Annali italiani di chirurgia
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A wandering or ectopic spleen is a rare condition in which the spleen is not located in the left upper quadrant but is found lower in the abdomen or in the pelvic region caused by improper fixation of the ligamentous attachments. Laxity of the peritoneal attachments of the spleen results in splenic hyper mobility, known as wandering spleen. Congenital and acquired causes have been advocated to explain its onset. ⋯ Laparotomy evidenced a large spleen (DL 22 cm.) with a long (1 mt) and tortuous vascular pedicle, both removed. Histopathologic examination showed partial infarction of the spleen. The postoperative course was uneventful.
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Comparative Study
APACHE II, POSSUM, and ASA scores and the risk of perioperative complications in patients with colorectal disease.
This study was designed to assess the role of the ASA, POSSUM and APACHE II score systems for predicting the complications in patients undergoing surgery for colorectal diseases. ⋯ APACHE II and POSSUM score systems may be useful tools helping surgeons to identify patient groups at high risk for complications. The ASA classification resulted less accurate, probably because related to the anesthesiologist's knowledge.
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Comparative Study
Mesh versus direct suture for the repair of umbilical and epigastric hernias. Ten-year experience.
The objective of this study was to evaluate outcomes of mesh versus primary suture procedures for repair of anterior abdominal wall midline hernias. ⋯ Anterior preperitoneal mesh repair of abdominal wall midline hernias under local anesthesia seems to be a safe and effective technique that can be performed as a day surgery procedure. A slightly increased risk of postoperative local complications following mesh repair is offset by a reduced rate of recurrence in comparison to suture repair.
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Synovial sarcoma accounts for 8-10% of all of the soft tissue sarcomas; it's characterized by high risk of local relapse, even after surgical complete excision, deceiving onset ed slowly growth. Generally arising in the contest of joint or from immediately surrounding anatomical sites, first of all affecting inferior limbs (2/3), a sarcoma of the knee, elective anatomical site, is described, accidentally diagnosed after traumatic event. Exhibiting a very poor 5 year survey, (55%), related to dimension, distal or proximal arising, necrosis rate and grading, it's the most fequently soft tissue malignancy misdiagnosed with benign neoplasms, such as Baker cyst or villonodular pigmented synovitis, considering its deceiving macroscopic and chronological features; the differential diagnosis seems to be very hard, relying on histhological biopsy. Though the normal conventional x-ray finding, clinical examination and anamnesis have suggested in our patient the ultrasonographic investigation in urgency, which revealed the suspected nature of the lesion, which must be distinguished by hematoma, much more frequent thraumatic pathology, inducing severe prognosis in false negative cases.
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Diverticular disease (DD) is one of the most common disorders of the colon with an increased prevalence in Western populations. There are still many unsolved issues about indications, timing of surgery and modality of surgical treatment. These topics were discussed during the Consensus Conference (CC). ⋯ On this matter farther randomized studies are required to compare Hartmann's procedure with other techniques (such as primary anastomosis with or without diverting colostomy). A wide left colonic resection (with splenic flexure mobilization) extended beneath sigmoid-rectal junction is recommended to avoid immediate or late complications. Laparoscopic approach is feasible, even for management of complicated diverticular disease, if strict patient selection criteria are followed, duration of the procedure is comparable to open surgery and conversion rate is under 10%.