Cricothyrotomie préhospitalière: à propos d'un cas

Case report of a patient with tonsillitis treated with anti-inflammatory. The patient presented a dyspnoea and finally a cardiac arrest. The oral intubation was impossible and cricothyrotomy had to be performed with a catheter over needle technique. We found a total airway obstruction due to an epiglottis abscess. The patient died few days later of sepsis. We recommend having wire-guided cricothyrotomy technique or catheter-over-needle technique in all prehospital emergency unit and having emergency physician trained to the cricothyrotomy technique.

Prognostic factors in rehabilitation of above knee amputees for vascular diseases

PURPOSE

This study was undertaken to predict rehabilitation potential and prognostic factors of patients undergoing above knee amputation for vascular diseases.

METHOD

In a prospective study on 144 patients consecutively admitted to our rehabilitation unit for above knee amputation, multiple regression analyses were used to assess the relationship between nine independent variables and a battery of outcome measures: the Rivermead Mobility Index (RMI) and Barthel Index (BI) effectiveness on discharge, length of hospital stay. Two multiple logistic regressions were performed, using as dependent variable the occurrence of good or partial autonomy in mobility, quantified as RMI scores.

RESULTS

Advanced age was the most powerful prognostic factor influencing effectiveness expressed as both mobility (RMI) and BI. Patients aged < 65 years had a greater probability (odds ratio 2.92) of good autonomy in mobility than older patients. The absence of vascular impairment of the residual limb and timely admission to the rehabilitation hospital correlated positively with effectiveness of mobility.

CONCLUSIONS

These findings indicate that relevant prognostic factors can be identified at the beginning of rehabilitation treatment.

[Use of the eutectic ointment EMLA (Eutectic Mixture of Local Anesthetics) in the surgical treatment of inguinal hernia under local anesthesia]

The use of EMLA eutectic cream is very effective and well tolerated in superficial anaesthesia. It is particularly indicated in surgical treatment of inguinal hernia by local anaesthesia, to achieve the analgesia of superficial layers. This allows to reduce the total dose of anaesthetics administrated by infiltration, reducing the risk of overdose, eliminating the pain due to injection, and is very agreeable for the patients.

Post-stroke rehabilitation: an economic or medical priority? Current issues and prospects in light of new legislative regulations

The aim of this study was to evaluate: 1) whether the reduction in duration of in-patient rehabilitation imposed by the Italian Ministry of Health's circular of 29/6/95 has been accompanied by a decline in the results achieved; and 2) whether the system of basing payments on diagnosis related group (DRG) criteria is capable of correctly evaluating differences in post-stroke clinical pictures. The study involved 461 of 497 patients consecutively admitted between 1991 and 1996 for rehabilitation after a first stroke. The average duration of hospitalisation for the period 1995-1996 was significantly shorter (p<0.001) than that of the previous years; at the same time, there was a significant increase (p<0.05) in the number of poor responders in both neurological and functional (mobility) terms. Furthermore, the early discharge after 60 days of the 1995-1996 patients compromised the stabilisation of recovery and led to a subsequent functional decline. It is therefore hoped that the current regulations will be revised and that payments based on a functional related group (FRG) criterion will be introduced.

[Surgery of inguinal hernias in the geriatric patient]

The Authors report a series of 73 elderly patients undergone to Lichtenstein hernioplasty with local anaesthesia. Treatment of inguinal hernia in emergency involves a high mortality; on the contrary, the lack of complications and a very good patient compliance shows that elective repair of inguinal hernia should be preferred and performed in the elderly.

Carcinoid to cecal bowel localization: a case report and literature review

The authors report a case of cecal malignant carcinoid, diagnosticated in a 68 years old male patient. Carcinoid tumours are rare neoplasm and their behaviour seems to change with the localization. Cecal carcinoid represents only 2-3% of gastrointestinal carcinoid. Some times it is discovered incidentally at autopsy, surgery or endoscopy. The aim of this paper has been to review, in literature, the frequency, treatment and prognosis of this neoplasm.

[Local anesthesia in the surgery of inguinal hernia. Technical notes]

Routine use of local anaesthesia associated with tension-free hernioplasty in surgical treatment of inguinal hernia allows an immediate patient walking and prompt discharge from the hospital unit: with this technique 89 cases in two years were operated. The anaesthesia-related discomforts and complications are minimal. The addition of an intravenous sedative (propofol) premis to extend this approach to anxious patients too.

