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Biomedical subjects

A Mambrini

Publications and source records attributed to A Mambrini.

At least 37 records · Page 2Linked to original sources
PubMed1996

[Treatment of postoperative abdominal eventrations with a resorbable prosthesis. Apropos of 160 cases].

We reviewed retrospectively a series of eventrations treated with a nonresorbable prosthesis. Most of the eventrations occurred after medial laparotomies (83.7%), predominantly with sub-umbilical incision (42.5%) and often after gynecological or biliary surgery (31.9 and 27.5% respectively). Predisposing factors were obesity (38.1%) and post-operative infection of the suture (21%). Delay to eventration was 5.5 years (range 1 to 30 years). In 17% of the cases recurrent eventration was seen after one or more cures (maximum of 5). The prosthesis was always positioned behind the muscle, either ventrally to the posterior sheath of the rectus abdominis or directly in a properitoneal position. Resorbable U sutures (41.2%) or stapling were used. There was one post-operative death due to massive pulmonary embolism on day 10. Morbidity was 8.1% (4 respiratory complications, 4 pulmonary embolisms, 1 intestinal occlusion due to loop agglutination, 9 hematomas including 6 requiring reoperation). There were also 11 cases of infection of the suture with 3 involving the prosthesis. Long-term follow-up of 149 patients (93.1%) revealed on death related to former repair.

Adult↗
PubMed1996

[Mesenteric-portal thrombosis after hematologic splenectomy].

Venous thrombosis of the portal system following splenectomy for haematological diseases is uncommon, being reported with an incidence of 0.2 to 6%. Diagnosis may be difficult and the clinical presentation varies greatly. We report 4 cases, included in a consecutive series of 350 splenectomies for hematological diseases. Case 1: a man of 22 years, operated on for autoimmune hemolytic anemia developed severe and generalized abdominal pain 20 days after splenectomy. The coeliac arteriography showed a thrombosis of the portal system. The laparotomy revealed segmentary small bowel necrosis. Outcome after intestinal resection was uneventful. Case 2: a man of 56 years, operated on for essential thrombocythemia had the laboratory findings of acute hepatic failure 28 days after splenectomy. Doppler ultrasonography revealed a portal vein thrombosis. He was treated with heparin. Case 3: a man of 69 years, operated on for acquired idiopathic anemia, developed asthenia and fever 23 days after splenectomy. The ultrasonography showed a portal vein thrombosis. He was successfully treated with heparin. Case 4: a man of 20 years, operated on for Minkowsky-Chauffard hemolytic anemia developed a severe and generalized abdominal pain and fever 13 days after splenectomy. The CT-scan showed a thrombosis of the portal system. Outcome after thrombectomy and regional thrombolysis was uneventful. The aim of this presentation is to review the pathophysiological diagnosis, therapeutic and prophylactic aspects of this serious complication of splenectomy.

Adult↗
PubMed1995

[Rupture of the diaphragm in closed traumas: apropos of 28 cases].

Twenty-eight cases of ruptured diaphragm due to blunt trauma are reported, including three with rupture on the right. Most of the patients were young men and rupture was an isolated lesion in only 6 patients, all others having multiple trauma. One patient died during surgery (3.6%) and complications, mostly respiratory, occurred in 17 patients (60.7%). Mid-term functional digestive and respiratory sequellae were evaluated. The gravity of ruptured diaphragm is basically related to the severity of the trauma and associated lesions. The diagnosis remains unrecognized in an important number of cases emphasizing the importance of repeated chest X-rays.

Abdominal Injuries↗
PubMed1994

[Current approaches in the medical treatment of advanced ovarian carcinoma].

Ovarian cancer is most frequently diagnosed at an advanced stage. In recent years there has been intense interest in the chemotherapy of this disease. About cisplatin, the most active agent in the treatment of advanced ovarian cancer, some questions are only partially answered, as the optimal dose, the duration of treatment, the role of ciplatin-based two-, three-, or four-drug regimens, the role of intraperitoneal therapy, the use of old and new drugs in cisplatin-resistant patients. Carboplatin is currently the most important cisplatin analogue with a toxicity pattern very different from that of the parent compound, but, up to date, the combination of these two drugs does not seem to be any better than standard chemotherapy. Among new drugs, three deserve particular attention: taxol, a natural produce from the bark of the Pacific yew Taxus brevifolia, taxotere, a taxoid obtained by semisynthesis from the needles of the European yew Taxus baccata and gemcitabine, a cytostatic agent with a close resemblance to cytosine-arabinoside. Anyway, new approaches must continue to be sought too: among these, probably gene therapy may offer the best mechanism to overcome both intrinsic and acquired drug resistance.

Female↗
PubMed1994

[Acute cholecystitis in the elderly].

