Cell differentiation and iodine-131 uptake in poorly differentiated thyroid tumour in response to nevirapine.
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Biomedical subjects
Antonio Ambrosi
Publications and source records attributed to Antonio Ambrosi.
Difficult cholecystectomies: validity of the laparoscopic approach.
OBJECTIVES: The aim of this work was to determine the outcome of "difficult cholecystectomy" caused by acute cholecystitis or cirrhosis, in relation to the number of conversions, principal biliary duct injuries, the length of the operation, and of postoperative hospitalization. METHODS: From 1998 through 2000, 51 patients, 38 females and 13 males, underwent cholecystectomy for acute cholecystitis and cholecystitis associated with liver cirrhosis; the average age was 58.8 years (range, 24 to 86 years). No preoperative selection was made for video laparoscopic treatment. An open laparoscopy was performed in all cases. RESULTS: All interventions were completed by video laparoscopy. No injury of the major bile ducts occurred in the 51 cases. The average time of operation was 110 minutes. The average length of hospitalization was 3 days. CONCLUSION: This study demonstrates that the results after "difficult laparoscopic cholecystectomy" are comparable to those after "open cholecystectomy." Difficult cholecystectomy executed with video laparoscopic methodology is safe and effective if performed with appropriate equipment and by experienced surgeons.
Adult↗
Indications for the laparoscopic treatment of gastroesophageal reflux disease.
BACKGROUND: The aim of the study was to evaluate the indications and surgical techniques for the treatment of gastroesophageal reflux disease. METHODS: From 1998 through 2000, we performed gastroesophageal reflux surgery on 12 patients. Preoperative studies revealed third-degree esophagitis in most patients with no functional alterations of the esophagus itself. The patients underwent a laparoscopic Nissen-Rossetti fundoplication. No conversions to open laparotomy were necessary. The mean operative time was 180 minutes. RESULTS: No intraoperative or immediate postoperative complications occurred. The mean postoperative stay was 6.2 days. Transitory postoperative dysphagia was noted in 8 patients. In 5 patients, it was mild and regressed after 2 weeks; in 3 cases, it was severe and regressed over 2 months. CONCLUSION: A laparoscopic surgical approach is a satisfactory method for correcting gastroesophageal reflux disease. The efficacy of medical therapy has been well established. However, in the young person who may be required to take medication for many years or in those persons who are intolerant of standard medical therapy for gastroesophageal reflux disease, a surgical intervention is a satisfactory option. The success of medical therapy can be used as a predictive criterion of the success of laparoscopic Nissen-Rosetti fundoplication when normal motility of the esophageal corpus is present.
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Laparoscopic adrenalectomy: transperitoneal lateral approach. Cases study.
AIM OF THE STUDY: To compare the results of the laparoscopic adrenalectomy achieved with the traditional laparotomic one. MATERIAL AND METHOD: In the period 1997-September 2004 we treated 17 patients with adrenal pathology: eight patients underwent to an open anterior transperitoneal adrenalectomy and nine patients underwent a laparoscopic adrenalectomy with lateral transperitoneal approach. RESULTS: Among the immediate results a longer operative time was evident in the laparoscopic approach and a greater blood loss in the open approach; there were no conversions to a laparotomic procedure. In the postoperative period there were some bronchopneumonic infiltrates and some infections of the laparotomy in the open group; in the laparoscopic group there was a parietal haematomas that cleared up spontaneously, in correspondence of a trocar access. DISCUSSION: Both procedures allow to achieve the complete resolution of the adrenal pathology if it is confined within the gland and no more than 8 cm. in size. The morbidity in the mininvasive approach is surely much lower than the open technique. The advantages of a laparoscopic approach can be found in a minor surgical stress. The evident datum that results from the literature analysis of the results of the the laparoscopic adrenalectomies, is the very rapid resumption of the normal activities in the postoperative course. CONCLUSIONS: The laparoscopic adrenalectomy with lateral transperitoneal approach is a safe and efficacious procedure. Therefore, the AA can believe that the laparoscopic approach is at present the gold standard in the treatment of all benign adrenal pathologies with a no more than 8 cm. size.
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Elective laparoscopic-assisted colectomy for sigmoid diverticulitis.
