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Vecchio R, Intagliata E, La Corte F, Marchese S, Cacciola RR, Cacciola E. Late results after splenectomy in adult idiopathic thrombocytopenic purpura. JSLS 2016; 19:e2013.00272. [PMID: 25848175 PMCID: PMC4370036 DOI: 10.4293/jsls.2013.00272] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] [Imported: 08/29/2023] Open
Abstract
Background: We performed a retrospective study on patients with idiopathic thrombocytopenic purpura (ITP) to evaluate the response to splenectomy in relation to preoperative platelet count. Materials and Methods: Two groups of patients operated on with laparoscopic or open splenectomy for ITP, with a platelet count ≤30,000/μL (study group: 22 patients) and >30,000/μL (control group: 18 patients), respectively, were compared. The two groups were homogeneous in relation to age, sex, length of preoperative steroid therapy, and time interval between diagnosis and surgery (Student t test with P > .1). The results of surgery were evaluated at one year after splenectomy. Positive response to surgery, according to the American Society of Hematologic Guidelines, was considered in patients with a postoperative platelet count ≥100,000/μL or in patients with a postoperative platelet count ≥30,000/μL and a twofold increase in platelet count from baseline, in the absence of bleeding. The postoperative platelet count increase rate was statistically related to preoperative platelet count in both the study and control groups. Statistical analysis was performed using the Student's t test for independent sample and the Pearson correlation in a 2-tailed test. Results: No relationship between preoperative platelet count and postoperative platelet percent increase was observed in the control group (r = –0.41; P = .089), whereas a significant negative correlation (r = –0.68; P = .0004) was found in the study group. Conclusions: A higher increase of postoperative percent platelet count may be predicted in patients with a low preoperative platelet count.
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Journal Article |
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Vecchio R, Intagliata E, Marchese S, La Corte F, Cacciola RR, Cacciola E. Laparoscopic splenectomy coupled with laparoscopic cholecystectomy. JSLS 2016; 18:252-7. [PMID: 24960489 PMCID: PMC4035636 DOI: 10.4293/108680813x13693422518434] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] [Imported: 08/29/2023] Open
Abstract
Background and Objectives: The aim of this study was to evaluate the results of laparoscopic surgery performed for coexisting spleen and gallbladder surgical diseases. Methods: Between May 2004 and October 2012, 12 patients underwent concomitant laparoscopic splenectomy and cholecystectomy. Indications for surgery included idiopathic thrombocytopenic purpura in 5 patients, hereditary spherocytosis in 4 patients, and thalassemia intermedia in 3 patients. Results: The mean operative time was 100 minutes (range, 80–160 minutes), and the blood loss ranged from 0 to 150 mL (mean, 50 mL). The mean longitudinal diameter of the spleen was 14 cm. One patient required conversion to open procedure. An accessory spleen was detected and removed in one case. The mean length of hospital stay was 5 days. No deaths or other major intraoperative and/or postoperative complications occurred. Conclusion: Provided that the technique is performed by an experienced surgical team, concomitant laparoscopic splenectomy and cholecystectomy is a safe and feasible procedure and may be considered for coexisting spleen and gallbladder diseases.
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Journal Article |
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Vecchio R, Cacciola E, Figuera M, Catalano R, Giulla G, Distefano ER, Intagliata E. Idiopathic intramural hematoma of the right colon. A case report and review of the literature. Int J Surg Case Rep 2019; 60:16-20. [PMID: 31181384 PMCID: PMC6556811 DOI: 10.1016/j.ijscr.2019.05.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Revised: 04/16/2019] [Accepted: 05/02/2019] [Indexed: 02/07/2023] [Imported: 08/29/2023] Open
Abstract
A very rare case of spontaneous colon hematoma has been reported. The rarity of our case of colon hematoma is due to the fact that it is idiopathic. The topic is still under discussion in the Literature since the pathophysiology remains still unknown.
