Myoxinol is a complex of oligopeptides obtained from the seeds of
Hibiscus esculentus
used in cosmetic as natural alternative to botulin toxin. The aim of the study was to evaluate the safety and ...effectiveness of local myoxinol for the treatment of acute anal fissure. All the consecutive patients with acute fissure treated from January to June 2014 underwent 30 days of topical treatment (twice/day) with a mioxinol based ointment. Pain, symptomatic relief, fissure healing and re-epithelization, 1-year recurrence rate, subjective satisfaction and need for further treatments were evaluated. During the study period 157 patients were eligible for data analysis (91 males: 58%; mean age 38 years: range 17–83). Median anal pain score was 7.1 pre-treatment and 1.7 and 0.9 after 30 days and 12 months from treatment, respectively (
p
: 0.0001). After the treatment period complete healing was achieved in 103 patients (65.5%), relevant improvement in 31 (20%) and no improvement in 21 patients (13.5%). Overall efficacy rate was 85.5%. A significant difference was reported considering patients with pre-treatment VAS between 1–5 and 6–10 (
p
: 0.004). Twenty-nine patients (18.5%) required further treatments. Hydrolyzed
Hibiscus esculentus
extract was proven to be an effective and well-tolerated topical treatment for acute fissure, with a high healing rate, a significant reduction of pain and a low 1-year recurrence rate.
"Fast Track surgery" is a therapeutic program of large application, despite some doubts about its applicability and real validity. Literature review shows that this approach to colo-rectal surgery, ...particularly video-assisted, can allow a rapid recovery, better performance and a faster postoperative functional autonomy of the work, which can be discharged without cause additional welfare costs; in addition it can be reproducible in different health reality.
To analyze the possibility to apply the Fast Truck protocol in patients undergoing colorectal surgery in a rural hospital and non specialistic Unit of Surgery.
We have conducted a prospective, randomized study on 80 patients subjected to colorectal surgery in the last year.
The protocol was observed in 95% of cases, compliance with the Fast Track was high and general morbidity was limited (7.8%).
This "aggressive" approach, which has fundamentally altered the usual surgical behavior, seems to allow a mean length of stay significantly lower than in controls (p < 0.05) with positive implications for patients and containment of health care costs, even after discharge (no need for home care in 92% of cases, no early re-admittance to the hospital). Homogeneous protocols are desirable, as well as an increased enrollment, to consolidate these rehabilitation programs in order to provide a reference for all hospitals.
Purpose
Stapled transanal rectal resection (STARR) in patients with obstructive defecation syndrome (ODS) is limited by the capacity of the circular stapler used. This prospective cohort study was ...conducted to assess real-world clinical outcomes of STARR with the new CONTOUR® TRANSTAR™ device, shortly named TRANSTAR, at 12 months postoperatively.
Methods
From January 2009 to January 2011, consecutive patients who underwent TRANSTAR in 22 European colorectal centers were enrolled in the study. Functional outcomes and quality of life were assessed by the changes in a number of scoring systems (Knowles-Eccersley-Scott-Symptom (KESS) score, ODS score, St. Mark’s score, Euro Quality of Life-5 Dimension (EQ-5D) score, and Patient Assessment of Constipation—Quality of Life (PAC-QoL) score), at 12 months as compared to baseline. All complications were recorded and analyzed.
Results
A total of 100 patients (98 % female), mean age 60 years, were entered in the study. Statistically significant improvements were seen in the KESS (median 18 vs. 6;
p
< 0.01), ODS (median 15 vs. 4;
p
< 0.01), and PAC-Qol scores (median 2.10 vs. 0.86;
p
< 0.01). St. Mark’s and EQ-5D scores improved nonsignificantly. Complications were reported in 11 % of patients, including bleeding (5 %), staple line complications (3 %), urinary retention (2 %), and persistent pain (1 %). No major complications or mortality occurred.
Conclusion
TRANSTAR facilitated a tailored, real circumferential full-thickness rectal resection, leading to improved patient functional and quality of life outcomes at 12 months postoperatively. It represents a safe and effective treatment for ODS in local clinical practice, although the sustainability of real-world results needs to be proven in the long-term follow-up.
Hemangiomas are the more frequent benign liver tumours. Therapeutic approach at these neoplasms is changed in the last years because has resulted that massive haemoperitoneum from a spontaneous ...rupture of the hemangiomas is a rare occurrence. From a personal review of 124 liver resection performed for traumatic and organic, benign and malignant, pathologies, the Authors present two cases of symptomatic liver haemangioma surgically treated Excluding emergency induced by tumour hemorrhage, actually indications to surgical treatment are controversial. In all patients the right approach is choice by the integrated evaluation of general conditions of the patient, liver functionality and from anatomical location of the neoplasm.
Patients who have undergone laparotomy can undergo laparoscopic procedures and thus benefit from the advantages that the technique offers without significantly increasing the risk of the operation.
...We present the results of 240 patients, chosen at random who underwent laparoscopic procedures and who had already had 1 or more laparotomic abdominal operations. We carried out 180 cholecystectomies, 12 of which for acute inflammation of the gall bladder, 10 for acute biliary pancreatitis, 3 with exploration of the common bile duct, 45 Nissen fundoplication procedures, of which 16 with removal of the gall bladder, 4 subtotal gastrectomies, 2 GEAs, 2 left colectomies, 4 adhesiolyses.
