Chirurgia italiana
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A case of rectus sheath haematoma and essential thrombocytosis during anticoagulation treatment is described. The difficulties encountered in reaching a clinical, differential diagnosis between rectus sheath haematoma and other abdominal acute conditions are stressed. Computed tomography may prevent inappropriate surgical treatment and its role is emphasized.
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Residual thoracic collections after thoracic traumas occur in 5-30% of patients and are a major risk factor for development of empyema. Management with a thoracostomy tube is the traditional treatment but it requires a prolonged hospital stay and 20% of patients treated continue to have a residual clot. Forty-two haemodynamically stable patients with chest trauma (36 blunt and 6 penetrating) were examined thoracoscopically. ⋯ All clotted haemothorax cases were successfully evacuated. No complications occurred. Videothoracoscopy appears to be a safe, accurate and reliable operative therapy for the assessment of diaphragmatic injuries, control of continued bleeding and evacuation of clotted haemothorax, reducing the hospital stay and possible complications.
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Comparative Study
[Prognostic value of peritoneal lavage cytology in gastric cancer].
The microscopic detection of free peritoneal tumour cells in peritoneal lavage fluid in gastric cancer patients is a useful predictor of peritoneal recurrence and poor prognosis. The aim of this study was to verify the prognostic significance of intraoperative peritoneal lavage cytology and its value as a predictor of peritoneal recurrence. We evaluated the presence of free peritoneal tumour cells with extemporary cytological examination in a series of 170 peritoneal washing samples from patients undergoing gastrectomy for gastric cancer over the period from January 1992 to June 2001. ⋯ All patients with positive cytology presented serosal infiltration (T3/T4). Positive peritoneal lavage cytology was a predictor of poor prognosis and peritoneal recurrence: the 24 month survival rate was 17% for positive and 60% for negative cases (P = 0.003); in positive cases 71% of recurrences were located in the peritoneum. Intraoperative cytological examination of peritoneal washings can detect the presence of free malignant cells in the peritoneal cavity and can be used to select patients who may benefit from intraperitoneal chemotherapy.
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The authors report the preliminary results of a new treatment for primary and secondary hepatic malignancies called radiofrequency ablation. Seven patients undergoing the new radiofrequency ablation procedure (4 M and 3 F; mean age 62 years) were studied. The 3 female patients were suffering from breast cancer metastases (1 case), left colon cancer metastases to the first hepatic segment with caval and portal compression (1 case), and metastases to the eighth hepatic segment from an operated left colon cancer (1 case). ⋯ Four patients underwent percutaneous radiofrequency ablation; one patient with concomitant gastric cancer underwent laparotomic radiofrequency ablation and simultaneous removal of the tumour; one patient was treated by celioscopic radiofrequency ablation in the course of laparoscopic cholecystectomy; and one underwent transpleural-diaphragmatic radiofrequency ablation for metastases to the seventh and eighth hepatic segments. None of the patients undergoing ultrasonography and CT follow-up examinations after 6 months presented recurrence of hepatic metastases. This treatment, though its use has so far been limited to only a few cases with a short follow-up, opens up new prospects for the surgical treatment of primary and secondary malignancies, also in the light of experience based on a substantial number of patients, recently reported in the literature.
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Substernal goitre is a clinical condition in which the masin bulk of the enlarged gland is firmly located in the chest. The incidence of this pathology ranges in literature from 1.7% and 30%. This study examines 230 cases of substernal goitre out of a total 5.362 operations performed from 1965 to 2000, for thyroid gland pathologies (4.36%). ⋯ Minor bleeds promptly stop as soon as the pathological mass is removed. Ligation of the vascular pedicles can be easily achieved; in this way, the goitre is freed from its anatomical connections and the surgeon can safely manage the substernal portion of the mass. The mortality reported in this study was 0.43% (one patient died 30 days postoperatively due to respiratory complications), whereas the morbidity rate was 2.6%.