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The aim of our work is to present the outcomes and complications that occurred to a group of 49 consecutive patients affected by a severe musculoaponeurotic laxity and or different abdominal wall defects, who underwent prosthetic wall defect repair and abdominoplasty. Severe laxity was the end result of repeated pregnancies in most of the female patients. A further aim of the work is also to demonstrate the metabolic and aesthetic advantages that occur with the association between prosthetic hernias repair and abdominoplasty.

The pathophysiology of chronic diabetic ulcers is complex and still incompletely understood, both micro- and macroangiopathy strongly contribute to the development and delayed healing of diabetic wounds, through an impaired tissue feeding and response to ischemia. With adequate treatment, some ulcers may last only weeks; however, many ulcers are difficult to treat and may last months, in certain cases years; 19–35% of ulcers are reported as nonhealing. As no efficient therapy is available, it is a high priority to develop new strategies for treatment of this devastating complication. Because experimental and pathological studies suggest that incretin hormone glucagon-like peptide-1 may improves VEGF generation and promote the upregulation of HIF-1α through a reduction of oxidative stress, the study evaluated the effect of the augmentation of GLP-1, by inhibitors of the dipeptidyl peptidase-4, such as vildagliptin, on angiogenesis process and wound healing in diabetic chronic ulcers. Although elucidation of the pathophysiologic importance of these aspects awaits further confirmations, the present study evidences an additional aspect of how DPP-4 inhibition might contribute to improved ulcer outcome.

Introduction: The total mesorectal excision (TME) for rectal tumours was introduced in 1982 by Heald and coll. and has led both to a 5% decrease of local recurrences 5 and 10 years after the operation if confronted with the cases treated with conventional surgery and to the increase of survival up to five years estimated in 80% of the cases. In Italy, TME firstly introduced for distal rectal cancer about 20 years ago, this surgical technique has shown the same rate of local recurrences reported by Heald. The aim of our work is to highlight TME advantages and demonstrate how this more demanding and longer method, has an acceptable risk for the surgery of rectal tumours. Materials and method: We have confronted two groups of patients operated for rectal carcinoma; the first group (no TME, including 50 patients) was treated with the standard surgery technique, while the second group (TME, 44 patients) underwent the total mesorectal excision. 14 no TME patients belong to Dukes stage A, 20 to stage B, 12 to C and the remaining 4 had miscellaneous diagnosis; whereas in the TME group 12 patients belonged to Dukes stage A, 16 to B, 6 to C and the remaining 10 patients had miscellaneous diagnosis. The patients of both groups were undergone the exams of follow up (blood test, hepatic echography, abdominal TC, thorax RX), the follow up pattern expect periodic controls with check-up to three and six months, one and five years. Results: postoperative complications in the groups considered do not show important differences in rates, although, the second group (TME) had 9 cases with postoperative complications confronted with the 11 cases of the first group (no TME). The complications taken into consideration were: anastomotic bleeding (2 patients TME, 4% vs 3 patients no TME, 6%), intestinal obstruction (1 patient TME, 2% vs 1 patient no TME, 2%), paretal infection (3 patients TME, 7% vs 4 patients no TME, 8%), anastomotic fistulae (2 patients TME, 4% vs 2 patients no TME, 4%), retention of urine and vesicular disorder (1 patient TME, 2% vs 1 patient no TME, 2%). Tumours closer to the anus have shown more complications compared with higher ones. As a matter of fact, 10 cases of no TME and TME patients with low placed tumours have undergone complications compared with the 3 cases of no TME and TME patients with tumours being more distant from the anus. A lower rate of local recurrences was noticed in the TME group: 3 (7%) compared with the no TME group: 18 (36%) with P < 0,001. Other tardy complications taken into consideration were: hepatic metastasis (5 patients no TME, 10% vs 6 patients TME, 14%), pulmonary metastasis (5, 10% of the no TME vs 3, 7% of the TME), anastomotic stenosis (4, 8% of the no TME vs 3, 7% of the TME), impotence and orgasm sine materia (2, 4% of the no TME vs 3, 7% of the TME). We also noticed that most of the tardy complications in the TME group belonged to Dukes stage C. Conclusion: from our experience, we deduced that, in TME patients, complications are lower than in no TME patients with no important P; the seat of the tumour affects the appearance of complications which are more frequent in distal localizations. The important result is a minor incidence of recurrences (P < 0,001) which brings us to the conclusion that TME can be considered a valid method with an acceptable risk for the surgery of rectal tumours.

