Search

The authors describe their technique and their experience of ambulatory surgical-cryotherapeutic combined, treatment of anal fissure. The data were observed in 35 patients (medium age 37.5); in 16 cases, previous treatments gave no benefit. The surgical treatment was the lateral internal close sphincterotomy according to Notaras, with local anesthesia (personal technique), followed by a fissure curettage with a N protosside cryosound. The results confirm the well known effectiveness of lateral internal sphincterotomy and the validity of ambulatory treatment and of cryotherapy.

The paper outlines the indications for the use of Kehr's tube in the surgical management of extra-hepatic biliary lithiasis by reporting the authors' personal experience relating to the period 1988-1992. In line with data reported in the literature the paper emphasizes the value of Kehr's tube not only in those cases where it is necessary to prevent choledochotomy and radiological control, but above all were the postoperative possibility of removing any residual calculi using litholytic, endoscopic or lithotripsic methods, is of prime importance.

The paper analyses the authors' initial experience of video laparoscopic cholecystectomy, outing the difficulties and incidence of morbidity in the preliminary group of 38 patients. The details of complications and their pathogenesis are also reported.

Following a brief review of the main method of prosthetic repair used for inguinal hernia: Lichtenstein, Stoppa, Rives, etc, the authors propose an original technique consisting in the placement of a marlex patch below the trasversalis fascia, in a pre-peritoneal site, using a classical inguinal access route. The prosthesis is fitted round the spermatic funicle and fixed with a single stitch to the pubis and with a few others, in resorbable material, to the posterior face of the trasversalis fascia. Above it, plastic surgery is performed to bring the triple stratum closer to the reflexio of the inguinal ligament. The prosthesis is kept in place by positive abdominal pressure. The method outlined here has been used in 71 cases of primary or recurrent inguinal hernia. Follow-up lasted for 1-24 months and showed the low morbidity (4.5%) due to sepsis of the surgical wound, which did not require reoperation, and only 1 case of recurrent hernia which was probably caused by the incorrect positioning of the prosthesis.

The authors report a series of 111 cases of non-palpable breast tumours. Radiological examinations showed the following mammographic patterns: microcalcification (63%); irregular opacity and/or denseness (26%); opacity and low density microcalcifications (12%), to which 3 progressive risk rates were assigned (high, medium, low). Histological controls of the tumours showed a positive predictive value of 73% for mammographic patterns defined as "high-risk". Localisation using a metal probe proved to be a simple and efficacious method which was well tolerated by patients.

The paper reports two rare cases of adrenal myelolipoma which were referred to the authors' attention. This is a functionally inactive benign tumour made up of fatty tissue and foci of hemopoietic cells. It is often diagnosed due to the compression disorders caused to adjacent structures, whereas at other times it is identified by chance during the course of diagnostic tests carried out for other pathologies.

Myelolipoma is a rare, benign tumour composed of fat and hematopoietic cells. Abdominal pain is often the only symptom and the result of compression by the tumour of contiguous organs. A personal case is reported after a review of the literature.