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Brillantino A, Renzi A, Talento P, Iacobellis F, Brusciano L, Monaco L, Izzo D, Giordano A, Pinto M, Fantini C, Gasparrini M, Schiano Di Visconte M, Milazzo F, Ferreri G, Braini A, Cocozza U, Pezzatini M, Gianfreda V, Di Leo A, Landolfi V, Favetta U, Agradi S, Marino G, Varriale M, Mongardini M, Pagano CEFA, Contul RB, Gallese N, Ucchino G, D'Ambra M, Rizzato R, Sarzo G, Masci B, Da Pozzo F, Ascanelli S, Foroni F, Palumbo A, Liguori P, Pezzolla A, Marano L, Capomagi A, Cudazzo E, Babic F, Geremia C, Bussotti A, Cicconi M, Di Sarno A, Mongardini FM, Brescia A, Lenisa L, Mistrangelo M, Sotelo MLS, Vicenzo L, Longo A, Docimo L. The Italian Unitary Society of Colon-proctology (SIUCP: Società Italiana Unitaria di Colonproctologia) guidelines for the management of anal fissure. BMC Surg 2023; 23:311. [PMID: 37833715 PMCID: PMC10576345 DOI: 10.1186/s12893-023-02223-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 10/06/2023] [Indexed: 10/15/2023] Open
Abstract
INTRODUCTION The aim of these evidence-based guidelines is to present a consensus position from members of the Italian Unitary Society of Colon-Proctology (SIUCP: Società Italiana Unitaria di Colon-Proctologia) on the diagnosis and management of anal fissure, with the purpose to guide every physician in the choice of the best treatment option, according with the available literature. METHODS A panel of experts was designed and charged by the Board of the SIUCP to develop key-questions on the main topics covering the management of anal fissure and to performe an accurate search on each topic in different databanks, in order to provide evidence-based answers to the questions and to summarize them in statements. All the clinical questions were discussed by the expert panel in different rounds through the Delphi approach and, for each statement, a consensus among the experts was reached. The questions were created according to the PICO criteria, and the statements developed adopting the GRADE methodology. CONCLUSIONS In patients with acute anal fissure the medical therapy with dietary and behavioral norms is indicated. In the chronic phase of disease, the conservative treatment with topical 0.3% nifedipine plus 1.5% lidocaine or nitrates may represent the first-line therapy, eventually associated with ointments with film-forming, anti-inflammatory and healing properties such as Propionibacterium extract gel. In case of first-line treatment failure, the surgical strategy (internal sphincterotomy or fissurectomy with flap), may be guided by the clinical findings, eventually supported by endoanal ultrasound and anal manometry.
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Affiliation(s)
- Antonio Brillantino
- Deparment of Surgery, "A. Cardarelli" Hospital, Via A. Cardarelli 9, Naples, 80131, Italy.
| | - Adolfo Renzi
- "Buonconsiglio-Fatebenefratelli" Hospital, Naples, Italy
| | - Pasquale Talento
- Department of Surgery, Pelvic Floor Center, AUSL-IRCCS Reggio Emilia, Reggio Emilia, Italy
| | - Francesca Iacobellis
- Department of General and Emergency Radiology, "A. Cardarelli" Hospital, Naples, Italy
| | - Luigi Brusciano
- Department of Advanced Medical and Surgical Sciences, University of Campania "L. Vanvitelli", Naples, Italy
| | - Luigi Monaco
- "Pineta Grande" Hospital, "Villa Esther" Clinic, Avellino, Italy
| | - Domenico Izzo
- Department of General and Emergency Surgery, AORN dei Colli Monaldi-Cotugno-CTO, CTO Hospital, Naples, Italy
| | - Alfredo Giordano
- Department of General and Emergency Surgery, University of Salerno, Hospital of Mercato San Severino, Salerno, Italy
| | | | - Corrado Fantini
- Department of Surgery, "Dei Pellegrini" Hospital, ASL Napoli 1, Naples, Italy
| | | | - Michele Schiano Di Visconte
- Department of General Surgery, Colorectal and Pelvic Floor Diseases Center, "Santa Maria Dei Battuti" Hospital, Conegliano, TV, Italy
| | - Francesca Milazzo
- Department of Surgery, Pelvic Floor Center, AUSL-IRCCS Reggio Emilia, Reggio Emilia, Italy
| | - Giovanni Ferreri
- Department of Surgery, Pelvic Floor Center, AUSL-IRCCS Reggio Emilia, Reggio Emilia, Italy
| | - Andrea Braini
- Department of General Surgery, Azienda Sanitaria Friuli Occidentale (ASFO), Pordenone, Italy
| | - Umberto Cocozza
- Department of General Surgery, "S. Maria Degli Angeli" Hospital, Putignano (Bari), Italy
| | | | - Valeria Gianfreda
- Unit of Colonproctologic and Pelvic Surgery, "M.G. Vannini" Hospital, Rome, Italy
| | - Alberto Di Leo
- Department of General and Minivasive Surgery, "San Camillo" Hospital, Trento, Italy
| | - Vincenzo Landolfi
- Department of General and Specalist Surgery, AORN "S.G. Moscati", Avellino, Italy
| | - Umberto Favetta
- Unit of Proctology and Pelvic Surgery, "Città di Pavia" Clinic, Pavia, Italy
| | - Sergio Agradi
- Humanitas Gavazzeni/Castelli Bergamo, Bergamo, Italy
| | - Giovanni Marino
- Department of General Surgery, "Santa Marta e Santa Venera" Hospital of Acireale, Catania, Italy
| | - Massimilano Varriale
- Department of General and Emergency Surgery, "Sandro Pertini" Hospital, Asl Roma 2, Rome, Italy
| | | | | | | | - Nando Gallese
- Unit of Proctologic Surgery, "Sant'Antonio" Clinic, Cagliari, Italy
| | | | - Michele D'Ambra
- Department of General and Oncologic-Minivasive Surgery, "Federico II" University, Naples, Italy
| | - Roberto Rizzato
- Department of General Surgery, Hospital of Conegliano AULSS 2, Marca Trevigiana, Treviso, Italy
| | - Giacomo Sarzo
- Department of General Surgery, University of Padova, "Sant'Antonio" Hospital, Padova, Italy
| | | | - Francesca Da Pozzo
- Department of Surgery, "Santa Maria dei battuti" Hospital, San Vito al Tagliamento, Pordenone, Italy
| | - Simona Ascanelli
- Department of Surgery, University Hospital of Ferrara, Ferrara, Italy
| | - Fabrizio Foroni
- Deparment of Surgery, "A. Cardarelli" Hospital, Via A. Cardarelli 9, Naples, 80131, Italy
| | - Alessio Palumbo
- Deparment of Surgery, "A. Cardarelli" Hospital, Via A. Cardarelli 9, Naples, 80131, Italy
| | | | | | - Luigi Marano
- Academy of Applied Medical and Social Sciences - AMiSNS: Akademia Medycznych i Spolecznych Nauk Stosowanych, Elbląg, Poland
| | | | - Eugenio Cudazzo
- Department of Surgery, Pelvic Floor Center, AUSL-IRCCS Reggio Emilia, Reggio Emilia, Italy
| | - Francesca Babic
- Department of Surgery, Hospital of Cattinara, ASUGI Trieste, Trieste, Italy
| | - Carmelo Geremia
- Unit of Proctology and Pelvic Surgery, "Città di Pavia" Clinic, Pavia, Italy
| | | | - Mario Cicconi
- Department of General Surgery, "Sant'Omero-Val Vibrata" Hospital, Teramo, Italy
| | | | - Federico Maria Mongardini
- Department of Advanced Medical and Surgical Sciences, University of Campania "L. Vanvitelli", Naples, Italy
| | - Antonio Brescia
- Department of Oncologic Colorectal Surgery, University Hospital S. Andrea, "La Sapienza" University, Rome, Italy
| | - Leonardo Lenisa
- Department of Surgery, Humanitas San Pio X, Surgery Unit, Pelvic Floor Centre, Milano, Italy
| | | | | | - Luciano Vicenzo
- Deparment of Surgery, "A. Cardarelli" Hospital, Via A. Cardarelli 9, Naples, 80131, Italy
| | | | - Ludovico Docimo
- Department of Advanced Medical and Surgical Sciences, University of Campania "L. Vanvitelli", Naples, Italy
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Gambardella C, Mongardini FM, Karpathiotakis M, Lucido FS, Pizza F, Tolone S, Parisi S, Nesta G, Brusciano L, Gambardella A, Docimo L, Mongardini M. Biosynthetic Mesh Reconstruction after Abdominoperineal Resection for Low Rectal Cancer: Cross Relation of Surgical Healing and Oncological Outcomes: A Multicentric Observational Study. Cancers (Basel) 2023; 15:2725. [PMID: 37345062 PMCID: PMC10216202 DOI: 10.3390/cancers15102725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Revised: 05/08/2023] [Accepted: 05/09/2023] [Indexed: 06/23/2023] Open
Abstract
BACKGROUND Local wound complications are among the most relevant sequelae after an abdominoperineal resection (APR) for low rectal cancer. One of the proposed techniques to improve the postoperative recovery and to accelerate the initiation of adjuvant chemotherapy is the mesh reinforcement of the perineal wound. The aim of the current study is to compare the surgical and oncological outcomes after APR performed with a biosynthetic mesh reconstruction versus the conventional procedure. METHODS From 2015 to 2020, in two tertiary centres, the surgical outcomes, the wound events (i.e., surgical site infections, wound dehiscence and the complete healing time) and the oncological outcomes (i.e., time length to start adjuvant chemo-radiotherapy, an over 8-week delay in chemotherapy and the recurrence rate) were retrospectively analysed in patients undergoing APR reinforced with biosynthetic mesh (Group A) and conventional APR (Group B). Results Sixty-one patients were treated with APR (25 in Group A and 36 in Group B). Patients in Group A presented lower time for: healing (16 versus 24 days, p = 0.015), inferior perineal wound dehiscence rates (one versus nine cases, p = 0.033), an earlier adjuvant therapy start (26 versus 70 days, p = 0.003) and a lower recurrence rate (16.6% vs. 33.3%, p = 0.152). CONCLUSIONS In our series, the use of a biosynthetic mesh for the neo-perineum reconstruction after a Miles' procedure has resulted in safe, reproducible results affected by limited complications, guarantying a rapid start of the adjuvant therapy with clear benefits in oncological outcomes. Further randomized clinical trials with long-term follow-up are needed to validate these results.
