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Biomedical subjects

A Lauro

Publications and source records attributed to A Lauro.

At least 37 records · Page 2Linked to original sources
PubMed2004

[Laparoscopic and general surgery guided by open interventional magnetic resonance].

Interventional magnetic resonance (IMR) machines have produced unique opportunity for image-guided surgery. The open configuration design and fast pulse sequence allow virtual real time intraoperative scanning to monitor the progress of a procedure, with new images produced every 1.5 sec. This may give greater appreciation of anatomy, especially deep to the 2-dimensional laparoscopic image, and hence increase safety, reduce procedure magnitude and increase confidence in tumour resection surgery. The aim of this paper was to investigate the feasibility of performing IMR-image-guided general surgery, especially in neoplastic and laparoscopic field, reporting a single center -- St. Mary's Hospital (London, UK) -- experience. Procedures were carried out in a Signa 0.5 T General Elettric SP10 Interventional MR (General Electric Medical Systems, Milwaukee, WI, USA) with magnet-compatible instruments (titanium alloy instruments, plastic retractors and ultrasonic driven scalpel) and under general anesthesia. There were performed 10 excision biopsies of palpable benign breast tumors (on female patients), 3 excisions of skin sarcoma (dermatofibrosarcoma protuberans), 1 right hemicolectomy and 2 laparoscopic cholecystectomies. The breast lesions were localized with pre- and postcontrast (intravenous gadolinium DPTA) sagittal and axial fast multiplanar spoiled gradient recalled conventional Signa sequences; preoperative real time fast gradient recalled sequences were also obtained using the flashpoint tracking device. During right hemicolectomy intraoperative single shot fast spin echo (SSFSE) and fast spoiled gradient recalled (FSPGR) imaging of right colon were performed after installation of 150 cc of water or 1% gadolinium solution, respectively, through a Foley catheter; imaging was also obtained in an attempt to identify mesenteric lymph nodes intraoperatively. Concerning laparoscopic procedures, magnetic devices (insufflator, light source) were positioned outside scan room, the tubing and light head being passed through penetration panels. Intraoperative MR-cholangiography was performed using fast spin echo (SSFSE) techniques with minimal intensity projection 3-dimensional reconstruction. About skin sarcomas, 2 of them were skin recurrences of previously surgically treated sarcomas (all of them received preoperative biopsy) and the extent of the lesion was then determined using short tau inversion recovery (STIR) sequence. The skin was closed in each case without need for any plastic reconstruction. The breast lesions were visualized with both Signa and real-time imaging and all enhanced with contrast: 2 (20%) were visualized only after contrast enhancement; intraoperative real time imaging clearly demonstrated a resection margin in all cases. Maximum dimensions of breast specimens (range 8-50 mm, median 24.5 mm) were not significantly different from those measured by Signa (p>0.17, Student's paired t-test) or real time images (p>0.4): also there was no significant difference in lesion size between Signa and real time images (p>0.25). All postprocedure scans clearly demonstrated complete excision. The extent of the tumor at MR imaging was greater in each case than suggested by clinical examination. Adequate resection margins were planned using STIR sequences. Histological examination confirmed clear surgical margins of at least 1 cm in each case. During right hemicolectomy, both intraoperative SSFSE and FSPGR contrast imaging revealed the lesion and details of the colonic surface; imaging of the lymph node draining right colon was only partially successful, due to movement artifact. Concerning laparoscopic procedures, both FSE and SSFSE techniques produced reasonable images of the gallbladder and intrahepatic ducts, but the FSE imaging was of poor quality due to respiration artifact; however, SSFSE allowed visualization of the gallbladder and part of the common bile duct. About skin sarcomas, the extent of the tumor at MR imaging was greater in each case than suggested by clinical examination and in each case the complete tumor excision was confirmed. Histological examination confirmed clear surgical margins of at least 1 cm in each case. Intraoperative MR scanning reliably identifies palpable breast tumours and skin sarcomas and is sufficiently accurate to guide their surgical excision. Further work may be done to develop laparoscopic and open abdominal surgery as well.