OBJECTIVES: The aim of this study was to evaluate the safety and effectiveness of laparoscopic-assisted sigmoid colectomy for diverticulitis and to assess its postoperative advantages. METHODS: From 1999 to 2001, 5 patients were selectively operated on with a laparoscopic-assisted procedure for uncomplicated sigmoid diverticulitis. In the preceding period (September 1997 through December 1998), 4 patients underwent open procedures for the same pathology. The surgical indication with the same criteria was restrictive: at least 2 acute episodes had occurred that were treated with hospital admission and that were separated by an adequate period (2 months) of medical therapy. RESULTS: No conversions of laparoscopy to an open procedure were necessary. Age, sex, weight, morbidity, and mortality were similar between the 2 groups. Operative time was 180 minutes for laparoscopy and 120 minutes for laparotomy. Postoperative resumption of peristalsis was 24 hours versus 4 days, resumption of alimentation was on the second postoperative day versus the fifth postoperative day, and hospital stay was 7 days versus 12 days for laparoscopy and laparotomy, respectively. CONCLUSION: This study shows the feasibility and the advantages of elective laparoscopic-assisted colonic resection for uncomplicated sigmoid diverticulitis. The advantages of the laparoscopic approach are the lower need for analgesics and the more precocious ambulation, canalization, resumption of alimentation, and the shorter hospital stay.
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[Video-assisted thyroidectomy with minimally invasive central cervicotomy: initial experience in an endocrine surgery division].
Minimally invasive video-assisted thyroidectomy, a recently developed technique, has been shown to be feasible and safe. Nevertheless, to obtain the best results, the surgeon should be well trained in endoscopic surgery. We attempted to answer the question whether an endocrine surgery division with no previous experience in endoscopic neck surgery could easily import the new technique. The inclusion criteria were nodules < or = 3.5 cm diameter or thyroid lobe volume less than 15 ml, and no thyroiditis or previous neck surgery. Suspect malignant nodules were excluded. The procedure was carried out through a 20 to 30 mm central neck incision, with external retraction and no neck insufflation. The vessels were ligated or closed by means of clips. From March 2004 to March 2005, 127 thyroidectomies were performed, of which 36 were thyroid lobectomies. Of these, 12 lobectomies by minimally invasive video-assisted thyroidectomy were performed for monolateral goiter (4 left, 8 right). There were no intraoperative complications. No recurrent laryngeal nerve palsy or permanent hypoparathyroidism occurred. The mean operative time was 74.4 min (median: 70; range: 45-115). The results, in terms of patient comfort, reduced postoperative pain and cosmetic quality were excellent. The technique allowed careful assessment of the inferior and superior laryngeal nerve. Thorough haemostasis was aided by the magnification of the image and optimal illumination. The learning curve appeared short, owing probably to previous experience in conventional endocrine surgery and the closer similarities of minimally invasive video-assisted thyroidectomy to enhanced-view conventional surgery than to laparoscopic surgery. In our experience the clinical impact was limited as a result of the small percentage of patients fulfilling the strict inclusion criteria.
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Duodenal perforation in course of endoscopic retrograde cholangiopancreatography-endoscopic sphincterotomy. Therapeutic considerations.
AIM OF THE STUDY: To define the therapeutic program for the treatment of perforative complication of the duodenum in course of endoscopic retrograde cholangio-pancreatography (ERCP) with endoscopic sphincterotomy (ES). MATERIAL OF THE STUDY: In the period from 1997 to 2003, 5 duodenal perforations occurred during 101 ERCP/ES (4.95%), executed in two digestive endoscopic centres. Three patients were operated in emergency (duodenostomy, external biliary drainage, gastric-enteric-anastomosis). The other two were treated conservatively with nasal-duodenal drainage in aspiration. RESULTS: The postoperative complications were modest. Anyway there were no signs of sepsis nor of retro/endoperitoneal purulent collections. Biliary drainage, upon radiologic control, and duodenostomy, were removed within the 4th postoperative week. There was no mortality. DISCUSSION: Immediate surgery was performed when the presence of the radio-contrast in the retroperitoneum was persistent. In case of retroperitoneal and/or small perforations, we preferred early oral intake, trusting on the diversion of the biliary and duodenal secretions. The point form perforations, without persistence of radio-contrast, were treated by the conservative approach. CONCLUSION: The proposed treatment of duodenal perforation in course of ERCP was efficacious and safe, and avoided in our experience every risk of septic evolution.
Cholangiopancreatography, Endoscopic Retrograde↗