Hysterectomy for the transsexual.
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Female↗
Biomedical subjects
A Pacifici
Publications and source records attributed to A Pacifici.
[Pre- and postoperative color Doppler ultrasonography of myocutaneous flaps in reconstructive surgery of the breast].
The authors present their experience in the study of blood supply of flaps. The machine used to study both pre and postoperatively the myocutaneous flap is the echo-color Doppler, a brand new device which has recently been used in investigating the morphology and the blood supply. The use of such method has provided us with the following information: detailed ultrasound structure of the skin, subcutaneous and muscular tissues of the examined flap; localization of vessels within the flap; size of the vessel in its whole length; quality and speed of both the arterial and venous flow. Such information is very important for the surgeon to plan in detail the reconstruction by knowing the blood supply of myocutaneous flap.
Breast↗
[Use of Doppler color ultrasonography in the microsurgical treatment of idiopathic varicocele].
The aim of this paper is to evaluate the role of Doppler and echo color-Doppler in the microsurgical treatment of varicocele. Since December 1993, 87 consecutive patients underwent microsurgical treatment of varicocele. The study demonstrates that Doppler and Color-flow-Duplex scanning provide an accurate, non-invasive method to identify the position of accessory spermatic veins, evaluating at the same time the flow characteristics of the microsurgical anastomosis.
Evaluation Studies as Topic↗
Anatomo-clinical study of rectus abdominis myocutaneous flap.
At the Plastic and Reconstructive Surgery Department of Perugia, 52 patients were examined by color flow duplex scanning, in order to study rectus abdominis myocutaneous flap vascular supply before surgical procedures. This ultrasound technique permits a precise and accurate measurement of blood flow volume and velocity within the epigastric arteries (which represent the superior and inferior vascular pedicles of the flap) and makes it possible to detect the exact location of the perforating branches with their cutaneous distribution. This preoperative evaluation, pointing out vascular pathologies which contra-indicate the use of rectus abdominis flap, can be considered a great help for the reconstructive surgeon in the choice of the operative procedure and can surely lead to a significant decrease in postoperative complication rate.
Adolescent↗
[Penetrating wounds of the thorax].
From January 1989 to December 1993 at the Institute of Clinical Surgery of the University of Perugia, 5 patients were under observation for penetrating chest injuries. Two of them had show-wounds, one a slash, one a stabbing and slash and one a cutting blow. One of the patients with shot-wounds died on the operating table from a haemorrhage while the other was saved by surgery. One patient successfully underwent surgery for loss of tissue in the thorax walls. Another had a mini-thoracotomy plus lung suture which were successful. Finally, in the patient with a slash in the front region of the thorax and a slight pneumothorax, we inserted a chest thorax tube and so obtained a complete re-expansion of the lung. Total mortality was 20%. Surgical exploration of the thorax we believe is necessary wherever there is a risk of haemorrhage or possible lung damage requiring only surgery. According to many authors, video-thoracoscopy has the advantage of a reliable diagnosis and above all, enable us to repair lung wounds without opening the thorax. In one of our patients we could have avoided the mini-thoracotomy and used thoracoscopy to repair the lung damage.
Adult↗
Preoperative and postoperative evaluation of latissimus dorsi myocutaneous flap vascularization by color flow duplex scanning.
At the Plastic and Reconstructive Surgery Department of the University of Perugia, 104 patients have been examined by color flow duplex scanning in order to study latissimus dorsi vascular supply before and after surgical procedures. This noninvasive ultrasound technique provides a precise and accurate measurement of blood flow velocity (15 cm/s) and volume (27 ml/min) within the thoracodorsal artery, which represents the vascular pedicle of the flap, and it allows us to detect the exact location of the perforating branches with their cutaneous distribution. This preoperative evaluation, pointing out vascular pathologies that contraindicate use of the latissimus dorsi flap, can be considered a great help for the reconstructive surgeon in the choice of the most suitable operation, and it can surely lead to a significant decrease in postoperative graft failure rates.
Adolescent↗
Colour flow duplex scanning: an accurate, non-invasive technique for preoperative evaluation of the vascular supply of the rectus abdominis myocutaneous flap.
Forty patients were examined with colour Doppler to study the vascularization of rectus abdominis myocutaneous flaps before operations. The accuracy of this non-invasive ultrasound technique allowed us to describe the characteristics of the blood flow, including volume and velocity, diameter of vessels and their transverse section area within the epigastric arteries which supply the superior and inferior vascular pedicles of the flap. Vessels are drawn on the skin surface so that the flap can be more precisely and rapidly dissected. We are now using colour Doppler to assess variations in the diameter of vessels and in other variables of blood flow within the vascular pedicle of the transferred flap. These evaluations before and after operation are a great help to the reconstructive surgeon in the choice of operation and will lead to an appreciable reduction in postoperative morbidity.