Introduction Intestinal hematoma is usually observed after an abdominal trauma or in patients treated with anticoagulant therapy. Conversely, idiopathic bowel hematoma is very rare, being colon involvement sporadic with few reports in the Literature. Presentation of case The Authors report a case of idiopathic spontaneous large bowel hematoma. A 48-year-old man was admitted for a thoraco-abdominal pain and signs of acute abdomen and fever. After ruling out heart diseases, a CT scan revealed a marked thickening of the ascending colon wall, obstructing the bowel lumen. Leukocytosis was observed. In an emergency setting, an explorative laparotomy was performed. Hemoperitoneum and a large hematoma involving the caecum and the ascending colon were detected, together with intramesenteric and retroperitoneal blood effusion. A right hemicolectomy was accomplished. Histopathology confirmed the diagnosis of large bowel hematoma. Post-operative molecular diagnostic testing for coagulative disorders failed to demonstrate any genetic variation associate with hemorrhagic predisposition. In the post-operative course, the patient experienced a left basal bronco-pneumonia with increased unilateral pleural effusion, successfully treated by a thoracic drain and antibiotic therapy. Discussion The reported case and Literature data show that diagnosis of idiopathic colon intramural hematoma is challenging, especially in the emergency setting. Although conservative therapy is the first line treatment, surgery still has an important role when the diagnosis is uncertain, medical treatment fails or a complication, such untreatable bleeding, perforation or occlusion occur. Conclusion The Authors report a very rare case of spontaneous intramural hematoma of the right colon. Surgery still has a role in selected cases.
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Benign adenomyoepitelioma of the breast: Presentation of two rare cases and review of literature. Int J Surg Case Rep 2020; 67:1-4. [PMID: 31991375 PMCID: PMC6992528 DOI: 10.1016/j.ijscr.2020.01.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2019] [Revised: 01/08/2020] [Accepted: 01/16/2020] [Indexed: 01/13/2023] [Imported: 08/29/2023] Open
Abstract
Adenomyoepithelioma of the breast is a rare benign breast neoplasm. The rarity of this histological type of benign breast tumor and the finding of two cases in a short period makes this case report unique. Although benign, adenomyoepithelioma has a potential for local recurrence; therefore, wide excision is recommended.
Introduction Adenomyoepithelioma of the breast is a rare benign breast neoplasm with a particular behaviour. Presentation of cases We report two cases of adenomyoepithelioma of the breast in two old female patients, diagnosed over a period of 5 years. The clinical presentation, the radiological and the histopathologic findings are discussed. Discussion Adenomyoepithelioma of the breast is characterized by the proliferation of both epithelial and myoepithelial cells belonging to the breast lobules and ducts. The imaging features are not pathognomonic and FNAB is usually not diagnostic. The morphologic appearance of this tumor varies, and it has to be considered in the differential diagnosis with other breast tumors. Although benign, adenomyoepithelioma has a potential for local recurrence, and malignant transformation is possible; therefore, wide excision is recommended to lower the recurrence rate. Conclusion The rarity of this histological type and the finding of two cases in a relatively short period makes this case report unique.
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Case Reports |
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Vecchio R, Catalano R, Basile F, Spataro C, Caputo M, Intagliata E. Topical hemostasis in laparoscopic surgery. G Chir 2017; 37:266-270. [PMID: 28350974 DOI: 10.11138/gchir/2016.37.6.266] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] [Imported: 08/29/2023]
Abstract
A major goal during any surgical intervention is minimization of blood loss, which reduces the need for blood transfusion. In open surgery, the possibility for the surgeon to use the hands directly in contact with the bleeding tissues for hemostasis, makes mechanical methods, such as compression, ligatures or sutures, important to achieve proper hemostasis. In laparoscopic surgery, where the intervention is performed by means of small incisions through which the surgeon's hand cannot directly achieve the tissues, the problem of hemostasis is critical and needs more attention. Either in open or in laparoscopic surgery, significant bleeding during surgery is controlled through vessel ligation, suturing, and electrocautery. Topical hemostatic agents are useful adjuncts to surgical hemostasis for controlling non-specific bleeding. The introduction of different devices and topical agents has made possible to perform more complex interventions also in laparoscopy. The Authors discuss about the type, the field of application, the side effects of the hemostatic devices and of the topical hemostatic agents.
