Biomedical subjects

Armando Sardi

Publications and source records attributed to Armando Sardi.

9 recordsLinked to original sources

PubMed2005

Absence of the retrohepatic inferior vena cava: what the surgeon should know.

Anomalies of the inferior vena cava are rare and can easily be misdiagnosed if one is not aware of such variants. We report a case of a 57-year-old patient that had a percutaneous CT-guided biopsy of what was considered to be enlarged pericaval lymph nodes. This occurred because of the poor technique of the CT scan and the unawareness of such a condition. These changes were related to a proximal varicele of an absent, retrohepatic inferior vena cava. There was an extensive collateral network with filling of large azygos and hemiazygos veins draining through the posterior mediastinum into the superior vena cava. This case emphasizes the importance of correctly identifying vascular anomalies before the initiation of biopsy attempts in order to prevent the risk of major complications that could arise during such biopsy.

Abdominal Neoplasms↗

PubMed2005

Thoracoscopic resection of a mediastinal intrathymic parathyroid adenoma.

Mediastinal parathyroid adenomas and thymomas can be resected via a transcervical approach, median sternotomy, or less invasive surgical option of video-assisted thoracoscopic resection and more recently by way of the da Vinci robot. We present a case of a mediastinal parathyroid adenoma in a 55-year-old female with primary hyperparathyroidism. MRI also confirmed a mediastinal adenoma localized on sestamibi scan. Significant laboratory values were elevated parathyroid hormone (PTH) of 171 pg/mL (normal range = 15 to 65 pg/mL) and calcium of 11.6 mg/dL (normal range = 8.5 to 10.5 mg/dL). Inability to hyperextend her neck due to cervical fusion made the transcervical approach unfavorable. To avoid a median sternotomy, we performed thoracoscopic resection of the adenoma via the left chest with the patient in a right lateral decubitus position. Three ports were placed; two in the anterior axillary line in the 4th and 6th intercostal spaces and one in the midaxillary line in the 5th intercostal space. Initial intraoperative PTH measurement was 192.9 pg/mL, and after adenoma removal the PTH level fell to 9 pg/mL. She was discharged home on postoperative day 1 without complications. At 3 months postprocedure, she remains asymptomatic with PTH and calcium levels within normal range. The 4 g, 2.4 cm intrathymic parathyroid adenoma had no evidence of malignancy. Thoracoscopic resection of an intrathymic parathyroid adenoma, a safe and less morbid alternative to median sternotomy, is an option when the transcervical approach is not viable.

Adenoma↗

PubMed2004

Hemicorporectomy for chronic pressure ulcer carcinoma: 7 years of follow-up.

Development of squamous cell carcinoma (Marjolin's ulcer), a well-known and rare complication of chronic ulcers, sinuses, chronic osteomyelitis and burn scars, may complicate chronic pressure ulcers. For several years, reports have suggested these cancers (pressure sore carcinoma, PSC) are highly fatal and aggressive, unlike other Marjolin's ulcers. A 39-year-old male, paraparetic from spina bifida, with history of chronic pressure sores and osteomyelitis of the pelvic bones underwent multiple resections. A descending colostomy was performed to avoid soiling of the perineum and decubitus ulcers. He developed squamous cell carcinoma in multiple pelvic areas. He was dependent on two daily visits by home care nurses for wound care. After negative workup for metastasis, as his only chance for cure he was offered hemicorporectomy, which was performed at the L4-L5 disc level. A prosthesis was applied 1 month after the surgery. As of November 2003, he remains disease-free after 7 years (90 months) from initial surgery. He is employed as a computer programmer, is self-dependent, and also drives. Aggressive treatment in select patients with PSC is essential and can lead to long-term disease control and increase in overall quality of life.

Adult↗

PubMed2003

Racial differences in mammographic breast density.