Abdominal Muscles↗
[Diagnostic and therapeutic problems of "second look" in acute intestinal ischemia].
The authors present their diagnostic approach to acute intestinal ischemia. They underline the need for early specific diagnosis because the therapeutic options vary widely in relation to different types of acute intestinal ischemia. Selective arteriography preceded by an aortogram is considered the diagnostic "gold standard". Although at present mesenteric ischemia is a serious, and often lethal, disease, an aggressive therapeutic approach can improve the outcome of this group of patients.
Acute Disease↗
[Intestinal obstructions caused by colorectal carcinoma in the aged].
Colorectal cancer is the second most common malignancy of the adult population in the United States. It is exceeded only by lung cancer among males and breast cancer among females. Malignancies of the colon and rectum are responsible for approximately 12 per cent of all adult cancer deaths. These tumors appear as surgical urgency by intestinal obstruction for 15-20 per cent and by perforation for 3-8 per cent of all cases. It often occurs in elderly patients; in fact, urgent surgical operations are especially performed in patients older than seventy. The mortality rate for urgent surgical operation in elderly patients is about 32-54 per cent. This high mortality is even due to concurrent pathologies and particular locoregional and/or general alterations induced by tumor. The authors studied all patients older than 75 years affected by colorectal cancer and treated by choice or by urgency at Dept. of Surgery of the University of Perugia from January 1987 to February 1993 to individualize some clinical, anatomo-pathological and therapeutical significant characteristics about colorectal cancer in geriatric age.
Age Factors↗
Preoperative evaluation of inferior vena cava involvement secondary to malignant abdominal neoplasms.
The authors report their experience of different imaging techniques (US, CT, MRI, and cavography) used to evaluate inferior vena cava involvement due to abdominal malignant neoplasms. The study is a retrospective analysis of preoperative data on 15 patients of both sexes in comparison with intraoperative and/or pathological findings. All patients underwent ultrasonography, with good results in all the venous segments studied, as for the CT scan; the limitation of both techniques is the unsafe evaluation of venous wall involvement when the neoplastic tissue is confined inside the vessel. The results obtained using MRI seem to be very encouraging, but we only studied three cases with this technique, and so cannot assess the real value of the method. In nine patients we performed inferior cava phlebography: we believe this to be a very reliable exam to demonstrate vessel wall invasion, even if it is a very invasive procedure, its limits being the inability to observe proximal thrombotic extension when the vein is completely obstructed by the tumor. On the basis of their experience the authors suggest a multi-technique imaging diagnostic procedure for preoperative staging with a view to obtaining as much information as possible to correctly program surgical procedure.
Abdominal Neoplasms↗
[Cryosurgery in the treatment of condylomatosis].
The authors report their personal experience of the treatment of condylomas in both male and female patients using cryosurgery. The temperature of -80 degrees C which can be obtained using hyperdry nitrogen monoxide equipment allow radical treatment to be performed without pain in an outpatient setting without general or loco-regional anesthesia. The characteristics of this treatment allow patients to be regularly monitored, thus eliminating all signs of recidivation of those lesions which were too small to be seen at the start of treatment. The patient is considered cured after an interval of approximately 30-40 days after the disappearance of all condylomas.
Anus Neoplasms↗
[Effects of somatostatin peridurally administered in the treatment of postoperative pain].
Somatostatin (SMS), a hormone extensively found within the CNS, has shown to have a powerful analgesic effects administered either via the epidural or subdural route. The aim of the present study was to evaluate the efficacy of SMS administered epidurally compared with placebo, for the treatment of post-operative pain in patients receiving epidural anaesthesia for surgery. Of the 86 patients observed, 58 entered the study and were randomized to receive either SMS or placebo in a double blind fashion. They were also divided into 3 groups according to the site of the operation (group A: procto-anal; group B: inguino-crural; group C: other), 28 of them receiving SMS and 30 placebo. The post-operative pain evaluation was obtained via VAS at the moment of request of treatment (basal) and after an hour. Twenty-eight of the 86 observed (32.5%) didn't complain of pain that necessitated analgesic treatment. A statistically significant difference in reduction of intensity of pain was observed in the somatostatin treated group (6.42 +/- 0.37 vs 3.64 +/- 0.59) and in the somatostatin treated subgroup A and B (6.4 +/- 0.4 vs 3.8 +/- 0.7 and 6.3 +/- 0.8 vs 3.0 +/- 0.6 respectively). No adverse reactions of any kind were observed. SMS has shown to be a safe and effective drug, reducing by 50% the intensity of pain in patients undergone procto-anal or inguino-crural surgery.