Anesthesia, General↗
PubMed2004

[Laparoscopic treatment for Crohn's disease].

AIM: Several studies have demonstrated the feasibility and safety of laparoscopic surgery for Crohn's disease. A trend towards less morbidity as compared to laparotomy has been suggested. However, problems noted early in the experience may have prevented the optimal benefit from having been conferred. Accordingly, the aim of this study was to evaluate perioperatively those patients. METHODS: All 51 patients with Crohn's disease who underwent an intestinal resection at Cleveland Clinic Florida between January 1997 and December 1998 were analyzed. RESULTS: Seventeen patients underwent laparoscopic treatment: there were no significant differences between the 2 groups as to age, gender, incidences of comorbidity, prior laparotomy, or the use of anti-inflammatory and immunosuppressive agents. Similarly, there were no significant differences between the 2 groups as to either surgical indication, intraoperative findings, or procedure performed. Moreover, there were no significant differences concerning total anesthetic time or surgical operative time, the incidence of intraoperative morbidity or need for enterolysis or stoma construction, use of intraoperative endoscopy, or need for transfusion. Significant differences were noted in the duration of patient controlled analgesic usage (3.1 days in the laparoscopic group vs 3.9 days, respectively; p = 0.03), the incidence of postoperative morbidity (7/17 patients in the laparoscopic group vs 27/34 patients: p = 0.01), and length of hospital stay (6.4 days in the laparoscopic group vs 9.6 days, respectively; p = 0.05). CONCLUSIONS: In this retrospective cohort comparative study, laparoscopic intestinal resection for Crohn's disease, when compared to laparotomy, was associated with a short duration of patient controlled analgesic usage, a lower incidence of postoperative morbidity and a shorter hospital stay, without significantly increased operative time.

Adult↗
PubMed2003

Changes in serum electrolytes during treatment of patients in liver failure with molecular adsorbent recirculating system.

PURPOSE: To study the effect of MARS on serum electrolytes during liver failure. DESIGN: Twenty-three patients admitted to a quaternary health care facility from September 2000 to May 2002, 22 adults and 1 child, 11 males (48%) and 12 females (52%), age 15-70 (median 53), treated with MARS for: 12 acute-on-chronic liver failure (52%); 4 fulminant hepatic failure (17%); 3 intractable pruritus (13%); 2 primary-non-function (9%); 2 following major liver resection (9%). PROCEDURES: Sodium, potassium, chloride, phosphorus, calcium, and magnesium were measured in the serum, ultrafiltrate and albumin circuit before and after MARS. STATISTICAL METHODS: A comparison of electrolyte concentrations, before and after MARS, was performed using a paired t test. MAIN FINDINGS: Serum electrolyte concentrations before and after MARS, while statistically significant in some cases, were very small, and of no clinical relevance. CONCLUSION: MARS exchanges potassium, chloride, calcium, and magnesium by ultrafiltration; sodium by the albumin dialysis.

Adolescent↗
PubMed2003

[Living donor liver transplantation, adult to adult].

AIM: Since living donor liver transplantation (LDLT) can offer a viable response to the lack of transplantable cadaveric organs, our center instituted an LDLT program in 2001. METHODS: The authors report their experience with the first 35 LDLT procedures successfully completed at the Liver and Multiorgan Transplant Center of the University of Modena between 9 May 2001 and 21 May 2003. The case series comprised 35 patients, 7 of which received a left-half liver and 1 a left lobe. RESULTS: The global survival rate was 77.2% (27 out of 35 patients), with a mean follow-up period of 295 days; the survival rate at 1 year was 81%. In 4 cases (11%) retransplantation was performed. The donor demographics are described; all donors returned to their normal activities before transplantation, after a mean follow-up period of 373 days. No intraoperative complications were experienced by the donors, whereas during the postoperative period, 2 donors (5.7%) developed major complications (1 biliary fistula on the cut surface, 1 stenosis of the main bile duct). CONCLUSION: Our study shows that LDLT can be safely completed in the donor, with good results achieved in the recipient as well. Underlying these results is the accurate pretransplant assessment that continued into the operation itself. Even more important was the demonstrated ability and experience of the surgical team to attain results in the donor which we believe are necessary for carrying forth a LDLT program.

