Leslie Fiengo

Play to Become a Surgeon: Impact of Nintendo WII Training on Laparoscopic Skills

Background Video-games have become an integral part of the new multimedia culture. Several studies assessed video-gaming enhancement of spatial attention and eye-hand coordination. Considering the technical difficulty of laparoscopic procedures, legal issues and time limitations, the validation of appropriate training even outside of the operating rooms is ongoing. We investigated the influence of a four-week structured Nintendo® Wii™ training on laparoscopic skills by analyzing performance metrics with a validated simulator (Lap Mentor™, Simbionix™). Methodology/Principal Findings We performed a prospective randomized study on 42 post-graduate I–II year residents in General, Vascular and Endoscopic Surgery. All participants were tested on a validated laparoscopic simulator and then randomized to group 1 (Controls, no training with the Nintendo® Wii™), and group 2 (training with the Nintendo® Wii™) with 21 subjects in each group, according to a computer-generated list. After four weeks, all residents underwent a testing session on the laparoscopic simulator of the same tasks as in the first session. All 42 subjects in both groups improved significantly from session 1 to session 2. Compared to controls, the Wii group showed a significant improvement in performance (p<0.05) for 13 of the 16 considered performance metrics. Conclusions/Significance The Nintendo® Wii™ might be helpful, inexpensive and entertaining part of the training of young laparoscopists, in addition to a standard surgical education based on simulators and the operating room.

Peripheral arterial disease in diabetic patients with renal insufficiency: a review

Peripheral arterial disease is common among diabetic patients with renal insufficiency, and most of the diabetic patients with end‐stage renal disease (ESRD) have peripheral arterial disease. Ischaemia is probably overrepresented as an etiological factor for a diabetic foot ulcer in this group of patients compared with other diabetic patients. ESRD is a strong risk factor for both ulceration and amputation in diabetic patients. It increases the risk of nonhealing of ulcers and major amputation with an OR of 2.5–3.

Endovascular repair for acute mesenteric ischemia: case report

Methods We present a case of a 75-year-old patient with acute occlusive mesenteric ischemia that was successfully treated with endovascular intervention. Angiography revealed high-grade stenosis of the proximal tract of the SMA. Immediate option for endovascular therapy was made, and a MARIS self-expandable 6x40 mm stent was positioned. The patient was discharged 2 days after with full recovery from the symptoms.

Giant Cardiac Hydatid Cyst in Children: Case Report and Review of the Literature

Cardiac echinococcus is a rare affliction of the heart caused by the tapeworm Echinococcus granulosus. Primary echinococcosis of the heart represents 0.5–2% of all hydatid disease cases in endemic regions. It evolves slowly, explaining its rarity in children. We report the case of a 11-year-old child affected by a giant cardiac cyst of the left ventricle (LV). The patient underwent cardiac surgery and medical treatment. A retrospective review of the current literature was realized. We found 18 cases: the mean age was 11-years old. Nine cysts were localized in the LV, four in the interventricular septum, three in the right ventricle, and two in the right atrium. All underwent surgery except six patients. Routine echocardiographic screening may be useful in endemic regions where infestation is common. Cardiac echinococcus should be diagnosed in the early and uncomplicated stages and be removed surgically even in asymptomatic patients.

Abdominal aortic occlusion of young adults

The occlusion of the infrarenal aorta is a rare event, which is potentially life threatening. We present the case of a heavy smoking, 35-year-old woman who was referred to the emergency department of our hospital because of sudden abdominal pain and urinary incontinence. She also complained of a two-year history of bilateral intermittent claudication. A computerized tomography revealed the thrombosis of the abdominal aorta and of both iliac arteries. Treatment consists of an aortoiliac thromboendarterectomy (AITE). For young patients with atheromatous occlusive disease of the infrarenal aorta, AITE is an attractive alternative to bypass grafting.

Successful embolization of a suprascapular artery aneurysm.

A 45-year-old woman was referred to our service because 9 months earlier she had developed a pulsating mass on the right supraclavicular fossa and torticollis. Ultrasounds and computed tomographic arteriography showed the presence of a subclavian collateral artery aneurysm with a diameter of 21 mm. On selective arteriography, an aneurysm of a suprascapular artery arising directly from the right subclavian artery was reported. The presence of thoracic outlet syndrome was excluded. The aneurysm was successfully treated with ethylene-vinyl alcohol polymer, a liquid embolic agent. The patient was discharged on postoperative day 1 in good general condition. After 12 months, control ultrasounds confirmed the complete thrombosis of the aneurysm sac.