We retrospectively studied 150 patients aged over 65 years who had been operated for acute cholecystitis in order to define the surgical results and evaluate this treatment as a function of age. The patients were divided into two groups. Group I included patients between the age of 65 and 79 years, n = 99 (53 males and 46 females). Group II included patients aged 80 years and over, n = 51 (14 males and 37 females). The data were compared with the chi 2 test and the Kruskall and Wallis test. Associated affections were observed in 69 patients in group I and in 36 patients in group II (NS). The clinical picture was similar in the 2 groups with manifestations of pain in the right hypochondral region (group I, n = 97; group II, n = 50), fever (group I, n = 73; group 2, n = 38) and abdominal defence (group I, n = 62; group II, n = 35). Echography revealed the diagnosis in almost all cases in both groups. There was no statistical difference between the two groups in terms of mean operative delay and length of hospital stay. Age increased significantly the risk of exploration of the main bile duct (group I, n = 14; group II, n = 15, p < 0.05). Nevertheless, this exploration did not affect post-operative follow-up. Mortality was 6.7% with 4 deaths in group I and 6% in group II (NS). Post-operative complications were observed in 36 patients in group I and 28 in group II (p < 0.05) (43% overall including deaths).(ABSTRACT TRUNCATED AT 250 WORDS)

Acute Disease↗
PubMed1994

[Intestinal-mesenteric lesions of closed abdominal traumas].

A retrospective series of 24 intestinomesenteric lesions after blunt abdominal trauma were investigated to determine the distribution of the lesions as a function of the type of accident and to establish diagnostic and therapeutic patterns based on observed post-operative results. The chi squared test was used for statistical analysis. There were 20 men and 4 women, mean age 39 +/- 15 years (range 17-74). Trauma was caused by a traffic accident in 16 cases (67%) including 12 victims under 40 (p < 0.01) and 14 drivers (87.5%) (12 wore a safety belt). Haemodynamic instability or generalized abdominal defense. Pneumoperitoneum was seen on only one of the 21 (5%) admission X-rays. Abdominal echography was often ordered (16 times). The mean interval between trauma and surgical intervention was 39 hours. Injury involved the mesentery (n = 15), the small intestine (n = 14), the colon (n = 7) and the colic mesenteriolum (n = 4). Lesions of the colon were observed more often in automobile accidents (p < 0.05). Injury to other abdominal organs was also observed in 12 patients: liver (n = 6), spleen (n = 5) and pancreas (n = 5). The thorax was involved in 14 patients including 11 under 40 (p < 0.01). Nine intestinal resections/anastomoses, 9 enterroaphies (including 4 colic injuries) and 1 Hartman were performed. Two patients died (8.3%) and follow-up was complicated in 14 (including the 2 deaths). Wearing the safety belt did not affect the greater number of intestinomesenteric lesions. In subjects wearing a safety belt, there were more injuries of the thorax but less neurological involvement.(ABSTRACT TRUNCATED AT 250 WORDS)

Abdominal Injuries↗
PubMed1994

[Epidermoid cysts of the spleen. Apropos of two cases: review of the literature].

Benign cysts of the spleen (excepting parasites) are rare. Less than 10% of the cases involve epidermoid cysts, as the two cases reported here. These lesions are often asymptomatic and can lead unspecific clinical manifestations. The diagnosis is based on echography and abdominal computed tomography. Generally, imagery can eliminate a hydatic cyst of the spleen but cannot differentiate between different types of non-parasite cysts. Major complications including rupture and intracystic haemorrhage, malignant transformation and the impossibility of obtaining a preoperative histological diagnosis make surgery the only possible treatment. A conservative approach with partial splenectomy is the usual option, but total splenectomy may be required. The question of whether surgery is always necessary for small asymptomatic cysts of the spleen in under debate. Certain authors suggest that only regular echographic monitoring is necessary.

Adolescent↗
PubMed1994

[Pregnancy in the uterine horn after total salpingectomy].

The authors report a case of pregnancy of the uterine horn occurring after total salpingectomy, i.e. including resection of the intramural portion of the tube. They identify the epidemiological, pathophysiological and clinical features of this complication with the help of a review of the literature of cases occurring after partial salpingectomy and total salpingectomy. They discuss the usefulness of resection of the interstitial portion of the tube and feel that prophylactic cesarean section is justified in patients who have remained fertile.

Adult↗
PubMed1994

[Predictive factors of nodular recurrence after thyroidectomy for goiter].