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Affiliation(s)
- Claudio Gambardella
- Division of General, Oncological, Mini-Invasive and Obesity Surgery, University of Study of Campania “Luigi Vanvitelli”, 80131 Naples, Italy; (F.M.M.); (F.S.L.); (S.T.); (S.P.); (G.N.); (L.B.); (L.D.)
| | - Federico Maria Mongardini
- Division of General, Oncological, Mini-Invasive and Obesity Surgery, University of Study of Campania “Luigi Vanvitelli”, 80131 Naples, Italy; (F.M.M.); (F.S.L.); (S.T.); (S.P.); (G.N.); (L.B.); (L.D.)
| | - Menelaos Karpathiotakis
- Division of General Surgery, Policlinico Umberto I, Sapienza University of Rome, 00185 Rome, Italy; (M.K.); (M.M.)
| | - Francesco Saverio Lucido
- Division of General, Oncological, Mini-Invasive and Obesity Surgery, University of Study of Campania “Luigi Vanvitelli”, 80131 Naples, Italy; (F.M.M.); (F.S.L.); (S.T.); (S.P.); (G.N.); (L.B.); (L.D.)
| | - Francesco Pizza
- Department of Surgery, Hospital ‘A. Rizzoli’, Lacco Ameno, 80076 Naples, Italy;
| | - Salvatore Tolone
- Division of General, Oncological, Mini-Invasive and Obesity Surgery, University of Study of Campania “Luigi Vanvitelli”, 80131 Naples, Italy; (F.M.M.); (F.S.L.); (S.T.); (S.P.); (G.N.); (L.B.); (L.D.)
| | - Simona Parisi
- Division of General, Oncological, Mini-Invasive and Obesity Surgery, University of Study of Campania “Luigi Vanvitelli”, 80131 Naples, Italy; (F.M.M.); (F.S.L.); (S.T.); (S.P.); (G.N.); (L.B.); (L.D.)
| | - Giusiana Nesta
- Division of General, Oncological, Mini-Invasive and Obesity Surgery, University of Study of Campania “Luigi Vanvitelli”, 80131 Naples, Italy; (F.M.M.); (F.S.L.); (S.T.); (S.P.); (G.N.); (L.B.); (L.D.)
| | - Luigi Brusciano
- Division of General, Oncological, Mini-Invasive and Obesity Surgery, University of Study of Campania “Luigi Vanvitelli”, 80131 Naples, Italy; (F.M.M.); (F.S.L.); (S.T.); (S.P.); (G.N.); (L.B.); (L.D.)
| | - Antonio Gambardella
- Department of Precision Medicine, University of Campania “L. Vanvitelli”, 80138 Naples, Italy;
| | - Ludovico Docimo
- Division of General, Oncological, Mini-Invasive and Obesity Surgery, University of Study of Campania “Luigi Vanvitelli”, 80131 Naples, Italy; (F.M.M.); (F.S.L.); (S.T.); (S.P.); (G.N.); (L.B.); (L.D.)
| | - Massimo Mongardini
- Division of General Surgery, Policlinico Umberto I, Sapienza University of Rome, 00185 Rome, Italy; (M.K.); (M.M.)
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Berra LV, Armocida D, Palmieri M, Di Norcia V, D’Angelo L, Mongardini M, Vigliotta M, Maccari E, Santoro A. Sacral Nerves Reconstruction After Surgical Resection of a Large Sacral Chordoma Restores the Urinary and Sexual Functionality and the Anal Continence. Neurospine 2022; 19:155-162. [PMID: 35130427 PMCID: PMC8987555 DOI: 10.14245/ns.2142724.362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 12/13/2021] [Indexed: 11/19/2022] Open
Abstract
Objective Chordomas are slow-growing tumors, with a high tendency to local relapse. En bloc resection is related to the most favorable outcome in terms of survival but is frequently associated with permanent neurological deficits involving sphincters and sexual functions. In the present article, we describe an innovative technique of en bloc resection followed by reconstruction of the sacral nerves with nerve grafts.
Methods The chordoma was excised through a posterior approach after dividing the proximal and distal sacral nerves using the established technique. After that, a microsurgical S2-S3-S4 nerve reconstruction was performed connecting the proximal and distal stumps with sural nerve grafts withdrawn from both lower limbs.
Results Immediately after surgery, the patient experienced complete impairment of sexual function and sphincters with urinary and fecal incontinence. After 6 months, there was a progressive recovery of sexual function and sphincter control. One year after the operation, the patient achieved an adequate sexual life (erection and ejaculation) and complete control of the bladder and anal sphincter.
Conclusion Reconstruction of nerves sacrificed during sacral tumor removal has been shown to be effective in restoring sphincter and sexual function and is a promising technique that may significantly improve patients' quality of life.
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Affiliation(s)
- Luigi Valentino Berra
- A.U.O. “Policlinico Umberto I”, Neurosurgery Division, Sapienza University, Human Neurosciences Department, Roma, Italy
- Corresponding Author Luigi Valentino Berra https://orcid.org/0000-0003-2605-9089 Policlinico Umberto I, Sapienza Università di Roma, viale del Policlinico 155, Roma, Italy
| | - Daniele Armocida
- A.U.O. “Policlinico Umberto I”, Neurosurgery Division, Sapienza University, Human Neurosciences Department, Roma, Italy
| | - Mauro Palmieri
- A.U.O. “Policlinico Umberto I”, Neurosurgery Division, Sapienza University, Human Neurosciences Department, Roma, Italy
| | - Valerio Di Norcia
- A.U.O. “Policlinico Umberto I”, Neurosurgery Division, Sapienza University, Human Neurosciences Department, Roma, Italy
| | - Luca D’Angelo
- A.U.O. “Policlinico Umberto I”, Neurosurgery Division, Sapienza University, Human Neurosciences Department, Roma, Italy
| | - Massimo Mongardini
- A.U.O. “Policlinico Umberto I”, Dipartimento di Chirurgia Generale, Sapienza University, Roma, Italy
| | - Massimo Vigliotta
- A.U.O. “Policlinico Umberto I”, Neurosurgery Division, Sapienza University, Human Neurosciences Department, Roma, Italy
| | - Edoardo Maccari
- A.U.O. “Policlinico Umberto I”, Neurosurgery Division, Sapienza University, Human Neurosciences Department, Roma, Italy
| | - Antonio Santoro
- A.U.O. “Policlinico Umberto I”, Neurosurgery Division, Sapienza University, Human Neurosciences Department, Roma, Italy
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Vescovo M, Pesci L, Lapenna L, De Santis E, Di Nardo D, de Anna L, Mongardini FM, Ascoli V, Mongardini M, De Santis A, Giordano C. Severe rectal prolapse and solitary rectal ulcer in a young anorectic woman with myxoid degeneration of visceral adipose tissue. Pathologica 2022; 113:475-480. [PMID: 34974555 PMCID: PMC8720390 DOI: 10.32074/1591-951x-253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Accepted: 01/27/2021] [Indexed: 11/30/2022] Open
Abstract
Rectal prolapse is a disorder in which the rectum protrudes from the anal canal. Solitary rectal ulcer may coexist. Both conditions have been associated with chronic constipation and excessive straining during defecation. Rectal prolapse has been rarely reported in women suffering from anorexia nervosa. Lack of rectal support because of loss of ischiorectal fat has been proposed as one of the possible mechanisms in this condition, together with chronic constipation and abuse of laxative. We report the case of an anorexic woman with a severe rectal prolapse and bleeding requiring urgent Altmeier’s procedure. Surgery was complicated by dehiscence of the anastomosis and volvulus, requiring ileostomy and laciniae debridement. Pathological analysis of all the surgical samples taken from different abdominal sites highlighted changes in the visceral adipose tissue consisting in nodular aggregates of small adipocytes dispersed in a myxoid matrix surrounding blood vessels within abundant fibrosis. The morphologic features resemble those observed in primordial fetal fat and are comparable to those observed in cancer associated cachexia. The diffuse myxoid degeneration of visceral adipose tissue may play a role in the pathogenesis of rectal prolapse in patients with anorexia nervosa. Besides starvation, the mechanism sustaining myxoid degeneration of the adipose tissue is not entirely clear. Whenever possible improving nutritional and clinical conditions should be ideal before any surgical approach.
