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Biofeedback therapy for faecal incontinence: our experience. 生物反馈治疗大便失禁:我们的经验。
Pub Date : 2009-03-01
Antonino Carlo Privitera, Conchita Emanuela Oliveri, Giuseppe Randazzo, Nnawuihe Luca Ohazuruike, Serafina Prumeri, Antonino Politi, Lino Succi

Biofeedback combined with electrical stimulation is an appealing conservative therapeutic option in patients with faecal incontinence. A total of 51 patients with faecal incontinence referred to our proctological division from March 2004 to June 2008 were studied. All patients were treated with biofeedback plus electrical stimulation. All patients underwent, on average, twice-weekly 15-minute electromyography-biofeedback training sessions followed by 5 minutes of electrical stimulation. Patients satisfaction, physiological data, clinical symptoms and a modified Wexner score were used to assess improvement. At 6 months' follow-up, nearly all physiological parameters showed a significant improvement (p < 0.05) and there was a reduction in the loss of solid stool (from 78.4 to 27.5 percent), in the loss of liquid stool (from 100 to 29.4 percent), and in pad usage (from 74.5 to 17.6 percent). At 1-year follow-up, an improvement in satisfaction was reported by 41/51 of patients (80.4%). This study suggests that biofeedback plus electrical stimulation leads to a substantial improvement in faecal incontinence symptoms and underlines the importance of anorectal functional tests to examine and guide the management of patients with faecal incontinence.

生物反馈联合电刺激是一种有吸引力的保守治疗选择,患者的粪便失禁。本文对2004年3月至2008年6月在我院肛肠科就诊的51例大便失禁患者进行了研究。所有患者均采用生物反馈加电刺激治疗。所有患者平均每周进行两次15分钟的肌电图生物反馈训练,随后进行5分钟的电刺激。患者满意度、生理数据、临床症状和改进的Wexner评分用于评估改善情况。在6个月的随访中,几乎所有的生理参数都显示出显著的改善(p < 0.05),固体粪便的流失(从78.4%减少到27.5%),液体粪便的流失(从100%减少到29.4%)和尿垫的使用(从74.5%减少到17.6%)。在1年的随访中,41/51的患者(80.4%)报告满意度改善。本研究表明,生物反馈加电刺激可显著改善大便失禁症状,并强调了肛肠功能检查对检查和指导大便失禁患者治疗的重要性。
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引用次数: 0
Thoracoscopic repair of lung herniation following minimally invasive cardiothoracic surgery. 微创心胸外科术后肺疝的胸腔镜修复。
Pub Date : 2009-03-01
Valentino Fiscon, Giuseppe Portale, Flavio Frigo, Giovanni Migliorini

Pulmonary hernias--defined as protrusions of the lung parenchyma and pleural membranes through a defect in the thoracic wall--are rare. They are usually congenital, spontaneous or traumatic iatrogenic lung herniations are extremely rare and secondary to thoracoscopic procedures or minimally invasive cardiothoracic surgery. There are very few reports of surgical repair of this iatrogenic condition and, to date, no reports of thoracoscopic repair of such defects of the thoracic wall have been reported. We present a case of a young patient with iatrogenic lung herniation in which a thoracoscopic approach was attempted and complete repair successfully accomplished.

肺疝-定义为肺实质和胸膜通过胸壁缺陷的突出-是罕见的。它们通常是先天性、自发性或外伤性医源性肺疝,极为罕见,继发于胸腔镜手术或微创心胸外科手术。手术修复这种医源性疾病的报道很少,到目前为止,还没有胸腔镜修复胸壁缺陷的报道。我们提出一个病例的年轻患者医源性肺疝,其中胸腔镜下的做法是尝试和完全修复成功完成。
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引用次数: 0
[Cavernous haemangioma of the lung: a case report and review of the literature]. [肺海绵状血管瘤:1例报告及文献复习]。
Pub Date : 2009-03-01
Ursula Basile, Chiara Cavallotti, Antonio Burza, Mario Albertucci, Renato De Angelis, Giampiero Facchini, Ettore Santini, Francesco Stipa

