Lift and VAAFT for high trans-sphincteric anal fistula: a single center retrospective analysis.

PURPOSE: The management of complex anal fistulas remains a challenge, mainly due to the considerable risk of incontinence. We compared LIFT and VAAFT in the treatment of complex anal fistulas in terms of healing time, recurrence, continence, morbidity, and postoperative pain, focusing also on patients with local abscess at the time of surgery. METHODS: We include all patients with high trans-sphincteric anal fistula even with abscess at the time of surgery. Anorectal manometry, endoanal ultrasound, Cleveland Clinic fecal incontinence score, VAS score, and number of previous fistula treatment were recorded. The clinical examination defined healing, insufficiency or recurrence of the fistula. RESULTS: Fifty-four consecutive patients are undergoing surgery: 26 patients underwent LIFT and 28 underwent VAAFT. During the 18 months of follow-up there were no differences in terms of AM, CCFIS and VAS scores. Days of healing, failure, and recurrence rate were comparable in both groups. The subgroup of patients with local abscess undergoing LIFT showed worse results in terms of failure and recurrence rate (p < 0.05). CONCLUSIONS: Both techniques are safe and effective and can offer long-term benefits. LIFT should not be used as a first treatment in high trans-sphincteric fistula with perianal abscess.

[Risk assessment method for psychosocial factors at workplace: a North-West Tuscany area project]. / Metodologia di valutazione dei rischi psicosociali in ambiente di lavoro: un progetto toscano di area vasta.

The rising awareness of psychosocial risks at workplace means that it is ever more important to prepare methods to assess psychosocial factors in occupational environment. This project of north west tuscany area has the aim to realize an instrument for a gradual risk assessment for this kind of factors without the support of specialists. A decisional flow chart helps to approach the risk assessment step by step on the basis of company features, management and organization problems and company symptoms of stress. The final assessment combines the evaluation of perceived risks with job analysis realizing a matrix containing 5 risk levels, which suggests the priority of preventive measures. The intermediate level (level three) represents the activation level for the medical surveillance. This experience means a proposal for a quantitative assessment of psychosocial risks at workplace.

Renal cell carcinoma in adolescents. A case report and review of the literature.

Renal cell carcinoma is rare in adolescents. Observation of a 16-year-old girl with a clear-cell carcinoma prompted us to review 372 published cases in adolescents. The tumor affects the sexes indifferently and has no side predominance. The incidence is higher in white races. The most frequent presenting sign is a palpable mass (52.7%). X-ray films typically show renal calcifications (25%). The most common histotype is the clear cell carcinoma (76.8%) and at diagnosis 59.5% of these tumors already extended beyond the kidney. The overall 5-year actuarial survival rate is 60.4%.

Ventilation-perfusion mismatching as prognostic factor of respiratory failure after pulmonary resection.

This paper reports the results of a retrospective study undertaken to assess the reliability of regional ventilation-perfusion pulmonary scanning in predicting the remaining respiratory function (pFEV1), and the early and long-term outcome of 33 patients with chronic airways disease, submitted to pulmonary resection at the 1st Department of Surgery. All patients had been diagnosed as resectable with the traditional tools and had a traditional pFEV1 (tpFEV1) greater than 800 ml. All pFEV1 were re-calculated (npFEV1) with our new formula which also includes as lost for function all lung areas not to be resected with V/Q mismatching. Normal perfusion and ventilation distribution was found in 24.2% of patients in the lesion area and in 33.3% in the remaining pulmonary areas. An impairment of perfusion was observed in the lesion area in 72.7% of patients, in the remaining areas in 48.4%. An impairment of ventilation was observed in the same regions in 66.6% and 48.5% of patients, respectively. Abnormality in ventilation/perfusion matching occurred in the lesion area in 15.2% of cases, in the ipsilateral lung areas in 18.2%, in the contralateral lung in 48.4% of cases. In predicting postoperative FEV1, and early and long-term mortality among our resectable patients, the tpFEV1 showed an accuracy of 91%, an index of resectability of 93.7%, of unresectability of 0%. Our npFEV1 reached an accuracy of 94.4%, an index of resectability of 100% and an index of unresectability of 66.7%.

[Malignant fibrous histiocytoma. Two case reports and review of the literature]. / L'istiocitoma fibroso maligno. Presentazione di due casi e revisione della letteratura.

