy with families of adolescent female runaways. The runaway adolescent is viewed as serving three functions within her family. First, she often parents her parents and siblings. Second, she protects her parents' marriage and regulates marital distance. Third, she preserves her family unit at the preadolescent developmental stage. Interventions are described that remove the adolescent from those roles by empowering the parents to take charge of the adolescent, by changing the communication process such that the couple deal with their marital issues without the help of the teenager, and by facilitating the family's movement toward a new stage of separation and individuation.

[Althesin or CT 1341 as a drug to induce balanced anesthesia with ethrane or fluothane associated with type II NLA in dental, maxillofacial and plastic surgery of the head area]. / L'Althesin o CT 1341 come farmaco di induzione alla narcosi bilanciata con ethrane o fluothane associati alla N.L.A. tipo II in chirurgia stomatologica, maxillo-facciale e plastica dell'estremo cranio-cefalico.

The Authors have tried Althesin as a medicine for the induction and maintainement of the narcosis in the stomatological, maxillo-facial and extra and intra-oral surgery. They have deduced that CT 1341 does not constitute to the anaesthetics Ethrane and Fluothane because of the anaesthetic-level instability (restlessness of the patient and clonic movements of the limbs during the most painful operations in particular). The Authors, supporters of the balanced anaesthesia, suggest using Althesin in the narcosis induction, the maintaining of which is carried on by the N.L.A. type II medicine and by the Ethrane or Fluothane. The latest ones are to be given in very small, not dangerous quantities. The Authors have so obtained a remarkable oxygenation of the patient, a ready, calm and lucid awakening without any collateral and dangerous consequences.

[Preventive therapy in stomatological and maxillofacial surgery. Clinical considerations on the administration of cephaloridine, using a new technic (short-term prophylaxis)]. / La profilassi antibiotica nella chirurgia stomatologica e maxillo-facciale. Considerazioni cliniche sulla somministrazione di cefaloridina secondo una nuova tecnica (Short term Prophylaxis).

The "Short term prophylaxis" technique was used in 100 patients who had undergone Stomatologic surgery and Maxillo-facial surgery for post-operative prophylaxis of surgical infections according to analogous researches conducted in other surgical branches by various authors. The results obtained can be summarized as following: 1) a marked reduction in administered antibiotics (cefaloridina); 2) a marked reduction of post-operative fever; 3) a maintainment of average febrile levels at 37,8 degrees-38 degrees. The above tecnique thus allowed a more rapid mobilization of patients who had undergone surgical intervention, a reduction of the recovery period and the therapeutic costs.

[Anesthesiological problems in maxillo-facial surgical interventions and reconstructive plastic surgery]. / Problemi di anestesiologia negli interventi di chirurgia maxillo-facciale e plastica ricostruttiva.

11 years of anaesthesiological experience in maxillofacial and reconstructive plastic surgery (1-4-1966/1-4-1977) are reviewed. The problems connected with these operations are examined. On the basis of localizations, types of operation and surgical requirements, the problems of greatest importance in these branches of surgery may be indicated in the following 5 parameters: 1. Control of the respiratory ways with naso-tracheal intubation under direct view or blind (more than a thousand cases), oro-tracheal intubation: their indications and contraindications as alternatives to pre- intra- and postoperative tracheotomy. 2. Local control of bleeding. 3. Arousal and prevention of possible postnarcotic complications. 4. Prevention and treatment of postoperative oedema. 5. Nutrition of the patient undergoing surgery. In the interests of history, the superseded problem of whether to use local anaesthesia and general anaesthesia in maxillofacial surgery is mentioned and the various problems are discussed exhaustively. Personal anaesthesiological conduct is then specified in relation to the parameters examined and results reported. The importance in certain endo- and extraoral operations of prolonged intubation in the immediate postoperative period (10-15-30 hours) with respect to the indication for postoperative tracheostomy is highlighted. Apart from certain special pathological situations, tracheostomy is rather exceptional and is no longer employed on a routine basis as it was 2-3 years ago.