The authors report the cases of two young female patients aged 17 and 27 years who underwent surgery for a rare tumor of the pancreas, Frantz's tumor or solid-cystic pseudopapillary tumor. Solid-cystic pseudopapillary tumor of the pancreas is a rare tumor, accounting for 2.7% of pancreatic exocrine tumors. About 90% of these tumors occur in young women and they can reach very large dimensions. Due to their rareness and behavior, they are often associated with diagnostic and therapeutic problems. In most cases surgical treatment is curative and neither chemotherapy nor radiotherapy should be added. In the few cases where surgery is not possible, radiotherapy can be used because these tumors appear to be radiosensitive.

It is very important to confirm the reliability of the sentinel node (SN) technique in breast cancer surgery, since it can avoid useless traumas, wide mutilations, prolongation of the operation. The aim of the study is to give a contribution to evaluate the real value of SN as regards axillary lymph nodes, in breast cancer, in order to limit axillary lymphadenectomy (AL).The search of LS was made in 42 patients (using Patent Blue alone in 5 cases, with radioisotope in 25 cases and with both techniques in 12 cases); their mean age was 62 years and they were suffering from not multicentric infiltrating carcinoma of the breast, with a diameter less than the 2.5 cm and no evidence of axillary gland at clinical examination. All the patients underwent histologic examination of SN and AL was carried out, whatever was the histologic result of SN.Lymphoscintigraphy identified the SN in 96% of the cases (1 case with no identification in a patient with a previous excisional biopsy), with the Patent Blue in 80% of the cases and with the combined technique in 100% of the cases. The average number of SN obtained was 3 and the number of removed lymph nodes in AL was 25. The metastasization of SN was verified in 10 cases, in 3 of them the SN turned out to be the only one interested by metastasis. In 1 case the intraoperative examination was negative and the postoperative one was positive. The percentage of false-negative was 5% (1 case with lymphoscintigraphy and 1 case with Patent Blue). These findings show that in about 70% of the patients AL could be avoided since axillary lymph nodes were without metastases. The predictive role of SN, particularly with lymphoscintigraphy, proved to be reliable with a very reduced number of false-negative.In our opinion, the SN technique can be considered reliable but it could be used in routine practice when all false-positive can be avoided, since even if not very numerous they represent the principal obstacle to its application.

Aims: A technical variant of Whithead haemorrhoidectomy is described. This technique consists in three semilunar incisions at points corresponding to the three primary piles at 3, 7 and 11 o'clock, detachment of the vascular structures of the anorectal mucosa, ligation by means of a transfixion stitch and reconstruction of the mucocutaneous plane with interrupted absorbable sutures. Patients and methods: The authors report the results of a prospective, randomised study of this technical variant comparing it with the standard Whithead technique in 210 patients divided into two groups (103 and 107 pts., respectively). Results: Both postoperative pain and early postoperative complications were significantly lower in the patients operated on using the modified technique. Seven days postoperatively there were distinct reductions in the incidences of soiling (27.1% vs 14.6%; P

The authors take a treated clinical case as a starting point to consider lateral ventral hernia, generally referred to as "Spigelian hernia". Such hernias are rare (1-2% of all hernias), with a slightly higher incidence in the female sex. Obesity and multiparous status are known to be predisposing factors. Instrumental tests of great importance in terms of specificity and definition such as ultrasonography and computed tomography are available, in cases of diagnostic doubt, for a pathology that in any case has to be detected early in order to avoid possible complications. The treatment is essentially surgical. A personal variant of the surgical repair technique is described with the use of prosthetic material, which guarantees a better result in terms of strength and resistance compared to simple repair surgery.

the aim of this study was to compare the effect of a pharmacological and a surgical vasodilatatory therapy in the treatment of chronic arterial disease of the lower limbs

