Purpose
To investigate pain and other complications following inguinal hernioplasty performed by the Lichtenstein technique with mesh fixation by fibrin glue or sutures.
Methods
Five hundred and ...twenty patients were enrolled in this 12-month observational multicenter study and received either sutures or fibrin glue (Tissucol
®
/Tisseel
®
) based on the preference of the surgeon. Pain, numbness, discomfort, recurrence, and other complications were assessed postoperatively and at 1, 3, 6, and 12 months. Pain intensity was assessed by a visual analog scale (VAS; 0 no pain to 10 worst pain).
Results
One hundred and seventy-one patients received sutures and 349 received fibrin glue. During the early postoperative phase, 87.4% of patients in the fibrin glue group and 76.6% of patients in the sutures group were complication-free (
P
= 0.001). Patients who received fibrin glue were also less likely to experience hematoma/ecchymosis than those in the suture group (both
P
= 0.001). The mean pain score was significantly lower in the fibrin group than the sutures group (2.5 vs. 3.2,
P
< 0.001). At 1 month, significantly fewer patients in the fibrin glue group reported pain, numbness, and discomfort compared with patients in the sutures group (all
P
< 0.05). Fibrin glue patients also experienced less intense pain (0.6 vs. 1.2;
P
= 0.001). By 3 months, the between-group differences had disappeared, except for numbness, which was more prevalent in the sutures group. By 12 months, very few patients reported complications.
Conclusions
Tissucol fibrin glue for mesh fixation in the Lichtenstein repair of inguinal hernia shows advantages over sutures, including lower incidence of complications such as pain, numbness, and discomfort, and should be considered as a first-line option for mesh fixation in hernioplasty.
Our purpose was to assess the potential of ultrasonography (US) in the detection of in-transit or satellite metastases.
Following a review of the relevant literature, we present the results of a ...retrospective study based on 2,000 malignant melanoma patients with complete case records. Of these, we selected 600 patients who had a thick melanoma (>1 mm) at presentation but were clinically free of in-transit or satellite melanoma metastases during follow-up. All patients underwent periodic clinical and imaging investigations, as well as US examination of the site of the surgical wound and surrounding soft tissues.
US raised the suspicion of in-transit or satellite metastases in 63 patients. A total of 95 lesions were identified. Average lesion diameter was 0.7 mm, and only four were larger than 1 cm. All suspected lesions were confirmed by surgery, follow-up or US-guided fine-needle aspiration (FNA) with 22-gauge needles using a freehand technique and exploiting the capillarity principle. In this series, there were apparently no false positive or false negative US results although inclusion criteria precluded correct evaluation of possible false negatives. Minimum lesion diameter allowing sonographic detection appears to be around 0.4 mm. US features of in-transit metastases have been well documented. They usually appear as solid lesions, hypoechoic relative to the surrounding subcutaneous fat and with relatively well-defined and regular contours and good US transmission. Internal structure is fairly homogeneous, and sometimes millimetresized fluid areas can be appreciated inside. Larger metastatic lesions may exhibit internal vascular signals at power Doppler imaging. These findings in dermatological sonography are almost exclusive of metastases but may also be seen in glomangioma, which, however, has intense intralesional vascularity. US-guided FNA plays an important role in diagnosis of metastases from malignant melanoma. Of the 32 nodules that were cytologically sampled, a definitive or most probable diagnosis of metastasis was made for nodules with a mean diameter of 0.7 mm (minimum 0.5 mm).
Sonography of soft tissues surrounding the original site of a malignant melanoma should be more widely used and associated with US-guided FNA biopsy.
Radiofrequency tumor ablation (RFA) is a therapeutic modality for liver cancer patients inducing localized tumor necrosis with maximal preservation of normal liver parenchyma. We investigated the ...immunomodulatory effects exerted by RFA treatment in liver cancer patients with metastatic liver lesions (13 patients) or hepatocellular carcinoma (HCC) (4 patients). Analysis of lymphocyte subsets by flow cytometry revealed that after RFA, CD3+ T cells, in particular CD4+, were decreased in metastatic cancer patients, while no change was observed in HCC patients. Moreover, RFA induced trafficking of naïve and memory CD62L+ T cells from circulation to tissues. When characterizing the function of T cells, proliferative response to PHA was strongly increased after 48 h from RFA in metastatic cancer patients. Furthermore, T cells produced IFN-gamma in response to the tumor associated MUC1 antigen. In contrast, humoral immune responses against tumor antigens such as MUC1 and HCV proteins were unaffected by RFA treatment, although increase of circulating B cells was observed only in metastatic cancer patients. These results indicate that RFA application can exert an activating effect on the immune system in metastatic cancer patients, favouring trafficking of lymphocyte subsets and enhancing tumor antigen specific cellular immune responses.
The aim of this study was to test the null hypothesis that the presence in the rectum of an endorectal ultrasound probe during transrectal voiding ultrasonography (TRVUS) would have no significant ...effect on uroflowmetry parameters.
We studied 43 randomly selected men undergoing TRVUS of the prostate for non-neurogenic lower urinary tract symptoms. Uroflowmetry was performed immediately before and during the TRVUS. Results were compared with a paired Student's
t test; the null hypothesis was confirmed by
p values >0.05.
