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A M Farinon

Publications and source records attributed to A M Farinon.

52 records · Page 3Linked to original sources
PubMed1976

[Observations on the immediate and remote results of 112 internal biliary drainage operations].

The Authors report on the indications and result of 112 operations of internal biliary drainage performed in two distinct periods. In the first period (1960-1968) direct operations on the papilla were preferred (30 cases) as compared with biliary-digestive anastomoses (10 cases). From 1969 to 1974 the two types of operation were roughly equivalent. An analysis of post-operative mortality, complications and long-term outcome in 80 patients observed indicates a lower risk, a smaller possibility of relapse and, on the whole, better stable results for biliary-digestive anastomosis as compared with direct operations on the papilla, thus justifying the increasing favour accorded to them in the second period considered. The indications for the two types of operation are also analysed and stated, with stress on the importance of accurate intraoperative diagnosis.

Adult↗
PubMed1976

[Critical considerations on the use in instrumental divulsion of the papilla in surgery of the bile ducts. Long-term results in 103 cases].

With a view to carrying out a critical review of the use of instrumental divulsion in surgery of the bile ducts, a long-term follow-up was made, from one to 12 years after performance of this operation, in 103 out of 157 cases. An examination of the immediate results which were favourable, in contrast with those found at long-term, led to the conclusion that this procedure was of little use and it has now been dropped both in diagnostics and, with greater reson, in treatment of benign papillary stenosis.

Ampulla of Vater↗
PubMedDate not supplied

[Acute biliary pancreatitis].

Biliary pancreatitis is a major complication of gallstones (6-8%) and mainly affects patients with microlithiasis (22%) and cholesterolosis (29%) of the gallbladder. Transient or prolonged obstruction of the ampulla represents the accepted cause and severe forms of acute pancreatitis are more frequently associated with microlithiasis (21.3% vs. 9.6%) with higher incidence of mortality (6.5% vs. 3.2%) as compared with patients with cholelithiasis. The treatment of cholelithiasis and choledocholithiasis performed electively during the same admission, after manifestations of acute pancreatitis had subsided, is an effective procedure to prevent the development of recurrent attacks of pancreatitis. Removal of the gallbladder alone in most patients may represent the definitive treatment, most common bile duct stones passing spontaneously through the papilla during the first four days after admission. Laparoscopic cholecystectomy has gained wide acceptance in the treatment of cholelithiasis, but the management of associated choledocholithiasis results still undefined. Personal strategy is to adopt a more selective approach during the acute attack, limiting the performance of ERCP-ES within the first 48 hours to those patients presenting with laboratory and clinical evidence of ampullary obstruction. If choledocholithiasis is found during laparoscopic cholecystectomy, personal recommendation is to attempt the transcystic removal of stones; if this is not feasible, a conversion of the laparoscopic procedure to an open common bile dut exploration should be carried out. Postoperative ERCP-ES does not seem a reasonably strategy, while preoperative ERCP-ES with gallbladder left in situ as treatment alone of associated biliary tract lesions may be considered in high risk patients. The surgical treatment of pancreatic lesions should be reserved to those patients with extended and unmarked or infected pancreatic necrosis, and pancreatic abscess. Closed management (surgical debridement associated with continuous local lavage of the lesser sac) is recommended, while less frequently ventral open packing should be required.

Acute Disease↗
PubMedDate not supplied

[Tissue expression of carbohydrate antigen 19-9 (CA 19-9) in adenomatous lesions of the colorectum].

Serum levels of tumor markers almost not detectable in precancerous states or early cancer, the behavior of the tumor associated antigen CA 19-9 in colorectal carcinogenesis was analysed. In order to investigate the adenoma-carcinoma sequence, tissue antigenic expression was measured in adenomas, characterized by different size and histology, and compared with that found in normal colonic mucosa. Tissue content of CA 19-9 was determined by an immunoperoxidase technique (ABC-POD) in 88 colonic polyps, and correlated to the degree of histological dysplasia, and dimension of adenoma. Tissue content of CA 19-9 was also evaluated in non-adenomatous mucosa obtained by endoscopic biopsy. Among the 88 polyps, 50 showed the tubular histological type, while 31 resulted tubulovillous and 7 villous. High degree of dysplasia was present in 7 adenomas (7.9%) and focal carcinoma was observed in 6 (6.8%). Positivity for CA 19-9 was registered in 60.2% of adenomas. No correlation was found between tissue-CA 19-9 and degree of dysplasia, size of adenoma and villous component. However, a statistically significant correlation was observed between expression and cellular distribution of the antigen (chi 2 = 98.07, p < 0.00001). Our data confirmed CA 19-9 expression in adenomas, but it is unlikely this tissue antigen proves to be a reliable marker of adenoma-carcinoma sequence.

Adenoma↗
PubMedDate not supplied

Hyperthyroidism with concurrent thyroid cancer.

The occurrence of thyroid malignancy is considered a rare event in hyperthyroid patients. With the aim of assessing the clinical relevance of this association, we have analyzed the incidence of thyroid cancer in hyperthyroid patients treated by surgery. The incidence of thyroid cancer was retrospectively evaluated in 202 hyperthyroid patients who underwent thyroidectomy during a twenty-year period. A thyroid cancer was diagnosed in 12 cases (5.9 per cent). Histologic examination revealed the presence of papillary carcinoma in 9 cases, follicular carcinoma in 1 case and Hürthle cell carcinoma in 2 cases. The association between thyroid cancer and hyperthyroidism was more frequent in toxic adenomas (17.8 per cent) than in toxic diffuse (5.3 per cent) or multinodular goiters (1.7 per cent). In 8 patients they presented as an occult carcinoma (maximum diameter below 1 cm), but unfavourable histologic features, such as local invasiveness and multifocality, were found in 5 of them. Follow-up data indicate that all 12 patients are currently alive and apparently free of disease. Hyperthyroid patients, particularly those affected by toxic adenomas, should be carefully evaluated to exclude the presence of concurrent malignancy. A special attention should be made moreover to the presence of "occult" lesions that, in our study was characterized in a higher proportion (62.5 per cent) of cases, by unfavourable histologic features.

