[Ambulatory treatment of hemorrhoidal pathology with elastic bands according to a modified Barron technique]. / Il trattamento ambulatoriale della patologia emorroidaria con legature elastiche secondo la tecnica di Barron modificata.

The authors report their experience in the treatment of hemorrhoids by rubber band ligation according to Barron's modified technique which foresees that the ligation is performed thanks to the suction of the hemorrhoidal node through the shaft of the band applicator connected with an aspirator. Eighty-four patients underwent consecutively this treatment over a 18-month period; all were performed with a minimum follow-up of 6 months. Forty male patients (mean age 46.6 years) showed symptoms lasting since 9 years. Forty-four female patients (mean age 42.6 years) showed such pathology since 8.9 years. 70.2% of the patients were classified as III stage of disease, 19% II stage and 10.7% I stage. Thirty-four patients had anal pain, 49 bleeding, 5 anemia, 21 thrombosis of the hemorrhoidal plexus, 54 prolapse of the ano-rectal mucosa. These symptoms and signs were present in most of the patients contemporaneously. Three patients had previously received rubber band ligations, 4 hemorrhoidectomy, 1 sclerotherapy and 1 rubber band ligation and sclerotherapy. In the whole we performed 285 sessions and 304 rubber band ligations. Each treatment consisted of 3.4 sessions and 3.6 rubber band ligations. Recovery was achieved with only one session in 9 patients; 66.7% of them showed 1st degree disease. Multiple sessions were necessary in patients with advanced disease degree; 100% at stage II and 94.9% at stage III. Sixty-five patients did not refer immediate and long-term significant complications. The remaining patients complained during the first hours about heavy feeling and/or tenesmus and two, 2 weeks after the end of treatment, showed bleeding episodes, which cleared up spontaneously. In 5 cases it was necessary, during follow-up, to carry out a completion rubber band ligation and in 3 we performed trimming surgery at the out-patients' department by resection of the exceeding skin and anal mucosa. The technique enables to achieve results just as valid as those of traditional methods in the treatment of hemorrhoidal pathology with the advantage that it can be performed in an out-patient's department, it does not need local anesthesia, it enables the patient to immediately return to his normal working activity and, restricted to the observation period (6- and 12-month follow-up) it allows a satisfactory control of the disease.

[Nonpalpable lesions of the breast. A new technique of ultrasound-guided excision biopsy]. / Le lesioni non palpabili della mammella. Una nuova tecnica di biopsia escissionale ecoguidata.

The authors have developed a simple and accurate technique of excisional biopsy for non-palpable breast nodes using an intraoperative sonographic technique. Identification, localization and exeresis of the lesions are guided by means of a sterilized transducer introduced through the surgical wound. The confirmation of the correct biopsy is evaluated by scanning the specimen gowned with a surgical glove and comparing the intra- and postoperative ultrasonographic images. The results of analysis showed that in all cases the altered area was removed with extreme accuracy and the ultrasonography is reliable in identifying pathological or suspicious areas since the dimensions of the lesion measured with the scanner correspond significantly to the dimensions of the lesions when measured histologically.