The duration of the procedure varied from 40 to 300 minutes, and hospitalization time after the operation from 1 to 15 days, depending on the previous operation and on the laparoscopic procedure used. A traditional operation (conversion) became necessary in 1.35% of patients. Complica-tions arose in 4% of cases: 4 hematomas, 1 infected wound, 2 bile leaks and 2 bowel fistulas at low flow.
Laparoscopic surgery in pa-tients who have previously undergone abdominal operations is difficult. The extent of conversions and complications can be contained within acceptable limits by choosing carefully the insertion point of the first trocar and dissecting the bowel with great precision.
Malignant tumors of the large bowel become often clinically evident as an obstruction in 8-29% cases, specially the neoplasms at the splenic flexure (50%) or descending colon (25%). Different factors ...(urgency, age, colonic distension and lack of adequate bowel preparation) influence therapeutic choice, specially about the bowel resection and one stage anastomosis. Twenty-six patient with neoplastic stenosis of the large bowel (8 of ascending colon and proximal transverse, 5 of splenic flexure or descending colon, 12 of the sigma, 1 of the rectum) have been surgically treated. 4 patient have been subjected to right emicolectomy and ileo-transverse anastomosis; 2 to Hartman's operation; 1 to anterior resection of the rectum; 3 to left hemicolectomy and 2 to resection of the sigma with colic on table irrigation and one-stage anastomosis; 13 to colostomy; 1 to palliative ileo-colic bypass. Two patients (7.5%) died in post-operative period. In patients subjected to one-stage procedures for left colic stenosis, the Authors haven't observed major complications, but one patient developed an anastomic leakage (4%), conservative treated. In stenosis localized to ascending colon or hepatic flexure standard surgical operation is right emicolectomy. In patients affected by cancer of descending colon, the Hartmann's operation is considered the more rational procedure, even if 50% of the patients aren't reoperated on for reconstruction. The one-stage anastomosis is indicated only in selected cases, specially subjected to TPN before surgery or balancing of the metabolic parameters and to antibiotic prophylaxis. The subtotal or total colectomy is indicated when signs of colic perforation are found or when the colon is massively dilatated or there are signs of colonic necrosis or in case of other lesions of the large bowel preoperatively known.
Malignant tumors of the large bowel develop colonic obstruction in 10-30% cases. Recently many authors have employed self-expandable stents to resolve the colonic obstruction. During 2002, seven ...patients affected by neoplastic malignant stenosis of the left colon underwent endoscopic placement of self-expandable enteral stent. The technique succeeded in relieving the obstruction in 6 patients, while in a woman affected by malignant tumor of the splenic flexure, colonic stenting was unsuccessful. The Authors didn't observe any procedure related complications; sign and symptoms of intestinal obstruction resolved within 24-72 hours from placement. Four patients needed hydro-electrolitemic correction, intestinal cleaning and R0 resection with one stage anastomosis within 5 and 9 days. Bowel decompression of the neoplastic stenosis relieved by self expandable metallic stents is useful to avoid emergency surgery and provide time for a complete preoperative staging, a metabolic correction and a mechanical bowel preparation. Complications of stent placement are common in many reports and include minor rectal bleeding (2%) and perforations (4%). Stenting is contraindicated in cases of enlarged colon with diameter superior to 8 cm or in flogistic lesions.
Sarcomas of the breast are rare neoplasm. Wide discordances exist about prognostic factors, therapy and life expectancy.
Two women affected by sarcoma of the breast; prognostic aspects and therapy ...are analyzed.
After radical mastectomy one patient, with neoplasm of 4.5 cm in diameter, is still alive one year after the surgical procedure.
Diagnosis of the sarcomas of the breast is very difficult with the common radiological imaging, specially in the early phases when the sarcomas often can simulate absolutely benign lesions. Prognostic factors are histological type and degree, mytosis number for field and, probably, dimensions of the neoplasm. Sarcomas less than 3 cm in diameter can be admitted to conservative surgical procedure, but radical mastectomy is unavoidable when dimensions exceed this limit.
Between 5-50% of patients undergoing gastric resection still develop postgastrectomy syndrome in spite of the development of surgical techniques and an improved knowledge of gastrointestinal ...physiopathology: unfortunately, 2-5% of these patients require surgery. The technique to be used depends on a careful clinical and instrumental evaluation aimed at identifying the dominant type of postresection syndrome and any associated lesions, on the previous operation and obviously on the intraoperative situation. Soupault-Bucaille's gastroduodenojejunoplasty aims to correct the postresection syndrome by reinserting the duodenum in the digestive circuit, interposing between it and the gastric stump a jejunal loop made from the efferent (or afferent in the case of Billroth II with efferent on the lesser gastric curvature). This reconstitutes a paraphysiological condition of the digestive circuit, reduces biliary reflux and resolves acute gastritis. It is indicated in patients affected by early or late dumping syndrome, or multi-deficiency syndromes that do not respond to pharmacological therapy. The presence of concomitant biliary reflux is not a contraindication for this procedure, but confirms the need. Roux-en-Y is able to produce better results in postgastrectomy syndromes with alkaline gastritis and/or esophagitis sustained by biliary reflux, gastric atonia and afferent loop syndromes.
The Authors report their experience of two patients with bile leakage following videocholecystectomy (VLC) among a series of 163 cases. Reviewing the Literature, they analyze possible causes and ...mechanisms of bile spillage occurring after VCL. They also suggest some guidelines for a safe VLC, stressing the importance of the routinary placement of the sub-hepatic drainage to remove 48 hours to early detect possible bile leakages after surgery.
PDF