Overexpression of NDP kinase nm23 associated with ploidy image analysis in colorectal cancer

The nm23 gene was originally identified by differential hybridization between two murine melanoma cell sublines with low and high metastatic potential. Nm23 is localized on chromosome 17q21.3-22. Allelic deletions of chromosome 17 have been related to the progression of colorectal carcinomas. We have evaluated and compared the expression of nm23 NPD kinase protein using an immunohistochemical method and DNA ploidy evaluation with image analysis. This study was performed on 20 patients, who underwent surgery for colorectal carcinoma. Patients were followed up during the period from 1992 to 1994. Results have shown an association between the parameters obtained for the nm23 NPD kinase protein expression, and aneuploid DNA and neoplastic progression. The expression of nucleoside diphosphate (NDP) kinase mm23 has been reported to be inversely related to the metastatic potential of experimental cells in human breast cancer. A relationship between the positivity in protein expression of gene product in the allele nm23 H1 and the state of the lymph nodes has also been found.

[Venous bypass for treatment of chronic obstructive venous insufficiency of lower limbs]

About 1 to 5 percent of patients affected by chronic obstructive venous disease of the lower extremity, are eligible to surgical treatment, by veno-venous bypass, for the relief of unerely invalidating symptoms. Indications to operation include a class II to III chronic venous insufficiency of the deep venous system, failure of medical treatment continued for at least 12 months, good patency of outflow axis, a significant gradient of pressure between discared and outflow axis, a good quality saphenous vein to be utilized for bypass. The case of an aged patient, successfully treated with a femoro-femoral venous bypass, associating an artero venous fistula, is presented and indications to the operation in the older patients, together with indication to and technical details of performing the fistula are discussed.

Primary intra-abdominal malignant fibrous histiocytoma. Case report and literature review

Malignant fibrous histiocytoma is a pleomorphic soft tissues sarcoma usually found in the extremity and in the retroperitoneum. The primary intra-abdominal localization of this tumour is very rare and only thirty-five previous reports are present in the world medical literature. The Authors report a case of giant malignant fibrous histiocytoma of the mesentery, which is treated by surgical removal plus adjuvant chemotherapy.

[Carcinoid of the thymus]

Thymic carcinoid is a rare lesion. Two cases are reported and diagnostic as well as therapeutic problems are discussed.

[Lipoma of the colon. Apropos of a case report]

Lipoma of the large intestine is a rare, benign tumor. The clinical findings and the diagnostic studies are analysed and a case of giant submucosal colonic lipoma removed by colonoscopy is reported. Colonoscopic removal of submucosal lipomas is recommended, while the necessity of a surgical treatment in presence of intussusception or subserosal lipomas is confirmed.

[Preparation of the colon for endoscopic examinations. A clinical study]

The paper gives a short critical bibliographic review of colonic preparation for endoscopy, focusing on the out-patient use of gastrointestinal endoscopy. A method of preparation based on dietary restrictions plus cathartics is proposed that allows the number of enemas used to be reduced to a minimum. The results obtained in 265 out-patients undergoing colonoscopy confirm the efficacy, practicality and tolerability of the method.

[Bilateral retroperitoneal lymphadenectomy in tumors of the testis: anatomo-clinical considerations]

Bilateral retroperitoneal lymphadenectomy is usually indicated for non-seminomatous testis tumour at stage IIA and IIB. For seminoma is generally used radiotherapy, although some Authors prefer the surgical approach. Radical retroperitoneal lymphadenectomy must be bilateral, because metastatic cell can often spread to the contralateral lymph nodes. Lymphadenectomy is used not only for therapy, but also for staging: thus clinical evaluation and other diagnostic techniques are not always correct (30% of understaging). Permanent sexual disfunction can follow radical surgery, due to extensive retroperitoneal dissection and exeresis of lumbar sympathetic nerves; so it is proposed, for stage I tumors, a monolateral or limited retroperitoneal lymphadenectomy. Eight patients with non-seminomatous testicular tumours are reported by the authors; 2 (stage I) were treated with monolateral, 4 (stage IIA and IIB) with bilateral retroperitoneal lymphadenectomy; in 2 patients (stage IIC and IID) chemotherapy was followed by debulking surgery. Relapses were observed between 3 and 19 months. Sexual dysfunctions after surgery were present in 5 patients (69%); in all of these a bilateral retroperitoneal lymphadenectomy was performed.

[Anastomotic dehiscence in colorectal surgery and the total parenteral nutrition. A clinical study]

After analysing previous investigations into the incidence of anastomotic dehiscence in colorectal surgery, the paper reports experience with a group of 27 patients treated by a "routine"-TPN after major surgery. In addition, a second group of 67 patients, treated by TPN alone after a postoperative complication, was included in this study. The results show the utility of TPN in the prevention or faster healing of anastomotic dehiscences.