BACKGROUND: African American women have a lower incidence but a higher mortality from breast carcinoma than Caucasians. A proposed explanation for this discrepancy is the decreased efficacy of screening among African American women. Increased breast density in African American women may result in decreased sensitivity of mammography. The purpose of this article is to determine whether there is a difference in mammographic breast density between African American and Caucasian women. METHODS: A series of 769 women were recruited from 5 sites. Mammograms were reviewed centrally by seven reviewers using Breast Imaging Reporting and Data System categories converted to numeric values. The mean mammographic densities for Caucasian, African American, and Latina patients were compared using a two-way analysis of covariance. The mean values for each race were estimated adjusting for the reader as well as for each patient's age and body mass index (BMI). RESULTS: African American women had the lowest mean breast density. The reported density in this group was 2.43, compared with 2.69 among Caucasians and 2.65 among Latina patients. After adjusting for age and BMI as well as the reader, there was still an independent racial effect on breast density (P = 0.0050). CONCLUSIONS: Mammographic breast density was lower in African American women than in Caucasians and Latinas. This discrepancy may be an intrinsic racial difference due to undetermined causes. Factors, such as the growth rate of tumors and the incidence of calcifications, must be studied to confirm that other forces do not have a negative impact on the efficacy of screening mammograms in African American women.

Adult↗

PubMed2003

Improved results using ultrasound guidance for central venous access.

Central venous cannulation is an essential part of patient management in a variety of clinical settings. The complications of cannulation may be as high as 10 per cent and include arterial puncture, pneumothorax, hemothorax, cardiac tamponade, hematoma, malposition of catheter, nerve injury, and death. Standard technique for placement of central venous catheters is by use of a blinded, external landmark-guided technique. Success rates and complication rates vary according to the technique employed. Ultrasound use in general surgery has gained popularity and is now readily available in most operating suites. A prospective study was conducted to evaluate the feasibility of ultrasound-guided placement of central venous access devices. Ultrasound guidance was used to place central venous ports for chemotherapy in 29 patients. Catheters were placed using a handheld ultrasound (7.5 MHz, linear probe, Aloka, Wallingford, CT) with the Seldinger technique. The internal jugular vein was used as the primary site. Accurate placement within the superior vena cava was confirmed with fluoroscopy. All procedures were performed under local anesthesia with intravenous sedation. The data analyzed included length of procedure, complications, and success rates. The right internal jugular vein was used in all but 4 of our patients. In 2 of those patients, the left internal jugular was chosen initially. In the other 2, anatomical variants were discovered requiring a modification of technique to cannulate the right internal jugular vein. Overall, ultrasound led to a change in management in 14 per cent of patients. The average time for placement was 30 minutes (range, 22-42 minutes). There were no failures in placement or misplacement of the catheters. Detection of anatomy prior to venipuncture and direct real-time visualization are the keys to success with ultrasound guidance. This study shows that placement of central venous catheters, using ultrasound guidance, may be done in a timely manner while minimizing risks and maximizing success.

Adult↗

PubMed2002

A case report of recurrent epithelial ovarian cancer metastatic to the sternum, diaphragm, costae, and bowel managed by aggressive secondary cytoreductive surgery without postoperative chemotherapy.

BACKGROUND: Ovarian epithelial cancer typically presents in advanced stage and has been traditionally managed by a combination of cytoreductive surgery followed by adjuvant systematic chemotherapy. The management of recurrent ovarian cancer has been individualized: surgical resection of intraabdominal and/or pelvic disease has been performed when technically feasible and usually followed with chemotherapy. CASE: This case describes aggressive surgical management of recurrent ovarian cancer metastatic to the lower ribs, sternum, and diaphragm. A clear cell, Stage IIIA ovarian cancer was successfully resected in a 73-year-old female. The patient had total abdominal hysterectomy, bilateral salpingo-oophorectomy, and omentectomy followed by six cycles of adjuvant chemotherapy, consisting of cyclophospamide and carboplatinum. A period of 8 years elapsed before recurrent disease was detected; there were two separate metastatic sites. A secondary cytoreductive surgery without further chemotherapy has been the mainstay of treatment. A combination of exploratory laparotomy and en bloc resection revealed the metastatic deposits, a 5-cm mass involving the diaphragm, the lower aspect of the manubrium sternum, and four right lower ribs. The second deposit was identified in the left paracolic gutter invading the sigmoid colon. CONCLUSION: At 47 months of follow-up, the patient is alive and without any evidence of measurable disease by exam and confirmed by CT scans of chest, abdomen, and pelvis. To our knowledge, this is one of the few reported cases managed successfully by surgical approach and is recommended in selected patients with metastatic ovarian cancer.

Aged↗

PubMed2002

The benefit of using two techniques for sentinel lymph node mapping in breast cancer.

