Annali italiani di chirurgia
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Neoadjuvant chemotherapy is being used with increasing frequency in the multidisciplinary treatment of patients with operable breast cancer. Although large clinical trials have shown no differences between the same systemic therapy given pre- or post-surgery on diseasefree and overall survival, neoadjuvant therapy may have several advantages. By downstaging of the tumor, chemotherapy can convert patients who are candidates for mastectomy to breast-conserving surgery candidates. ⋯ To optimize the oncological and aesthetic results and minimize local recurrence rates, there are essential procedures to be respected as: - Careful local and systemic staging before chemotherapy (Ultrasonography, Mammography, Magnetic Resonance and PET- TAC); - Use of the technique of breast tattooing as practical method to delimit the initial tumor size and its margins before chemotherapy; - Placement of clips before chemotherapy to mark the primary tumor site and metastatic lymph nodes; - Accurate clinical restaging of the disease performed at the completion of chemotherapy; - Adequate radiological preoperative study with localization of residual tumor and/or calcifications and/or clips especially after a good response to neoadjuvant chemotherapy; - Use of innovative oncoplastic techniques that gives more options to have wide resections without compromising the cosmetic outcome; - Intraoperative radiological and pathological evaluation of the specimen, for the definition of the lesion and the margins of resection; - Accurate pathological management and assessment of the specimen using histological large sections (macrosections). In conclusion, sufficient evidence is now available to suggest that breast conservation after neoadjuvant chemotherapy is safe and effective for selected patients. Though neoadjuvant chemotherapy may increase the complexity of breast conservative treatment, a close collaboration between a multidisciplinary team and use of oncoplastic surgical techiques permit to optimize oncological and cosmetis outcomes.
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Nausea and vomiting are among the most frequent complications following anesthesia and surgery. Due to anesthesia seems to be primarily responsible for post operative nausea and vomiting (PONV) in Day Surgery facilities, the aim of the study is to evaluate how different methods of anesthesia could modify the onset of postoperative nausea and vomiting in a population of patients undergoing inguinal hernia repair. ⋯ Compared to Remifentanil, Fentanyl has a major influence in causing PONV. Nonetheless, an appropriate antiemetic prophylaxis can significantly reduce this undesirable complication. Key words: Day Surgery, Fentanyl, Inguinal, Hernia repair, Nausea, Vomiting.
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Controlled Clinical Trial
Controlled hypotension during middle ear surgery: hemodynamic effects of remifentanil vs nitroglycerin.
Controlled hypotension is a well-known technique used by anesthesiologists to limit intraoperative bleeding in patients undergoing middle ear surgery and improve visibility of the surgical field. Nitroglycerin and remifentanil are among the drugs used to induce controlled hypotension.The aim of our study was to compare the hemodynamic effects of remifentanil and nitroglycerin in this patient population. ⋯ Controlled hypotension, Middle ear surgery, Nitroglycerin, Remifentanil.
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Nowadays, there is no standardization in surgical procedures for treatment of colon cancer. Since its introduction, laparoscopic surgery has gained increasing interest in colorectal surgery and it is now performed worldwide for treatment of colon cancer. Following the concept of total mesocolic excision introduced by Heald in 1988 in order to reduce local recurrence after surgical treatment of mid/low rectal tumors, the idea of complete removal of the mesocolon mesocolic envelope has been developed also for colon cancer, has evolved longtime and complete mesocolic excision has been recently adopted as the optimal approach for colon cancer. However, complete mesocolic excision, whose purpose is to remove all lymphatics and lymph nodes draining the tumor, is still discussed as far as oncologic results are concerned. Moreover, the role of laparoscopic approach for complete removal of mesocolon has to be defined. ⋯ Colorectal-tumor, Complete mesocolic excision, High vascular ligation, Laparoscopic colorectal surgery, Splenic flexure mobilization, Total mesocolic excision.
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Patients with thoracic trauma constitute one third of all the trauma cases, in west Sicily were recorded 941 thoracic trauma during the period between 2006 and 2009. Sicily is one of the Italian regions with the highest rate of obesity: some studies have demonstrated that obesity is an independent risk factor for mortality in high energy blunt traumas. ⋯ BMI, Obesity, Thoracic trauma.