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Affiliation(s)
- Mariavittoria Vescovo
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, Policlinico Umberto I, Rome, Italy
| | - Ludovica Pesci
- Department of Precision and Translation Medicine, Sapienza University of Rome, Policlinico Umberto I, Rome, Italy
| | - Lucia Lapenna
- Department of Precision and Translation Medicine, Sapienza University of Rome, Policlinico Umberto I, Rome, Italy
| | - Emanuela De Santis
- Department of Precision and Translation Medicine, Sapienza University of Rome, Policlinico Umberto I, Rome, Italy
| | - Domenico Di Nardo
- Department of General and Plastic Surgery, and Orthopedics, Sapienza University of Rome, Policlinico Umberto I, Rome, Italy
| | - Livia de Anna
- Department of General and Plastic Surgery, and Orthopedics, Sapienza University of Rome, Policlinico Umberto I, Rome, Italy
| | - Federico Maria Mongardini
- Department of General and Plastic Surgery, and Orthopedics, Sapienza University of Rome, Policlinico Umberto I, Rome, Italy
| | - Valeria Ascoli
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, Policlinico Umberto I, Rome, Italy
| | - Massimo Mongardini
- Department of General and Plastic Surgery, and Orthopedics, Sapienza University of Rome, Policlinico Umberto I, Rome, Italy
| | - Adriano De Santis
- Department of Precision and Translation Medicine, Sapienza University of Rome, Policlinico Umberto I, Rome, Italy
| | - Carla Giordano
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, Policlinico Umberto I, Rome, Italy
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Maccioni F, Al Ansari N, Buonocore V, Mazzamurro F, Indinnimeo M, Mongardini M, Catalano C. Erratum to: Prospective Comparison between two different magnetic resonance defecography techniques for evaluating pelvic floor disorders: air-balloon versus gel for rectal filling. Eur Radiol 2016; 27:1333. [PMID: 27401081 DOI: 10.1007/s00330-016-4489-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Francesca Maccioni
- Department of Radiological Sciences, Oncology and Pathology, Policlinico Umberto I Hospital, Sapienza University of Rome, Viale Regina Elena 324, 00161, Rome, Italy.
| | - Najwa Al Ansari
- Department of Radiological Sciences, Oncology and Pathology, Policlinico Umberto I Hospital, Sapienza University of Rome, Viale Regina Elena 324, 00161, Rome, Italy
| | - Valeria Buonocore
- Department of Radiological Sciences, Oncology and Pathology, Policlinico Umberto I Hospital, Sapienza University of Rome, Viale Regina Elena 324, 00161, Rome, Italy
| | - Fabrizio Mazzamurro
- Department of Radiological Sciences, Oncology and Pathology, Policlinico Umberto I Hospital, Sapienza University of Rome, Viale Regina Elena 324, 00161, Rome, Italy
| | - Marileda Indinnimeo
- Department of Surgical Sciences, Policlinico Umberto I Hospital, Sapienza University of Rome, VialeRegina Elena 324, Rome, Italy
| | - Massimo Mongardini
- Department of Surgical Sciences, Policlinico Umberto I Hospital, Sapienza University of Rome, VialeRegina Elena 324, Rome, Italy
| | - Carlo Catalano
- Department of Radiological Sciences, Oncology and Pathology, Policlinico Umberto I Hospital, Sapienza University of Rome, Viale Regina Elena 324, 00161, Rome, Italy
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Mongardini M, Maturo A, De Anna L, Livadoti G, D'Orazi V, Urciuoli P, Custureri F. Appendiceal abscess in a giant left-sided inguinoscrotal hernia: a rare case of Amyand hernia. Springerplus 2015. [PMID: 26217555 PMCID: PMC4515216 DOI: 10.1186/s40064-015-1162-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
The hernia of Amyand is an inguinal hernia containing the appendix in the sac. It is a rare pathology often diagnosed only intra-operatively. We report a case even more rare of a giant left-sided inguinoscrotal Amyand hernia with appendiceal abscess without clinical findings of incarceration/strangulation, occlusion, perforation, or acute scrotum and with the presence in the sac of the caecum and other anatomical structures (last ileal loops, bladder and omentum). The 68-years-old man patient successfully underwent surgical treatment only through the hernia sac (meshless repair according to Postempski technique).
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Affiliation(s)
- Massimo Mongardini
- Department of Surgical Sciences, "Sapienza" University of Rome, "Umberto I" University Hospital, Viale Regina Elena 324, 00161 Rome, Italy
| | - Alessandro Maturo
- Department of Surgical Sciences, "Sapienza" University of Rome, "Umberto I" University Hospital, Viale Regina Elena 324, 00161 Rome, Italy
| | - Livia De Anna
- Department of Surgical Sciences, "Sapienza" University of Rome, "Umberto I" University Hospital, Viale Regina Elena 324, 00161 Rome, Italy
| | - Giada Livadoti
- Department of Surgical Sciences, "Sapienza" University of Rome, "Umberto I" University Hospital, Viale Regina Elena 324, 00161 Rome, Italy
| | - Valerio D'Orazi
- Department of Surgical Sciences, "Sapienza" University of Rome, "Umberto I" University Hospital, Viale Regina Elena 324, 00161 Rome, Italy
| | - Paolo Urciuoli
- Department of Surgical Sciences, "Sapienza" University of Rome, "Umberto I" University Hospital, Viale Regina Elena 324, 00161 Rome, Italy
| | - Filippo Custureri
- Department of Surgical Sciences, "Sapienza" University of Rome, "Umberto I" University Hospital, Viale Regina Elena 324, 00161 Rome, Italy
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Urciuoli P, Buonopane CE, Sottile D, Livadoti G, Foresi E, Dalfino MG, Mongardini M, D'Orazi V. Laparoscopic cholecystectomy in Steinert's myotonic dystrophy. About two clinical cases. Ann Ital Chir 2014; 85:385-388. [PMID: 25263797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Myotonic dystrophy type 1, or Steinert's myotonic dystrophy, is a rare RNA-mediated autosomal dominant disease. Here we describe two clinical cases of patients with Steinert's disease who underwent laparoscopic cholecystectomy under general anaesthesia in conjunction with thoracic peridural anaesthesia, without muscle relaxants. Using such an anaesthesiological technique allowed for rapid recovery from anaesthesia, quick and complete recovery of autonomous breathing, and a significant haemodynamic and arterial blood gases stability, as well as an adequate and complete analgesic coverage over the entire perioperative period.
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Urciuoli P, D'Orazi V, Livadoti G, Foresi E, Panunzi A, Anichini S, Cialini M, Wlderk A, Cirelli C, Colangelo M, Mongardini M, Custureri F. Treatment of renal angiomyolipoma: surgery versus angioembolization. G Chir 2013; 34:326-331. [PMID: 24342162 PMCID: PMC3926473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Renal angiomyolipoma (AML) is a benign mesenchymal tumour. AML often leads to haemorrhagic complications such as retroperitoneal haematoma. Treatment varies from case to case, ranging from minimally invasive approaches such as selective embolization of the renal artery to invasive wedge resection, partial nephrectomy or, in more severe cases, radical nephrectomy. Here we report a case of retroperitoneal haematoma secondary to AML, treated with conservative approach by super-selective embolization of the lower-pole segmental renal artery.
