Minerva chirurgica
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Review Case Reports
[The ingestion of foreign bodies for the purpose of self-injury. The conservative treatment of 2 clinical cases].
Although not rare, the ingestion of foreign bodies becomes uncommon when it is done with intent to cause self-damage. When used for this purpose, foreign bodies usually take the form of liquid substances, such as caustic agents, detergents, poisons, etc. It is less rare in certain situations like psychiatric and prison settings. The author reports two cases of foreign bodies voluntarily swallowed by patients in prison.
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The authors report a case of urachal fistula diagnosed after repeated omphalitis, this disease was associated with coronal hypospadias. Diagnosis was done thanks to a fistulography; subsequently, during the operation, to evidence the fistula, this was injected with methylene blue, this expedient showed that the fistula was longer than that disclosed from fistulography. ⋯ After 5 years the patient is in perfect health. This case allowed some anatomic, clinical and semeiotic considerations.
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Case Reports
[Pneumoperitoneum caused by barotrauma. Laparoscopic approach to an unrecognized pathology].
Pneumoperitoneum as a complication of barotrauma is a rare condition due to mechanical ventilation. The diagnostic dilemma often leads to perform an exploratory laparotomy, with the suspect of perforation of a hollow viscus, that makes worse the prognosis of these patients. We describe three patients who developed pneumoperitoneum, secondary to barotrauma. In the last one the use of laparoscopy allowed us to avoid an useless laparotomy.
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Comparative Study
[Clinical and therapeutic aspects of stab and gunshot wounds].
In the last three years (1992-1995) 130 stab (114) and gunshot (16) wounds were observed at and admitted to the Emergency Surgical Department of Fatebenefratelli Hospital of Milan. We observed a high incidence of non-EEC patients (62%). Imaging devices (US and CT scan) and surgical minimally invasive procedures have reduced open surgery rate with a remarkable reduction in drawbacks and mortality.
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Five patients of a mean age of 76, have been submitted to combined vertebral and carotid artery revascularization for a severe vertebro-basilar insufficiency. Vertebral artery revascularization consisted of a transposition to the common carotid artery in one case and of a carotid-distal vertebral artery saphenous bypass graft. The associated carotid artery revascularization consisted of a carotid endarterectomy with patch in 4 cases and without patch in one case. ⋯ At 11 months mean follow-up, all revascularizations are patent. Combined carotid and vertebral artery surgery is effective in well selected cases, and it does not enhance the risk of the two operations performed separately. It also eliminate the possibility of failure of isolated carotid revascularization for vertebrobasilar symptoms.