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Review |
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Intagliata E, Basile F, Vecchio R. Totally implantable catheter migration and its percutaneous retrieval: case report and review of the literature. G Chir 2017; 37:211-215. [PMID: 28098057 DOI: 10.11138/gchir/2016.37.5.211] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] [Imported: 08/29/2023]
Abstract
Totally subcutaneous intravascular portals have been increasingly used to administer long-term chemotherapy and parental nutrition. The reported complications are rare. Accidental endovascular rupture of a fragment of catheter is one of the most formidable complications of the central vein catheterization. The Authors report a case of deployment of a Port-a-Cath catheter and its percutaneous retrieval. The catheter accidentally detached and migrated from the reservoir of the port-a-cath placed in the left subclavian vein to the right heart cavities through the blood stream. A review of the Literature is also given, focusing on the possible factors responsible for this unusual complication.
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Review |
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Vecchio R, Intagliata E, Fiumara PF, Villari L, Marchese S, Cacciola E. A rare case of myeloid sarcoma presenting as anal fissure. G Chir 2015; 36:222-4. [PMID: 26712260 DOI: 10.11138/gchir/2015.36.5.222] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] [Imported: 08/29/2023]
Abstract
Myeloid sarcoma is a tumor composed of myeloblasts occurring at an extramedullary site. It may develop in patients with acute myeloid leukemia, myeloproliferative or myelodysplastic syndrome, sometimes preceding onset of the systemic disease. Frequent sites of myeloid sarcoma are bones or various soft tissues. Gastrointestinal involvement is very rare. We report a unique case of myeloid sarcoma presenting as a painful anal fissure, in a patient with a history of acute myeloid leukemia. The diagnosis was achieved by a surgical excisional biopsy and immunoistochemical staining.
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Case Reports |
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1 |
8
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Vecchio R, Cacciola E, Intagliata E. Using Stapler in Laparoscopic Splenectomy Does Not Affect the Risk of Pancreatic Tail Injury. J Indian Assoc Pediatr Surg 2020; 25:416-417. [PMID: 33487952 PMCID: PMC7815020 DOI: 10.4103/jiaps.jiaps_8_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Revised: 01/11/2020] [Accepted: 04/01/2020] [Indexed: 11/30/2022] [Imported: 08/29/2023] Open
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Journal Article |
5 |
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9
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Vecchio R, Cacciola E, Cacciola RR, Marchese S, Troina G, Intagliata E, Basile F. Hemocoagulative post-operative changes after laparoscopic surgery compared to open surgery: the role of lupus anticoagulant. Updates Surg 2020; 72:1223-1227. [PMID: 32170631 DOI: 10.1007/s13304-020-00724-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2019] [Accepted: 02/12/2020] [Indexed: 10/24/2022] [Imported: 08/29/2023]
Abstract
Although still debated, post-operative modification of hemostasis seems to be less pronounced after laparoscopy compared to open surgery. Antiphospholipid antibodies might play a role in the post-operative thromboembolic risk, although their evaluation in surgical patients has never been performed. Post-operative modification of antiphospholipid antibodies could be related to the surgical approach (laparoscopic or open). In this prospective study, the authors statistically compared the pre-operative values and post-operative modification of antiphospholipid antibodies in two homogeneous groups of patients operated on by laparoscopic and open surgery. No statistical differences within each group and between the two groups were shown comparing mean values of pre-operative and post-operative antiphospholipid antibodies. In the open group, there was a significant difference between pre-operative and post-operative LAC means (P < 0.01). In the laparoscopic group, on the contrary, no significant change in LAC values between pre- and post-operative tests (P = 0.55) was observed. Since LAC could be related to coagulation disorders, this study seems to support that laparoscopic surgery might induce a less risk of post-operative thromboembolic disease.