Adult↗
[Total parenteral nutrition: a study of the microbial contamination of the bags and the infusion lines].
The authors have examined during 60 groups of patients submitted to TPN each for a period of 10-15 days. In the first group the whole infusional set became replaced after 24 h., in the second and in the third group such replacement was done, respectively, after 48 and 72 h. The bacteriological examination of the fluid in the was always sterile 6 h. after preparation except in one case of the third group. The bacteriological examination of the terminal part of the infusional set was always negative in the first group, it was positive in the 3.33% of the cases, in the second group and in the 6.66% of the cases in the third group. The authors, consequently, believe that the infusional set has to be replaced after a period no longer than 24 h. Total parenteral nutrition: study on microbial contamination of bags and infusion lines.
Asepsis↗
[A clinical study of prevention of stress ulcer].
The authors have studied the possibilities of preventing digestive bleedings caused by "stress ulcers" in a large number of risk-patients recovered in the Reanimation Center of St. Camillo in Rome. On 1012 patients recovered from 1985 to 1987 the authors have pointed out 69 cases of bleeding by "stress ulcer" (6.9%). The mortality was in these patients 75%. In every patient with risk factors the Authors have performed a prophylactic treatment. This treatment, achieved with randomized standards, has been performed in a group of 311 patients with ranitidine and in a second group of 170 patients with ranitidine and somatostatin joined. In the group of patients treated with ranitidine alone the incidence of digestive bleeding was of 30 patients (9.9%), in the second group treated with ranitidine and somatostatin the incidence was of 18 patients (10%). In a previous study the authors have noted an incidence of digestive bleeding by "stress ulcers" in the 16.6% of patients prophylactically treated with cimetidine and in the 8.66% in a first group of patients treated with anti-acids and in the 11.92% of a second group of patients equally treated with anti-acids. The authors point out that their results are disappointing in opposition to the good results relieved by other Authors possibly in connection with the seriousness, the number and the length of the risk factors in the patients they have treated. They believe that the results will be better when it will be possible to dispose of effective treatment able to increase the defensive powers of the gastric mucosa, seriously impaired by the stress factors.
Humans↗
[Primary choledocholithiasis after side-to-side choledochojejunostomy].
Primary choledocholithiasis represents a quite unusual sequela of biliary tract surgery. Primary stones originate in the common bile duct and are soft, smooth, with a yellowish or brown-reddish colour, reproducing the shape of the duct in which arise. The Authors report a review of the cases observed in the division of General and Vascular Surgery-Department of Surgery and Surgical Emergencies of the University of Perugia. From January 1988 to December 1993, 577 laparotomic biliary tract operations were performed, and in 8 cases a re-operation was needed. Among the latter, particularly interesting were 2 cases of primary choledocholithiasis occurred in two patients with bilio-digestive anastomosis previously performed, i.e. two side-to-side Roux-en-Y or Braun loop choledochojejunostomies, respectively. Therefore, primary lithiasis following a choledochojejunostomy occurred when the bilio-digestive anastomoses were performed with the indication of a curative re-operation on the biliary tract. On the contrary, most choledochojejunostomies are performed as a palliative procedure in patients presenting a low survival rate not allowing to develop a Sump Syndrome and a consequent choledocholithiasis, which are long-term complications.
Biliary Tract Surgical Procedures↗
Surgery of local recurrence in rectal cancer.
The local recurrence, after radical exeresis of a large intestinal cancer represents until now an extremely interesting question, taking into consideration that it represents the cause of death in 50% of operated patients. Frequency is higher after an exeresis of a rectal cancer, with a range of 2.6-83% in the different case histories, than after a surgical intervention on a colon cancer, whose incidence is lower than 5%. The early diagnosis of rectum cancer recurrence is the first step towards the favourable issue of treatment. Surgical treatment of loco-regional recurrences of rectum cancer can be curative when it is possible to perform a total resection of the recurrences and of the infiltrated structures, without microscopic residuals of disease, or palliative, aiming to reset the intestinal and urinary functions or to reduce pain. At the Department of Surgery of the University of Perugia, from January 1984 to December 1983, 153 patients with rectal cancer-79 males (52%) and 74 females (48%)-were treated. The operations, all involved total removal of the affected segment and were in 88 cases (58%) an anterior resection and in 65 cases (42%) an abdomino-perineal amputation. The analysis was made of 128 patients with a follow-up of at least five years; the local recurrence incidence was 12.5%. The authors adopted a follow-up protocol based on clinical examination, CEA antigen and routine Lab tests, chest X-rays, colonoscopy, abdominal ultrasonography, pelvic CT scan; these procedures are performed starting 3 months after operation.
Female↗