Adolescent↗
PubMed2003

[Laparoscopic surgery for endoscopically irretrievable colonic polyps].

AIM: The vast majority of benign colorectal neoplasms can be safely removed by colonoscopic polypectomy; while peduncolated polyps can be easily endoscopically excised, the removal of sessile polyps may be more difficult. METHODS: Between January 1997 and December 1998, 12 patients underwent laparoscopic or laparoscopic-assisted colonic resection for treatment of endoscopically irretrievable colonic polyps; this group was compared to 12 patients who underwent a laparotomic approach for polyps in the same period of time and to 23 patients who previously underwent similar laparoscopic resections. RESULTS: There were no significant differences between laparoscopic and laparotomic groups. CONCLUSION: Laparoscopic or laparoscopic-assisted colonic resection for treatment of endoscopically irretrievable colonic polyps remains our preferred method of treating these lesions.

Aged↗
PubMed2002

[Laparoscopic surgery for colon diverticulitis].

BACKGROUND: Laparoscopic surgery is used with increasing frequency to treat colorectal pathologies and some groups have also attempted to treat the complicated forms of diverticulitis (abscesses and/or fistulas). The results reported in the international literature are still controversial, especially in terms of the duration of surgery, the frequency of laparotomic conversions and postoperative morbidity. The aim of this study was to analyse the results of laparoscopic or laparotomic treatment of diverticular disease of the colon in patients admitted to the Department of Colorectal Surgery at the Cleveland Clinic in Florida over a three-year period. METHODS: A retrospective analysis was made of 57 patients with diverticular disease of the colon who were admitted to CCF (Cleveland Clinic Florida) between January 1996 and December 1998 and underwent elective laparoscopic or laparotomic surgery. A comparative analysis was made of the results in the two groups. RESULTS: Of the 57 patients treated only 15 underwent laparoscopic surgery; the majority were treated for uncomplicated diverticulitis. 22 out of 42 patients (53%) undergoing laparotomic surgery presented complicated diverticulitis (abscesses, fistulas or stenosis), whereas 12 out of 15 patients undergoing laparoscopic surgery (80%) were treated for uncomplicated diverticulitis. Statistically significant differences were found in relation to the duration of surgery: 152 min in the laparotomic group vs 209 in the laparoscopic group. No differences were found in the frequency of intraoperative complications, transfusions and the number of drainages inserted (p=0.66). The postoperative period showed significant differences in terms of the reappearance of intestinal peristalsis, use of PCA and postoperative stay. CONCLUSIONS: This retrospective study confirms that the laparoscopic treatment of colon diverticulitis offers a number of advantages: reduced postoperative pain, more rapid recovery of intestinal peristalsis and shorter postoperative stay. Laparoscopic sigma colectomy represents the treatment of choice for diverticulitis in uncomplicated cases.

Aged↗
PubMed2001

Spontaneous gram-negative cellulitis in a liver transplant recipient.

A 47-year-old liver transplant recipient developed fever and cellulitis on the 8th post-transplant day. The clinical appearances were of a rapidly advancing cellulitis. The patient had a past history of severe peripheral edema and hypoalbuminemia. Blood cultures and skin biopsy grew Escherichia coli. To our knowledge, this is the first reported case of E. coli cellulitis in a liver transplant recipient. However, cases have previously been described in patients with cirrhosis or idiopathic nephritic syndrome, conditions which share predisposing features of peripheral edema and hypoalbuminemia. Bacteremic gram-negative cellulitis should be considered in compromised patients with unusual presentations of cellulitis.