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Comparative Study |
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10
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Vecchio R, Vecchio V, Intagliata E. Transmission ways of Echinococcus granulosus in rare muscular locations of hydatid disease. Ann Med Surg (Lond) 2020; 55:332-333. [PMID: 32566219 PMCID: PMC7296182 DOI: 10.1016/j.amsu.2020.04.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Revised: 03/20/2020] [Accepted: 04/18/2020] [Indexed: 11/30/2022] [Imported: 08/29/2023] Open
Abstract
The most common modality of transmission of the Echinococcus granulosus is through the alimentary tract. Other ways of infestation are questionable. Airborne penetration of bronchial venules to reach the heart and the systemic circulation has been advocated, but never demonstrated. Direct subcutaneous contamination through an injured skin has also been considered. Moreover, the hypothesis that a contamination different from eggs ingestion is not possible, is justified by the reason that eggs transform into larvae in the gastro-intestinal environment. Therefore, it is accepted the possibility that parasites might reach organs and tissues other than liver and lungs through a lymphatic or venous shunt that skip the portal filter. In cases of myocardial muscle or skeletal muscle involvement, it could be speculated that eggs of Echinococcus granulosus might hatch not only in the gastrointestinal tract, but also in soft tissues due to the lactic acid produced by the muscle. These unconventional ways of transmission suggest that the lifecycle of the Echinococcus is not at all known and must be revised. Issues that can help in ideating new therapies may emerge.
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Vecchio R, Marchese S, Intagliata E. Controversial issues on rare subcutanous hydatid disease. Int J Surg Case Rep 2019; 57:91-92. [PMID: 30927710 PMCID: PMC6441736 DOI: 10.1016/j.ijscr.2019.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Accepted: 03/04/2019] [Indexed: 11/29/2022] [Imported: 08/29/2023] Open
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Letter |
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Rosario V. Re: JSLS. 2018;22(4):1-9. Prediction of Success Following Laparoscopic Splenectomy for Immune Thrombocytopenic Purpura Seems Still so far from to be Understood. JSLS 2020; 24:JSLS.2020.00010. [PMID: 32273672 PMCID: PMC7141486 DOI: 10.4293/jsls.2020.00010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] [Imported: 08/29/2023] Open
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Letter |
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13
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Intagliata E, Vecchio R. Combined Laparoscopic-Endoscopic Techniques for Removal of Small Gastric Tumors: Advantages and Tricks. Clin Endosc 2019; 52:390-391. [PMID: 31370381 PMCID: PMC6680020 DOI: 10.5946/ce.2019.102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2019] [Accepted: 05/24/2019] [Indexed: 11/14/2022] [Imported: 08/29/2023] Open
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Vecchio R, Catalano R, Distefano ER, Intagliata E. Totally Laparoscopic Transluminal Resection Versus Combined Laparo-Endoscopic Technique for Removal of Iuxta-Cardial Gastric Stromal Tumors. Ann Surg Oncol 2019; 26:2651-2652. [PMID: 31144142 DOI: 10.1245/s10434-019-07473-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Indexed: 11/18/2022] [Imported: 08/29/2023]
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Letter |
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15
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LEANZA V, INTAGLIATA E, LEANZA G, CANNIZZARO M, ZANGHÌ G, VECCHIO R. Surgical repair of rectocele. Comparison of transvaginal and transanal approach and personal technique. G Chir 2013; 34:332-336. [PMID: 24342163 PMCID: PMC3926474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023] [Imported: 08/29/2023]
Abstract