Treatment of diabetic foot infections (DFIs) represents an important challenge for surgeons, especially in light of the poor results achieved by traditional therapeutic approaches. In this study, the clinical and bacteriological efficacy of TZP for treatment of DFIs in 38 outpatients was evaluated. All patients (median age 63 yrs) were affected by DFIs to different degrees of severity according to Wagner's classification: degree 0, 7 pts; degree 1, 17 pts; degree 2, 10 pts; degree 3, 4 pts. Degree 0-1 infections underwent a 10-18 day course with TZP given i.m. (2.25 g bid); degree 2-3 infections were initially treated with TZP i.v. (4.5 g bid or tid). Some patients began treatment in hospital and after early discharge continued parenteral therapy at home; others were treated exclusively at home. Some pts, after a 5-7-day course of i.v. therapy switched to i.m. route. The average duration of antibiotic therapy was 28 days. At the end of treatment with TZP, some patients underwent a new treatment with oral coamoxi-clav for 10-15 days. A bacteriological examination was done for all patients: ulcus (degree 1) and deep tissue (degree 2-3) swabs at the first surgical toilette. Clinical controls, medications, surgical toilettes and microbiological cultures were performed according to the degree of severity, extension of the lesion and response to treatment. All cultures were positive for polymicrobial infections (Staphylococcus spp, Enterococcus spp, Enterobacteriaceae, Pseudomonas spp). In 30/38 pts (79%) a complete resolution was observed; in 4 pts (10%) an improvement. DFIs require long term parenteral treatment, with wide spectrum antibiotics including Gram +, Gram - and anaerobes. OPAT represents a valid alternative to hospitalisation when the general conditions of the patient are stable, the infection is not too severe and complications are not present. TZP proved to be a good choice for treatment of diabetic foot infections that, due to its high safety, can be successfully utilized also in OPAT programmes

The total mesorectal excision (TME) for rectal tumours was introduced in 1982 by Heald et al. and has led both to a 5% de crease of local recurrences 5 and 10 years after the operation when compared with cases treated with conventional surgery, and to an increase of survival up to five years estimated in 80% of all cases. In Italy TME was firstly introduced for distal rectal carcinomas about 20 years ago, and has shown the same rate of local recurrences reported by Heald. The aim of our work is to highlight TME advantages and demonstrate how this more demanding and longer lasting method has an acceptable risk for the surgery of rectal tumours.We have compared two groups of patients operated for rectal carcinoma; the first, "historical control group" (no TME, including 46 patients) was treated with the standard surgery technique, while the second group (TME, 47 patients) underwent the total mesorectal excision technique. 14 of non TME patients belonged to Dukes stage A, 20 to stage B and 12 to C; whereas in the TME group 16 patients belonged to Dukes stage A, 23 to B and 8 to C. The patients of both groups undergone the exams of follow up (blood test, hepatic ultrasonography, abdominal CT, thorax Ro); the follow up pattern included periodic controls with a check-up every three and six months, from one to five years.Postoperative complications in both groups do not show important differences in rates, although, the first group (no TME) had 11 cases with postoperative complications confronted with the 8 cases of the second group (TME). The complications taken into consideration were: anastomotic bleeding (3 patients no TME, 6% vs 1 patients TME, 2%), intestinal obstruction (1 patient no TME, 2% vs 1 patient TME, 2%), parietal infection (4 patients no TME, 9% vs 3 patients TME, 6%), anastomotic fistulae (2 patients no TME, 4% vs 2 patients TME, 4%), retention of urine and vesicular disorder (1 patient no TME, 2% vs 1 patient TME, 2%). Tumours closer to the anus have shown more complications compared with tumours at higher levels. As a matter of fact, 9 cases of no TME and TME patients with low located tumours have undergone complications compared with the 3 cases of no TME and TME patients with tumours being more distant from the anus; the rest 7 cases belonged to the middle rectum. A higher rate of local recurrences was noticed in the no TME group: 6 (13%) compared with the TME group: 3 (6%). Other tardy complications taken into consideration were: hepatic metastasis (5 patients no TME, 11% vs 4 patients TME, 8%), pulmonary metastasis (3, 6% of the no TME vs 2, 4% of the TME), anastomotic stenosis (4, 9% of the no TME vs 2, 4% of the TME), impotence (2, 4% of the no TME vs 1, 2% of the TME). We also noticed that most of the tardy complications in the TME group belonged to Dukes stage C.From our experience, we concluded that, in TME patients, complications are lower than in no TME patients; the site of the tumour affects the appearance of complications which are more frequently in distal localizations. An important result is the minor incidence of local recurrences after TME, which brings us to the conclusion that TME can be considered a valid method with an acceptable risk for the surgery of rectal tumour.