Cavernous haemangioma is a rare benign vascular tumour rarely seen in the lung. A 73-year-old male complaining of haemoptysis and dyspnoea, with a solitary nodule of the left lower pulmonary lobe, underwent left lower wedge resection. Pathology showed a 3 cm cavernous haemangioma. One year later symptoms recurred and CT showed a second nodule in the left upper lobe. Upper left lobectomy was performed, confirming the diagnosis of cavernous haemangioma. There are less than 25 case reports of this type of tumour in the literature. Radiological findings usually show a single pulmonary nodule. The preoperative diagnosis is quite difficult because pulmonary biopsy is often non-diagnostic. Standard treatment is complete surgical resection. For asymptomatic patients a brief period of observation is suggested.

海绵状血管瘤是一种罕见的肺部良性血管肿瘤。73岁男性,主诉咯血、呼吸困难,左下肺叶单发结节,行左下肺叶楔形切除。病理显示为3厘米海绵状血管瘤。一年后症状复发,CT显示左侧上叶有第二个结节。行左上肺叶切除术,确诊为海绵状血管瘤。在文献中,这种类型的肿瘤的病例报告少于25例。影像学表现通常为单个肺结节。术前诊断是相当困难的,因为肺活检往往是非诊断性的。标准治疗是完全手术切除。对于无症状的患者,建议进行短暂的观察。
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引用次数: 0
[Haemoperitoneum secondary to avulsed short gastric arteries after vomiting]. [呕吐后胃短动脉撕脱所致腹膜出血]。
Pub Date : 2009-03-01
Leonardo Piccagliani, Matteo D'Arienzo, Gianrocco Manco, Davide Luppi, Aldo Rossi

We present the case of a rare and serious complication of vomiting. A 25-year-old man presented to the emergency room with acute abdomen secondary to haemoperitoneum. There was no evidence or history of trauma in the previous 30 days. The only antecedent was a history of violent vomiting in the afternoon. Laparoscopy showed a massive haemoperitoneum secondary to avulsed short gastric arteries.

我们提出一个罕见而严重的呕吐并发症的病例。一名25岁男子因腹膜出血并发急腹症被送往急诊室。在过去30天内没有外伤的证据或病史。唯一的先例是下午有强烈的呕吐史。腹腔镜检查显示大量腹膜出血继发于胃短动脉撕脱。
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引用次数: 0
Ultrasonographic venous anatomy at the popliteal fossa in relation to tibial nerve course in normal and varicose limbs. 正常和静脉曲张肢体腘窝与胫神经走行关系的超声静脉解剖。
Pub Date : 2009-03-01
Massimiliano Tuveri, Valentina Borsezio, Raffaela Argiolas, Fabio Medas, Augusto Tuveri

The aim of this study was to investigate the ultrasonographic venous anatomy at the popliteal fossa in relation to tibial nerve course in normal and varicose limbs in order to detect anatomical abnormalities suggesting the potential risk of tibial nerve damage during surgery. Ninety-seven consecutive patients (194 limbs) were investigated by duplex ultrasound examination of the popliteal fossa. Forty-seven patients (48%) were candidates for surgery due to small saphenous vein (SSV) reflux. The tibial nerve course and its relation to the SSV were investigated in healthy and diseased patients. The tibial nerve ran along the medial edge of the SSV in 171 (88%) of the examined limbs. It ran behind the vein in 7 limbs (4%) and laterally in 16 limbs (8%). In this particular anatomical arrangement the SSV ends in the popliteal vein, running horizontally behind or wrapped around the tibial nerve for a distance of several centimetres. The median distance of the tibial nerve from the SSV was 0.2 cm (range: 0.1-0.3) in healthy limbs and 0.1 cm (range: 0.1-0.2) in varicose limbs, progressively diminishing as it proceeds upward. A posterior and lateral course of the tibial nerve (12%) would expose the nerve to potential damage during surgical procedures. Patient eligibility for treatment for SSV incompetence should always be based on a detailed ultrasonographic assessment of the course of the tibial nerve at the popliteal fossa in order to avoid the slightly higher risk of nerve damage due to particular anatomical abnormalities.