Adult↗
PubMedDate not supplied

Skeletal muscle and peripheral nerve changes caused by chronic arterial insufficiency--significance and clinical correlations--histological, histochemical and ultrastructural study.

A histological, histochemical and ultrastructural study on muscle changes in chronic arterial insufficiency has been carried out in 40 patients. Muscle biopsy probes were taken in each patient either from the gastrocnemius or rectus femoris. In 7 patients submitted for amputation of a lower limb due to a more severe vascular disease, specimens were also obtained from both the sciatic and sural nerve for light and electron microscopic study. Our findings confirm the previous histological, histochemical and ultrastructural data on chronic ischemia of the skeletal muscle, suggesting that muscle damage is mainly based on a neurogenic noxa initiated by an ischemic peripheral neuropathy. In addition, many morphologic features also show the presence of a primary myopathic noxa, possibly depending on the direct damage of the mitochondrial respiratory chain by the deficit of the muscle blood supply.

Adult↗
PubMedDate not supplied

Symptomatic non-parasitic congenital cysts of the liver.

Seven cases of symptomatic non-parasitic congenital cysts of the liver are reported. Preoperative correct diagnosis can be established with non-invasive examinations, essentially with echotomography. Laparoscopy can represent a decisive investigation, permitting the direct view of the cysts. Surgical treatment of non-parasitic congenital cysts is based upon the excision of the lesions when symptomatic; this is the only definitive treatment.

Aged↗
PubMedDate not supplied

[Intraoperative colonoscopy: current indications].

From January 1987 to December 1991, 37 patients underwent intraoperative colonoscopy for several indications; these latter can be summarized in the need to define the site or extension of the lesions treated or detected by endoscopy before surgery. This procedure is therefore necessary in those cases in whom intraoperative endoscopy is likely to be useful in planning the surgical treatment. The use of intraoperative colonoscopy should be however considered complementary, but not substitutive, of the preoperative colonoscopy.

Adult↗
PubMedDate not supplied

Major acute inflammatory complications of diverticular disease of the colon: planning of surgical management.

BACKGROUND/AIMS: The aim of this study was to determine the most appropriate surgical strategy in the management of patients with major inflammatory complications of colonic diverticular disease. MATERIALS AND METHODS: Out of 259 patients affected by complicated diverticular disease of the colon, 43 consecutive patients (16.6%) who underwent urgent or emergency surgical intervention for diverticular perforation during a 20-year period (1975-1994) were retrospectively analyzed. According to the changes in the surgical approach over the time, the series was divided into two groups: 1975-1985 group A (n = 23), 1986-1994 group B (n = 20). The clinical diagnosis was confirmed by operative and pathologic findings. RESULTS: Out of 43 patients, 11 underwent derivative procedure and 32 resection. There were no significant differences among the two groups of patients according to sex ratio and mean age. The overall percentage of patients in group B who underwent resective procedure (100%) was significantly greater in comparison with that in group A (52%) (p < 0.001). Colostomy and drainage was employed only during the first period (30%)(vs group B, p < 0.05) and the proportion of patients who underwent primary resection and anastomosis was significantly higher during the second period (45%) (vs group A, p < 0.05). CONCLUSIONS: It must be stressed that resection of the diseased segment at initial operation appears mandatory; one-stage procedure is indicated when infection is confined to the mesentery, while resection and anastomosis with covering colostomy (two-stage procedure) is preferable whenever peritoneal contamination has occurred. Hartmann's operation remains the procedure of choice in the patients presenting known impaired immunity or fecal contamination.

Abdominal Abscess↗
PubMedDate not supplied

Acute pseudo-obstruction of the colon (Ogilvie's syndrome): advances in management.

The management of the patients with acute pseudo-obstruction of the colon (APOC) still represents a matter of debate. To better evaluate and compare the effectiveness of various therapeutic approaches in the management of APOC 29 patients were considered. These were included according to three consecutive periods in: group A (1977-1982) concerning patients who underwent medical treatment alone (n = 8) or endoscopic (n = 4) and surgical (n = 1) decompression; group B (1983-1990) in which the management was based on simple endoscopic decompression (n = 10); group C (1991-1995) including patients in whom placement, under fluoroscopic control, of a tube in the cecum following endoscopic decompression was provided (n = 6). Mean time required for resolution of colonic distension was 2.3 (+/- 0.50 SD) days in patients who underwent endoscopic decompression and tube placement, as compared to 4.5 (+/- 2.47 SD) days in the group of patients treated either with conservative measures or simple endoscopic decompression (p = 0.04). No recurrence occurred after colonoscopic decompression and tube placement while colonic distension recurred in 4 of 14 patients managed by simple endoscopic decompression (0% vs. 28.6%, n.s.). Our experience showed that endoscopic decompression is an effective method, moreover if associated with the placement of an indwelling tube into the right colon. This method, for its easiness and safeness, besides its effectiveness in preventing the recurrence of colonic distension, may be surely considered an advance in the management of acute pseudo-obstruction of the colon.

Aged↗