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A Pronio

Publications and source records attributed to A Pronio.

11 recordsLinked to original sources
PubMed1995

[Restorative proctocolectomy. A morphological-functional study by computed tomography with coronal scans].

Restorative proctocolectomy with ileal pouch has become the surgical treatment of choice for patients with ulcerative colitis and familial polyposis of the colon. Defecography is the radiologic technique commonly used to obtain detailed information on function and morphology of the ileal pouch, but it fails to depict the pelvis. Computed Tomography (CT), with coronal images only was used to examine 10 patients with ulcerative colitis, submitted to restorative proctocolectomy. Coronal CT, yielding a panoramic view of the pelvis, represent an effective alternative technique to defecography. In fact, the two techniques provide comparable information relative to the ileal pouch; coronal CT also depicts the possible thickening of pouch walls and of pelvic fat tissue. Coronal CT also depicts the continence of ileo-anal and ileo-ileal anastomoses and the functional changes of the perineal muscles at rest and during squeezing. Coronal CT images allow easy and clear detection of such major postoperative complications as pelvic inflammation and fistulae (less frequently stenosis or dehiscences of the anastomosis).

Adult↗
PubMed1991

Extended resection in the treatment of colorectal cancer.

Between 1975 and 1990, 525 patients underwent resection of colorectal cancer in our unit. Of these, 38 had tumour invading adjacent structures and underwent an extended resection. Overall, there were 67 cases treated palliatively. Of these, three were in the group of 38 having an extended resection. When the groups of radical not extended (n = 423) and radical extended resections (n = 35) were compared, respective values for mortality (1.9% vs 0) and morbidity (12.8% vs 11.3%) were not different. Respective local recurrence rates (13% vs 26%) were significantly greater after extended resection. Five-year survival after extended resection was 30%, no different from the general survival rate for standard resections for T2-3 node-positive tumours. Extended resection is thus a safe and important approach for locally advanced tumours.

Adult↗
PubMed1988

Restorative proctocolectomy with J reservoir in the treatment of ulcerative colitis.

The results of 16 cases of restorative proctocolectomy with J-pouch and ileoanal anastomosis performed for ulcerative colitis, associated with polyposis in one, and for diffuse polyposis in the last one, are reported. Satisfactory functional results as for continence, number of daily bowel movements and with moderate nocturnal leakage in a single patient, were obtained. The anal sphincter function, assessed manometrically about one year after surgery was shown to be normal in all cases except for the loss of sphincteric and inhibitory reflex. In spite of the still debated problems, it is concluded that this procedure based on the absence of operative mortality, acceptable morbidity and satisfactory long-term results, is the treatment of choice in surgery of ulcerative colitis with severe rectal lesions or dysplasia and of familial polyposis with carpeting rectum and/or cancer.

Adenomatous Polyposis Coli↗
PubMedDate not supplied

Restorative proctocolectomy: morphological and functional study with coronal CT.

BACKGROUND: Restorative proctocolectomy with ileal pouch has become the surgical treatment of choice for patients with ulcerative colitis (UC) and familial polyposis of the colon. Defecography is the radiological technique commonly employed to obtain detailed information on function and morphology of the ileal pouch; it allows the direct visualization of the ileal pouch and the anal canal, but it does not provide the visualization of the pelvis. METHODS: In all patients, computed tomography (CT) on coronal planes was performed to determine its possibilities as an alternative to defecography; 10 patients with UC submitted to restorative proctocolectomy and were examined. RESULTS: Coronal CT images provided a panoramic vision of the pelvis and demonstrated the morphology of the ileal pouch, the thickness of its walls, and its correlation with the surrounding tissues. Coronal CT also allowed the evaluation of the continence of ileo-anal and ileo-ileal anastomosis and the functional changes of the perineal muscles at rest and during squeezing. CONCLUSION: CT images acquired on coronal planes allows an easy and clear detection of the major postoperative complications, such as stenosis or dehiscences of the anastomosis, pelvic phlogosis, and fistulae.

Adenomatous Polyposis Coli↗
PubMedDate not supplied

Restorative proctocolectomy: histological assessment and cytometric DNA analysis of ileal pouch biopsies.