Radiotherapy-related axillary arteriopathy

Treatment of breast cancer involves surgery, then perhaps radiation, hormonal or chemotherapy. Radiation-induced arterial injury is a well-known entity that represents a rare cause of arterial occlusion. We present the case of a 76-year old woman who complained of a severe intermittent claudication of the right upper limb. Twenty years before, she underwent a right-sided radical mastectomy followed by intense radiation therapy for several weeks. The patient was found to suffer of a radiotherapy-related axillary artery thrombosis and was successfully treated by angioplasty and stenting.

Mini Transsternal Approach to the Anterior High Thoracic Spine (T1–T4 Vertebrae)

Purpose. The anterior high thoracic spine is one of the most complex segments to be accessed surgically due to anatomical constraints and transitional characteristics. We describe in detail the mini transsternal approach to metastatic, infective, traumatic, and degenerative pathologies of T1 to T4 vertebral bodies. We analyse our surgical series, indications, and outcomes. Methods. Over a 5-year period 18 consecutive patients with thoracic myelopathy due to metastatic, infective, traumatic, and degenerative pathologies with T1 to T4 vertebral bodies involvement received a mini transsternal approach with intraoperative monitoring. Frankel scoring system was used to grade the neurological status. Results. Mean follow-up was 40 months. 78% patients improved in Frankel grade after surgery and 22% patients remained unchanged. Average operation time was 210 minutes. There were no intraoperative complications. One patient developed postoperative pneumonia successfully treated with antibiotics. Conclusion. The mini transsternal is a safe approach for infective, metastatic, traumatic, and degenerative lesions affecting the anterior high thoracic spine and the only one allowing an early and direct visualisation of the anterior theca. This approach overcomes the anatomical constraints of this region and provides adequate room for optimal reconstruction and preservation of spinal alignment in the cervicothoracic transition zone with good functional patient outcomes.

Critical limb ischemia in a young man: saddle embolism or unusual presentation of thromboangiitis obliterans?

Thromboangiitis obliterans (TAO), also known as Buergers disease, is a rare cause of peripheral arterial disease in western countries. Tobacco smoking is strongly correlated to the pathogenesis of this inflammatory vascular disease. We report the case of a 32-year-old tobacco and cannabis consumer presenting with right critical limb ischemia. Computerized tomography angiography revealed a bilateral tibioperoneal arterial occlusion and an aortoiliac saddle embolus. The patient was treated with intravenous heparin, transcatheter thrombolysis, and selective Fogarty embolectomy. Instrumental and laboratory examinations revealed that patients most likely diagnosis was TAO. Arterial embolism is uncommon in Buergers disease but should be always excluded in these patients.

Surgical treatment for primary hyperparathyroidism in the elderly: a single- center analysis

BackgroundsThe suspicion of a hyperparatiroidism is mostly guidedby the finding of an increase in serum calcium levels byroutine measurements. Primary hyperparathyroidism is acommon disease occurring in 0.2 to 0.5% of the popula-tion. The incidence in the United States is approxi-mately 100000 new cases per year and increases withage affecting up to 2% of elderly people [1].Materials and methodsFrom January 1995 to December 2009, 172 patientsunderwent operations for Hyperparathyroidism, 130 ofthese were Primary Hyperparathyroidism at our Depart-ment of General Surgery. Patients were divided into twogroups: patients of≤ 69 years old (Group A) andpatients of ≥ 70 years old (Group B). The following vari-ables were studied: demographic characteristics, co-mor-bidities, preoperative symptoms, laboratory values,operative procedures, postoperative complications andanatomo -pathological findings.ResultsGroup A: 110 patients operated 25 were male, 85 werefemale with a M:F ratio of 0.3:1. Mean age at admissionwas52.4(SD±12.9).Wereportedamorbidityrateof5.4% (6 patients) and a mortality rate of 0%. Group B:20 patients operated 6 were male, 16 were female with aM:F ratio of 0.25:1. Mean age at admission was 74.2 (SD±3.7). We reported a morbidity rate of 5% (1 patient)and mortality rate 0%.ConclusionsElderly patients with Hyperparathyroidism present avariety of symptoms that are often different from thoseseen in younger patients. They are more likely to mani-fest fatigue and psychiatric symptoms that are difficultto distinguish from those due to their age, therefore inthe majority of cases the suspicion of hyperparathyroid-ism is guided by the finding of an increase in serum cal-cium levels on a routine measurement. If serum calciumlevel is high or if hypercalcaemia is discovered, measure-ment of PTH confirms the diagnosis [2,3]. Cervicotomyand parathyroidectomy is still to be considered as thetreatment of choice in elderly patients with primaryhyperparathyroidism.