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Biviano I, Badiali D, Candeloro L, Habib FI, Mongardini M, Caviglia A, Anzini F, Corazziari ES. Comparative outcome of stapled trans-anal rectal resection and macrogol in the treatment of defecation disorders. World J Gastroenterol 2011; 17:4199-205. [PMID: 22072851 PMCID: PMC3208364 DOI: 10.3748/wjg.v17.i37.4199] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2010] [Revised: 03/04/2011] [Accepted: 03/11/2011] [Indexed: 02/06/2023] Open
Abstract
AIM: To prospectively assess the efficacy and safety of stapled trans-anal rectal resection (STARR) compared to standard conservative treatment, and whether preoperative symptoms and findings at defecography and anorectal manometry can predict the outcome of STARR.
METHODS: Thirty patients (Female, 28; age: 51 ± 9 years) with rectocele or rectal intussusception, a defecation disorder, and functional constipation were submitted for STARR. Thirty comparable patients (Female, 30; age 53 ± 13 years), who presented with symptoms of rectocele or rectal intussusception and were treated with macrogol, were assessed. Patients were interviewed with a standardized questionnaire at study enrollment and 38 ± 18 mo after the STARR procedure or during macrogol treatment. A responder was defined as an absence of the Rome III diagnostic criteria for functional constipation. Defecography and rectoanal manometry were performed before and after the STARR procedure in 16 and 12 patients, respectively.
RESULTS: After STARR, 53% of patients were responders; during conservative treatment, 75% were responders. After STARR, 30% of the patients reported the use of laxatives, 17% had intermittent anal pain, 13% had anal leakage, 13% required digital facilitation, 6% experienced defecatory urgency, 6% experienced fecal incontinence, and 6% required re-intervention. During macrogol therapy, 23% of the patients complained of abdominal bloating and 13% of borborygmi, and 3% required digital facilitation.No preoperative symptom, defecographic, or manometric finding predicted the outcome of STARR. Post-operative defecography showed a statistically significant reduction (P < 0.05) of the rectal diameter and rectocele. The post-operative anorectal manometry showed that anal pressure and rectal sensitivity were not significantly modified, and that rectal compliance was reduced (P = 0.01).
CONCLUSION: STARR is not better and is less safe than macrogol in the treatment of defecation disorders. It could be considered as an alternative therapy in patients unresponsive to macrogol.
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10
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Caviglia A, Mongardini M, Malerba M, Giofrè M, Maturo A, Del Grammastro A, Straniero A, Scarnò M, Custureri F. Single Stapler Parachute Technique (SSPT): a new procedure for large hemorroidal prolapse. G Chir 2011; 32:404-410. [PMID: 22018214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Procedure for Prolapse and Hemorrhoids (PPH or Longo procedure), a stapled circumferential anal mucosectomy, has proven to be very popular as it is considered safe and successful. However, a high haemorrhoid recurrence rate is reported, specially due to insufficient mucosal resection. The authors have come up with a technical modification to the mucoprolapsectomy, notably the Single Stapler Parachute Technique (SSPT), in order to obtain more abundant mucosal resection. In this study they will present the results obtained in 80 patients treated for muco-haemorrhoidal prolapse, 40 of whom underwent traditional PPH, while the remaining 40 patients underwent SSPT, both performed in two different specialised centres located in Rome, Italy.
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Affiliation(s)
- A Caviglia
- San Camillo-Forlanini Hospital, Rome, Italy
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11
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Mongardini M, Lisi A, Giofrè M, Ledda M, Grimaldi S, Scarnò M, Trucchia A, Kyriacou KA, Badiali D, Custureri F. Human muscle-derived stem cells. Effectiveness in animal models of faecal incontinence. Research scheduling. G Chir 2011; 32:357-360. [PMID: 22018255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Researchers believe that human muscle-derived cells are able to restore leak-point pressure to normal levels by differentiating into new muscle fibres that prevent anal sphincter muscle atrophy. Laboratory data are needed to identify exactly how these cells work to regenerate muscle. The objective of this study is to test whether stem cells can be employed to treat internal anal sphincter (IAS) injuries in humans; to this end, this work will use a two-step process to study: first, the effectiveness of the treatment in a sample of animals with artificial injuries to the IAS and then to verify the results in a population of selected humans affected by pathology.
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Affiliation(s)
- M Mongardini
- Department of General Surgery, Sapienza, University of Rome, Italy
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12
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Mongardini M, Cola A, Iachetta RP, Gioffrè M, Karpathiotakis M, Maturo A, Custureri F. [Treatment of obstructive defecation syndrome related to hedrocele. Our experience]. G Chir 2010; 31:502-506. [PMID: 21232192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Hedrocele represents an unusual variant of the rare posterior perineal hernia and results from a defect in the rectogenital septum. We report two cases of obstructive defecation syndrome (ODS) related to presence of hedrocele successfully treated by laparoscopy-assisted transanal surgery.
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13
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Mongardini M, Iachetta RP, Cola A, Effetti ED, Custureri F. Altemeier operation associated with dynamic graciloplasty: a case report. J Med Case Rep 2009; 3:9317. [PMID: 20062746 PMCID: PMC2803840 DOI: 10.1186/1752-1947-3-9317] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2008] [Accepted: 12/04/2009] [Indexed: 11/13/2022] Open
Abstract
Introduction More than 80% of patients with full-thickness rectal prolapse have co-existing fecal incontinence. Choosing the ideal surgical strategy is always a difficult task. We combined an Altemeier rectosigmoid resection with anal dynamic graciloplasty to provide a functional neosphincter. We found no published reports describing this surgical association. Case presentation We report the case of a 72-year-old Caucasian woman with full-thickness rectal prolapse associated with fecal incontinence from severe neuromuscular damage. Conclusion Combined dynamic graciloplasty and an Altemeier operation could be a valid therapeutic option in patients with severe rectal prolapse with fecal incontinence from severe neurogenic damage.
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Affiliation(s)
- Massimo Mongardini
- Department of Surgical Sciences, Division of General Surgery L, "Sapienza" University of Rome, Italy
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14
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Mongardini M, Iachetta RP, Cola A, Maturo A, Giofrè M, Custureri F. [Low rectovaginal fistula treated with platelet-rich plasma (PRP)]. G Chir 2009; 30:507-509. [PMID: 20109382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Rectovaginal fistula (RVF) is an abnormal communication between vagina and anorectum. Most frequent causes are iatrogenic. Often surgery is the therapy of choice. The suggested treatments include trans-anal access or combined trans-anal and vaginal access. We present the case of a woman with complicated iatrogenic fistula treated by a combined trans-anal and vaginal access, interposition of buccal mucosa and opposition of PRP (platelet rich plasma).
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Affiliation(s)
- M Mongardini
- "Sapienza" Università di Roma, Dipartimento di Scienze Chirurgiche, U.O.C. di Chirurgia Generale
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15
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Salvi PF, Stagnitti F, Mongardini M, Schillaci F, Stagnitti A, Chirletti P. Splenic infarction, rare cause of acute abdomen, only seldom requires splenectomy. Case report and literature review. Ann Ital Chir 2007; 78:529-532. [PMID: 18510036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Splenic infarction is a rare disorder, commonly without a characteristic symptomatology, that rarely requires surgical procedure; in fact it has the peculiar feature of an high tendency for complete healing after the only medical approach. Furthermore in order to prevent OPSI, only in case of clear, persistent symptoms or complications it may be necessary surgical laparoscopic or open approach. The Authors report on a recent case observed in emergency of splenic infarction with infectious complications that made the surgical procedure mandatory.
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Affiliation(s)
- Pier Federico Salvi
- II Facoltà di Medicina e Chirurgia, Università degli Studi "La Sapienza" di Roma.
