Short reports+frontesp96-98 - Acta Bio Medica Atenei Parmensis

106 Short Reports
Results: One hundred-twelve incisional hernias, 86
primary (M:31; F:55; mean age 60.4±9.44 yrs; range:
29-82 yrs) and 26 recurrent (M:10; F:16; mean age
62.1±12.3 yrs; range: 39-85 yrs), have been treated.
Overall, 37 patients were older than 65 years. Mean
hospital stay was 6.7±3.4 and 6.7±3.1 days for primary
and recurrent incisional hernia respectively. In the primary
group were observed 11/86 (12.7%) seromas,
5/86 (5.8%) hematomas and one sinus. No seroma or
hematoma has been found in the ULTRAPRO®
group. Recurrence rate was 3.4%. In the recurrent
group, 4/26 (15.3%) seromas, 1/26 (3.8%) hematomas
and 2/26 (7.6%) recurrences were observed. Discussion:
The employment of synthetic meshes for the treatment
of incisional hernia is, to date, a widely accepted
practice. Several types of meshes, with different composition
and structure (pore size, width, etc.) are now
available. Ultrapro ® mesh is a composite mesh (poliglecaprone-25
and polypropylene) which provides the
advantage to reduce the implanted permanent mass to
40%; its structure made by thinner filments creates a
macroporous structure which results to be more susceptible
to “tissue ingrowth”. Such mesh represents,
to our opinion, a balanced compromise between rigidity
which allows an easier mesh implantation, and
flexibility which provides an anatomic dynamic allocation.
The fixation of the mesh through a fibrin glue,
furthermore, allows a quick and homogeneous adhesion
of the prosthesis, so avoiding wrinkling, reducing
the incidence of seromas and hematomas and the need
of sutures and metal agraphes which could result, in
our opinion, in a lower incidence of postoperative
pain.
References
1. Kingsnorth A, Le Blanc K. Hernia: inguinal and incisional.
Lancet 2003; 362: 1561-71.
Cardiologic risk in patients over 75 years of age
undergoing pulmonary resection
A. Fiorello, G. Vicidomini, P. Laperuta, A. Perrone, M.
Santini
Department of Anesthesiology, Surgery and Emergency Medicine,
Thoracic Surgery Unit, University of Naples II, Naples,
Italy
Aims: Cardiocirculatory function testing is a fundamental
part of patient work-up prior to pulmonary
resection, particularly in individuals at risk (age >75
years or with cardio-respiratory deficiency). This
study aimed to assess the incidence of cardiac complications
in patients aged over 75. Materials and
methods: In the last 5 years, 457 patients underwent
pulmonary resection due to NSLC. The patients were
divided into 2 groups: Group A: 280 patients aged
between 65 and 75 (15.7% of the population (n=44)
presenting with underlying heart disease). Group B:
65 patients aged >75 years. (58.4% of the population
(n=38) presenting with underlying heart disease). All
the patients were examined clinically and given a basic
ECG with supplementary exercise test in the case
of ischemic heart disease. The electrocardiogram was
performed in the patients in Group A who were candidates
for a pneumonectomy, and in all the patients
in Group B. patients with increased pulmonary resistance
or significant coronary deficiency were subsequently
given a Myocardial Scintigraphy or Angiocardio-scintigraphy.
Lastly, the high cardiac risk patients
with respiratory functionality were catheterized.
Results: In Group A we detected 26 patients (9.2%)
with arrhythmia: 18 (69.2%) atrial fibrillation (7 with
previous atrial fibrillation), 5 (19.2%) atrial flutter (2
with previous flutter), 3 (11.6%) extrasystole. In
Group B we detected 23 patients (35.8%) with supraventricular
arrhythmia: 15 (65.21%) atrial fibrillation
(8 patients with previous arrhythmia), 5 (21.8%) atrial
flutter (1 with previous flutter), 3 (13%) extrasystole.
One patient in Group B died post-operatively due to
AMI. In Group A the incidence of supraventricular
arrhythmia was 68% after pneumonectomy, 18% after
bilobectomy, 11% after lobectomy and 3% after atypical
resection. In Group B the incidence of supraventricular
arrhythmia was 58% after pneumonectomy,
12% after bilobectomy, 15% after lobectomy and 15%
after atypical resection. We did not detect differences
in survival among the cardiac complication patients
with respect to the controls. Conclusions: Atrial fibrillation
was the most frequent cardiac complication; it
was reversible in all patients who did not have
arrhythmia prior to surgery. Important risk factors are:
age, pre-operative heart disease, extent of the pulmonary
resection, surgical procedure (opening of the pe-