Laparoscopic splenectomy for the treatment of wandering spleen.

Wandering spleen is a very rare pathologic condition that initially presents with unremarkable clinical symptoms, then dramatically manifests severe complications. A case of wandering spleen treated with laparoscopic splenectomy is described and compared with other similar reports in the literature. Laparoscopic exploration of the abdominal cavity allowed the diagnosis to be confirmed and splenectomy to be performed. An enlarged spleen led to the choice of total splenectomy to avoid both future complications and future organ torsion resulting from the long and twisted vascular pedicle. The laparoscopic approach led to a rapid recovery, a 3-day postoperative course, and satisfactory cosmetic results.

Laparoscopic partial splenectomy for a splenic pseudocyst.

We describe a laparoscopic hemisplenectomy that was performed to treat a 21-year-old patient with a large splenic pseudocyst located in the upper splenic pole. The diagnosis was made by computed tomography and ultrasound, and surgery was performed with ultrasound scalpel, clips, and fibrin glue. Surgery lasted 70 min and did not require blood transfusions. The patient was discharged on postoperative day 3, and at 28-month follow-up there were no sequelae or recurrences. The laparoscopic approach is a valid alternative to laparotomy because the integrated magnified view enables the surgical team to perform surgery in a much shorter time and with greater hemostatic accuracy than the traditional technique.

[Morgagni-Larrey diaphragmatic hernia: report of a case]. / Ernia diaframmatica di Morgagni-Larrey: descrizione di un caso.

The Authors presents a Morgagni-Larrey's diaphragmatic hernia case, observed during subocclusive manifestation. They emphasize the utility to perform always the surgical intervention, also in the asintomatic cases.

High prevalence of myocardial ischemia and vasoconstrictive hormonal release in hypertension during chronic renal failure.

OBJECTIVE: Indexes of myocardial ischemia and vasoconstrictive hormonal release were evaluated in order to investigate the difference between essential hypertension and hypertension during chronic renal failure. BACKGROUND: Arterial hypertension induces several cardiovascular alterations that reflect themselves either on the heart and/or on the coronary blood flow enhancing the cardiovascular risk. Since chronic renal failure can influence the neuroendocrine response, various mechanisms involved in hypertension during chronic renal failure are still unclear. High endothelin 1 (ET-1) levels have been found both in arterial hypertension and during chronic renal failure. Interestingly, either ET-1 or catecholamines seem also to be implied in the pathogenesis of myocardial ischemia. METHODS: 20 hypertensive uremic and 20 essentially hypertensive patients underwent echocardiographic wall motion and wall thickening analysis performed at baseline and immediately after the end of exercise. Simultaneously, myocardial perfusion was evaluated by 99mTc-MIBI-SPECT. In addition, plasma norepinephrine and ET-1 concentrations were measured at baseline and at peak exercise. RESULTS: The segmental radionuclide analysis showed a greater ischemic degree in hypertensive uremic patients. Yet, we were able to identify one or more regions of the left ventricle in which both systolic thickening measurements and wall motion after exercise were impaired. After exercise, wall thickening impairment was correlated with both wall motion abnormalities (r = 0.72, p < 0.01) and MIBI ischemic grade (r = 0.82, p < 0.001). Basal and after-exercise plasmatic norepinephrine and endothelin levels were higher in hypertensive uremic than in essentially hypertensive patients. Moreover, there was a significant correlation between increments in norepinephrine concentration and MIBI perfusion defects, and between the increment in ET-1 concentration and both MIBI perfusion defects, or kinetic alterations assessed by wall motion as well as by wall thickening. CONCLUSIONS: This is the first cross-sectional study in which a higher degree of myocardial ischemia has been observed in hypertensive uremic patients combined with an enhanced plasma release of both norepinephrine and ET-1. This phenomenon may contribute to enhance the cardiovascular risk of these patients.

Role of arterial hypertension in plasma secretion of prostacyclin during renal failure in man.

Cardiac function and morphology in chronic hemodialyzed patients are modified in consequence of both vascular and neurohormonal factors. In the present study we investigate on the role of prostacyclin (PGI2) vasodilator agent, during hemodialytic (HD) treatment. Twenty-four patients (13 males and 11 females; 9 hypertensive and 15 normotensive) aged 58.5 +/- 14.4 years were studied; 2.5 ml of venous blood were collected before (time 0) and 15', 120', and 240' of dialytic session. The PGI2 levels were measured in plasma, after extraction in ethyl acetate by RIA method, as levels of 6-Keto-PGF1 alpha, a stable metabolite. The results have shown as increase of PGI2 levels at 15' in hypertensive HD patients (HHD) from the begin of dialysis that increased until 240'. This phenomenon was more significant in hypertensive than in normotensive group (NHD) (p < 0.05 vs NHD). These preliminary data suggest that in HHD patients the role of PGI2 is more important than in NHD patients as regards the effects on regulation of circulatory tone. The increment of PGI2 levels could be in relation with the sympathetic activation occurred during hemodialytic treatment.

Intravenous propafenone for suppression of symptomatic atrial fibrillation and atrial flutter in a first aid hospital.

The efficacy and safety of propafenone (PPF) were prospectively evaluated in 20 patients (13 men and 7 women, age 39 +/- 14 years) with atrial arrhythmias (AA) (atrial fibrillation: n = 13; atrial flutter: n = 7). All patients had arrhythmias from 109 +/- 63 minutes, (iT) without clinical evidence of heart failure. Intravenous PPF was given as a 1 mg/kg bolus over 5 minutes, with a therapeutical possibility of a second bolus (1 mg/kg) after 10 minutes if sinus rhythm was not restored. The conversion time (cT) was 6.4 +/- 2.2 minutes (range 3 to 18 minutes). In 19 patients (95%) sinus rhythm was restored and no serious adverse and proarrhythmic effects were noted in each patient. We conclude that 1) PPF is effective and acted significantly faster in controlling AA; 2) PPF appears to be well tolerated and relative safe with a low incidence of adverse and proarrhythmic effects in patients in a first aid station.

[Therapy and iron supplements with ferritin iron during pregnancy. Randomized prospective study of 458 cases]. / Terapia e supplemento marziale con ferro ferritinico durante la gravidanza. Studio prospettico randomizzato di 458 casi.

A randomized polycentric study was programmed to establish the effects of daily administration of ferritin iron from early pregnancy to puerperium. 254 women with normal iron balance at the beginning of their pregnancy were randomized receiving no supplements or 40 mg iron daily. At the end of pregnancy iron balance was still normal only in one third of the pregnant women of the first group versus two third of the second group. 204 women who were iron-deficient received daily 40 or 120 mg of iron; in this group anemia developed less frequently (13% versus 29%) and iron balance normalized in one subject on four; the great majority of these women remained iron-deficient. Unwanted effects of minimal or mild relevance, and almost always sporadic were observed in 6.5% of cases and with the reduction or withdraw of the treatment in only 1.4% of cases. These results showed that daily administration of ferritin iron during pregnancy is effective and well tolerated; furthermore they suggest that the treatment must be done with at least 60 mg daily in women with normal iron balance and protracted also after the puerperium in iron deficient subjects.