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16
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Pappalardo G, Frattaroli FM, Mongardini M, Salvi PF, Lombardi A, Conte AM, Arezzo MF. Neurectomy to Prevent Persistent Pain after Inguinal Herniorraphy: A Prospective Study Using Objective Criteria to Assess Pain. World J Surg 2007; 31:1081-6. [PMID: 17420959 DOI: 10.1007/s00268-006-7627-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Although tension-free mesh repair has markedly improved the outcome of inguinal hernia surgery, it has only minimally reduced the incidence of persistent postoperative pain. The pathogenesis of this complication and treatment remain unclear. STUDY DESIGN In order to objectively assess whether iliohypogastric neurectomy reduces the incidence and intensity of persistent postoperative pain, we prospectively studied 100 male patients with bilateral inguinal hernia who underwent tension-free surgical repair, combined with iliohypogastric neurectomy on the right side alone. Pain was evaluated postoperatively on days 1 and 7 and at 1 and 2 years by means of a visual analog scale. Patients were given a questionnaire including coded terms for describing pain. These terms were designed to compare pain on the neurectomized and non-neurectomized sides and assess altered sensation (hypoesthesia and paresthesia) on both sides. RESULTS There were differences in the incidence and intensity of pain between the neurectomized and non-neurectomized sides, though these differences were not significant. Individual patient assessment showed that from postoperative day 7 onward patients had on average less pain on the neurectomized side. Pain reduction was more prominent in patients who scored 4 or more on the visual analog scale. No significant difference was found in the incidence of sensory alterations between the two sides. Two years after inguinal hernia repair, only one of the 100 patients studied still had persistent pain (>4 on the visual analog scale); this pain was on the non-neurectomized side. CONCLUSIONS Our prospective data do not reach statistical significance to claim that iliohypogastric neurectomy reduces the incidence and intensity of persistent postoperative pain after tension-free inguinal hernioplasty. Studies on larger patient samples are warranted to provide definitive, statistically supported conclusions.
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Affiliation(s)
- Giuseppe Pappalardo
- Department of General Surgery, P. Stefanini, University La Sapienza, Rome, Italy.
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17
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Mongardini M, Iachetta RP, Cola A, Brunelli D, Degli Effetti E, Blasi S, Maturo A, Benedetti F, Custureri F. [Gastric lipoma presenting as intestinal obstruction]. G Chir 2006; 27:90-2. [PMID: 16681867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
Gastric lipoma is a rare benign tumor. The symptoms are correlated with the size and the dimensions of neoplasm. It can be the cause of bleeding, gastroduodenal intussusception and intestinal obstruction, as in case reported and surgically treated. The Authors make a literature review to define the better diagnostic and surgical approach.
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Affiliation(s)
- M Mongardini
- Università degli Studi di Roma La Sapienza, I Facoltà di Medicina e Chirurgia, Dipartimento di Scienze Chirurgiche
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18
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Mongardini M, Merlino P, Schillaci F, Cola A, Blasi S, Fanello G, Benedetti F, Maturo A, Pappalardo G. [Gangrene of Meckel's diverticulum in strangulated left inguinal hernia]. G Chir 2005; 26:384-6. [PMID: 16371191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
We report a case of a 57-year-old woman admitted for abdominal pain and a not reducible mass in left inguino-abdominal region. With a diagnosis of strangulated inguinal hernia, the patient underwent urgent surgery. The surgical exploration showed a gangrenous intestinal loop with a Meckel's necrotic diverticulum. A small bowel resection (20 cm) was performed. The post-operative course was uneventful. This seems the first case reported in the literature of woman with a Meckel's diverticulum involved in a strangulated left inguinal hernia.
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Affiliation(s)
- M Mongardini
- Dipartimento di Scienze Chirurgiche, Prima Facoltà di Medicina e Chirurgia, Università degli Studi La Sapienza di Roma
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19
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Mongardini M, Schillaci F, Cola A, Fanello G, Benedetti F, Maturo A, Pappalardo G. [Adhesion ileus in patient with previous diagnosis of Ogilvie's syndrome]. G Chir 2005; 26:318-20. [PMID: 16329775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
A case of a 72-year-old man with abdominal pain and ileus is reported. Previous surgery for Ogilvie's syndrome had been performed. Despite conservative therapy, the occlusive symptoms worsen. Therefore the patient was submitted to surgery. At laparotomy two abdominal adhesions were found and sectioned. The differential diagnosis between mechanical ileus and pseudoobstruction for neuro-mechanics dissociation (Ogilvie's syndrome) is difficult, particularly in patients with neurodegenerative diseases.
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Affiliation(s)
- M Mongardini
- Università degli Studi La Sapienza, Roma Prima Facoltà di Medicina e Chirurgia, Dipartimento di Scienze Chirurgiche, UOC Chirurgia Generale L
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20
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Mongardini M, Custureri F, Schillaci F, Leone G, Cola A, Fanello G, Benedetti F, Maturo A, Pappalardo G. [Rectal stenosis after stapler hemorrhoidopexy]. G Chir 2005; 26:275-7. [PMID: 16332306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
We report a case of a 52-year-old woman with hemorrhoids submitted to Procedure for Prolapse and Hemorrhoids (PPH), i.e. stapled hemorrhoidopexy, using a modified Longo's technique (double purse string) to treat an associated rectocele and rectal prolapse; the STARR technique (Stapled Trans Anal Rectal Resection) was not yet codified. The post-operative course was uneventful and the patient is discharged in II p.o. day. In fifth post-operative day the patient came back with an unusual rectal stenosis due to the superior purse string. The stricture was easily resolved by 'opening' the purse string with a transanal approach in outpatient setting.
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Affiliation(s)
- M Mongardini
- Prima Facoltà di Medicina e Chirurgia, Dipartimento di Scienze Chirurgiche, UOC Chirurgia Generale L, Università degli Studi "La Sapienza" di Roma
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21
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Moschella CM, Mattiucci S, Mingazzini P, Mongardini M, Chein A, Miccolis D, Modini C. Intestinal anisakiasis in Italy: a case treated by emergency surgery. G Chir 2005; 26:201-5. [PMID: 16184702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
Anisakiasis is a fish-borne zoonotic disease. A case of intestinal anisakiasis in a woman who had consumed raw marinated anchovies was reported. The intestinal localization resulted in occlusive acute abdomen which required an emergency surgical treatment. The histological examination of the eosinophilic granuloma removed from the resected colon revealed the presence of larval nematodes of the genus Anisakis as causative agents.
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Affiliation(s)
- C M Moschella
- Department of Surgery "Pietro Valdoni", University La Sapienza" of Rome, Italy
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22
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Mongardini M, Moschella CM, Schillaci F, Cola A, Fanello G, Benedetti F, Maturo A, Pappalardo G. [Strangulated abdominal herniation by Ladd's band]. G Chir 2005; 26:207-9. [PMID: 16184703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
A case of a 64-year-old man with abdominal pain since three days, with vomiting and ileus and without previous surgery is reported. Faecal material was aspirated by a nasogastric tube; TC showed dilatation of the small bowel with the walls of the loops thickened. The patient was submitted to emergency surgery with diagnosis of intestinal infarction. At laparotomy an extensive necrosis (two meters) of small bowel was present, caused by visceral herniation by a Ladd's band. Intestinal resection was performed with latero-lateral stapled anastomosis. The postoperative course was uneventful and the patient was transferred in VII p.o. day to an hospital of his Country.
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Affiliation(s)
- M Mongardini
- Dipartimento di Scienze Chirurgiche, Prima Facoltà di Medicina e Chirurgia, UOC Chirurgia Generale L, Università degli Studi "La Sapienza" di Roma
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23
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Mongardini M, Custureri F, Schillaci F, Cola A, Maturo A, Fanello G, Corelli S, Pappalardo G. [Prevention of post-operative pain and haemorrhage in PPH (Procedure for Prolapse and Hemorrhoids) and STARR (Stapled Trans-Anal Rectal Resection). Preliminary results in 261 cases]. G Chir 2005; 26:157-61. [PMID: 16035252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
Intra- and early (first week) post-operative haemorrhages are the most common complications in stapled hemorrhoidectomy PPH (Procedure for Prolapse and Hemorrhoids) and in circumferential resection of the rectal prolapse STARR (Stapled Trans Anal Rectal Resection). Performing PPH and STARR we employed a gelatin based haemostatic sealant with thrombin component (FloSeal) to control intra-operative bleeding and to reduce post-operative bleeding avoiding haemostatic stitches on suture line. We report the preliminary results on 197 PPH and 64 STARR; 44 PPH (22.4%) and 27 STARR (42.2%) were treated by FloSeal. No major post-operative bleeding was observed in all patients treated by FloSeal, compared to 1.3% and 2.7% of hemorrhage respectively in PPH and STARR patients treated without sealant. Post-operative pain was less severe in patients treated by FloSeal, without a difference statistically significant. The data are preliminary and must be confirmed in prospective randomized trials in larger series.