Rectocele is defined as a herniation of the rectal wall inside the vagina due to a defect of the recto-vaginal septum. It is traditionally considered a posterior compartment damage with weakness of posterior vaginal wall support resulting in a bulging of the rectum into the vaginal cavity. One of the main causes of rectal prolapse is the operative vaginal birth, although the evidence of the defect may occur after many years The treatment of rectocele is surgical, and the approach can be transperineal, transvaginal, and transanal or, in selected cases, transperitoneal through open or laparoscopic techniques. In this study we compare two transvaginal surgical techniques - i.e. the perineal body anchorage to the posterior septum and the traditional Denonvilliers' transversal suture after removing of the vaginal skin, with the mostly performed transanal procedure, the STARR - comparing the data from the literature on their results. Mean hospital stay, rectal symptoms, dyspareunia, quality of life, recurrence rate and postoperative complications have been considered. Both transvaginal and transrectal surgical techniques are effective to solve posterior compartment defect and to improve the quality of life. Vaginal approach may interfere with the sexual activity; furthermore it is associated with minimal postoperative pain than the transanal approach. Better anatomic results are assured after endovaginal surgery, while better rectal function prevail after the transanal approach. Vaginal techniques are more suitable to gynecologists, whereas the transrectal ones are usually performed by colo-proctologists or general surgeons.
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Comparative Study |
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Eva I, Rosario V, Guglielmo R, Clarissa V, Federica LP, Emma C, Rosaria CR, Veronica V. Laparoscopic surgery: A randomised controlled trial comparing intraoperative hemodynamic parameters and arterial-blood gas changes at two different pneumoperitoneal pressure values. Ann Med Surg (Lond) 2022; 81:104562. [PMID: 36147166 PMCID: PMC9486856 DOI: 10.1016/j.amsu.2022.104562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 08/28/2022] [Accepted: 08/28/2022] [Indexed: 11/16/2022] [Imported: 08/29/2023] Open
Abstract
Background The benefits of laparoscopic surgery are well known. However, clinic and metabolic consequences of pneumoperitoneum, achieved by insufflation of gas carbon dioxide, are still debated. Cardiovascular system suffering due to the compression of intra-abdominal venous structures can cause life-threatening complications. Increased partial pressure of carbon dioxide induces metabolic acidosis with further vascular suffering. Pneumoperitoneum reduces the pulmonary exchange volumes and bring renal suffering. Methods The aim of this study is to evaluate the alterations in hemodynamic and hemogasanalysis parameters during the laparoscopic surgery at different pressure settings of pneumoperitoneum in order to assess the best pressure value. We evaluated and compared intraoperative hemodynamic and hemogasanalytic alterations in two groups of patients respectively subdue to laparoscopic cholecystectomy at a pneumoperitoneum pressure of 12 mmHg (group A) and at a pressure of 8 mmHg (group B). Results In both groups, after the induction of anesthesia we observed a flexion in the heart rate, with no significant difference between the two groups. During the intervention, group A showed a significantly higher respiratory rate than the group B. The average blood pressure decreased mostly in group B. The oxygen saturation increased at the end of the procedure in group A, more than in the group B. The pH value was higher in group B. The hydrogen carbonate ion settled at lower levels in group A. Conclusion Although significant differences between the two groups were appreciated on several parameters, they were never of such magnitude to prefer the induction of pneumoperitoneum at 8 mmHg. Pneumoperitoneum induces hemogasanalytic and hemodynamic alterations. Different settings in pneumoperitoneum pressure cause different levels of hemodynamic and hemogasanalytic alterations. A pneumoperitoneum pressure value that could reduce the alterations in hemodynamic and hemogasanalytic parameters while mantaining the surgical safety, has to be established.
