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A Liboni

Publications and source records attributed to A Liboni.

71 records · Page 4Linked to original sources
PubMedDate not supplied

[Malignancy: treatment and prognosis of gastrointestinal and pancreatic endocrine neoplasia: retrospective study of a series of 16 cases].

The aim of this study was to review our experience with endocrine tumours of the gastrointestinal tract and pancreas (ETGIP). Between February 1991 and March 2000, sixteen patients with ETGIP were operated on at our institution. Of these patients we reviewed preoperative symptoms, diagnostic techniques (ultrasound, CT, MRI, radiolabelled octreotide scintigraphy, angiography, immunohistochemical study), treatment (surgical operation, neoadjuvant and adjuvant chemotherapy, and radiometabolic therapy) and survival. Nine patients (56%) had a carcinoid tumour, three (19%) an unspecified endocrine tumour, and four (25%) an endocrine tumour associated with a non-endocrine neoplasm. Only five patients (31%) had a preoperative diagnosis of endocrine tumour. Eight patients (50%) had metastatic disease at the time of the operation. All patients without preoperative metastasis (eight patients, 50%) are still alive without recurrent disease, with a mean postoperative survival of 36 months (12-60 months). Of eight patients with metastatic disease, six (75%) died after a mean of 20.5 months (3-60 months) and two (25%) are still alive with the disease after 3 and 6 months, respectively. These data show that presence of metastasis strongly influence survival. Furthermore, survival of patients with metastatic disease seems to be longer as compared to other gastrointestinal tract malignancies. ETGIP are more common and aggressive than previously believed and, therefore, early diagnosis is crucial for cure. Nowadays, however, new diagnostic tools such as radiolabelled octreotide scintigraphy are available for diagnosis and postoperative follow-up. The optimal treatment for ETGIP is a multimodal approach with surgical operation, chemoradiation, radiometabolic, and genetic therapies.

Adult↗
PubMedDate not supplied

[The ideal length of hospital stay in the surgical treatment of colorectal cancer].

In order to verify the safety of an ideal length of hospital stay (5-6 days) after open colectomy, we reviewed complications after 371 consecutive, elective colorectal resections for cancer at our institution between April 1991 and December 1998. Specifically, age of the patient, length of hospital stay and when the complication was diagnosed were registered. The median postoperative hospital stay was 9 days (range, 4-34 days). No difference in length of hospital stay was detected in patients < or = 65 years old versus > 65 years old (P = NS). All major complications (anastomotic leak, intestinal bleeding, intestinal occlusion, pneumonia, pulmonary embolism, pulmonary edema, stroke, angina pectoris, and fascial dehiscence) were diagnosed before the fifth postoperative day (P < 0.05). Among the minor complications (vomiting, packed red blood cells transfusion, diarrhea, wound infection, urinary tract infection, and pleural effusion), none requiring hospitalization was detected later then 5 days after the operation. We conclude that postoperative length of stay after colorectal resection for cancer can be reduced safely to five to six days after the operation.

Adult↗
PubMedDate not supplied

[Emergency surgery for complicated colorectal cancer. Retrospective study].

INTRODUCTION: Emergency surgery for the complications of colorectal cancer poses a significant surgical problem with published mortality rates as hight as 25% to 30%. We reviewed the results of the analysis and quantification of the influence of complications on the outcome of the patients who underwent emergency colectomy for colorectal cancer. MATERIALS AND METHODS: Retrospective study of the clinical features from, a series of 63 patients operated on from 1991 to 1997 (12% of all colorectal cancer operations in the same period). The correlations between complications and cancer stages were estimated by the KW (ANOVA method). RESULTS: Fifty-three patients underwent colorectal resection for intestinal occlusion (84%), 5 for perforation (8%) and 5 for lower gastrointestinal bleeding (8%). When the cancer complications were correlated to the different cancer stage at operation, the complications rate were 32%, 32%, and 36% in the stage II, stage III, and stage IV, respectively. This data was statistically significant: (KW = 58, p = 0.0001). The overall mortality rate was 8% (5 patients) and the total postoperative morbity rate was 32% (21 patients). The overall 5-year, 3-year, and 1-year survival was 47%, 48%, and 76% respectively. CONCLUSIONS: Emergency surgery for complicated colorectal cancer can be performed safely with low postoperative morbidity and mortality rate and can be advocated to realize both short and long-term survival rates comparable to elective surgery; the KW test supports the hypothesis that the a complication in the natural history of colorectal cancer doesn't correlate with the stage of disease.

Adult↗
PubMedDate not supplied

The elongation of the internal carotid artery. Diagnosis and surgical treatment.

Cerebro-vascular insufficiency is rarely caused by an abnormal elongation of the internal carotid artery (the ratio is 15% to 17% of symptomatic patients). The anomalies can be defined as: tortuosity, when the artery has a "C" or "S" shape; coiling, when the elongation is more evident and the artery forms one or more loops; kinking, when there is a sharp angulation of the first portion of the internal carotid artery. The etiology of these peculiar arterial modifications seems to be related to a congenital basis which may become exaggerated with ageing of the artery. Surgical correction should include intra-arterial inspection (TEA) as well as eliminating the pathological elongation. The Authors presents their 9 cases surgical experience.

Carotid Arteries↗
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Medullary carcinoma of the thyroid. (Clinical and endocrinological features of six cases).

