Causative classification of river flood events.

A wide variety of processes controls the time of occurrence, duration, extent, and severity of river floods. Classifying flood events by their causative processes may assist in enhancing the accuracy of local and regional flood frequency estimates and support the detection and interpretation of any changes in flood occurrence and magnitudes. This paper provides a critical review of existing causative classifications of instrumental and preinstrumental series of flood events, discusses their validity and applications, and identifies opportunities for moving toward more comprehensive approaches.

Early experience with laparoscopic major liver resections: a case-comparison study.

Laparoscopic major liver resections are regarded as demanding operations whose convenience is still under evaluation. The aim of the present study was to report our early experience and to describe surgical technique of laparoscopic major liver resections. Study group consisted of 6 female patients with benign disease and a mean age of 40.

Solitary fibrous tumour of the liver with IGF-II-related hypoglycaemia. A case report.

Introduction: We report a rare case of solitary fibrous tumour (SFT) of the liver associated with non-islet cell tumour hypoglycaemia (NICTH), which caused a hypoglycaemic coma due to over-production of big-insulin-like growth factor-II.

Discussion: Although generally benign, SFTs are better characterised, lately due to Western blot, but less than 40 cases have been reported where the liver is the target organ. In only two benign cases has hypoglycaemia been a feature.

LigaSure vs clamp-and-tie technique to achieve hemostasis in total thyroidectomy for benign multinodular goiter: a prospective randomized study.

Hypothesis: Occurrence of adverse effects and advantages of the LigaSure diathermy system (or LigaSure vessel sealing system) in total thyroidectomy have not been tested in prospective randomized studies comparing its use with that of the time-saving clamp-and-tie technique to ligate and divide thyroid vessels. The effectiveness of LigaSure in achieving vessel division and hemostasis remains dependent on vessel diameter, and the risk of damage to adjacent structures cannot be completely excluded. We tested the hypothesis that use of LigaSure compared with the clamp-and-tie technique can significantly and conveniently reduce operative time without increasing postoperative complications in patients undergoing total thyroidectomy for benign multinodular goiter.

Quality of life and predictors of long-term outcome in patients undergoing open Nissen fundoplication for chronic gastroesophageal reflux.

Background: Long-term outcome of antireflux operations as well as pre- and postoperative parameters able to predict their clinical results are still controversial. The aim of the present study was to evaluate long-term quality of life of patients undergoing open fundoplication for chronic GERD and to investigate pre- and early postoperative functional parameters possibly related to persistence or recurrence of symptoms.

Methods: A cohort of 25 patients who underwent open Nissen fundoplications was reviewed for an evaluation of long-term residual symptoms and quality of life at an average follow-up of more than 10 years.

Lymph node metastasis from gastric carcinoid tumors occurring concomitantly with gastric adenocarcinomas and atrophic gastritis.

We describe a case of gastric carcinoids concomitant with gastric adenocarcinoma in a 50-year-old woman affected by atrophic gastritis. Number and size of the lesions, pathological examinations, and underlying gastric disease all indicated low-risk carcinoids. Nevertheless, when R1 gastrectomy was carried out, an unsuspected lymph node metastasis from carcinoid was found along the lesser curvature.

Laparoscopic palliative gastrojejunostomy for advanced recurrent gastric cancer after Billroth I resection.

Palliative surgery for advanced gastric cancer has equivocal results. Laparoscopy is likely to provide some advantage compared to open procedures. We present a case of laparoscopic gastrojejunostomy for advanced gastric cancer, which recurred after Billroth I resection.

Prospective evaluation of ultrasonography plus MIBI scintigraphy in selecting patients with primary hyperparathyroidism for unilateral neck exploration under local anaesthesia.

Background: Unilateral neck exploration (UNE) is currently replacing conventional bilateral neck exploration with cervicotomy for the surgical treatment of primary hyperparathyroidism (PHPT). However, many concerns still exist about the indications and the effectiveness of this minimally invasive approach.

