International journal of surgery
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The role of sentinel lymph node biopsy (SLNB) in patients with ipsilateral breast tumor recurrence (IBTR) remains to be elucidated. The aim of this study was to evaluate feasibility and validity of SLNB in patients with IBTR. ⋯ SLNB is a technically feasible and valid procedure for staging and treatment of regional lymph nodes in patients with IBTR.
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Prosthetic mesh implants in hernia repair are frequently used based on the fact that lower recurrence rates are detected. However, an undesirable side effect is persistent foreign body reaction that drives adhesions and shrinkage among other things in the course of time. Thereby a variety of meshes have been created in an attempt to alleviate these side effects, and particular relating to shrinkage, the ideal mesh has not been developed. Large pore size is one of the properties to get better ingrowth of the implants but could also be a risk factor to shrinkage behavior. The aim of this preclinical study was to determine optimal pore size based on mesh integration and shrinkage in a hernia minipig model. ⋯ Tissue ingrowth of meshes depends on increasing pore size. Macroporous mesh design >1.5 mm diameter appears to be optimal in terms of mesh integration. Lightweight meshes with a large pore size on one hand and a lack of structural stability on the other hand drives mesh shrinkage. High stretchability (Elongation >50 N) induces higher shrinkage and therefore elongation at 50 N appears to be a new parameter to estimate mesh shrinkage. Three-dimensional mesh constructions relate to the lowest shrinkage behavior caused by higher structure stability.
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Resuscitation to euvolemia in trauma as well as in the critically ill patient, although necessary, continues to be a challenge. Focused cardiac ultrasound has been shown to be a reliable tool to evaluate fluid status and to guide therapy. The present manuscript reviews the evidence supporting the use of this tool and describes the clinical applications for image-based resuscitation using echocardiogram.
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Irreversible electroporation (IRE) is a non-thermal ablation technique recently used in pancreatic cancer. In our prospective study we evaluated safety, feasibility and efficacy of a neoadjuvant protocol based on CT-guided percutaneous IRE followed by chemotherapy in patients with locally advanced pancreatic cancer (LAPC). ⋯ Our preliminary study suggests that IRE followed by chemotherapy is safe, feasible and effective in producing local control of LAPC, with a possible downstaging effect to resectable lesions.
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Appendicitis represents one of the most frequent condition requiring surgery. In Italy almost 0.2% of the population will be affected by acute appendicitis every year. Laparoscopic appendectomy (LA) has gained acceptance over the past years and despite several meta-analyses, randomized studies and retrospective studies have been conducted, the indications and results are still conflicting especially in cases of complicated appendicitis. The aim of our study is to evaluate which factors are related to conversion to open appendectomy (OA) during laparoscopic appendectomy (LA). ⋯ The majority of patients with acute appendicitis can be successfully managed with laparoscopy. We found that the only preoperative independent factor related to conversion during laparoscopic appendectomy is the presence of comorbidities. Nevertheless surgeons should take into account that presence of peri-appendicular abscess and diffuse peritonitis are both independently related not only to higher rate of conversion but also to higher risk of postoperative complication.