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Affiliation(s)
- M Mongardini
- Prima Facoltà di Medicina e Chirurgia, Dipartimento di Scienze Chirurgiche, UOC Chirurgia Generale L, Università degli Studi "La Sapienza", Roma
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24
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Salvi PF, Moles N, Gazzetti M, Lombardi A, Puzzovio A, Mongardini M. [Desmoid tumor of rectus muscle of abdomen in a woman of childbearing age: what can we do?]. G Chir 2003; 24:413-7. [PMID: 15018410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Abstract
The desmoid tumor (DT) is a soft tissue neoplasm most frequently localized in the anterior abdominal wall typically in females of childbearing age. Because its particular incidence in women who had recently been pregnant, it was correlated with delivery's trauma stimulating proliferation of muscolo-aponeurotic tissues. Complete surgical resection is the recommended treatment approach to prevent recurrence. Many authors emphasize the role of radiotherapy in regression of DT and in controlling local recurrence in patient who had incomplete resection. Many others emphasize the role of chemotherapy or antiestrogenic compounds, even though tumour does not express estrogen receptors. DT, otherwise, is neoplasm with high rates of recurrence after surgery but it never develops distant metastases, so that function and structure-sparing surgery may be a reasonable choice in young women when possible without leaving macroscopic residual disease. Furthermore literature data suggest that the presence of incomplete histological surgical resection does not correlate with local recurrence and that pregnancy does not represent a risk factor. In women of childbearing age, even after non radical histological DT primary resection, adjunctive radiotherapy, chemotherapy or antiestrogen therapy could be avoided and clinical observation alone may be considered.
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Affiliation(s)
- P F Salvi
- Università degli Studi "La Sapienza" di Roma, Policlinico Universitario Umberto I, Istituto di Clinica Chirurgica d'Urgenza e Pronto Soccorso
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25
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Mongardini M, Pappalardo G. [The use of Floseal in the prevention and treatment of intra- and post-operative hemorrhage in the surgical treatment of hemorrhoids and colporectocele. Preliminary results]. G Chir 2003; 24:377-81. [PMID: 14722999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/28/2023]
Abstract
Stapled hemorrhoidectomy (PPH) is a modern approach to the treatment of hemorrhoids removing a circumferential strip of mucosa. In the same way the circumferential resection of the rectal prolapse (STARR) is successfully used for effective treatment of colporectocele and obstructed defecation syndrome. These surgical procedures offer several advantages over conventional techniques including reduced postoperative pain, stenosis and recurrences, an earlier recovery time and return to work. Furthermore, bleeding is one of the most common immediate complication (first week) and one of the possible late complication in these procedures. Our results with this surgery (153 PPH and 37 STARR) confirmed the data of many other Authors regarding the incidence of intra and early post-operative haemorrhages (1.3% in PPH and 2.7% in STARR). With the aim to reduce this complications, which represents the only negative side-effect of these procedures, we employed the FloSeal, a gelatine based haemostatic sealant with thrombin component, to control intraoperative bleeding. The preliminary results obtained in 10 PPH and in 7 STARR confirmed the theoretical usefulness of FloSeal in reducing this hemorrhagic complications.
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Affiliation(s)
- M Mongardini
- Servizio Speciale di Chirurgia d'Urgenza e Pronto Soccorso, Istituto Dipartimentallzzato di Clinica Chirurgica d'Urgenza e Pronto Soccorso, Università degli Studi La Sapienza, Roma
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26
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Stagnitti F, Mongardini M, Schillaci F, Ribaldi S, Priore F, Corona F, Tiberi R. [Packing: current concepts of "life-saving" surgery]. G Chir 2003; 24:315-22. [PMID: 14664191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/27/2023]
Abstract
Abdominal packing is a lifesaving technique for temporary control of severe injury and it is used in Damage Control Surgery schedule. Technically bleeding from abdominal cavity can generally be achieved by applying pressure with several large abdominal packs. It's possible too applying packs in organ-specific techniques (early abdominal packing). A wide review of the literature has allowed to emphasize the most common problem of this technique, the adequacy of the particular indications, their evolution, timing, the results in general and particular which multiple critical situations and not always predictable when an intensive diagnostic and methodological approach is necessary in. The principal indications are when complex anatomic lesions are diagnosed with not ruleable hemorrhages, in presence of metabolic failure--like hypothermia < 35 degrees C, acidosis > 7.2, coagulopathy PTT > 16 seconds: these three derangements become established quickly in the exsanguinating trauma patient and, once established, form a vicious circle which may be impossible to overcome. The results are encouraging and we can evaluate a median survival of the 60%, certainly superior to the obtainable survival with immediate surgical repair. Immediate failures are substantially due to bleeding, especially in "underpacking" case, and remote: these last can be premises, fundamentally septic and bound at the time of stay (above the 72 hours) and associated by the coexistence of lesions; in these situations is possible a MOF syndrome due to excessive intraabdominal pressure (overpacking) or to an abdominal compartment syndrome.
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Affiliation(s)
- F Stagnitti
- Istituto di Clinica Chirurgia d'Urgenza e Pronto Soccorso, Università degli Studi La Sapienza, Roma
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27
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Monacelli G, Cascioli I, Mongardini M, Corelli S, Cigna E, Spagnoli AM. [Glomus tumor and neovascular syndrome of the arm: a clinical case]. G Chir 2003; 24:235-8. [PMID: 14569920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/27/2023]
Abstract
Glomus tumour represents a benign tumor which originates from myoepithelial cells of arteriovenous anastomosis that has a preference for subungual localization with painful and multiform symptomatology. A fifty-year-old female presented a vasospastic symptom with hyperalgesia and cold hypersensitivity in the fourth finger of the right hand. There was a little palpable tumefaction and after an echography, we decided for surgical revision. Differential diagnosis with Raynaud's phenomenon is very important but not simple. The diagnosis is often late. MRI and angio-MR with its typical symptomatology could give the accurate diagnosis. The therapy is only surgical. The excision must be very careful making sure to spare the nervous structures.
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Affiliation(s)
- G Monacelli
- Policlinico Umberto I, Neuromed IRCCS, Pozzilli (Is) Università degli Studi La Sapienza, Roma
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28
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Stagnitti F, Coletti M, Corona F, Priore F, Tiberi R, Mongardini M, Costantini A, Schillaci F. [Small intestine tumors: our experience in emergencies]. G Chir 2003; 24:34-8. [PMID: 12728796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2023]
Abstract
Small bowel tumours are relatively rare neoplasms; unusual occurrence associated with nonspecific symptoms, and low-sensitivity tests availability, are responsible for diagnostic delay. A retrospective study was performed on 42 cases with acute presentation, from 1972 to 2001; median age was 52 years (range 14-79) and there was a slight female prevalence (57.1% vs 42.9%). The most common acute presentation was occlusion (57.1%), followed by gastrointestinal (GI) bleeding (23.8%), perforation (14.3%) and occlusion/perforation (4.8%). Benign neoplasia were 38.1% (16 cases) and adenoma is was the most common type; malignant forms were 61.9 (26 cases) and adenocarcinoma and lymphomas were the most common histotype. Radical surgical procedures were possible only in 57% of malignant forms (24 patients); morbility was 4.8% (2 cases: 1 anastomotic dehiscence and 1 subphrenic abscess); mortality was 14.3%. From our retrospective study, we can state that survival for malignant lesions is strictly dependent of early TNM staging and possibility of radical surgical procedure. An extremely high index of suspicion in evaluating mild and often misleading symptoms, integrated with specific diagnostic studies, should be the proper approach. Prognosis for benign from is excellent in all cases.
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29
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Stagnitti F, Mongardini M, Schillaci F, Scirocchi R, De Petris L, Malizia A, Marenga G, Patrizi V, Priore FM, Corona F, Tiberi R, Di Placido M, Calderisi MD, Longo F. [Peritoneal papillary serous carcinoma: clinical report]. G Chir 2002; 23:379-82. [PMID: 12611260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Abstract
Peritoneal papillary serous carcinoma (PPSC) is a rare tumour that involves the surface of the peritoneum, with prevalence in female patients and can originate from a single or multicentric focus is here described. A primary peritoneal serous carcinoma is here described. The patient has been treated with paclitaxel 175 mg/m2 and carboplatinum AUC 6.
