Minerva chirurgica
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Crush injuries and crush syndrome are common after natural (e.g. earthquake, land-slide, tornadoes, tsunami) or man-made catastrophes (e.g. wars, terrorist attacks), in fact the history of this disease is well reported both in earthquake rescue reviews and in military literature. However, there are instances due to conventional causes, such as building collapses, road traffic accident, accident at work or altered level of consciousness after stroke or drug overdose. These situations of ''big or small'' catastrophes can occur at any time and anywhere, for this reason every clinician should be prepared to address issues of crush syndrome quickly and aggressively. ⋯ This article reviews the various evidences and summarizes the treatment strategies available. Fundamental targets in crush syndrome management are early aggressive hydration, urine alkalinization and, when possible, forced diuresis. Since electrolyte imbalance may be fatal due to arrhythmias secondary to hyperkalemia (especially associated with hypocalcemia), it's necessary to correct these abnormalities using insulin-glucose solution and/or potassium binders, and if nevertheless serum potassium levels remain high this serious disease will necessitate dialysis, which is often a vital procedure.
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The surgical approach on the colon and rectum represents a wide slice of the surgical procedures carry out in election or emergency in a general surgery unit. The literature reports prospective and retrospective studies evidencing emergency surgery, advanced age, comorbidity and other factors can determinate a worsening of short-term outcome (postoperative mortality, morbidity and hospital stay). The aim of the study was to verify, through a statistical analysis on a group of patients operated on the colon and the rectum, which are the factors weighting on the short-term outcome. ⋯ Despite of the literature, this study found none of the analyzed variables related on postoperative mortality and morbidity in statistically meaningful way. The POSSUM-score demonstrated once again validity in estimating the probability of dead and of postoperative complications. The variables that influenced in lengthening of hospital stay were: more staged surgery, blood transfusion, emergency surgery, presence of social factors conditioning the discharge, comorbidity and advanced age of the patients. The good results about mortality and morbidity can be explained by the fact we prefer in emergency more staged surgery that protect the patients from complications related to the anastomosis, the presence of sub-intensive surgical beds with a constant monitoring of high risk patients and the close collaboration between surgeons and intensive care medical doctors.
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A 68-year-old male patient was referred to our hospital due to protrusion and pain in the right iliac fossa. On physical examination a palpable oval tumor was found. Ultrasonography and computed tomography revealed a cystic mass in right iliac fossa. ⋯ Retroperitoneal cystic lymphangiomas are rare lesions, most often seen in pediatric patients. Surgical excision is the treatment of choice because of its potential to grow and develop complications, especially due to mass effect. The laparoscopic approach is a safe and effective alternative for treatment of retroperitoneal cystic lymphangioma in the elderly.
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Comparative Study
Kinetics of plasma heat shock protein HSP-70 release in coronary artery surgery: on-pump versus off-pump.
Heat shock protein HSP-70 is known as protective chaperone molecule synthetized in response following ischemia and stress agents. It is detected in the myocardium and endothelium as well as in the circulation. Damaged as well as viable but exposed to stress cells contribute to the release of HSP-70 into the circulation. The aim of the study was to investigate if cardiopulmonary bypss (CPB) leads to more circulating HSP-70, on the basis of comparison dynamics of plasma concentration HSP-70 in 8 men undergoing procedures with the use of CPB (coronary artery bypass grafting, CABG group) and 8 men undergoing off-pump surgery (OPCAB group). ⋯ The use of CPB leads to significant more release of HSP-70 into the circulation. According to our findings high plasma concentration of HSP-70 may be the measure of operative cellular stress, ischemia or injury and may be related with greater onset of postoperative AF. High circulating HSP-70 levels is connected with higher incidence of postoperative AF after open heart surgery.