We report a retrospective series of 44 recurrences of nodular goitre following 430 partial thyroidectomies over a 10 years period. There were 40 women and 4 men with a mean age of 43 and 37 years respectively. Twenty-four recurrences were from our institution (6%) and 20 were referred to us. The median follow-up of primary thyroidectomies was 8.5 years for patients with recurrence and 4 years for patients free of recurrence (p < 10(-6)). The incidence of recurrence was analysed in a statistical and actuarial model considering clinical intra-operative and post-operative variables. The following risk-factors for recurrence were found: age < 50 years (p < 0.01), family history of goitre (p < 0.04), unilateral multinodularity (p < 0.0002), diffuse and bilateral distribution of nodules (p < 0.02), atypical resections with conservation of isthmus (p < 0.0001), scintigraphically "warm" nodules (p < 0.001). Interestingly, sex, heterogeneous thyroid parenchyma without macroscopic nodules and the use of post-operative levothyroxine did not modify the risk of recurrence. Thirty-three patients were non symptomatic. Thirty-four patients underwent re-operation. Three primary non suspected carcinomas were found. There was no mortality related to re-operation. There were not definitive vocal cord paralysis or hypocalcemia. There was no significant difference in vocal or parathyroid morbidity when total thyroidectomy for primitive goitre was compared to total thyroidectomy as re-operation. Long-term and periodic follow-up is necessary to detect non-symptomatic recurrences in a high-risk population. Total thyroidectomy is the treatment of choice for bilateral multinodular goitre.(ABSTRACT TRUNCATED AT 250 WORDS)

Actuarial Analysis↗
PubMed1993

Splenectomy for splenomegaly exceeding 1000 grams: analysis of 47 patients.

Forty-seven patients who underwent splenectomy for splenomegaly > or = 1000 g were studied retrospectively. There were 29 men and 18 women of mean age 56 (range 19-87) years. Haematological malignancy was the most common disorder (42 patients). The main indications for splenectomy were cytopenia (20 patients), diagnosis (14), initial treatment of leukaemia (eight), pain (four) and spontaneous rupture (one). Thirteen patients underwent an associated surgical procedure. One patient died (mortality rate 2 per cent) and 12 (26 per cent) had postoperative complications. The advantages of splenectomy included histopathological diagnosis in 13 of 14 patients with splenomegaly of unknown origin, effective initial treatment in prolymphocytic and hairy cell leukaemia, definitive relief of pain in all affected patients, and long-term improvement of cytopenia in most.

Adult↗
PubMed1993

[Nodular goiter. Retrospective analysis of 608 cases].

A retrospective study was carried out on a series of 608 patients, of whom 430 had undergone partial and 178 total thyroidectomy for single or multinodular goitre. Statistical analysis of data for the 532 women (88%) and 76 men (12%), mean age 45 and 39 years respectively, included clinical and operative features, specific morbidity of the exeresis, incidence of cancer on multinodular goitre and the frequency of recurrence of nodular lesions. The men were significantly younger at time of diagnosis (p < 0.0006). Bilateral multinodular forms (n = 577) and hypofixing lesions (n = 515) predominated. The incidence of unsuspected thyroid cancer in the multinodular cases was 3% (15/444). Carcinoma development on single nodules in our series during the same period was 8% (n = 15/195), the difference being statistically significant (p < 0.02). Mortality was nil and non specific morbidity 2% (n = 12/608). No compressive hematoma was reported and tracheotomy was never required. A clinically detectable alteration in the voice was noted in 10% (n = 67/608), this persisting in 0.5% (n = 3) beyond the 6th postoperative month. No significant difference existed between general and vocal morbidity as a function of the type of exeresis. Hypocalcemia was observed in 11% of patients (n = 67/608), 49% (n = 33/67) being asymptomatic and the anomaly spontaneously reversible. Four percent (n = 7/178) were permanent after total thyroidectomy (including 15 cancers on multinodular goitre discovered fortuitously, 8 of which received lymph node dissection) and 3% (n = 2/68) after a "wide" subtotal thyroidectomy.

Actuarial Analysis↗
PubMed1992

[Restoration of colonic continuity after Hartmann's operation].

A retrospective analysis of data from 69 patients treated by Hartmann's operation between 1981 and 1991 determined prognostic factors for colon continuity re-establishment and the mortality of this second intervention. The 15 patients who died during the first month after the Hartmann's operation were excluded from the study, the 54 survivors including 32 men and 22 women, mean age 68 +/- 12 years (range 19 to 87 years). The initial indication for surgery was: complicated sigmoid diverticulis (n = 26), cancer of colon (n = 14) or other site (n = 14). Colon continuity was re-established in 23 patients (42.6%), including 15 men and 8 women, mean age 60 +/- 10 years (range 38 to 78 years). In this latter group, 82.6% of the patients were under 70 years of age, indicative of a significant effect of age (p < 0.001) on re-establishment of continuity. Secondary anastomosis was obtained in 65.4% of cases of complicated sigmoid diverticulitis, whereas re-establishment of continuity was possible in only 7.1% of colon cancer patients (p < 0.001). The mean duration prior to re-establishment was 4.8 +/- 1.6 months (range 2.5 to 9 months). Morbidity was high (47.8%) and mortality 4.3% (1 patient). Hartmann's operation remains indicated for stages III and IV of complicated sigmoid diverticulosis, as well as for other benign affections (volvulus of sigmoid, perforation of sigmoid following injury), although it must be recognized that the possibilities of re-establishment are limited more in elderly patients and that fewer patients with colon cancer can benefit from the procedure. A period of 3 to 4 months appears sufficient to allow healing of the inflammatory phenomena of the initial operation, without the development of excessive retraction of the rectal stump.

Adult↗