本研究的目的是探讨正常和静脉曲张肢体腘窝静脉超声解剖与胫神经走行的关系,以发现手术中提示胫神经损伤的解剖异常。对97例患者(194条肢体)进行腘窝双超声检查。47例(48%)患者因小隐静脉(SSV)反流而选择手术。研究了健康和患病患者胫神经的走行及其与胫神经的关系。在171例(88%)被检查的肢体中,胫神经沿SSV内侧边缘走行。7个肢体(4%)在静脉后,16个肢体(8%)在静脉外侧。在这种特殊的解剖结构中,SSV止于腘静脉,水平地在胫神经后面或环绕胫神经几厘米的距离。健康肢胫神经离骶髂静脉的中间距离为0.2 cm(范围:0.1-0.3),曲张肢胫神经离骶髂静脉的中间距离为0.1 cm(范围:0.1-0.2),随着向上的距离逐渐减小。胫骨神经的后外侧走行(12%)会使神经在手术过程中受到潜在的损伤。SSV功能不全的患者是否有资格接受治疗应始终基于对腘窝胫骨神经的详细超声评估,以避免由于特殊解剖异常而导致神经损伤的略高风险。
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引用次数: 0
Horner's syndrome after video assisted thoracoscopic surgery for spontaneous pneumothorax: where can it be attributed? 自发性气胸视频胸腔镜手术后的霍纳综合征:原因何在?
Pub Date : 2009-03-01
Georgios I Tagarakis, Andony Baddour, Athanassios Hevas, Charalampos Stroumpos, Nicolaos Antonopoulos, Apostolos Tsantilas, Nikolaos B Tsilimingas
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引用次数: 0
Giant symptomatic myelolipoma of the right adrenal gland: a case report. 右肾上腺巨大症状性骨髓瘤1例。
Pub Date : 2009-03-01
Roberto Dell'Avanzato, Fabio Castaldi, Cristiano Giovannini, Edoardo Mercadante, Paolo Cianciulli, Massimo Carlini

Adrenal myelolipoma is an uncommon tumour of the adrenal gland, usually unilateral, frequently associated with hypertension and obesity, with a benign biological behaviour and without hormonal activity, first described in 1905. The neoplasm consists of adipose tissue and myelopoietic cells of the bone marrow. These tumours have a very slow but continued growth and their volume and weight vary significantly from small lesions of a few grams to huge masses weighing up to several kilograms. If symptoms occur, surgery should be performed without delay, especially for large myelolipomas that are at high risk of spontaneous rupture with haemorrhage and life-threatening shock. In this report a case of a 43-year-old male with a 22 x 18 x 9 cm giant myelolipoma, weighing 3500 g and originating from the right adrenal gland is described. The large mass dislocating and compressing the inferior vena cava, was removed surgically. The early postoperative course and the late outcome were favourable without recurrence after 30 months. The different aetiological hypotheses of this rare neoplasm and its clinical features, diagnosis and treatment are discussed.

