Search

Background: We sought to determine the efficacy of sutures, human fibrin glue and N-butyl-2-cyanoacrylate for mesh fixation in patients undergoing the plug and mesh procedure for groin hernia. Methods: A total of 156 patients with 167 inguinal hernias (11 bilateral) underwent a plug and mesh procedure and were randomly assigned to received either sutures (n = 59 hernias), human fibrin glue (n = 52) or N-butyl-2-cyanoacrylate (n = 56) for mesh fixation. Results: The overall morbidity rate was 38.98% in the suture group, 9.62% in the fibrin glue group and 10.71% in the N-butyl-2-cyanoacrylate group (suture v. fibrin glue, p < 0.001; suture v. N-butyl-2-cyanoacrylate, p < 0.001). There was no significant difference in morbidity between the fibrin glue and N-butyl-2-cyanoacrylate groups. Overall, short-term morbidity was significantly higher in the suture group (27.12%) than in the fibrin glue (9.62%, p = 0.01) or N-butyl-2-cyanoacrylate (8.93%, p = 0.004) groups, but there was no significant difference between the fibrin glue and N-butyl-2-cyanoacrylate groups. There was no significant difference between the groups in terms of mean postoperative stay (32.6 h in the suture group v. 30.8 h in the fibrin glue group v. 32.0 h in the N-butyl-2-cyanoacrylate group) or mean time to return to work (20.4 d in the suture group v. 20.3 d in the fibrin glue group v. 19.8 d in the N-butyl-2-cyanoacrylate group). Overall, long-term morbidity was significantly higher in the suture group (11.86%) than in the fibrin glue (0%, p = 0.001) or N-butyl-2-cyanoacrylate (1.78%, p = 0.03) groups. There was no recurrence in any of the groups. Two cases (3.39%) of chronic groin pain were reported in patients in the suture group. A sensation of extraneous body was reported in 5 (8.47%) patients who received sutures and in 1 (1.78%) patient in the N-butyl-2-cyanoacrylate group; there were no reported cases in the fibrin glue group (suture v. fibrin glue, p = 0.01; suture v. N-butyl-2-cyanoacrylate, p = 0.03; fibrin glue v. N-butyl-2-cyanoacrylate, p = 0.30). Conclusion: The use of human fibrin glue or N-butyl-2-cyanoacrylate is better tolerated than sutures in tension-free inguinal open repair using the plug and mesh technique in terms of overall immediate results, and there is a better trend in the long-term data. Contexte : Nous avons cherche a determiner l'efficacite des sutures, de la colle de fibrine humaine et du cyanoacrylate de butyle pour fixer le treillis chez les patients qui subissent la reparation d'une hernie inguinale au moyen de la technique de l'obturateur prothetique (plug) et du treillis. Methodes : Au total, 156 patients qui avaient 167 hernies inguinales (11 bilaterales) ont subi une intervention basee sur la technique du plug et treillis et ont ete repartis au hasard pour recevoir des sutures (n = 59 hernies), une colle de fibrine humaine (n = 52) ou du cyanoacrylate de butyle (n = 56) pour fixer le treillis. Resultats : Le taux global de morbidite s'est etabli a 38,98 % chez les patients qui ont recu des sutures, a 9,62 % chez ceux qui ont recu la colle de fibrine et a 10,71 % chez ceux qui ont recu le cyanoacrylate de butyle (sutures c. colle de fibrine, p < 0,001; suture c. cyanoacrylate de butyle, p < 0,001). Il n'y avait pas de difference significative au niveau de la morbidite entre les patients qui ont recu la colle de fibrine et ceux qui ont recu le cyanoacrylate de butyle. Dans l'ensemble, la morbidite a court terme a ete beaucoup plus elevee chez les patients qui ont recu les sutures (27,12 %) que chez ceux qui ont recu la colle de fibrine (9,62 %,p = 0,01) ou le cyanoacrylate de butyle (8,93 %, p = 0,004), mais il n'y avait pas de differences significatives entre les patients qui ont recu la colle de fibrine et ceux qui ont recu le cyanoacrylate de butyle. Il n'y avait pas de difference significative entre les groupes sur le plan de la duree moyenne du sejour postoperatoire (32,6 heures chez les patients qui ont recu les sutures c. 30,8 heures chez ceux qui ont recu la colle de fibrine c. 32,0 heures chez ceux qui ont recu le cyanoacrylate de butyle) ou du temps moyen qui s'est ecoule avant le retour au travail (20,4 j chez les patients qui ont recu les sutures c. 20,3 j chez ceux qui ont recu la colle de fibrine c. 19,8 j chez ceux qui ont recu le cyanoacrylate de butyle). Dans l'ensemble, la morbidite a long terme etait beaucoup plus elevee chez les patients qui ont recu les sutures (11,86 %) que chez ceux qui ont recu la colle de fibrine (0 %,p = 0,001) ou le cyanoacrylate de butyle (1,78 %, p = 0,03). Aucun groupe n'a presente de recidive. On a signale deux cas (3,39 %) de douleur chronique a l'aine chez les patients qui ont recu des sutures. Cinq (8,47 %) des patients qui ont recu des sutures et un (1,78 %) de ceux qui ont recu le cyanoacrylate de butyle ont signale avoir une sensation de presence d'un corps etranger; on n'a pas signale de cas de ce genre chez les patients qui ont recu la colle de fibrine (sutures c. colle de fibrine, p = 0,01; sutures c. cyanoacrylate de butyle, p = 0,03; colle de fibrine c. cyanoacrylate de butyle, p = 0,30). Conclusion : La colle de fibrine humaine ou le cyanoacrylate de butyle sont mieux toleres que les sutures pour la reparation ouverte d'une hernie inguinale sans tension par la technique du plug et treillis, pour ce qui est des resultats immediats globaux, et les donnees a long terme revelent une meilleure tendance., The incidence of symptomatic inguinal hernias is about 16% in adult men. Groin hernioplasty is the most common operation in general surgery and is one of the top 3 surgical [...]

