Computerized archives in surgery. Our experience

In recent years, the necessity for a surgical department to obtain a wide range of clinical data in a short period is greatly increased. This necessity has been almost satisfied with widespread use of information systems in medicine using database programs and the integration of these database with other programs has allowed graphic representation of data. Anyhow, some difficulties are still present, such as low knowledge in using personal computers and lacking of a common program for all surgical departments. In the article the authors present a computerized program for the filing of medical records in a surgical department. Starting from January 1992, clinical data of all patients admitted in our department have been recorded in the described program. After three years of use, the system has shown to be easy to use, and able to give useful information for data analysis regarding the population observed, the clinical activity performed and the level of quality obtained. For these reasons, it can represent an attempt to diffuse and uniform computerized data recording in surgical departments.     

Cutaneous mechanical staplers. Our experience

This paper reports the results of a trial, comparing the use of disposable skin staplers with conventional nylon or silk sutures in skin closure. This study began in 1986; 7274 patients undergoing elective and emergency operations were controlled during the postoperative period, 3 and 6 months after surgery. It was shown that skin clips instead of sutures decrease the operative time, produce wound healing with a good cosmetic results, and above all a significant lowering of the wound infection rate.     

Total intravenous anaesthesia in Charcot-Marie-Tooth disease. Case report

A Total Intravenous Anaesthesia (TIVA) protocol in a case of hereditary motor-sensory neuropathy Charcot-Marie-Tooth disease in three consecutive orthopaedic surgical procedures is described. History, physical examination and sural nerve fascicular biopsy findings are reported. Problems related to the perioperative anaesthesiological management in peripheral neuropathies are discussed. Propofol and fentanyl without muscle relaxants, proved to be a safe technique, fast at reaching the level of surgical anaesthesia required, manageable for maintenance and rapidly reversible.     

Reversal of Hartmann's procedure. Our experience

Hartmann's procedure has progressively changed its indications in the last years; nowadays they are reduced by the increasing of anesthesiology and the introduction of stapler devices. The introduction of staplers makes reconstructive operation easier and it contributes to a sensible increasing of reversal percentage after Hartmann's procedure. Video-assisted techniques make Hartmann's procedure possible for older patients with high-risk of post-operative general complications. The authors describe the results obtained with traditional and video-assisted reversal Hartmann's procedure, comparing with data from Literature.     

Local use of levomycetin in neurosurgery]

A method of local application of the unsoluble medicinal form of chloramphenicol during operations has been developed. Administration of the preparation in a dose up to 2g under an osteal or cutaneous graft induces no side complications and forms a depot of the agent therapeutic concentrations for more than 8 days. There exists a direct relationship between the increasing of staphylococcus resistance to chloramphenicol and the quantity of the agent used in patients.     

Peridural anesthesia versus subarachnoid anesthesia in cesarean section. Prospective clinical study

OBJECTIVE: To compare technical and clinical differences between epidural and spinal anesthesia for cesarean section. STUDY DESIGN: Randomized prospective trial. PATIENTS AND METHODS: 64 pregnant women at term scheduled for elective cesarean section. Two groups were randomized: A) PD Group (n = 32): continuous epidural anesthesia by administration of bupivacaine 0.5% plus epinephrine 1/400,000 via an epidural catheter. Epidural morphine 3 mg was administered at the end of surgery. B) SP Group (n = 32): "single shot" spinal anesthesia by intrathecal administration of hyperbaric 1% bupivacaine 1-1.4 ml plus morphine 0.2 mg. The pin prick block level reached T2-T6 at incision time. DATA COLLECTION: 1) Time from the beginning of anesthesia to surgical incision. 2) Hypotension episodes. 3) Ephedrine consumption. 4) Intraoperative discomfort at delivery, traction and uterine manipulation, peritoneal toilette. 5) Nausea and vomiting. 6) Apgar score. 7) Postoperative headache. RESULTS: Women in the SP group had more hypotensive episodes (81% vs 53%: p < 0.05) and more ephedrine consumption with a large individual variability (29.12 mg +/- 20.4 vs 12.83 +/- 13.8: p < 0.01) when compared to PD group, without any difference in the Apgar score. The SP group required less time consumption (10.5 min. +/- 6.7 vs 35.9 min. +/- 17.3: p < 0.01) and had less intraoperative discomfort with less analgesic and/or sedative drugs consumption (9.7% vs 29%: p < 0.05) and less vomiting (3% vs 22.5%: p < 0.05). No postoperative headache was noticed in both groups. CONCLUSIONS: With the described pharmacological and technical approach, spinal anesthesia is more suitable than continuous epidural technique for cesarean section, unless contraindicated.     

Rubber band ligation of hemorrhoids. Our experience

The authors present their series of rubber band ligation of hemorrhoids performed from 1991 to 1994 in the Unità di Colon Proctologia of Modena, that is located in the Second Division of Surgery of the Surgical Department of Modena University. In that period 158 patients were treated. Age range was between 17 and 93 years old, and patients were affected by II and III degree of hemorrhoids. The complications verified were: 14 cases of recurrence (8.8%), 2 cases of severe bleeding, no case of perineal sepsis or urinary retention. Other complications of less importance were 89 cases of pain (56.3%), not severe bleeding in 23.41% of patients. Results show that this method of treatment of hemorrhoids, used by experts, is the first choice treatment of this pathology.     