肾上腺骨髓瘤是一种罕见的肾上腺肿瘤,通常为单侧,常与高血压和肥胖相关,具有良性生物学行为,无激素活性,于1905年首次被描述。肿瘤由脂肪组织和骨髓的骨髓生成细胞组成。这些肿瘤生长缓慢但持续,其体积和重量变化很大,小到几克,大到几公斤。如果出现症状,应立即进行手术治疗,特别是对于有自发性破裂并出血和危及生命的休克高风险的大骨髓瘤。在这个报告中,我们描述了一个43岁男性,患有22 x 18 x 9厘米的巨大骨髓脂肪瘤,重3500克,起源于右肾上腺。大肿块脱位和压迫下腔静脉,手术切除。术后早期和晚期预后良好,30个月后无复发。本文讨论了这种罕见肿瘤的不同病因假说及其临床特征、诊断和治疗。
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引用次数: 0
[Intestinal reconstruction after dehiscence of a jejunal suture in a patient submitted to aorto-enteric fistula repair: a case report]. 【空肠缝合线破裂后肠重建一例报告】。
Pub Date : 2009-03-01
Maurizio Castriconi, Antonio Muzi, Giovanni Bartone, Mauro Natale Maglio, Maria Elena Giuliano, Beatrice Ulloa Severino, Francesco Renda

Aorto-enteric fistulas are serious complications of aortic surgery that require swift, effective surgical intervention. We report a case of a secondary aortoenteric fistula treated with prosthesis replacement and an intestinal suture subsequently complicated by the dehiscence of the previously constructed anastomosis. We opted for reconstruction re-intervention, closing the intestinal lesion by means of a mechanical suture above the jejunal dehiscence, making a side-to-end jejuno-jejunal Roux anastomosis and an end-to-side anastomosis at the base of the loop. The operation was completed by performing a gastrostomy and transforming the fistula into a jejunostomy. This intervention enabled us to discharge the patient in good general condition after 30 days.

主动脉肠瘘是主动脉手术的严重并发症,需要迅速、有效的手术干预。我们报告一例继发性主动脉肠瘘治疗假体置换和肠缝合线随后复杂的先前构建的吻合破裂。我们选择重建再干预,通过空肠裂口上方的机械缝合线关闭肠道病变,进行空肠-空肠Roux侧端吻合和环底端端侧吻合。手术通过胃造口术和将瘘管转化为空肠造口术完成。这种干预使我们在30天后出院,病人的总体状况良好。
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引用次数: 0
Use of a dynamic self-regulating prosthesis (P.A.D.) in inguinal hernia repair: our first experience in 214 patients. 动态自我调节假体(P.A.D.)在腹股沟疝修补中的应用:我们在214例患者中的首次经验。
Pub Date : 2009-03-01
Fabrizio Ferranti, Marco Marzano, Alberto Quintiliani

Numerous techniques exist for inguinal hernia treatment. Currently, open mesh tension-free repair is regarded as the repair method of choice. In particular Lichtenstein repair is the most common procedure performed, although several articles have reported long-lasting postoperative pain and a higher recurrence rate than originally reported. This study describes the P.A.D. (Protesi Autoregolantesi Dinamica) prosthesis implantation technique and reports postoperative complications and long-term results. From June 2002 to May 2005 a total of 214 patients underwent P.A.D. prosthesis inguinal repair. All patients were male, with a mean age of 51 years. All hernias were treated via an open inguinal approach using the original technique described by Valenti, with slight modifications. A total of 171'patients (80%) were available to follow-up 3 years after surgery. Early postoperative complications occurred in 14 patients (8.4%). Four patients (12.1%), who had undergone regional anaesthesia, developed urinary retention. Wound infection occurred in 3 patients (1.4%). There were two direct recurrences (0.93%) whereas chronic postoperative inguinal pain was reported in 4.2% of patients. Within the limitations of a short follow-up, our results show that the P.A.D. prosthesis procedure is a reliable technique with a low recurrence rate and low postoperative morbidity.