Biopsy↗
PubMed2001

The hepatic artery in liver transplantation and surgery: vascular anomalies in 701 cases.

The purpose of this study is to report the variations in hepatic arterial supply of a mixed population of organ donors in which the anatomy was individually examined during the bench surgery, and patients who underwent a selective angiogram of the celiac axis and superior mesenteric artery. We reviewed the donor forms and/or angiograms of 701 patients. The donor forms were completed personally by one of the authors, while all the radiology images were obtained through studies performed by one single radiologist. The arterial anatomy was anomalous in 296 out of 701 cases with an overall incidence of hepatic artery anomalies of 42.22%. In this paper we describe previously unreported arterial anomalies of the hepatic artery, collecting the second largest series of hepatic artery anatomical variations of the English literature. This anatomical update can be useful for transplant and general surgeons, as well as vascular radiologists.

Female↗
PubMed2001

Malignant fibrous histiocytoma of the gallbladder: case report and review of the literature.

Malignant fibrous histiocytoma is a soft tissue sarcoma of mesenchymal origin. It can rarely present as a primary gallbladder tumor with only five cases having been reported to date in the English literature. Here we report the sixth documented case of malignant fibrous histiocytoma of the gallbladder, and we review all other cases reported. The outcome of the visceral sarcomas is poor when compared with tumors arising from the soft tissues. The treatment of primary malignant fibrous histiocytomas of the gallbladder is surgery. However, tumor recurrence is the norm even if wide clean margins are obtained. In contrast to tumors arising from the extremities the role of adjuvant radiotherapy and chemotherapy is less clear in the case of retroperitoneal and visceral sarcomas. Our patient is still alive and free of disease 46 weeks after surgery. The fact that this is the longest survival reported to date underscores the dismal prognosis of this disease.

Aged↗
PubMed1999

[Splenic pseudoaneurysms following acute pancreatitis].

Splenic artery pseudoaneurysms are the most common of visceral artery pseudoaneurysms. Splenic pseudoaneurysms appear to have developed as a consequence of inflammatory processes adjacent to the splenic artery, particularly acute pancreatitis and chronic pancreatitis with associated pseudocysts. They are often asymptomatic and picked up on abdominal examination for ultrasound or CT scanning for other conditions. Complications include rupture with retroperitoneal hemorrhage or intraperitoneal hemorrhage. Two cases of splenic pseudoaneurysms, following acute pancreatitis, are reported between the years 1987 and 1996.

Adult↗
PubMed1999

Hepatoid carcinoma of the stomach: is it still an unusual anatomo-clinical entity? Six cases-report.

Hepatoid carcinoma of the stomach is a rare neoplasm (especially in western countries) characterized by high levels of serum alpha-fetoprotein (AFP), the presence of "hepatoid foci" inside the gastric tumor and poor prognosis, due to the earlier onset of liver metastases. We treated six patients for hepatoid carcinoma of the stomach between 1990 and 1997. The female to male ratio was 1:1, the average age was 71 (54-81) and the average AFP-level was 1160 ng/ml (603-1531). We performed 2 total gastrectomies, 2 subtotal gastrectomies and 2 gastro-jejunostomies (due to presence of liver metastases): in one case, the patient underwent a splenectomy as well. All the tumors showed the presence of "hepatoid foci" (the morphological feature is close to the hepatocellular carcinoma) and a positive immunoreactivity to AFP. The mean survival was 3 months: only one patient is still alive and disease-free (with a 52 months follow-up). After radical surgery, she underwent a chemotherapic treatment with cisplatin, epirubicin, 5-fluorouracil and l-leucovorin. We conclude that our series (the widest in Italy and one of most impressive in Europe) confirm the poor prognosis of this neoplasm, but we also want to underline that this tumor is not so "unusual" any more and it requires new types of treatment, like postoperative chemotherapy, besides surgery, to be fighted properly.