Forty patients were able to void with the endorectal probe inserted, and 95% described this micturition as representative of their usual voiding behavior. No significant statistical difference was found between uroflowmetry parameters before and during TRVUS, confirming our null hypothesis.
Our data suggest that uroflowmetry in combination with TRVUS can be a reliable tool for evaluating disorders of micturition in males, at least in selected cases.
Valutare l'effettivo impatto della sonda endorettale biplana sui parametri uroflussimetrici del maschio.
Abbiamo studiato 43 pazienti, scelti a random, giunti alla nostra osservazione per disturbi non neurogeni del basso apparato urinario. L'uroflussimetria è stata effettuata subito prima e nel corso dell'ecografia transrettale. I risultati ottenuti, senza e con sonda ecografica, sono stati comparati con il test del T di Student e la nulla ipotesi era confermata dal valore di
p
>
0.05.
Quaranta pazienti sono stati in grado di effettuare la prova e 95% di essi hanno confermato di tipo standard le minzioni effettuate nel corso dell'indagine; non sono state osservate differenze tra i parametri uroflussimetrici ottenuti senza e con sonda endorettale ecografica.
Non vi sono rilevanti differenze tra la minzione ottenuta senza e con sonda endorettale ecografico e tale metodica è uno strumento utile per valutare i difetti di minzione del maschio.
The Authors present a short review of the literature comparing transrectal ultrasound of the prostate (TRUS) and ultrasound guided biopsy and the results of 694 consecutive prostatic biopsies from ...their cohort. All the biopsies were US guided with an endorectal biplanar 5 MHz probe and transperineal samples were carried out with an 18 G needle (cutting length 22 mm) over the last 4 years. The histological exam showed 187 prostates affected by cancer while 112 had only inflammation. The operator's opinion, based on ultrasonography and integrated with a digital rectal exam (DRE) and a prostate specific antigen (PSA) blood test, was correct in 80% of the cases, with 90% sensitivity and 70% specificity. The positive prediction rate was 74% and the negative prediction rate was 89%.
The increasing incidence of obesity and the wider acceptance of laparoscopic surgery, have lead to a 10-fold increase in bariatric operations in the last 10 years. Widely used indices of obesity ...(weight and body mass index - BMI) cannot adequately distinguish between fat mass (FM), represented by the sum of kilograms (kg) of lipid, and fat-free mass (FFM), inclusive of lean (kg of proteins), bone (kg of minerals), glycogen, and total body water (TBW), which are important parameters for clinical and physiological studies.
Anthropometric variables were measured in 19 Caucasian Italian individuals according to standard methods. Body weight (kg) and height (m) were measured, and BMI was calculated as kg/m(2). Body composition was evaluated, with a mean BMI of 25.95+/-5.04 kg/m(2), by dual X-ray absorptiometry (DXA) and by digital image plethysmographic (DIP) acquisition with a digital camera. The clear-colored body of the subjects was automatically converted into a front and lateral red-shaped figure, and then through algorithms the 2 pictures were transformed into a nominal volume; body weight was then divided by the estimated volume, so that the body density could be obtained. DXA was used as a comparison to assess fat mass and fat-free mass. Radiation exposure was <0.6 mSv.
Significant positive correlation (R= 0.971, P<0.001) was found between data of body composition obtained by DXA and DIP.
Body volume assessed using DIP or DXA did not differ. According to this validation study, DIP represents a new promising tool for clinical applications.
Percutaneous biopsy is considered one of the most important diagnostic tools to evaluate diffuse liver diseases. The introduction and widespread diffusion of ultrasounds in medical practice has ...improved percutaneous bioptic technique, while reducing postoperative complications. Although ultrasonography has become almost ubiquitous in prebiopsy investigation, only one third of biopsies are performed under ultrasound control. Moreover, the one-day procedure, reported in several studies to be safe and cost effective, accounted for only 4% of biopsies done. We report our experience of 142 percutaneous US-guided biopsies performed on 140 patients affected by chronic diffuse liver disease over a four-year period. Liver biopsies were performed under US guidance at the patient's bed using an anterior subcostal route. We evaluated postoperative pain, modifications of blood pressure and red cell count, hospital stay, morbidity and mortality rates, and adequacy of specimens for histologic examination. There was no operative mortality. As for major complications, one case of hemobilia occurred. As for minor complications, two cases of persistent postoperative pain required analgesic therapy. Patients were discharged the day following the procedure in all cases but two, who were discharged on the third and fifth postoperative days. Liver specimens were suitable for histologic diagnosis in all but one case, in which there were no portal spaces. According to our experience, we believe that hepatic biopsy guided by ultrasonography could replace blinded biopsy in the diagnosis of diffuse liver disease. The procedure is suitable to be performed safely on an outpatient basis.
Palliation of proximal gastric cancer Di Lorenzo, Nicola; Coscarella, Giorgio; Lirosi, Francesca ...
Journal of the American College of Surgeons,
04/2001, Letnik:
192, Številka:
4
Journal Article
PDF