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LEANZA V, INTAGLIATA E, FERLA F, LEANZA A, LEANZA G, CANNIZZARO M, VECCHIO R. Mini-invasive tension-free surgery for female urinary incontinence. G Chir 2014; 35:36-41. [PMID: 24690339 PMCID: PMC4321581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023] [Imported: 08/29/2023]
Abstract
The Authors describe the techniques they perform of prepubic, retropubic and transobturator mini-invasive anti-incontinence surgical procedures and point-out some technical details. The state of art and the results of these three main surgical procedure are compared and discussed. Data from the Literature have been reviewed in order to evaluate the efficacy of the techniques. A Medline search has been performed, and 65 relevant articles from 1996 to 2012 were selected. Literature showed similar cure rates among retropubic (71,4-91%), trans-oburator (77,3-95%) and prepubic (81-87,2%) anti-incontinence procedures. Cystoscopy was considered necessary in the retropubic, optional in transobturator and in the prepubic techniques. Intra-operative cough stress test was believed useful only in the retropubic and prepubic procedures. Obstruction symptoms prevailed in the retropubic, were rare in the transobturator and missing in the prepubic technique. Erosion rate was very low and similar for all the three techniques. Intra-operative vascular and perforating risks prevailed in the retropubic technique, due to the danger present in the retropubic space, whereas late infective complications overcame in the transobturator procedure. Severe complications in the prepubic procedure were not reported, but the procedure is performed only in few centers.
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Review |
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Eva I, Rosario V, Cesare S, Clarissa V, Federica LP, Rosaria CR, Emma C, Veronica V. Hemocoagulative Modifications after Laparoscopic Surgery at Different Pneumoperitoneum Pressure Settings. Int J Surg Protoc 2022; 26:41-48. [PMID: 35800883 PMCID: PMC9205367 DOI: 10.29337/ijsp.173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 05/18/2022] [Indexed: 11/24/2022] [Imported: 08/29/2023] Open
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VECCHIO R, INTAGLIATA E, MARCHESE S, BATTAGLIA S, CACCIOLA R, CACCIOLA E. Surgical drain after open or laparoscopic splenectomy: is it needed or contraindicated? G Chir 2015; 36:101-105. [PMID: 26188753 PMCID: PMC4511037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023] [Imported: 08/29/2023]
Abstract
OBJECTIVE The Authors report their experience with the routine use of surgical drainage in a large series of splenectomies. SUMMARY OF BACKGROUND DATA Benefits and risks related to surgical drains have been always discussed, with some surgeons in favor of them and skeptic others considering not physiological their use. After splenectomy, their use is also largely debated, especially because of susceptibility of operated patients to infections. PATIENTS AND METHODS Two thousand nine cases have been reviewed. Indications for splenectomy, performed either by open or laparoscopic approach, included idiopathic thrombocytopenic purpura in 137 patients (65,4%), splenic lymphoma in 36 (17,2%), hereditary spherocytosis in 15 (7,4%), β-thalassemia in 8 (3,7%), other diseases in 13 (6,1%). RESULTS "Active" or "passive" drains were placed in 80% and 20% of cases, respectively. Drains were removed 2-3 days after surgery in 90,2%, within 10 days in 4,3%, within 2 months in 0,4% of cases. In 2 cases a post-operative bleeding, detected through the drainage, required re-operation. One patient developed a subphrenic abscess, successfully treated by a percutaneous drainage. One case of pancreatic fistula was observed. CONCLUSIONS In Authors' experience, the use of drains after splenectomy does not affect the risk of subsequent infectious complications, independently on the type of the drainage system used. Early removal of drains in this series might have played an important role in the very low incidence of abdominal infections reported. The use of surgical drains after splenectomy might play an important role to early detect post-operative bleeding, as it happened in 2 cases of this series.
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research-article |
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LEANZA V, COCO L, GENOVESE F, PAFUMI C, CIOTTA L, LEANZA G, ZANGHÌ G, INTAGLIATA E, VECCHIO R. Laparoscopic removal of a giant paratubal cyst complicated by hydronephrosis. G Chir 2013; 34:323-325. [PMID: 24342161 PMCID: PMC3926472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023] [Imported: 08/29/2023]
Abstract
Paratubal cysts represent approximately 10% of all adnexal masses. In most cases they are very small, but very few cases are reported in the literature where they exceed 15 cm of diameter. Furthermore, giant paratubal cysts complicated by bilateral hydronephrosis are unique. The Authors describe a case of a huge paratubal cyst (30 cm in diameter), in a 14 year old obese girl, treated by complete laparoscopic enucleation.