Methods: Prospective evaluation of operative results in consecutive patients having indications for UNE on the basis of strict selection criteria consisting of ultrasound-MIBI agreement in adenoma localization, absence of thyroid disease, and psychological suitability for undergoing a procedure under local anesthesia.

A primary pancreatic carcinoid tumour with unusual clinical complaints: A case report.

Background: Unless metastatic or compressing the pancreatic duct, carcinoid of the pancreas are asymptomatic showing normal levels of serotonine and its metabolites in plasma and urine, thus resulting in delayed diagnosis and a consequent poor prognosis. However, if resection is timely accomplished, no local recurrence might be encountered and a normal survival might be expected in the absence of metastatic disease.

Case Presentation: The reported case of pancreatic carcinoid tumour in a 62-year-old woman reporting only atypical symptoms consisting of intermittent epigastric pain and nausea.

A new method of packaging cocaine for international traffic and implications for the management of cocaine body packers.

Clinical outcome of cocaine body packers is considered to be unpredictable and there are no clear guidelines for the management of these patients. Their surveillance in casualty wards, where they are usually admitted during evacuation of the packets, can be very difficult. The authors refer to a new type of cocaine packet, allowing these patients to be managed with a more conservative approach than in the past, and report their experience with 161 body packers, observed from January 1999 to December 2000.

Minimally invasive management of insulinomas. A case report.

Background: Recently, preoperative endoscopic ultrasonography (EUS) was shown to be less time consuming, posing less risk of adverse events than other more invasive diagnostic procedures used for locating insulinomas. Furthermore, laparoscopy can be part of a less aggressive approach in the management of such tumors, avoiding open surgery, which is used all out of proportion for benign small-size lesions, as insulinomas frequently are.

Case Report: The reported case of pancreatic insulinoma involved a 45-year-old woman suffering from a neuroglycopenic syndrome.

Results of laparoscopic and open splenectomy for nontraumatic diseases.

The medical records of patients who had undergone splenectomy for nontraumatic diseases of the spleen between 1997 and 2000 were reviewed. The aim of the study was to evaluate the short-term outcomes of open and laparoscopic splenectomies and to determine whether some well-known benefits of laparoscopic surgery could be observed in patients who underwent laparoscopic splenectomy for nontraumatic splenic diseases. The data of 44 patients were available for analysis and included 20 patients (45.

Bilateral lumbar hernia associated with abdominal hernias. A case report.

Multiple abdominal hernias constitute a quite rare event in surgical practice. Lumbar hernias are even rarer and, to our knowledge, this is the first report in the English literature of its association with abdominal hernias. A case of multiple abdominal hernias, namely an epigastric hernia and a left inguinal hernia together with a bilateral lumbar hernia in a 65-year-old man attending the Out-patient department of Hoima Hospital-Uganda is described.

[Urogenital sequelae in surgery of rectal carcinoma].

Seventeen consecutive patients with rectal cancer underwent surgery at our institution between January 1988 and December 1990. The aim of this study was to assess the urogenital symptoms after radical resection of the rectum. Ten of these patients were suitable for the study, 9 of whom had an Anterior Resection (with colorectal anastomosis in 7 cases and with coloanal anastomosis in 2) and 1 a Miles operation.

[Acquired phimosis due to lichen sclerosus et atrophicus].

From January 1986 to December 1991, 6 cases of acquired phimosis secondary to balanitis xerotica obliterans were observed. The authors report their experience in the diagnosis and treatment of this disease. Five patients were treated with plastic of the foreskin, one was circumcised and treated with local instillation of corticoids.

[Reflux esophagitis. What factors influence the choice of antireflux surgery?].

The surgical goal of gastroesophageal reflux treatment is to restore the ability of antireflux barrier. The basal tone and the length of lower esophageal sphincter are commonly considered the most important factors in the assessment of gastroesophageal reflux symptoms. However, reflux symptoms may also occur after surgical correction of sphincter incompetence.