Excision and primary closure of pilonidal sinus using a drain for antiseptic wound flushing.

Background: In the case of pilonidus sinus treated with primary intention surgery the uneventful healing is still difficult to obtain, as indirectly proven by the number of different procedures that have been suggested, such as cyst excision with or without primary closure, excision followed by marsupialisation, and excision followed by skin flap transposition. The procedure described here involves excision and primary closure, with a drain being used to flush the operative cavity with an antiseptic solution.

Methods: Two hundred and forty-three patients (173 men and 70 women) were treated by excising the pilonidal sinus and placing a 12F suction drain at the base of the wound, with its tip being brought out in the left gluteal region at least 5 cm laterally to the lower end of the suture.

[A comparative evaluation of the efficacy of the excisional new attachment procedure (ENAP) relative to root planing in the etiological phase of periodontal therapy].

Background: In the present study, the effectiveness of root planing has been compared to the excisional new attachment procedure (ENAP) during the etiological phase of periodontal therapy, after the supragingival scaling, in order to establish if a technique offering an easy access to the subgingival areas could reduce the need for a surgical phase in the periodontal treatment.

Methods: Twenty-seven patients, affected by moderate periodontitis, participated in this study; in each of them root planing was performed in a half of the oral cavity (control site) and the ENAP in the other half (test site). The main clinical parameters of periodontal health (probing depth--PD-, attachment loss--AL-, plaque index--PlI- and gingival index--GI-) were evaluated before and 1, 2 and 6 months after the periodontal treatment.

Predictive factors for cholelithiasis complications.

Background: Cholelithiasis is a benign disease that is very frequently encountered throughout the world. Its surgical mortality is usually minimal (0.1%), but the risk is considerably greater (2-10%) in patients developing complications particularly if they are elderly.

Problematic bile duct stones: polyvalent treatment.

Background: The availability of different methods for the non-surgical treatment of complicated bile duct stones makes it possible to choose the most appropriate therapy on the basis of the particular characteristics of each individual case and a careful evaluation of their related risks/benefits/costs.

Methods: The present study involved 26 patients treated using different techniques; in some cases, after the failure of the first approach, one of the alternative treatments was adopted. Twenty-one of the patients had isolated stones that were large (> 20 mm in diameter: 11 cases), impacted (5) or upstream of a stenotic tract; five had multiple stones (two of whom had undergone previous biliodigestive anastomosis and two had Caroli's disease).

Treatment of intrahepatic calculi in Caroli's disease by non-invasive saline washout.

The case of a 59 year old pluriparous woman who underwent cholecystectomy and exploration of the main biliary pathway for cholecystic and common bile duct stones is described. Postoperative T-tube cholangiography showed a voluminous saccular dilatation stacked with calculi located on the left main hepatic duct. The patient was immediately transferred to our Centre, and a T-tube was used to introduce a guidewire/M 0.

In vitro study comparing the ability of mono-octanoin and mono-octanoin plus methyl tert-butyl ether to dissolve biliary stones.

This in vitro study compared the gallstone dissolution rates of mono-octanoin, mono-octanoin plus 10% distilled water, and mono-octanoin plus methyl tert-butyl ether 2:1. Sixteen stones were treated with each solvent at a slow perfusion rate of 3-4 ml/h and a rapid perfusion rate of 2.5 ml/30 min with 20-sec instillation/aspiration cycles, both with and without bile.

Long-term effects in bilio-digestive shunts.

Duodenogastric reflux (DGR) and its effects were studied in patients with bile stones, operated by various bilio-digestive by-pass techniques, and followed up for 13-73 months. Ten patients underwent cholecystectomy and choledochoduodenostomy (CD), eight cholecystectomy and transduodenal sphincteroplasty (TDS) and ten cholecystectomy and endoscopic papillotomy (EP). The control group consisted of eight patients who had undergone minor surgery.

Mono-octanoin and methyl tert-butyl ether mixture for bile duct stones.

A new litholytic mixture of mono-octanoin (MO) and methyl tert-butyl ether (MTBE) in a ratio of 2:1 (v/v) was employed in 42 patients with bile duct stones, 29 of them failures after papillotomy. Twenty-two of these patients had complicated stones. The new solvent mixture was given for 4-6 h/day and 2-3 ml were instilled every 30 min.

Selective and early increase of IL-1 inhibitors, IL-6 and cortisol after elective surgery.

After trauma, inflammatory, immunological and hormonal changes are well documented. Surgical intervention is a form of programmed trauma. Through the study of surgical patients, changes in early endogenous mediators of inflammation, immune response and tissue repair can be investigated.

[Treatment of residual and recurrent biliary calculi: the surgical option].