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Case Reports |
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Intagliata E, Giugno S, Vizzini C, Cacciola RR, Vecchio R, Vecchio V. An unusual association between pancreatic cancer and Purtscher-like retinopathy: Presentation of a unique case. Int J Surg Case Rep 2022; 96:107338. [PMID: 35753234 PMCID: PMC9249796 DOI: 10.1016/j.ijscr.2022.107338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Revised: 06/18/2022] [Accepted: 06/18/2022] [Indexed: 02/07/2023] [Imported: 08/29/2023] Open
Abstract
INTRODUCTION Purtscher's retinopathy causes sudden loss of vision of varying severity, secondary to head injury or chest compression. Its pathophysiology is unclear. Purtscher's-like retinopathy has more attenuated clinical and objective features and can be associated with many non-neoplastic pathologies. Otherwise, an association of this kind of retinopathy with malignancies has been described once in the Literature. We present a case report on a unique association between pancreatic cancer and Purtscher-type retinopathy. CASE PRESENTATION A 79-year-old man with reduced central vision in both eyes required an ophthalmic evaluation. Visual acuity was 20/40 in the right eye and 20/50 in the left eye. Fundus examination showed yellow-white peripapillary spots and bilateral retinal hemorrhages in the superficial retina. The patient complained of abdominal pain and received a CT scan of the abdomen, which showed a pancreatic mass extending into the spleen. A percutaneous needle biopsy sample showed mucinous pancreatic adenocarcinoma. CLINICAL DISCUSSION This case report should warn of a possible association between pancreatic adenocarcinoma and Purtscher's-like retinopathy. CONCLUSION Patients with this kind of retinopathy should be evaluated to rule out not only benign associated disease, but also malignant tumors of the pancreas.
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case-report |
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LEANZA V, INTAGLIATA E, LEANZA A, FERLA F, LEANZA G, VECCHIO R. Comparison between three mini-sling surgical procedures and the traditional transobturator vaginal tape technique for female stress urinary incontinence. G Chir 2014; 35:80-84. [PMID: 24841685 PMCID: PMC4321593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023] [Imported: 08/29/2023]
Abstract
OBJECTIVES To compare mini-sling and traditional tension-free operations for female stress urinary incontinence. STUDY DESIGN A systematic review of articles in the Literature published between 2002 and 2012, was conducted. A Pubmed search was performed. Primary outcomes were subjective and objective cure rates at 12 months comparing the three single-incision mini-slings techniques (TVT-Secur, MiniArc and Monarc systems) with the standard midurethral sling procedure TOT (Transobturator Vaginal Tape). Secondary outcomes included peri-operative (vaginal and/or bladder perforation, urine retention, urinary tract infection, bleeding, pain) and post-operative (mesh exposure, de novo urgency, and dyspareunia) complications. RESULTS In term of objective cure rate at 12 month after surgery, it is evident that TOT at first, and MiniArc are the most effective procedures. The incidence of post-operative urgency and UTI was lower in TOT technique, while vaginal perforation was described in equal frequency both in TOT and in MiniArc procedures. The advantages of the three above described mini-invasive techniques seem to consist into lower cases of urinary retention, pain and bleeding. Furthermore, bladder perforation and bleeding are not described in the Literature for TVT-Secur and Monarc systems. CONCLUSIONS Some single-incision slings look promising and as effective as conventional sub-urethral slings at short term evaluation. However, at this moment a clear statement in favor of the widespread use of single-incision slings cannot be made. More studies must define the efficacy of these techniques.
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