Minerva chirurgica
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The diagnosis of extra-adrenal paraganglioma requires the recognition of catecholamine hypertension and the site of the lesion. I-131-MIBG scintigraphy, CAT scan and angiography may localize primitive and metastatic lesions. Six cases of extra-adrenal paraganglioma (5 abdominal, 1 thoracic) surgically treated with complete resolution of the hypertensive state are presented here.
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Reducing the quantitative level of bacterial contamination in an open, acute or chronic, soft tissue wound below the critical level of 10(5) bacteria per gram of viable tissue is essential to delayed primary closure. First step in the management of the contaminated or infected wound is accurate local debridement, preferably with pulsating jet irrigation. ⋯ Contrary to systemic antibiotics, these agents penetrate adequately into the open, granulating wound with a direct bacteriostatic or bactericidal action on a wide spectrum of gram positive and negative organisms, without the effect of local tissue injury typical of topical antiseptics. The use of topical antibacterials, traditionally confined to the treatment of the burn wound, the open "difficult" wound for excellence where control of local infection is first priority, provides a rapid local reduction of the bacterial level and paves the way to the final goal of primary delayed closure of the wound, either direct or with the use of grafts or local, distant, or free flaps.
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Case Reports
[Distal gastric volvulus as a cause of acute occlusion in paraesophageal hernia. Considerations on a clinical case].
A case of distal volvulus of the stomach as a cause of acute intestinal obstruction in a paraesophageal hernia is presented. The patient, an old woman aged 82, had been suffering from abdominal pain and vomiting for about 48 hours. She successfully underwent emergency operation for the reduction of hernia and plasty of the hiatus anterior the esophagus. On the basis of personal experience and review of literature data, stress is laid on the high incidence of paraesophageal hernia complications and the importance of early diagnosis and surgical repair is underlined.
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The results of a study on the use of DuoDerm Hydroactive sterile occlusive dressing on the operative wound after simple excision of pilonidal fistula are reported. Two groups of 20 patients were studied: in the first group the wound was treated with traditional medications, in the second group with DuoDerm. Comparing the results obtained from these two groups, the Authors conclude underlining the therapeutic efficacy of the dressing which stimulates granulation and accelerates re-epithelialization with complete healing in 6 weeks on average compared with the 10 needed with traditional medications.
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Review Case Reports
[The so-called spontaneous hematoma of the anterior rectus abdominis reproducing syndromes of acute surgical abdomen].
Personal experience of spontaneous haematoma on the anterior straight muscles of the abdomen over 15 years is reported. True spontaneous haematoma on the anterior straight muscles of the abdomen are extremely rare, even exceptional and must be distinguished from those haematomas, improperly called spontaneous that are, in fact, clearly traumatic in origin. Personal observation suggests that true spontaneous haematoma is the expression of a pathological rupture of the muscle and/or the epigastric blood vessels that in its turn reflects a serious basic pathology.