This paper presents the results of the study of six patients with medullary thyroid carcinoma (MCT) and the epidemiological screening carried out on the families of individuals affected by MCT. Three patients had the familial and three the sporadic type of disease. In all the subjects the plasma calcitonin (CT) level was measured under basal conditions and after pentagastrin stimulation. Patients with familial disease were also found to have pheochromocytoma (MEA syndrome). One patient, whose thyroid was normal to palpation and radioisotope scanning and who did not have an elevated resting level of CT, showed a clearcut CT elevation after provocative testing and subsequently was shown, by surgery, to have a small nodule of C-cell hyperplasia. These results confirm that pentagastrin is a good stimulator of CT secretion and that i.v. administration of pentagastrin is a useful test in the investigation of MCT in its early subclinical stage.

Adolescent↗
PubMedDate not supplied

[Video-laparoscopic splenectomy: experience in 3 cases].

BACKGROUND: In selected cases the spleen can be removed: METHODS: 2 women and 1 men with immune thrombocytopenic purpura, with hypersplenism without splenomegaly, underwent splenectomy by laparoscopic means. RESULTS: In 2 cases the splenectomy has been performed entirely by laparoscopic means. In 1 case the operation has been converted as we have not been able to control a venous bleeding from injured hilar spleen vessels. DISCUSSION: No particular technical problems arose in the 2 cases entirely conducted by laparoscopic means. Care must be taken manipulating the hilar vessels as the veins are fragile and their bleeding is difficult to be controlled in laparoscopy. The laparoscopic splenectomy seems to offer less postoperative pain, shorter hospitalization and improved cosmesis according to our previous experience with open splenectomy. CONCLUSIONS: The good result of the operations encourages the laparoscopic approach to splenectomy, in selected cases.

Adolescent↗
PubMedDate not supplied

[A new technique in positioning of Kehr's tube in laparoscopy].

The enlargement of the indications in the use of the laparoscopic technique puts the surgeon in front of the need to project new techniques and to improve new instruments daily. On one hand, the technique and instruments used to perform a video-laparoscopic cholecystectomy are codified. However, there is still a lot of work to do for the laparoscopic treatment of the common bile duct stones. The aim of the present scientific contribution is the exposition of an original methodology for the positioning of the T-tube in laparoscopy which would be a difficult manoeuvre otherwise.

Cholecystectomy, Laparoscopic↗
PubMedDate not supplied

[Video-assisted venous surgery].

The use of intraoperative angioscopy, till now utilized exclusively in arterial surgery, is now used also in venous surgery. From January 1992 54 patients underwent to video-guided venous surgery: 23 cases of external valvuloplasty of the sapheno-femoral junction (EV-SFJ), 25 cases of hemodynamic correction of varicose veins (French acronyms CHIVA), 5 cases of high ligation plus long saphenous vein intraoperative sclerotherapy (HL-IS) 1 case of sub-fascial perforators interruption (SPI), the only extraluminal videoguided procedure. We have used 3 different video-angioscopes: a 1 mm monofibroscopy let in a 6 Fr Fogarty catheter, a disposable 2,8 mm colangioscope and a 2,2 mm operative angioscope. For the perforators interruption we have utilised the thoracoscope. EV-SFJ: the angioscopy has confirmed the presence of normal valvular cusps in a dilated vein wall in 21 cases, so excluding 2 patients from the planned treatment. At the end of the operation the angioscope has verified the reapproach of valvular cusps. CHIVA: the angioscopy has allowed to identify the exact points of the superficial venous system which should be interrupted, according to the Franceschi's theory. This procedure can avoid the technical errors due to intraoperatory misleadings of the duplex mapping. HL-IS: consists of a classic high ligation followed by long saphenous vein intraoperative sclerotherapy. The angioscopy has allowed a complete deconnection of the long saphenous vein from tributaries and perforators. Furthermore has facilitate the proportional distribution of the sclerosing agent along the long saphenous vein. SPI: the videoassistance have permitted the identification of the insufficient perforating veins reducing their surgical exposures.(ABSTRACT TRUNCATED AT 250 WORDS)

Angioscopy↗
PubMedDate not supplied

[New directions in the surgical treatment of gastroesophageal reflux. Review of the literature].

The pathophysiology of gastroesophageal reflux disease (GERD) is often multifactorial, as abnormal function of the lower esophageal sphincter (LES) may be associated to abnormalities of the esophageal peristalsis, the esophageal clearance, and the gastric reservoir. The preoperative evaluation of patients with GERD must include esophageal function tests (esophageal manometry and ambulatory pH monitoring) and evaluation of the gastric emptying in addition to UGI series and endoscopy. The information provided by these tests is essential to identify the pathophysiology of the disease in the individual patient, and tailor the operative treatment accordingly. For patients with an incompetent LES but normal esophageal peristalsis, the Nissen fundoplication is the procedure of choice. When abnormal peristalsis and delayed clearance are identified by preoperative esophageal function tests, a partial fundoplication must be chosen in order to avoid postoperative dysphagia and gas bloat syndrome. Too many eponyms have been used to describe antireflux surgery (Nissen, Rossetti, Toupet, Lind, Hill, Guarner). It is time to go beyond these eponyms, and focus on the technical details which contribute to the stability of the wrap, as this is the main determinant of long term outcome.

Fundoplication↗