Abstract Background Acute respiratory failure due to thyroid compression or invasion of the tracheal lumen is a surgical emergency requiring urgent management. The aim of this paper is to describe a series of six patients treated successfully in the emergency setting with total thyroidectomy due to ingravescent dyspnoea and asphyxia, as well as review related data reported in literature. Methods During 2005-2010, of 919 patients treated by total thyroidectomy at our Academic Hospital, 6 (0.7%; 4 females and 2 men, mean age: 68.7 years, range 42-81 years) were treated in emergency. All the emergency operations were performed for life-threatening respiratory distress. The clinical picture at admission, clinical features, type of surgery, outcomes and complications are described. Mean duration of surgery was 146 minutes (range: 53-260). Results In 3/6 (50%) a manubriotomy was necessary due to the extension of the mass into the upper mediastinum. In all cases total thyroidectomy was performed. In one case (16.7%) a parathyroid gland transplantation and in another one (16.7%) a tracheotomy was necessary due to a condition of tracheomalacia. Mean post-operative hospital stay was 6.5 days (range: 2-10 days). Histology revealed malignancy in 4/6 cases (66.7%), showing 3 primitive, and 1 secondary tumors. Morbidity consisted of 1 transient recurrent laryngeal palsy, 3 transient postoperative hypoparathyroidism, and 4 pleural effusions, treated by medical therapy in 3 and by drains in one. There was no mortality. Conclusion On the basis of our experience and of literature review, we strongly advocate elective surgery for patients with thyroid disease at the first signs of tracheal compression. When an acute airway distress appears, an emergency life-threatening total thyroidectomy is recommended in a high-volume centre.

Abstract Background Secondary involvement of the thyroid gland by malignant metastases is uncommon. Acute respiratory crisis due to infiltration of the upper airways is a recognised complication of anaplastic thyroid carcinoma or thyroid lymphoma. Renal cell carcinoma is a tumour that metastasizes diffusely and in an unpredictable manner. Case presentation We report a case of a 73-year-old man with a painful neck mass, dyspnoea, stridor and dysphonia that was evaluated in emergency. A right radical nephrectomy for renal cell carcinoma was performed 8 years previously. An emergency endotracheal intubation was followed by total thyroidectomy. Histological examination confirmed the diagnosis of thyroid metastasis from renal cell carcinoma. Conclusion A literature review regarding emergency treatment for acute respiratory compromise resulting from secondary thyroid tumours was undertaken. Only two cases of metastatic colon cancer and one case of metastatic meningioma requiring emergency thyroidectomy for acute respiratory failure are reported in the literature. This appears to be the first case of emergency surgery performed for acute respiratory compromise due to thyroid metastasis from renal cell carcinoma.

