A 78-year-old man presented to the casualty department, complaining of recurrent and worsening constipation for the previous 2 months. This was associated with central, colicky abdominal pain and ...melena. In the last days, the symptoms worsened and the patient became partially obstructed, with nausea, vomiting and passing flatus but not stools for 72 h. The past medical history was unremarkable. The radiological findings of the plain abdominal film were consistent with mechanical small-bowel obstruction. CT scan revealed an intraluminal mass in the small bowel, which drew attention away from gross thickening of the caecal wall that was also present. A careful review of the images should not be omitted. One must be aware of a polymorphous appearance and the multiple causes of intestinal obstruction and avoid underestimating even the minor and less evident radiological findings.
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Pancreatic Trauma Catena, Fausto; Di Saverio, Salomone; Ansaloni, Luca ...
Surgical Treatment of Pancreatic Diseases
Book Chapter
Traumatic injuries of the pancreas are rare. Epidemiological studies in a Scandinavian population have reported an incidence of 0.4 cases per 100,000 head of population per year, accounting for 7% of ...laparotomies performed for abdominal trauma 1. An earlier study reported the same incidence of pancreatic injuries (7.4%) among trauma laparotomies performed in the Los Angeles urban area 2.
Adhesive Small Bowel Obstruction Catena, Fausto; Di Saverio, Salomone; Ansaloni, Luca ...
The Role of Laparoscopy in Emergency Abdominal Surgery
Book Chapter
In recent years, progress in technology and surgical techniques has led to a rapid development in laparoscopic surgery, which is beginning to be frequently used even for several kinds of abdominal ...emergencies, such as inflammatory syndromes, and more rarely in cases of trauma and bowel obstruction. In the latter, however, the indication for the laparoscopic approach today is debated among surgeons due to the potential visceral risk associated with this method and also because the scientific evidence currently available in the literature supporting the use of the laparoscopic approach over open surgery is poor.
Although at present nonabsorbable meshes are the preferred material for tension-free hernioplasty, some problems with their use are still to be addressed (i.e., chronic pain and infections). To ...address these disadvantages, a collagen-based material, the porcine small intestinal submucosa mesh, has recently been developed for hernia repair. The technique to use this material in performing an hernioplasty is described. A preshaped Surgisis Inguinal Hernia Matrix (IHM) is fashioned as appropriate, with a slit 2 cm from its inferior edge to accommodate the spermatic cord, placed for at least 10 min into a dish with room-temperature normosaline to be rehydrated and then transferred to the already prepared and dissected inguinal region. After drawing its tails around the cord, the mesh is sutured to the inguinal ligament with a continuous suture of PDS II 2/0, starting from the pubic tubercle laterally up to the deep orifice. The fixation of the mesh to the internal oblique abdominal muscle and the rectus sheath is accomplished with interrupted stitches. An extra stitch is placed between the two tails to close the new deep orifice. We conclude that an hernioplasty using Surgisis IHM is feasible with promising results.
To identify indicators of guideline-concordant care in lung cancer, to implement such indicators with cancer registry data linked to health databases, and to pilot them in a cohort of patients from ...the cancer registry of the Milan Province.
Thirty-four indicators were selected by revision of main guidelines by cancer epidemiologists, and then evaluated by a multidisciplinary panel of clinicians involved in lung cancer care and working on the pathway of lung cancer diagnosis and treatment in the Lombardy region, Italy. With a modified Delphi method, they assessed for each indicator the content validity as a quality measure of the care pathway, the degree of modifiability from the health professional, and the relevance to the health professional. Feasibility was assessed using the cancer registry and the routine health records of the Lombardy region. Feasible indicators were then calculated in the cohort of lung cancer patients diagnosed in 2007-2012 derived from the cancer registry of the Milan Province. Criterion validity was assessed reviewing clinical records of a random sample of 114 patients (threshold for acceptable discordance ≤20%). Finally, reliability was evaluated at the provider level.
Initially, 34 indicators were proposed for evaluation in the first Delphi round. Of the finally 22 selected indicators, 3 were not feasible because the required information was actually not available. The remaining 19 were calculated on the pilot cohort. After assessment of criterion validity (3 eliminated), 16 indicators were retained in the final set and evaluated for reliability.
The developed and piloted set of indicators is now available to implement and monitor, over time, quality initiatives for lung cancer care in the studied health system.
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