Annali italiani di chirurgia
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Multicenter Study
Blunt trauma to the extrahepatic biliary tract. A multicenter study.
Blunt trauma to the extrahepatic biliary tract is a rare and challenging injury The purpose of this paper is to review our experience of these injuries, with special reference to their clinical presentation. ⋯ In patients with blunt trauma, especially to the right upper quadrant, a high index of suspicion and liberal use of diagnostic studies to exclude an isolated extrahepatic biliary tract injury is recommended.
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Comparative Study
[The treatment of blunt abdominal trauma. Personal experience].
Aim of the study is to work out diagnostic and therapeutic guidelines in blunt abdominal trauma, considering our modern diagnostic tools and actual international propensity for non-operative treatment. ⋯ The study of personal experience of the last three years on abdominal blunt trauma (75 patients) has allowed the Authors to work out diagnostic-therapeutic guidelines, which are based mainly on patients' haemodynamic conditions and on sonographic and CT results. The applications of this protocol has allowed the Authors during last 12 months to practice more frequently the non-operative treatment, avoiding unnecessary surgical operations, sparing the patient organic deficit and possible intra and post-operative complications.
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Inferior vena-cava (IVC) injuries are uncommon but mortality is high, despite the improved organization and technical skills. The most important prognostic factors are the grade of hemorragic shock, the anatomical level of caval injury and the associated vascular lesions. Supra and retro-hepatic lacerations have the worst prognosis and their management is more difficult, as it's sometimes necessary performing complicated and high mortality related procedures, such as atrio-caval shunt and total vascular occlusion. ⋯ Infrarenal cava ligation can be an acceptable, significant complication free option. Caval thrombosis and pulmonary embolism represent the most important but uncommon complications. US and CT-scan are used in non-invasive follow-up of injuried IVC but timing is still controversial.
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Comparative Study
[Complications in thyroid surgery: symptomatic post-operative hypoparathyroidism incidence, surgical technique, and treatment].
Total thyroidectomy has a definite role in the management of malignant and benign thyroid disorders, with minimal complications and rare postoperative mortality. Even though thyroid surgery is quite safe, mechanical damage, devascularization or inadvertent removal of the parathyroid glands are possible. The aim of this study is to report report the personal surgical experience and to define some of the pathologic and clinical characteristics of unintentional parathyroidectomy and post-thyroidectomy hypocalcemia. ⋯ Postoperative hypocalcemia is the most immediate surgical complication of total thyroidectomy; it is a multifactorial phenomenon, where surgical technique has a greater phisiopatologic impact. However, hypoparatyroidism does not appeared to be the main reason for hypocalcemia after thyroidectomy, and other causes (surgical stress, "hungry bone syndrome", release of calcitonin during surgical manipulation) may be important contributory factors. In conclusion, as we exposed, extent of resection, surgical technique and thyroid pathologic condition had a greater impact on the rates of postoperative hypoparathyroidism. By developing understanding of the anatomy and the ways to prevent each complication, the surgeon can minimize each patient's risk and can handle complications expediently and avoid worse consequence.