Aged↗
PubMed1998

Prevalence and distribution of incompetent perforating veins in chronic venous insufficiency.

PURPOSE: The purpose of this study was the investigation of the prevalence and distribution of incompetent perforating veins (IPVs) in patients with different classes of chronic venous insufficiency (CVI) as defined by the updated clinical, etiologic, anatomic, and pathologic classification (CEAP) in relation to the pattern and the extent of venous reflux. MATERIAL AND METHODS: The study included 468 limbs of 330 subjects who ranged in age from 18 to 101 years (median, 49 years). The investigation entailed a medical history, a clinical examination, and color flow duplex imaging of the lower limb veins, which were performed by the same vascular surgeon operator. The patients were classified into 7 clinical classes according to CEAP. The superficial and deep venous systems were scanned, with an emphasis on the detection of IPVs. Venous reflux was considered abnormal when its duration exceeded 0.5 seconds. IPVs were classified as medial, posterior, and anterolateral in the upper, middle, or lower third of the thigh or calf (9 thigh and 9 calf fields). RESULTS: The IPVs were found mainly in the medial aspect, more frequently in the middle third of calf, followed by the lower calf and the middle thigh. IPVs were rare in the lateral aspect of the thigh, the medial upper and posterior lower thigh and the posterior upper and lower calf. The prevalence of the IPVs and of deep vein incompetence increased significantly with the clinical severity of CVI (r =.95, P <.01, and r =.9, P <.01, respectively). In the limbs with a documented perforating vein (PV) incompetence, the ratios of calf-to-thigh IPVs and of superficial-and-deep (S + D) over superficial-alone (S; [S + D]/S] venous incompetence increase significantly (r =.87, P <.01 and r =.9, P <.01, respectively) with CEAP grade. The prevalence of reflux involving all systems (S + D + PV) increases significantly (r =.9, P <.01) with clinical severity. In legs with CVI of CEAP 2 to 6, reflux was invariably proximal (thigh) and distal (below knee). CONCLUSION: In CVI, IPVs are located predominately in the medial aspect of the lower extremity, more often in the middle third of the calf, followed by the lower calf and middle thigh. The prevalence of IPVs and their calf-to-thigh ratio increase linearly with the clinical severity of CVI. Both the prevalence of deep vein incompetence and the ratio of superficial and deep to superficial ([S + D]/S) increase linearly with CEAP classification. These findings support the significant relationship between deep venous reflux and PV incompetence, although the latter may exist in the absence of the former. In CEAP classes 2 to 6, reflux is invariably proximal and distal. Incompetence involving all systems (S + D + PV) increases in prevalence with the severity of CVI.

Adolescent↗
PubMed1997

["Hepatoid" gastric tumor].

In this study the Authors describe two cases of hepatoid adenocarcinoma of the stomach: one is characterized by the presence of alpha-fetoprotein (AFP) high levels of the serum both pre and post-operating and by the very positive response to the adjuvant chemotherapy (how the return to the normality of such values demonstrates). The other is instead characterized by the presence of post operating hepatic metastasis, event which is very frequent in this kind of neoplasm, but presents many problems concerning the differential histological diagnostics with the primitive hepatocarcinoma (problems which are nowadays not completely solved). Moreover the Authors relate to this study the revision of the international literature of the main characteristics and of prognosis of this particular and rare neoplasm.

Adenocarcinoma↗
PubMed1987

Efficacy of diltiazem in variant angina. Results of a double-blind crossover study in CCU by Holter monitoring. The possible occurrence of a withdrawal syndrome.