Our experience with silicone in rhinomentoplasty

Twelve young (mean age 23 years, range 18-28) and 12 elderly (mean age 76 years, range 65-89) volunteers were given a single oral dose of 80 mg valsartan after an overnight fast. Each group consisted of six male and six female subjects. Mean systemic exposure to valsartan was higher in the elderly when compared with the young (AUC(0-24 h), 52% increase and AUC(0-infinity), 70% increase). Variability, as shown by the coefficient of variation (CV), was larger for the elderly subjects and ANOVA of the log transformed AUC showed a significant difference between the two groups. This difference was largely brought about by five elderly subjects (one male, four females), whose AUC was about 2-fold higher than the rest of the group. For the remaining elderly subjects, plasma valsartan AUC was similar to that observed for the young volunteers. This higher systemic exposure in five of the elderly subjects is not thought to be of clinical relevance when data from the patient population are considered. Other covariates--such as body weight, comedication, creatinine clearance, valsartan kinetics (absorption rate, distribution, and elimination)--did not explain the higher AUC in this subset of the elderly group. Data from the present study were compared with population kinetic data obtained from larger clinical trials including hypertensive patients in all age groups. Using this population approach, there was no difference in the pharmacokinetics of valsartan between male and female patients. Also, a relationship between plasma clearance of valsartan and age was established. The median age of patients in the hypertensive pool was 55 years. For an average 70-year-old patient, plasma clearance of valsartan is predicted to fall by 22% compared with an average 55-year-old. For the population this difference is not sufficient to warrant initial dose adjustment based on age per se. The covariate age, does not completely explain the variability in the pharmacokinetics of valsartan within the general population. The treatment was well tolerated.     

Video laparoscopic surgery and rectal prolapse. Our experience in rectopexy

BACKGROUND: Laparoscopy is gaining an important role in the treatment of benign colorectal disorders. The aim of this study is the evaluation of clinical and functional results in 4 patients submitted to a laparoscopy rectopexy according to Wells. METHODS: Four females (22-76, mean 53.7 years) affected from a total rectal prolapse with fecal incontinence underwent this procedure from 1993 through 1995. Six months after surgery, at the end of a rehabilitation program consisting of kinesitherapy, bio-feedback and electrostimulations, all patients have been re-evaluated by means of a clinical exam, anorectal manometry, defecography. RESULTS AND CONCLUSIONS: Preliminary results seem satisfactory and may allow to prefer this approach instead of the traditional open one.     

Urethral diverticula in the male. Our experience over 10 years

Following mobilising chemotherapy and myeloid growth factors, some heavily pretreated patients do not mobilise adequate numbers of peripheral blood progenitor cells (PBPC). It would be clinically useful to identify such patients in advance. A recent scoring system based on previous therapy may be useful in predicting CD34-positive cell yield. In this study we validated this scoring system on an independent group of 99 patients undergoing 103 harvesting episodes. In 61 patients mobilised with cyclophosphamide 1.5 g/m2 and G-CSF, those with treatment scores less than 21 yielded significantly more CD34-positive cells than patients with scores greater than 63 (P = 0.0012). Previous treatment with melphalan or carmustine was associated with a significantly lower yield of CD34-positive cells (P= 0.0001). No relationship was seen between the time from previous chemoradiotherapy and harvest outcome. Patients with treatment scores less than 21 required a shorter duration of G-CSF therapy (P = 0.05). Similar findings were seen in 42 further mobilisation cycles undertaken with alternative mobilisation schedules. The present data suggest that a score summarising previous treatment can be used to predict CD34 yields, and could be of clinical use to identify poor PBPC mobilisers in advance.     

Aplastic anemia in acute viral hepatitis type A. Our experience

Tropical pyomyositis is an infection of large muscle groups that can lead to sepsis and death. The most common etiologic agent is Staphylococcus aureus. It usually occurs in patients living in the tropics but is seen with increasing frequency in temperate climates, particularly in immunosuppressed patients, where it may be misdiagnosed and may cause severe morbidity and mortality. Diagnosis is based on the examination of pus from a muscle aspirate and treatment consists of surgical incision, drainage and appropriate antibiotic therapy. It is stressed to take into account pyomyositis in the differential diagnosis of immunocompromised patients with "cryptic" myalgia.     

Accumulation of 14C-lidocaine in the inner ear. Preliminary clinical experience utilizing intravenous lidocaine in the treatment of severe tinnitus

Clinical experience has demonstrated that intravenously administered local anaesthetics have a mitigating effect on severe tinnitus. In an attempt to gain some insight into the mechanism of this effect, autoradiography of the inner ear of young pigmented rats was performed after intravenous injection of 14C-lidocaine. Some accumulation of lidocaine was found in the modiolus, but almost none in the stria vascularis. A large accumulation was observed in other melanincontaining tissues, such as the hair follicles and uvea. The in vitro accumulation of 14C-labelled lidocaine adsorbed on melanin granules was low (12%) as compared with that of other drugs, such as kanamycin (89%) and chloroquine (85%). These autoradiographic results indicate that lidocaine has an effect upon the inner ear, in addition to its previously demonstrated effect on the CNS.