腹股沟疝有多种治疗方法。目前,开网无张力修复被认为是修复方法的首选。特别是列支敦士登修复是最常见的手术,尽管有几篇文章报道了持久的术后疼痛和比最初报道的更高的复发率。本研究描述了P.A.D. (Protesi Autoregolantesi Dinamica)假体植入技术,并报告了术后并发症和长期结果。从2002年6月至2005年5月,共有214例患者接受了P.A.D.假体腹股沟修复术。所有患者均为男性,平均年龄51岁。所有疝气均采用Valenti描述的原始技术通过腹股沟开放入路进行治疗,并进行了轻微修改。171例患者(80%)术后随访3年。术后早期并发症14例(8.4%)。4例(12.1%)患者行区域麻醉后出现尿潴留。伤口感染3例(1.4%)。有2例直接复发(0.93%),而术后慢性腹股沟疼痛发生率为4.2%。在短时间随访的限制下,我们的结果表明,P.A.D.假体手术是一种可靠的技术,复发率低,术后发病率低。
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引用次数: 0
[Role of laparoscopy in acute obstruction of the small bowel: personal experience and analysis of the literature]. 【腹腔镜在急性小肠梗阻中的作用:个人经验及文献分析】。
Pub Date : 2009-01-01
Carmine Cartanese, Serafina Lattarulo, Graziana Barile, Gennaro Fabiano, Angela Pezzolla, Nicola Palasciano

Small bowel obstruction is caused by postoperative adhesions in most patients. The traditional surgical treatment has been laparotomy with adhesiolysis and possible resection of the ischaemic intestine. The laparoscopic approach has proved feasible but not without risks. We analysed our experience in the management of acute small bowel obstruction and then reviewed the literature in an attempt to identify the real role of laparoscopy. From January 2003 to June 2008, 19 patients operated on for small bowel obstruction were identified. We evaluated our performance in terms of the aetiology of the obstruction, operative time, length of postoperative hospital stay, conversion rate, and major morbidity and mortality. Postoperative adhesions were responsible for the occlusion in 13 cases; a single band was identified in 47% of patients (9 cases). Neoplastic disease (3 cases), a gallstone ileus, Crohn's disease and an internal hernia were the remaining cases. Laparoscopic treatment was only possible in 7 patients with single adhesions (77%), and a conversion was carried out in the remaining 12 cases (63%), including "laparoscopy-assisted" cases (6 cases). The duration of the intervention (89 +/- 21 min vs 135 +/- 27.5 min) and postoperative hospitalisation (3.6 +/- 1 days vs 6.25 +/- 1.6 days) were in favour of the completely laparoscopic group as compared to the laparoscopy-assisted group. A case of postoperative peritonitis due to bowel perforation required a second intervention. With an appropriate selection of patients, confirming the high incidence of the single adhesions responsible for the occlusion and the resulting high success rate of laparoscopy, we believe that only an initial laparoscopic approach can help identify such favourable situations.

小肠梗阻多由术后粘连引起。传统的手术治疗方法是剖腹手术并粘连松解,并可能切除缺血性肠。腹腔镜方法已被证明是可行的,但并非没有风险。我们分析了我们在处理急性小肠梗阻方面的经验,然后回顾了文献,试图确定腹腔镜的真正作用。本文自2003年1月至2008年6月共收治19例小肠梗阻手术患者。我们根据梗阻的病因、手术时间、术后住院时间、转换率、主要发病率和死亡率来评估我们的表现。术后粘连导致闭塞13例;47%的患者(9例)发现单带。肿瘤疾病(3例)、胆石性肠梗阻、克罗恩病和内疝为剩余病例。仅7例(77%)单发粘连患者可以进行腹腔镜治疗,其余12例(63%)进行了转换,其中包括“腹腔镜辅助”病例(6例)。干预时间(89 +/- 21分钟vs 135 +/- 27.5分钟)和术后住院时间(3.6 +/- 1天vs 6.25 +/- 1.6天)均优于腹腔镜辅助组。一例术后腹膜炎由于肠穿孔需要第二次干预。通过适当的患者选择,确认导致闭塞的单一粘连的高发生率以及由此产生的腹腔镜检查的高成功率,我们认为只有最初的腹腔镜方法才能帮助识别这种有利的情况。
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引用次数: 0
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Chirurgia italiana
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