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Affiliation(s)
- F Stagnitti
- Dipartimento di Medicina Sperimentale e Patologia, Istituto di Chirurgia d'Urgenza e Pronto Soccorso, Università degli Studi La Sapienza, Roma
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30
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Stagnitti F, Mongardini M, Coletti M, Calderale SM, Ribaldi S, Salvi PF, Schillaci F, Bresadola L. [Superior vena cava syndrome]. G Chir 2002; 23:322-4. [PMID: 12564306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/28/2023]
Abstract
Superior vena cava syndrome is due to an intrinsic or extrinsic caval obstruction that evolves in acute or subacute way with distinctive clinical feature such as respiratory symptoms and venous stasis. Since 1998 we have treated three cases of spontaneous superior vena cava thrombosis in neoplastic patients who underwent several infusion of chemotherapy, respectively for a breast, uterine and rectum cancer. All patients was female, 52, 58 and 70 years old. The first two cases was treated with locoregional thrombolysis by infusing Urokinase 50,000 UI/h during 24 hours and Urokinase 50,000 UI/h during 12 h the third one. After that, we have positioned a 16/9 wallstent: in the first two cases directly into the superior vena cava, in the third case in the subclavian-anonyma truncus. We had in all cases the complete opening of the stent within the first 48 hours without complications, enabling us to reach a free caval diameter of about 2 cm with resolution of the clinical signs. In patients with high surgical risk, the caval wall-stent is the first choice to solve the vein recanalization.
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Affiliation(s)
- F Stagnitti
- Università degli Studi La Sapienza, Roma Istituto di Clinica Chirurgica d'Urgenza e di Pronto Soccorso
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31
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Mongardini M, Stagnitti F, Schillaci F, Monacelli G, Di Placido M, Calderisi MD, Spagnoli AM. [Cutaneous Merkel cell carcinoma: case report]. G Chir 2002; 23:334-6. [PMID: 12564309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/28/2023]
Abstract
Merkel cell carcinoma is an unusual cutaneous malignancy with a propensity for spreading to regional lymph nodes, with recurrence at original site or/and in lymph node. Occurring most often on the head and neck of the elderly patients. Complete surgical resection is the mainstay of treatment of the primary tumor. A case is here described of an old patient with more than one local relapse and in regional lymph nodes too, complete surgical resected, actually in good state of health, treated with radiotherapy.
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Affiliation(s)
- M Mongardini
- Università degli Studi La Sapienza, Roma Istituto di Chirurgia d'Urgenza e Pronto Soccorso
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32
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Scamporrino A, Mongardini M, Stagnitti F, Corona F, Costantini A, Priore FM, Tiberi R, Iannetti A, Occhigrossi G. [Difficult endoscopic extraction: pneumomediastinum and bilateral pneumothorax after attempted endoscopic extraction of needle incarcerated in hiatal hernia]. G Chir 2002; 23:261-7. [PMID: 12422783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/27/2023]
Abstract
From June 1987 to April 2000, 167 (74%) of 223 patients suspected of swallowing foreign bodies were treated. Hundred-sixty-three were successfully treated endoscopically. The surgery rate was 2.4%. There was failure to remove a tablespoon, a tooth-brush, a dental prostheses with metallic hook, a knitting-needle. The sharp and pointed foreign bodies were 35 (20.9%). Endoscopic removal of sharp and pointed foreign bodies in the upper gastrointestinal tract can be very difficult to manage. The Authors report iatrogenic perforation of esophagus-gastric-fundus in a patient with hiatus hernia who ingested a big knitting-needle in order to suicide. They think that it is absolutely necessary to use special endoscopic equipment during the taking out of foreign-body procedure, especially when pointed and sharp-edge shaped bodies are involved and when there is high risk of iatrogenic lesions.
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Affiliation(s)
- A Scamporrino
- Istituto di Clinica Chirurgica d'Urgenza e di Pronto Soccorso, Università degli Studi La Sapienza Roma
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33
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Stagnitti F, Mongardini M, Schillaci F, Priore F, Tiberi R, Ribaldi S, Coletti M, Calderale SM, Di Paola M. [Damage control surgery: the technique]. G Chir 2002; 23:18-21. [PMID: 12043464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
Abstract
Abdominal packing and planned reoperation is a lifesaving technique for temporary control of haemorrhage in severely injured patients. Morbidity and mortality, however, remain significant. The purpose of this study is to evaluate all surgical technique and our results during 31 years of trauma surgery. In the last 12 years the Authors have performed 11 packing. They stressed fully "damage control technique" in trauma surgery in the last four years. Overall mortality was 45.5%.
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Affiliation(s)
- F Stagnitti
- Istituto di Clinica Chirurgica d'Urgenza e di Pronto Soccorso, Università degli Studi La Sapienza, Roma
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34
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Stagnitti F, Accettella U, Mongardini M. [Informed consent in emergency surgery]. G Chir 2001; 22:317-20. [PMID: 11816940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
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35
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Stagnitti F, Schillaci F, De Pascalis M, Mongardini M, Patrizi V, Cilurso F, Costantini A, Dall'Olio D, Priore F, Tiberi R, Natalini E. [Use of adhesives in emergency surgery]. G Chir 2001; 22:309-12. [PMID: 11682969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
Abstract
In a prospective study, the Authors present an analysis on the use of surgical adhesives in the wounds treatment. In sixteen months we have treated 157 patients exclusively with a surgical tissue adhesive 2-octylcianoacrylate to repair traumatic wounds and surgical ones. In the Emergency Department were treated 110 patients (70%) with 2-octylcianoacrylate for skin incisions, lacerations and the length of lesion. We have paid attention to prepare regular wound edges, irrigation and debridement when appropriate to reduce skin tension at the site of laceration. Forty-seven patients (30%) whit surgical skin incisions for thyroidectomy, appendicectomy, hernio-plastic and safenectomy were treated with 2-octyl-cianoacrylate. In both groups of patients, the surgical adhesive has made possible a simple and quick wounds repair as well as good aesthetic results. No relevant complications have been arisen. The writers recommend the surgical adhesive in Emergency Department to abridge waiting time and to avoid the psychological impact caused by local anaesthesia, suture and medications especially in the treatment of all wounds types in children.
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Affiliation(s)
- F Stagnitti
- Clinica Chirurgica d'Urgenza e di Pronto Soccorso Scuola di Specializzazione in Chirurgia Generale V ad Indirizzo d'Urgenza, Università degli Studi La Sapienza, Roma
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36
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Marenga G, Merlino P, Mongardini M, Sciarretta FM, Serafini G, Malizia A. [Unusual case of kidney rupture]. G Chir 2000; 21:283-6. [PMID: 10916950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
The Authors report a case of renal rupture in a patient 36 years with acute abdominal pain and progressive anaemia. The history of the patient shows no past signs and symptoms of either renal pathology or traumatic event. Radiological examinations demonstrates dislocation of the kidney through presence of large retroperitoneal formation interpretable as haematoma. Progressing bloodless, they proceeded to embolization of renal artery and successive nephrectomy. Only histological examination of the removed kidney demonstrates the presence of a renal clear cells adenocarcinoma.
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Affiliation(s)
- G Marenga
- Istituto di Clinica Chirurgica d'Urgenza e di Pronto Soccorso, Università degli Studi La Sapienza di Roma
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37
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Stagnitti F, Mongardini M, Schillaci F, Dall'Olio D, De Pascalis M, Natalini E. [Spontaneous biliodigestive fistulae. The clinical considerations, surgical treatment and complications]. G Chir 2000; 21:110-7. [PMID: 10810820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
To reevaluate the current feature of spontaneous bilioenteric fistula we reviewed 81 cases who had been treated for biliary fistula between 1948 and 1998. After a review of the literature on this subject, the multiple problems relate to pathological anatomy, pathogenesis and physiopathology are discussed. Of 81 patients, 55 were women and 26 were men with the average age of 54.5 years. The most common type of fistula was cholecysto-duodenal (55 cases--68%), followed by cholecysto-colonic (11 cases--13.6%), choledocho-duodenal (7 cases--8.6%), cholecysto-gastric (4 cases--4.9%) and duodeno-left hepatic duct fistula (4 cases). The authors have found in 41 cases the gallstone ileus complications, in 12 cases inflammatory disease of biliary three, in 8 cases hemobilia, gallstone ileus with perforation and digestive hemorrhage compliances respectively. All the patients were treated with surgery. A first procedure consists of enterolithotomy, in gallstone ileus cases, followed by biliary surgery. In 14 patient the general or local conditions argued against one-stage procedure and two-stage procedure had been considered. In 63 patients a cholecystectomy was done, 15 were treated with enterolithotomy and 8 with intestinal resection. Seven patients with gastroduodenal ulcer based fistula have required a gastroduodenal resection. The mortality was 13.6% (11 cases).