The authors report two cases of malignant fibrous histiocytoma localised in the gluteus maximus and re-evaluate some clinical and biological aspects of the neoplasia. Although its histiogenesis is still unsure, the tumour can be classified into various isotopes: the vorticoid-polymorphous variety (70%), and the myxoid, giant cell, angiomatous and inflammatory varieties. It is the most common soft tissue sarcoma in adults and onset is most frequently observed on the trunk and limbs. Biological behaviour shows a marked tendency to local recidivation, with metastatic diffusion occurring mainly late. The choice of therapy consists of more or less radical surgical removal with or without ratio- and immunotherapy. The results of surgery are influenced by the technique used, and the biological and clinical behaviour of the tumour; in view of the numerous case reports of anomalous behaviour, these factors are only indicative. Therapeutic efficacy is on the whole greater in cases of tumours with diameters of less than 5 cm and more superficial localisations compared to the deep muscular fascia.

[Risk factors and breast carcinoma: our experience in a department of senology]. / Fattori di rischio e carcinoma mammario: esperienza di un servizio di senologia.

In relation to their experience, the Authors affirm that currently an early diagnosis of breast cancer, in an absolute preclinical stage, is obtainable by adequate screening using specific methods especially among women who are at greater risk. Primary prevention is not achievable at present; however some considerations based on protocols which provide a surgical prophylactic therapy in high risk breast pathologies and in very selected patients, are possible. In the light of these considerations secondary prevention has a predominant role and may be more effective and curative if the treatment is carried out in the earliest stages of the disease.

[Local anesthesia in breast augmentation]. / L'anestesia locale negli interventi di mastoplastica additiva.

The Authors report their experience in the application of local anesthesia during breast prosthesis implantation.

[Evaluation of the respiratory function by lung scintigraphy in patients candidates for pulmonary resection]. / Valutazione della funzione respiratoria mediante scintigrafia polmonare nei pazienti candidati a resezione polmonare.

Sixty-one patients undergoing pulmonary resection were studied pre- and post-operatively by spirometry, arterial gas determination, and quantitative ventilation/perfusion lung scanning. Our results showed that ventilation and/or perfusional scintigraphic scanning is currently the most reliable method in identifying patients at risk for postoperative respiratory insufficiency. Specifically, this technique was successful in detecting pulmonary areas other than those to be resected presenting ventilation or perfusional abnormalities. Therefore, the technique is particularly useful in predicting residual pulmonary function.

[The role of surgery in the treatment of primary carcinoma of the gallbladder. Review of 86 cases]. / II ruolo della chirurgia nel trattamento del carcinoma primitivo della colecisti. Revisione di 86 casi.

The records of 86 patients with primary adenocarcinoma of the gallbladder were reviewed. All patients were staged according to the Nevin classification. Twenty-nine patients underwent resection, 57 were submitted to palliative procedures or exploratory laparotomy. Survival was directly related to tumor staging and modality of treatment. The 5- and 10-year survival expectancy after curative resection was 46.8% in stage II patients, 14.2% and 0%, respectively, in stage V patients. None of the unresectable cases survived beyond 24 months, except for one patients who lived 62 months. No significant difference in survival expectancy was found between resectable and unresectable patients with stage V tumor.

[Surgery associated with intraoperative hyperthermia-chemotherapy in the treatment of malignant tumors of the digestive system with peritoneal carcinosis]. / Chirurgia associata ad ipertermochemioterapia intraoperatoria nel trattamento dei tumori maligni dell'apparato digerente con carcinosi peritoneale.

In the last two years the authors have treated 4 patients affected with malignant tumors of large bowel with very poor prognosis. In every cases they found large spreading to peritoneal cavity. These patients underwent to intraperitoneal hyperthermia-chemotherapy using a special device conceived by authors. This treatment produced promising results as related to life quality in these cases.

[Prognostic criteria in ruptured aneurysm of the abdominal aorta]. / Criteri prognostici associati negli aneurismi dell'aorta addominale rotti.

A logistic regression analysis of risk factors affecting the mortality on 69 cases of ruptured abdominal aortic aneurysm (RAAA), treated between 1988-1996, has been carried out. Mortality was 33.3%. No single risk factor significantly influenced mortality except the shock (p = 0.0016). The presence of two o less risk factors in the same patient was associated with 24% mortality, whereas three o more risk factors were associated with 92.4% mortality.