Minerva chirurgica
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Review Case Reports
[Coarctation and hypoplasia of the abdominal aorta].
In this study we report one case of abdominal aortic coarctation of unknown etiology, probably congenital or connatal, and two cases of aortoiliac occlusion in young non-diabetic patients, with an intrinsically small aortoiliac tree. These syndromes usually appear in young age; the principal clinical features are arterial insufficiency involving the lower extremities, often well tolerated, and hypertension. ⋯ Echography and Doppler-echography can be helpful in the diagnosis, but intra arterial digital angiography is mandatory in confirming it. Medical therapy is usually unsuccessful, especially in controlling blood pressure, therefore surgery still remains the treatment of choice, together with PTA that can be applicable in selected cases.
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Reducing the quantitative level of bacterial contamination in an open, acute or chronic, soft tissue wound below the critical level of 10(5) bacteria per gram of viable tissue is essential to delayed primary closure. First step in the management of the contaminated or infected wound is accurate local debridement, preferably with pulsating jet irrigation. ⋯ Contrary to systemic antibiotics, these agents penetrate adequately into the open, granulating wound with a direct bacteriostatic or bactericidal action on a wide spectrum of gram positive and negative organisms, without the effect of local tissue injury typical of topical antiseptics. The use of topical antibacterials, traditionally confined to the treatment of the burn wound, the open "difficult" wound for excellence where control of local infection is first priority, provides a rapid local reduction of the bacterial level and paves the way to the final goal of primary delayed closure of the wound, either direct or with the use of grafts or local, distant, or free flaps.
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Review Case Reports
[The so-called spontaneous hematoma of the anterior rectus abdominis reproducing syndromes of acute surgical abdomen].
Personal experience of spontaneous haematoma on the anterior straight muscles of the abdomen over 15 years is reported. True spontaneous haematoma on the anterior straight muscles of the abdomen are extremely rare, even exceptional and must be distinguished from those haematomas, improperly called spontaneous that are, in fact, clearly traumatic in origin. Personal observation suggests that true spontaneous haematoma is the expression of a pathological rupture of the muscle and/or the epigastric blood vessels that in its turn reflects a serious basic pathology.