[The endoscopic diagnosis of reflux esophagitis: the value of color endoscopy].
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Barrett Esophagus↗
Biomedical subjects
A Pezzolla
Publications and source records attributed to A Pezzolla.
[Esophageal manometry in non-organic pharyngo-esophageal dysphagia syndromes].
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Adult↗
Improved acceptability of laparoscopic surgery and increasing rate of cholecystectomy implications for surgeon and patients.
BACKGROUND/AIMS: The aim of our study was to evaluate the impact of introduction of laparoscopic cholecystectomy (LC) and reasons for the increase in cholecystectomy rate, by a retrospective review of all admissions for gallbladder disease before and after the introduction of laparoscopic surgery in our department. METHODOLOGY: Chi-squared test was used for statistical analysis of the comparisons. RESULTS: Comparing the 2 periods, cholecystectomy rate increased by 35% (p<0.01) and patients aged 25-44 years were more likely to undergo LC (p<0.001); a 35% decrease in unjustified refusal (p<0.02) was also observed. The number of both longstanding disease patients and asymptomatic ones operated upon was not different (p=1; p=0.06), while a 46% increase (p=0.02) in cholecystectomy rate was shown in patients with low-grade symptoms or at 1st colic episode. CONCLUSIONS: An increase in the patient pool due to improved acceptability was responsible for the increase in cholecystectomy rate after introduction of laparoscopic surgery, rather than lowered surgical threshold, as previously suggested by other authors. Judiciousness is required to prevent the increased acceptability of LC from leading to its uncontrolled and unrestricted use, as alteration of the surgical threshold may occur without surgeon awareness, particularly when dealing with low grade symptomatic patients.
Adolescent↗
[Therapeutic problems in euthyroid multinodular goiter].
Now therapeutic different possibilities of goitre pathology seem well defined, in front of limit of suppressive therapeutic range in initial stages, prevalently diffuse, that interest young people and arise in jodic want lands; it's possible that medic theraphy ends can't be obtained because of not responders patient, or even for possibilities of controindications. Local presence of suspicious nodules and the need of goitre volumetric reduction for aesthetical and compressory ends, with the possibility in course of time of functional changes are sure reasons to surgery. Certainly main problems exist about surgery definition of multinodular disease with bilobar involvement where there is comparing between total and subtotal thyroid exeresis. Now by literature analysis and our School experience we think that surgery choice, considered before operation, must find absolute assurance after preoperative morphotopographic careful exploration of thyroid. We think that total thyroidectomy must be done when it's certain a total gland involvement, reserving subtotal thyroidectomy in the other cases; always employing a careful surgery technique, keeping operative field interely bloodless to identify important structures and dissection plan narrowly close by capsule.
Follow-Up Studies↗
[Clinical study of residual function and recurrences in patients after partial thyroidectomy for non-toxic nodular goiter].
The different surgical chances for the treatment of non toxic nodular goiter led the Authors to study the residual function after partial thyroidectomy. A variable rate of recurrences and hormone deficiency was shown in patients who underwent sub-total thyroidectomy, lobectomy and enucleation. It depended on the amount of residual gland and the different methods they used. Recurrences occurred more in patients studied by ultrasonography. After sub-total thyroidectomy the Authors noted a more reduced number of recurrences than after lobectomy and enucleation. There was a meaningless connection between high plasmatic levels of TSH and recurrences. Subclinical hypothyroidism was higher in patients who underwent subtotal thyroidectomy than in patients treated with lobectomy and enucleation. These clinical data show that recurrences could depend on growth factors (EGF, IGF) in thyroid tissues and not only on TSH action. Therefore the surgical attitude of the authors in the treatment of nodular goiter consists in total thyroidectomy.
Aged↗
[Schwannomas of the digestive tract. Observations on a case localizing in the ileum].
The schwannomas are rare tumors taking origin from Schwann's cells; even rarer is their location at a peripheral level. Even if they show the macroscopic and microscopic characteristics of a benign tumor, it is possible that they engage malignant course, with possibility of recurrency and of distant metastasis. In the alimentary tract the schwannomas reveal with repeated episodes of digestive hemorrhage which could engage, according to the location, the characters of enterorrhagia or melena. Arteriography has the higher diagnostic sensibility, in course of bleeding. The CT could demonstrate a submucosal neoplasia. The diagnosis of schwannomas is based on the immunohistochemical search of the protein S100, that allows to differentiate them from the tumors of muscular origin, having such tumors common histological and cytological aspects. The schwannomas are today set in the widest chapter of the so-called "stromal tumors of the gastrointestinal tract" (GISTs) with an indefinite malignancy which need surgical excision and an attentive follow-up. The authors report a case of schwannoma located at the first jejunal loop, having had repeated episodes of digestive hemorrhage. The diagnosis was based on the selective arteriography of the upper mesenteric artery and the immunohistochemical search of the protein S100. The surgical treatment consisted of the resection of the jejunal loop, after having sought for eventual multiple locations of the neoplasia.
Female↗
[Comparison of hernioplasty using the technic of Bassini and Trabucco. Comparative analysis and results].
We evaluated comparatively trough a randomized perspective study the hernioplasty by Bassini technique and the Trabucco repair, respectively using general and local anaesthesia, in a group of 80 patients. We studied incidence of complications and recurrences, surgery, in-patient hospitalization time, postoperative pain, costs and work resuming. Trabucco repair had better results in each considered parameter: hospitalization time, pain and costs respectively 80%, 50% and 66% lower vs Bassini technique; moreover we found no recurrence and work resuming two weeks shorter.
Adult↗