BACKGROUND/AIMS: The pathological changes and the risk of developing cancer in the ileal pouch mucosa of patients who received restorative proctocolectomy with ileal pouch-anal anastomosis (IPAA) were studied. The presence or absence of remaining rectal mucosa below the IPAA in both patients with stapled and handsewn IPAA was also examined. MATERIALS AND METHODS: Endoscopy of the ileal pouch was performed on 38 patients at 4, 12, 18 and 36 months after restorative proctocolectomy with ileal pouch. Mucosal biopsy specimens were taken from the ileal reservoir in order to assess the histological incidence of inflammation. In 23 patients, biopsies were taken to perform cytometric DNA analysis. Clinical symptoms of pouchitis (over six evacuations in 24 hours, night-time evacuations, leakage of feces, bloody diarrhea, abdominal pain and fever) were recorded and correlated with the histological findings. Biopsies were also sampled below the ileo-anal anastomosis (IPAA) in order to identify residual rectal mucosa. RESULTS: Results of histological assessment showed various degrees of chronic inflammation increasing over time (from 42 to 60%) while the presence of both acute and chronic inflammation of the reservoir was less frequent (from 18 to 30%). Villous atrophy was present in 39-68% of patients and the grade of villous atrophy was correlated to the grade of inflammation. Clinical pouchitis was present in 3 to 8% of cases at the different controls and it was always associated with the highest grade of histological inflammation and severe villous atrophy. No significant alteration of the DNA cellular content was observed. Very low incidence of aneuploidy (0.7-1% Ex.R.) has been reported in three cases. However, we found dysplasia in only one patient who underwent surgical treatment for familial polyposis coli. IPAA evaluation showed no residual rectal mucosa in 40% of cases with stapled IPAA; in the remaining 60%, we found a small amount of rectal mucosa (maximum 1 cm). We did not find rectal mucosa after handsewn IPAA with mucosectomy. CONCLUSIONS: Patients treated with restorative proctocolectomy with IPAA showed a higher and increased incidence of inflammation during follow-up. No significant alteration of DNA cellular content nor dysplasia of the pouch mucosa were observed. In this study the chance of leaving rectal mucosa after stapled IPAA was about 60%.

Adolescent↗
PubMedDate not supplied

Solid cystic tumor of the head of the pancreas in a young woman.

This a case report of a solid papillary tumor of the pancreas in a young woman of 18 years, who was referred to after having suffered for a period of 8 months with a rather vague symptomatology, characterized by dyspepsia, fatigue and, towards the end of the 8 month period, weight loss (approximately 2 kg). In the last week, as a consequence of a modest abdominal trauma, the patient was submitted to abdominal CT that showed a burden at the head of the pancreas, demonstrating a round neoformation about 6 cm in diameter with solid echogenicity slightly hypodense. Subsequently, she underwent an operation with the diagnosis of pseudocystis of the pancreas. During surgery, a big cystic formation of the head of the pancreas, into which a drain was introduced, was revealed. The histological postoperative examination was compatible with pancreatic tumor with a low grade of malignancy, cystic papillary or solid papillary type. Therefore, the patient came under our observation and underwent an operation of pancreatoduodenectomy. Two years after the operation, the patient had completely recovered. In this case, we discussed the problem of performing certain preoperative diagnoses despite the aid of modern diagnostic imaging, this being a very rare illness that almost exclusively plagues young women (median age 19 years). This diagnosis has an uncertain histological origin and is generally accompanied by a modest and vague symptomatology. The surgical procedure, given the low grade of malignancy of the neoplasm and the excellent long-term prognosis, must be, with respect to the oncological radicality, as conservative as possible.

Adolescent↗
PubMedDate not supplied

End to side mucomucosal Wirsung jejunostomy after pancreaticoduodenectomy: immediate results and long term follow-up.

BACKGROUND/AIMS: Pancreatico-duodenectomy (PD) is nowadays a widely performed operation which still carries a risk of some morbidity and mortality due to leakage of the Pancreatico-jejunostomy. The aim of the present paper is to describe critically the experience of a surgical team with a large number of consecutive non-selective PDs, where the same surgical procedure was adopted in all cases to manage the pancreatic stump. METHODOLOGY: Sixty six Whipple/Child PDs and 4 Traverso-Longmire (Duodenum Preserving PD) were performed between 1974 and 1993, by the same surgical team in our surgical department. The management of the pancreatic stump was always the same: a hand-made end-to-side mucomucosal Wirsung-jejunostomy, completed by a second layer between pancreatic capsula and jejunal sero-muscular wall. RESULTS: The overall mortality was 7.1% (5 cases). Only one death could be ascribed to pancreatico-jejunostomy related complications (post-operative acute pancreatitis). Specific morbidity was 12.6% (9 cases). Only one complication was related to the Wirsung-jejunostomy (leakage of the anastomosis, treated by a "sleeve" end-to-end pancreato-jejunostomy). Long-term patency of the anastomosis was shown by ERCP. CONCLUSIONS: Even if this anastomotic technique requires a little more time and attention by the surgeon, we think that the low incidence of pancreatico-jejunal anastomosis related complications represents a validation of the method, and a motivation to adopt this anastomotic technique. The long-term patency of the muco-mucosal Wirsung-jejunostomy is another valid argument that supports this kind of management of the pancreatic stump after PD.

Adult↗