Abstract Background Parathyroid adenoma is the most common cause of primary hyperparathyroidism. Preoperative serum calcium and intact-parathyroid hormone levels are the most useful diagnostic parameters that allow differentiating primary hyperparathyroidism from non-parathyroid-dependent hypercalcemia. Parathyroidectomy is the definitive treatment for primary hyperparathyroidism. Approximately 5% of patients who underwent parathyroidectomy present with persistent or recurrent hyperparathyroidism due to ectopic localization of the adenoma. Functioning oxyphil parathyroid adenoma is an uncommon histological form, seldom causing primary hyperparathyroidism. Parathyroid adenoma with hypercalcemia exhibiting normal parathyroid hormone level is rare. An incidence of 5% to 33% has been documented in the literature; no etiologic explanation has been given. In 1987, parathyroid-hormone-related peptide was isolated as a causative factor of humeral hypercalcemia of malignancy. The presence of parathyroid-hormone-related peptide in parathyroid tissue under normal and pathological conditions has been described in the literature; however, its role in causing hyperparathyroidism has not yet been defined. Case presentation We present a case of persistent hypercalcemia with a normal level of intact-parathyroid hormone due to a substernal parathyroid adenoma, treated with radioguided parathyroidectomy. The final histological diagnosis was oxyphil adenoma, positive for parathyroid-hormone-related peptide antigens. Conclusion In clinical practice, this atypical biochemical presentation of primary hyperparathyroidism should be considered in the differential diagnosis of hypercalcemia. The parathyroid-hormone-related peptide should be considered not only in the presence of malignancy.

The recent outbreak of COVID-19 in Italy caused a limitation of the resources of the health system, which necessarily led to their rationalization in the critical phase (phase 1) and a reorganization of the system in the following phase (phase 2). The Italian Society of Oncological Surgery–SICO has drafted these practical recommendations, calibrated on the most recent scientific literature and taking into account current health regulations and common sense. Surgical activity during phase 1 and 2 should follow a dynamic model, considering architectural structures, hospital mission, organizational models. Surgical delay should not affect oncological prognosis. However, COVID-19-positive cancer patients should be postponed until the infection is cured. The patients to consider more carefully before delaying surgery are those who have completed neoadjuvant therapy, patients with high biological aggressiveness tumors or without therapeutic alternatives. The multidisciplinary discussions are fundamental for sharing clinical decisions; videoconference meetings are preferable and use of telemedicine for follow-up is recommended. Especially in phase 1, maximum effort must be made to reduce the spread of the pandemic. Prefer intra-corporeal rather than open anastomosis during laparoscopy and mechanical rather than hand-sewn anastomosis in open surgery. Consider PPE for caregivers during stoma management. Minimal invasive surgery is not discouraged, because there is little evidence for augmented risk. Specific procedures have to be followed and use of energy devices has to be limited. Training programs with COVID-19 + patients are not recommended. All staff in OR should be trained with specific courses on specific PPE use. Differentiate recommendations are presented for every district cancer. Surgical oncology during phase 2 should be guaranteed by individual and distinct protocols and pathways between cancer patients and COVID-19 + patients with resources specifically addressed to the two distinct kind of patients to limit diagnostic/therapeutic interferences or slowdowns. These recommendations are based on currently available evidence about management of oncologic patients during COVID-19 pandemic, were endorsed by the SICO Executive Board, and are considered suitable for nationwide diffusion. They will be subject to updates and revisions in case of new and relevant scientific acquisitions. [ABSTRACT FROM AUTHOR]

Byline: Giuseppe. Piccinni, Andrea. Sciusco, Angela. Gurrado, Germana. Lissidini, Mario. Testini Dear Sir, Thank you very much for the attention paid to our paper, this letter permits me to clarify [...]

Byline: Giuseppe. Piccinni, Andrea. Sciusco, Angela. Gurrado, Germana. Lissidini, Mario. Testini Background: Appendicitis is the most common cause of acute abdomen, and appendectomy is the most frequent surgical procedure performed [...]