The short and long term efficacy of diltiazem, a calcium-entry blocker, has been evaluated in a group of ten patients with Prinzmetal's variant angina admitted to a CCU. In the short term part of the study, after a run-in period, diltiazem 60 mg tid and placebo were administered alternatively during 4 randomized 72 hour periods. Response was assessed using continuous Holter monitoring, measuring the frequency of transient ischemic attacks. During the run-in period the number of episodes/day/patient was 16.1. No episodes of transient ST segment elevation were recorded during both periods of diltiazem treatment in 3 patients and during one of the two periods in 4. For the group as a whole the number of episodes during the first placebo period was not statistically different from that during the run-in period (208 versus 161). No statistically significant difference was also found in 8 patients comparing the number of episodes during the second placebo period and the run-in period (166 versus 101). During each period of diltiazem treatment an highly significant reduction in the number of episodes was observed (43 and 5, p = .006 and p = .02). Two patients did not complete the study protocol. Both patients had a worsening of angina during the first placebo period following diltiazem treatment. One of them developed an acute myocardial infarction. The possible occurrence of a rebound phenomenon after withdrawal of diltiazem seems to be indicated, in 6 patients, by a significant increase in the number of ischemic episodes recorded during the placebo period following active treatment in respect to the number during the first placebo period (159 versus 73, p = .04).(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMedDate not supplied

The cardiogenic syncope in the elderly: a review on the epidemiology and social costs.

Although syncope is a common clinical problem in the elderly, little is known of its epidemiology and social costs. According to some epidemiological enquiries, syncope is responsible for 3% of emergency room visits and for 6% of the medical admissions in general hospitals. Although some types of syncope are benign and self-limited, those of traumatic origin with abrupt loss of consciousness represent a considerable morbidity, particularly in elderly patients. The prevalence in 10 years was of 23%, with an annual occurrence of 6-7% and a recurrence rate of 30%. Despite accurate investigations, syncope remains unexplained in about 50% of the patients. The first year mortality for cardiac syncope is 20-30%, against 5% for non-cardiac causes and 10% for syncope of unknown origin. Sudden death occurred in 17% of cardiac syncope cases. An approximate cost analysis can be obtained through the survey of costs relative to the length of the hospitalization and to the number of the main diagnostic tests applied. It must be underlined, however, that the clinical history and physical examination supply the most important contribution to the diagnosis in old patients, and these often are more than sufficient to suggest the suitable choice among the instrumental tests to be applied; this approach helps considerably to reduce the hospital costs.

Journal Article↗
PubMedDate not supplied

Kidney transplantation combined with other organs: experience of Bologna s. Orsola hospital.

AIM: We report a series of patients who underwent combined heart-kidney transplantation (CHKT) and combines liver-kidney transplantation (CLKT) at a single center. METHODS: From January 1997 to October 2004, 13 CLKT and 2 CHKT were performed. The CLKT indications were as follows: polycystic disease (2), kidney polycystic disease associated with Caroli (1) and cirrhosis-hepatitis C virus (HCVs) (1), chronic glomerulonephritis with cirrhosis-HCV (4), and other diseases (5). From December 2003 to October 2004, 2 patients underwent CHKT for idiopathic cardiomyopathy plus glomerulonephritis and ischemic cardiomyopathy associated with vascular nephritis. RESULTS: In the CLKT group, 1 patient had acute rejection involving both liver and kidney grafts, whereas 1 patient had liver rejection and another 1 had kidney rejection alone. Of the 13 patients, 10 are alive with a mean survival of 583 days (range, 36-2688 days); 2 patients died within 1 month of transplantation (both with polycystic disease) due to ARDS and MOF. Another patient died 6 years and 9 months after CLKT of metastasis from a de novo tumor. In the CHKT group, no patient suffered heart-kidney rejection. They are all alive at 333 and 116 days, with heart and kidney allografts functioning well. CONCLUSION: In the CLKT group, the worst results were for patients with polycystic disease, in whom a more rigorous selection is necessary because of greater technical difficulties. For the remaining patients we had acceptable complications and excellent long-term results. In selected cases, CHKT can provide long-term graft function and patient survival. Our experience indicates that end-stage kidney failure combined with liver or heart failure does not necessarily preclude dual-organ transplantation.

Adult↗