Minerva chirurgica
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Comparative Study
[Sliding hiatal hernia in patients with gastroesophageal reflux: physiopathology and surgical treatment].
The aims of the study were to evaluate how the sliding hiatal hernia, in patients with gastroesophageal reflux disease (GERD), acts on the lower esophageal sphincter (LES) and esophageal clearance, and how surgical therapy corrects the physiopathological parameters. ⋯ The presence of hiatal hernia, in patients with GERD, causes worse LES, peristalsis and clearance with a greater acid exposure of the esophagus. Fundoplication, by reconstructing the sphincter-diaphragm unit, normalises the preoperative physiopathology situation but without an effective peristalsis improvement.
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The use of local anesthesia in non-septic anal surgery is now well established. Tolerance to local injection, duration of local effect and the risk of local or systemic complications still represent unsolved issues. Ropivacaine, a new local anesthetic, seems particularly indicated for this kind of surgery because of its pharmacologic properties which reduce patient's discomfort during infiltration and provide good antalgic coverage in the first hours following the operation. ⋯ This new drug can be safely used in the outpatient or Day-Surgery treatment of hemorrhoids.
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Due to the severity of respiratory symptoms, congenital lobar emphysema often requires surgical treatment in the early stages of life. Diagnosis of congenital lobar emphysema in adult life is therefore unusual, often presenting with mild symptoms. Diagnostic assessment is therefore of great importance in the treatment of these patients. ⋯ The use of new diagnostic techniques such as dynamic RMN and SPET V/Q lung scan may improve the accuracy of the diagnostic evaluation. Pulmonary lobectomy led to marked improvement in respiratory function. Accurate diagnosis and appropriate management of congenital lobar emphysema in adult patients can lead to favourable results.
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During last 20 years ultrasonography has been widely used in Europe to investigate abdominal trauma. In United States it has not been considered a reliable test especially because of its lack of sensitivity in diagnosing parenchymal injuries. ⋯ Advantages are remarkable: ultrasound is cost-effective, fast, non-invasive, can be performed by surgeons even on unstable patients. FAST is now included in ATLS framework for examination of thoraco-abdominal trauma.
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Historical Article
[History of surgery in Preci better known as surgeons of Norcia].
This paper makes a small contribution to a more detailed knowledge of the history of Italian surgery. Few know that Italy can boast a category of surgeons who should be regarded as the world forebears of modern surgery. These skilled individuals are better known as "Norcini", a term which is often regarded as negative and contemptible. ⋯ They developed specific instruments and were the first to introduce cauterization and narcosis. The latter enabled them to overcome almost all the factors which limited surgery at the time, namely infection, pain and hemorrhage. This study attempts to explain how and why such skillful surgeons were to be found in such a small and isolated area of Umbria.