Retained and recurrent bile duct stones can be treated with a variety of non-surgical methods. The list includes endoscopic papillotomy, chemical dissolution, by T-tube extraction, percutaneous or extracorporeal lithotripsy. The various attempts at non-surgical therapy are described in two patients with retained bile duct stones before biliary clearance was achieved by re-operation.

Infusional therapy for post-surgical biliary stones.

A variety of effective non-surgical forms are used for dealing with retained and recurrent biliary stones. These are endoscopic papillotomy, infusional therapy, intraductal laser or electrohydraulic lithotripsy and extracorporeal shock waves. Saline washout or chemical stone dissolution is currently used in high-risk subjects or in cases in which endoscopic papillotomy fails.

Dissolution of bile duct stones with monooctanoin: in vitro study.

Mono-octanoin (Mo) is the drug of choice in the topical litholytic treatment of residual gallstones following cholecystectomy. Although this drug does not produce significant side effects, it requires a lengthy period of treatment (15-20 days). The purpose of this study was to verify the in vitro efficacy of the mixture Mo + 10% H2O vs pure Mo in human cholesterol stones.

[Pros and cons of chemical litholysis in bile duct calculi].

Chemical litholysis of biliary stones is currently performed using monooctanoin (Mo) and methyl tert-butyl ether (MTBE). These two solvents dissolve cholesterol gallstones at different speeds due to their viscosity, high for Mo (47 cps) and low for MTBE (0.2 cps).

[Primary therapy after radical removal of sinus pilonidal].

The successful closure of the operative wound after removal of the Sinus pilonidalis, is linked, in our opinion, to the application of certain measures that should be taken during surgery. Specifically: 1) careful haemostasis, 2) correct positioning of effective deep drainage with exit into the left gluteal region, 3) diligent suture of the deep layers, 4) correction of tension at operative wound level. Two-year follow-up of 29 of 32 operated patients did not reveal relapses.

[A new therapeutic approach to retained biliary calculi. Results in 6 patients].

A new three-phase therapeutical approach to retained biliary stones (RBS) is designed to shorten the long treatment times with Monooctanoin (Mo). In the first phase, the litholytic agent is infused to soften the stones. In the second one the calculi are crushed, and in the last complete elimination of the fragmentary stones into the duodenum is obtained after 1-2 flushings with ceruletide.

Unexpected dilatation of the common bile duct after methyl tertiary butyl ether (MTBE) in rabbits. Possible implications to findings in man.

Methyl tertiary butyl ether (MTBE) rapidly dissolves cholesterol gall stones in vitro and in vivo. To further characterise tolerability and safety of this aliphatic ether, either MTBE (1 ml/kg body wt daily for two days) or an equal amount of saline was infused into the common bile duct (CBD) of eight cholecystectomised rabbits. Transient vomiting, dyspnoea and somnolence developed during MTBE instillation.

Prevention of S-adenosylmethionine of estrogen-induced hepatobiliary toxicity in susceptible women.

Women with past histories of intrahepatic cholestasis of pregnancy (ICP) exhibit a congenital exaggerated sensitivity to estrogens, which may express as abnormal hepatic reactivity to oral contraceptive intake and increased risk of developing gallbladder disease. Since previous investigations have shown that S-adenosylmethionine (SAMe) is effective in antagonizing ICP, we wondered whether its administration to subjects with previous ICP could 1) protect them from a challenge with ethynylestradiol (EE) or 2) normalize the cholesterol saturation index (CSI). To test the first hypothesis, six women volunteered to receive EE (0.

Spontaneous and polyclonal Ig secretion by circulating B cells after surgery.

Abnormalities of the immune response are commonly observed after surgery. In many cases, they are part of a physiologic rather than of a pathologic response to trauma. In this study we show that after elective surgery in otherwise healthy subjects the B cell compartment is deeply affected, as documented by the appearance, 7 days after the intervention, of circulating lymphoblastoid B cells spontaneously secreting in vitro IgG and IgA antibodies.

Non-invasive treatment for retained common bile duct stones in patients with T tube in situ: saline washout after intravenous ceruletide.

The combination of ceruletide-induced relaxation of the sphincter of Oddi plus flushing with saline has recently been proposed as a novel procedure for the treatment of residual common bile duct (CBD) stones. In this study we have administered intravenous ceruletide (2 ng kg-1 body weight min-1 for 1 h) plus intraductal saline (800-3000 ml, infused at a rate that kept biliary pressure below 30 cmH2O) to a group of 14 patients. The treatment induced the passage of residual stones in 11 subjects (79 per cent) with complete clearance in 7 (50 per cent).