Preservation of left colic artery with lymph node dissection of IMA root during laparoscopic surgery for rectosigmoid cancer. Results of a retrospective analysis.

BACKGROUND: During sigmoid or rectal cancer surgery, dissection of lymph-nodes at the origin of inferior mesenteric artery is mandatory. Nevertheless, ligation of the origin of IMA should compromise blood supply to left colon and affect anastomosis. The aim of this retrospective evaluation is to compare high IMA ligation and low IMA ligation with preservation of LCA and skeletonization of the origin of IMA during laparoscopic colorectal resection. METHODS: All 120 patients included were affected by clinically M-0 sigmoid or rectal cancer. A laparoscopic colorectal resection with low or high ligature of IMA was performed. Low ligation was carried out with lymphadenectomy of the arterial root. Patients were divided in 2 groups according to type of treatment: Group A, high IMA ligation (N=65), Group B, low ligation with lymphadenectomy of IMA root (N=55). RESULTS: Preoperatively 59 patients had stage I, 42 patients had stage II  and 19 patients had stage III tumor. A mean of 20.3 +/- 4.5 lymph nodes were removed in group A patients and 18.9 +/- 9.1 in group B patients, and this difference was not statistically significant. Operative time, intraoperative and postoperative complication rates were not different between the two group. CONCLUSIONS: Low IMA ligation combined with lymph-node dissection at its origin is safe and effective, not time consuming and not associated to increased risk of complications and nerve damage. This technique can be considered as alternative to standard high IMA ligation in selected patients.

[The environment and health protection of the child]. / Ambiente e tutela della salute del bambino.

The authors outline the relationship between environment and children health care. They describe the environmental situations able to produce damages to the children's health.

[Goldenhar's syndrome: a case report]. / La sindrome di Goldenhar: descrizione di un caso osservato.

The Authors describe one case of Goldenhar's syndrome. They concentrate on the etiopathogenetic hypothesis and they believe it helps the gradual healing in time.

[A case of hereditary angioedema]. / Su di un caso di angioedema ereditario.

The authors describe a case of hereditary angioedema in a female child of four years. Treatment with C1 human-immuno-inactivator. Good success of therapy.

[A case of persistent fever]. / Su di un caso di febbre persistente.

The Authors report a case of difficult diagnosis, clinically characterised by long-term persistent fever. Clinical and laboratory tests led to a first conclusion of a tubercular infection; later of a perisplenic hematoma and the persistence of high inflammatory indices directed to a different diagnosis.

[Rheumatic manifestations and dental foci: a review of the cases in 12 years of activity in a pediatrics division]. / Manifestazioni reumatiche e foci dentari: revisione della casistica di 12 anni di attività in una divisione di pediatria.

By examining 8244 clinical records, in a period of 12 years of paediatric activity, the authors point out the connection between dental caries and rheumatic fever. They suggest fluoride supplementation since the early age, in countries where the fluoride is lack in drink able-water.

[Axial polydactyly: a clinical case]. / Polidattilia assiale: caso clinico.

After a short review of the normal embryonal development of lower limbs the authors describe a case of polydactyly associated with a 2nd-grade hypospadias observed in a 4-month-age patient. The authors, after the surgical treatment of both defects, have made the follow-up of the patient until six year age.

[The Guillain-Barré syndrome in childhood]. / La sindrome di Guillain-Barré nell'infanzia.

The authors describe a case day Guillain-Barré syndrome admitted in pediatrics hospital department for asthenia. Approximately an hour after admission, the patient showed dysphagia and respiratory insufficiency and was diagnosed a Guillain-Barré syndrome, successfully treated.

[Cheilognathopalatoschisis: its embryology, epidemiology, etiology, clinical picture and therapy. The experience of a division of pediatrics]. / La cheilognatopalatoschisi: embriologia, epidemiologia, etiologia, clinica e terapia. Esperienza presso una divisione di pediatria.

The authors report their experience about cleft lip and palate.

[Abdominal pain in childhood: multidisciplinary approach. A clinical case]. / Il dolore addominale in età pediatrica: approccio multidisciplinare. Caso clinico.

The Authors describe a case of mature cystic teratoma found in a little girl 9 + 8/12 years old and removed in laparoscopic way. Various specialists' contribution shows up for the resolution of the case.