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Affiliation(s)
- F Stagnitti
- Istituto di Clinica Chirurgica d'Urgenza e di Pronto Soccorso, Università degli Studi La Sapienza, Roma
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38
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Stagnitti F, Mongardini M, Pascalis MD, Natalini E. [Inhaled foreign bodies: first aid]. G Chir 2000; 21:124-6. [PMID: 10810823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
In the last 30 years 1,484,576 patients with traumatic lesions of different kind of seriousness were observed and managed. By mean of retrospective investigation, the authors selected and statistically analysed a sample of 95 patients treated for accidental tracheobronchial foreign bodies inhalation: authors' aim was to punctually determinate--step by step--diagnosis and treatment procedure in a "time-saving" frame. Inhalation of foreign bodies is a very dangerous event, particularly in children. In authors' experience, in 60% of cases they were children under 3 years; in 25% of cases children under 10; in 10% patients from 10 to 60 and in 4.5% over 60. As regards the gender of the patients, the male/female ratio has been 2 to 1 in favour of male. Since 85% of the study population was represented by children under 10, its clear that male children in this range of age has a greater statistical risk for accidental tracheobronchial foreign bodies inhalation.
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Affiliation(s)
- F Stagnitti
- Istituto di Clinica Chirurgica d'Urgenza e di Pronto Soccorso, Università degli Studi La Sapienza, Roma
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39
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Schillaci F, Stagnitti F, Iurato C, Mongardini M, Dall'olio D, Salvi PF, Cazzaniga M, Bresadola L, Schultze W, Natalini E. [Deep venous thrombosis and neoplastic pathology: our experience in emergencies]. G Chir 1998; 19:293-300. [PMID: 9707837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Deep vein thrombosis incidence is 1/1000 per year; it is associated with many risk factors which is considered as "thrombophilic states". Its pathogenesis is complex, caused by alterations of hemostasis system. Many studies have established the relation between cancer and subsequent venous thromboembolism, confirming the relationship of neoplastic cell interaction with coagulation system. Forty-seven patients admitted to the hospital from 1987 to 1996 with symptomatic clinically proved deep vein thrombosis were included in a retrospective study. Routine examination at the time of diagnosis of deep vein thrombosis revealed an occult cancer in 8 out of 47 patients; 9 out of 47 patients were admitted in hospital with vein thrombosis and known cancer. The aim of this study is to suggest the best, first treatment of vein thromboembolism in emergency to avoid the dangerous pulmonary embolism complication. The patients affected with deep vein thrombosis and cancer were elderly (over 70 years old, in mean); the neoplasia was of digestive system (8/17) in advanced metastatic stage there was cancer familiarity in 7 out of 47 patients. The high risk of pulmonary embolism associated to deep vein thrombosis suggests the importance of early starting the anticoagulant therapy and placing caval filter.
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Affiliation(s)
- F Schillaci
- Istituto di Clinica Chirurgica d'Urgenza e di Pronto Soccorso, Università degli Studi La Sapienza, Roma
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40
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De Antoni E, Custureri F, Salvati B, Colio B, Evangelista T, Capoano R, Passa G, Zocchi L, Mongardini M, Galatioto GL. [Primary "small-cell" lymphoma of the lung. A clinical case report]. G Chir 1991; 12:261-4. [PMID: 1911075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Primary lymphoma of the lung is a rare pathological condition arising from mucosa-associated lymphoid tissue (MALT). The lack of specific symptoms and the related diagnostic problems induced the authors to report a clinical case recently observed. Therefore, some histopathologic characteristics useful for a correct differential diagnosis with the pseudolymphoma of the lung and the interstitial lymphocyte pneumonia are analysed.
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MESH Headings
- Aged
- Diagnosis, Differential
- Humans
- Leukemia, Lymphocytic, Chronic, B-Cell/diagnosis
- Leukemia, Lymphocytic, Chronic, B-Cell/pathology
- Leukemia, Lymphocytic, Chronic, B-Cell/surgery
- Lung/pathology
- Lung Neoplasms/diagnosis
- Lung Neoplasms/pathology
- Lung Neoplasms/surgery
- Male
- Pneumonectomy
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Affiliation(s)
- E De Antoni
- Istituto di III Clinica Chirurgica Generale e Terapia Chirurgica, Università degli Studi La Sapienza, Roma
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41
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Custureri F, Oddi A, Evangelista T, Mongardini M. [An unusual case of spontaneous idiopathic hemothorax]. G Chir 1991; 12:46-8. [PMID: 1867974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Spontaneous haemothorax is an extremely rare pathology. Up to date, only 3 cases have been described in literature. The authors report the fourth case personally observed.
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Affiliation(s)
- F Custureri
- III Clinica Chirurgica Generale e Terapia Chirurgica, Università degli Studi La Sapienza, Roma
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42
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Chiarini S, Bove A, Filippini A, Lania M, Mongardini M, Ipri D, Sica G, Zakaria M, Gaspari AL. [Free microvascularized flaps in head and neck lesions: the technics of microsurgical reconstruction]. G Chir 1991; 12:54-5. [PMID: 1867977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
The authors report their experience of microsurgical reconstructive techniques using musculo-cutaneous free flaps after radical operations for head and neck neoplasms.
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Affiliation(s)
- S Chiarini
- Semeiotica Chirurgica, Università degli Studi G. D'Annunzio, Chieti
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43
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Chiarini S, Filippini A, Lania M, Mongardini M, Irpi D, Zakaria M, Sica G, Gaspari AL. [Indications for a reconstructive technique using micro-revascularized free flaps in traumatic and neoplastic lesions: our clinical experience]. G Chir 1990; 11:647-9. [PMID: 2091727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- S Chiarini
- Semeiotica Chirurgica, Università degli Studi G. D'Annunzio, Chieti
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44
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Chiarini S, Filippini A, Lania M, Mongardini M, Sica G, Zakaria M, Gaspari AL. [A case of carcinoma of the cervical esophagus treated with interposition of an intestinal loop revascularized using a microsurgical technique]. G Chir 1990; 11:631-2. [PMID: 2091723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
The Authors present a case of hypopharyngeal tumor in which digestive continuity was assured by a jejunal autotransplant. Tumoral exeresis and jejunal preparation were carried out at the same time by two surgical teams. The use of microsurgical techniques assures the revascularization of the neck transplant by implementing the superior thyroid artery and the internal jugular vein. Digestive anastomoses complete the operation.
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Affiliation(s)
- S Chiarini
- Semeiotica Chirurgica, Università degli Studi G. D'Annunzio, Chieti
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45
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Mongardini M, Benedetti F, Chiarini S, Palazzini G. [Venous replacement surgery: history, update and perspectives]. G Chir 1990; 11:371-81. [PMID: 2147562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
The impulse given to vascular surgery by new technologies has facilitated the use of the bypass technique in a number of arterial pathologies with better and better results over time. At the moment, however, we haven't a "sure prosthesis" in venous surgery. Our intention has been to examine the most significant developments, studying all the available material dating from the beginnings of the art up to the present. After a careful examination of the venous pathophysiology as well as the most valid surgical approaches, we tried to evaluate on laboratory animals the results of experimental graft replacement of the inferior vena cava. In this study we analysed prostheses in PTFE, biological prostheses, spiral composite vein grafts, arterial autologous grafts. For the experimental study we used 55 rabbits (New Zealand and Fiandra). Results have been rather successful with respect to biological prostheses (62.5% patency) and PTFE (66.6%). As for spiral composite vein graft prosthesis patency over time was very low (16.6%); this was affected by the different venous graft (heterologous graft) and caval wall thicknesses. Arterial autologous graft was carried out only once because rabbit experimented on did not stand up to surgical stress.
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Affiliation(s)
- M Mongardini
- Ill Clinica Chirurgica Generale e Térapia Chirurgica, Università degli Studi La Sapienza, Roma
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46
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Chiarini S, Bove A, Horvath F, Marchese V, Mongardini M, Ortensi A. [Experimental microsurgery: the main technical bases for research]. G Chir 1990; 11:197-205. [PMID: 2223508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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47
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Cancrini A, Mongardini M, Bellotti C, Boemi L, Benedetti F, Tarroni D, Chiarini S. [Mesorectal resection in oncologic surgery]. G Chir 1989; 10:51-4. [PMID: 2518531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
A surgical technique to "en bloc" resect the mesorectum while performing an anterior resection is here described. The procedure aims at preserving those nerves whose injury is responsible for a series of neurological sequalae, which affect the patient's quality of life. Fifteen dissections were carried out in order to demonstrate the possibility to perform an accurate mesorectal lymphadenectomy while preserving, in most cases, the nervi erigentes and, in some cases, the hypogastric plexus.
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48
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Cancrini A, Mongardini M, Benedetti F, Bellotti C, Boemi L, Chiarini S, Tarroni D, Greco L. [Vascular substitution in oncologic surgery]. G Chir 1988; 9:912-5. [PMID: 3152907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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