Silvia Ficarella

Granulomatous Mastitis during Chronic Antidepressant Therapy: Is It Possible a Conservative Therapeutic Approach?

Granulomatous mastitis is a rare benign inflammatory disease of the breast with multiple etiologies such as tuberculosis, sarcoidosis, foreign body reaction, and mycotic and parasitic infections. In contrast, idiopathic granulomatous mastitis (IGM) is characterized by the presence of chronic granulomatous lobulitis in the absence of an obvious etiology. Clinically and radiologically it may mimic breast carcinoma and so awareness of surgeons, pathologists, and radiologists is essential to avoid unnecessary mastectomies. Cases of IGM are reported during antidepressant therapy in patients also showing high levels of prolactinemia. In these cases, we believe that surgical excision must be avoided being replaced with a conservative management of the pathological condition based on a corticosteroid treatment.

Enteral Nutrition in Pancreaticoduodenectomy: A Literature Review

Pancreaticoduodenectomy (PD) is considered the gold standard treatment for periampullory carcinomas. This procedure presents 30%–40% of morbidity. Patients who have undergone pancreaticoduodenectomy often present perioperative malnutrition that is worse in the early postoperative days, affects the process of healing, the intestinal barrier function and the number of postoperative complications. Few studies focus on the relation between enteral nutrition (EN) and postoperative complications. Our aim was to perform a review, including only randomized controlled trial meta-analyses or well-designed studies, of evidence regarding the correlation between EN and main complications and outcomes after pancreaticoduodenectomy, as delayed gastric emptying (DGE), postoperative pancreatic fistula (POPF), postpancreatectomy hemorrhage (PPH), length of stay and infectious complications. Several studies, especially randomized controlled trial have shown that EN does not increase the rate of DGE. EN appeared safe and tolerated for patients after PD, even if it did not reveal any advantages in terms of POPF, PPH, length of stay and infectious complications.

Argentum-quarz solution in the treatment of anorectal fistulas: Is it possible a conservative approach?

Patients suffering from chronic intestinal diseases (Crohns disease, Ulcerative Colitis, Indeterminate Colitis) are prone to the development of pyogenic complications. These complications are most commonly in the form of perianal or intraabdominal abscesses and/or fistulas. The treatment of these complications are managed differently but, after an initial treatment based on medical or minimally invasive management, the solution of the pathological condition is always achieved by a surgical procedure. In the last few years prospective studies have proposed an alternative conservative therapeutic approach based on application of fibrin glue in the healing of patients with fistulas-in-ano. In this paper we suggest and discuss the therapeutic potential of silver and quarz in the conservative treatment of anorectal fistulas pointing out their role in modulating particular steps of the pathogenetic process which characterizes this pathological condition.

Laparoscopic repair of boundary incisional hernia in a kidney transplanted patient. A safe tacks-fibrin glue combined mesh fixation technique.

BACKGROUND Incisional hernia in renal transplant patients is a complication that negatively affects the global outcome of transplant and quality of life. The repair of this condition was classically made by open repair with mesh. Increasing evidence suggests that laparoscopic repair could be advocated as the technique of choice in these patients with optimal results. However, the fixation of mesh should be performed by a mixed combination of fibrin sealant (lateral margin of wall defect) and tacks (medial margin). The tacks fixation of the mesh along the lateral margin of the wall defect, close to the graft, is generally difficult for the small size of the remaining aponeurotic plane and dangerous for the underlying presence of the graft. MATERIALS AND METHODS A case of incisional hernia in a kidney transplant recipient was repaired by laparoscopic mesh technique. The polypropylene-polyglycolic acid composite mesh was fastened with a mixed technique of absorbable tacks for medial margin of the defect and fibrin sealant for the lateral side in contiguity with graft surface. RESULTS The patient was discharged after 4 days. The 6-month follow-up did not show mesh displacement or recurrence of hernia. CONCLUSIONS The laparoscopic mesh repair may become the criterion standard for kidney transplant patients affected by incisional hernia. The difficulties of mesh fixation close to the graft can be overcome by the combination of fibrin sealant glue and absorbable tacks at different margins of the wall defect. This technique may offer advantages for this population of patients.

Laparoscopic lower lateral incisional hernia repair after kidney transplant

Background: The main principle of abdominal incisional hernia repair is to restore the anatomical and physiological integrity of the abdominal wall by reconstructing the midline. Ideally, midline structural support is restored by midline approximation of local musculo-aponeurotic tissues. Approximation of these tissues without tension on the suture line will restore the elasticity and flexibility of the abdominal wall. However, 30% to 50% of defects larger than 6 cm recur after primary closure, because of the tension on the suture line. Insertion of an alloplastic material to decrease or eliminate tension on the suture line can reduce the incidence of recurrence to 10% or less. But inorganic prosthetic materials have been associated with a high risk of complications such as protrusion, extrusion, infection, and intestinal fistulization. With the availability of biological materials, surgeons are increasingly using these materials for effective surgical management of abdominal incisional hernia The aim of this study was to determine the feasibility and efficacy of repairing large abdominal incisional hernias by reconstructing the midline using bilateral abdominis rectus muscle sheath (ARS) relaxing incisions and a biological material onlay.

Obtaining Mesenchymal Stem Cells From Adipose Tissue Of Murin Origin: Experimental Study

1 Phd School in Surgical Biotechnology and Regenerative Medicine. School of Medicine – School of Biotechnology, University of Palermo, Italy. 2 DICHIRONS Department, School of Medicine. University of Palermo. Italy. 3 Istituto Zooprofilattico Sperimentale della Sicilia A.Mirri, Palermo, Italy. 4 AUOP “P. Giaccone”, Universitary Hospital, Palermo, Italy. 5 School of Biotechnology, University of Palermo, Italy. 6 Euromediterranean Institute of Science and Technology (IEMEST), Palermo, Italy.