Giuseppe D'Ermo

Usefulness of Harmonic Focus During Axillary Lymph Node Dissection A Prospective Study

Background: Axillary node dissection (ALND) is affected by various complications, (hematoma, seroma, lymphocele, infections). The aim of this study was to evaluate the effectiveness of Harmonic Focus (HF) in reducing these complications. Materials and Methods: 92 patients requiring ALND, were divided into two group: Group A (HF) (33 women, 14 men), and Group B (control) (28 women, 17 men). Results: Operating time was lower in Group A than in Group B. The amount of drain volume was lower in Group A than in Group B, the drain was removed earlier in Group A than in Group B. Seroma incidence was lower in Group A than in Group B. Conclusions: The use of HF during ALND is effective in reducing operating time, drain volume and complications.

Duodenal gastrointestinal stromal tumors: review on clinical and surgical aspects.

INTRODUCTION Gastrointestinal stromal tumors (GISTs) arising in the duodenum represent a rare entity and can be very demanding to manage. The diagnosis can be difficult (as these tumors can be misdiagnosed as pancreatic head tumors), and to treat owing to the complex anatomy of the duodenum and of the pancreatic head. Complete resection may require extensive procedures such as pancreaticodudodenectomy. METHODS AND RESULTS An extensive literature review regarding clinico-pathological features, diagnostic investigations and surgical options in the management of duodenal GISTs has been performed. CONCLUSIONS Duodenal GISTs have uncertain malignant potential, and they may be asymptomatic, or present with abdominal pain or bleeding. A preoperative diagnosis can be difficult to obtain. Endoscopic ultrasound and fine needle aspiration cytology (FNAC) may be helpful. Surgical R0 resection remains the only curative approach. However, owing to the complex anatomy of the duodenum, limited resection is not always feasible. In these cases, extensive procedures such as pancreaticoduodenectomy or pancreas-preserving duodenectomy are the treatment of choice.

Ultrasound-Guided Vein Puncture Versus Surgical Cut-Down Technique in Totally Implantable Venous Access Devices (Tivads): A Prospective Comparative Study on Safety, Efficacy and Complications

otally implantable venous access devices (TI-VADs) consist of a central venous catheter(made of silicone rubber or polyurethane) and asubcutaneously-implanted injection port made oftitanium or plastic, providing a simple, safe, andpermanent means of accessing the vascular systemfor intravenous delivery of drugs and fluids.

Partial adrenalectomy: when, where, and how? Considerations on technical aspect and indications to surgery

SummaryBACKGROUND: Partial (or sub-total) adrenalectomy, first proposed for the treatment of hereditary, bilateral pheochromocytoma in order to preserve adrenocortical function and avoid lifelong steroid replacement therapy, has been adopted more recently in case of sporadic, monolateral tumors, like functioning adenomas or pheochromocytomas, in order to minimize the risk of potential adrenal failure, especially in young patients. METHODS: Based on a literature review and personal experience, the authors critically review this surgical procedure. RESULTS: The authors discuss surgical approach and indication for partial adrenalectomy, and focus on technical aspects and clinico-pathologic results. CONCLUSIONS: Because of the rarity of adrenal tumors and the consequent lack of consistent series, many issues such as correct surgical indications and technical aspects (management of the main adrenal vein, section margins, hemostasis of the adrenal stump, and surgical and functional results) still need to be debated.