Sentinel lymph node (SLN) mapping has revolutionized the way we stage breast cancer. A blue dye technique (BD) and the use of a radiotracer with the assistance of a gamma-detecting probe (GDP) have been used for the identification of the sentinel nodes. Some groups have suggested that only one technique is necessary. The reported false negative rates have been 0 to 12 per cent and success rates as low as 65 per cent. We have prospectively evaluated these techniques and have used both for the identification of the SLN. Ten surgeons participated in this study. From April 1998 through May 1999, 58 patients underwent SLN mapping followed by an axillary lymph node dissection. After the injection of 0.3 to 1.96 mCi of filtered sulfur colloid diluted to 4 mL all patients had preoperative lymphoscintigraphy. Five minutes before surgery 3 to 5 mL of isosulfan blue was injected around the tumor or tumor bed. Even though preoperative lymphoscintigraphy identified an SLN in 35 patients (63%) successful intraoperative detection of an SLN was possible using both techniques in 53 patients (91%). The SLN was detected by the BD and the GDP in 37 (65%) and 45 (80%) respectively. Nineteen patients (33%) were positive for metastatic disease in the axilla. Twenty-two (19%) of 113 SLNs removed were positive for disease. All cases of metastatic disease in the axilla were detected by the mapping technique. False negative rate was 0 per cent. In 11 patients the only positive node was the sentinel node (58%). Furthermore six (32%) patients were upstaged by the use of immunostains for cytokeratin. Twenty-two positive SLNs were detected in the 19 patients. The positive lymph node was identified only by BD in four patients (21%), only by GDP in six patients (31%), and by both techniques in nine patients (47%). We conclude that if only one technique had been used the false negative rate could have been as high as 32 per cent. Both techniques must be used to obtain a low false negative rate and high yield in the identification of the SLN.

Breast Neoplasms↗

PubMedDate not supplied

Technetium-99m sestamibi scintimammography complements mammography in the detection of breast cancer.

Mammography remains the technique of choice for the detection of early breast cancer. The sensitivity of mammography is 85%, but is decreased in patients with dense breasts. Sestamibi scintimammography (SCM) has been suggested as an adjunctive modality to improve the detection of breast cancer. We conducted a study to determine the impact of SCM in patient management. A prospective study was conducted in 95 patients presenting with palpable masses and/or abnormal mammography scheduled for biopsy. Injection of 20-30 mCi of technetium-99m (Tc-99m) sestamibi into a pedal vein was performed. Ten-minute images of the breast and axilla were obtained in multiple projections. The mammography and SCM were correlated with pathology and clinical findings. The median age was 44 years (range 28-86 years). The total number of lesions was 104, as eight patients had bilateral lesions and one patient had two lesions in the same breast. Fifty-nine patients presented with palpable lesions and 45 patients with nonpalpable lesions (42 with abnormal mammography only and 3 with nipple discharge). A comparison of sensitivity, specificity, positive and negative predictive values, and overall accuracy of SCM and mammography were performed. The sensitivity and specificity for SCM were 83% and 83%, respectively, and for mammography were 65%, and 72%, respectively. The sensitivity and specificity for combined SCM and mammography were 87% and 94%, respectively. The p-value for mammography versus combined SCM and mammography was 0.0003 and that for SCM versus SCM and mammography was 0.0098. There were 80 (77%) benign and 24 (23%) malignant lesions. Of the 24 malignancies, SCM missed six (25%), versus eight (33%) by mammography. In two patients (9%) SCM detected malignancy in the breast that was not visualized by mammography or found on clinical examination. Sestamibi SCM improves the sensitivity of mammography and it detects up to 9% of malignancies not detected by mammography or clinical examination. This testing could impact the management of 16,500 patients in the United States every year. More studies are needed to better define its role in breast cancer detection.

Adult↗

PubMedDate not supplied

Results of curative therapy for esophageal cancer in a community training hospital.

A 12-year experience of therapy for esophageal carcinoma in a community-based cancer center was reviewed retrospectively. Of a total of 88 patients with histologically proven carcinoma of the esophagus 30 (34.1%) underwent curative esophagectomy. Twelve patients received preoperative chemoradiotherapy. Fourteen esophagectomies were performed transhiatally and 16 via the thoracolaparotomy approach. The average distance from incisors was 32.2 and 32.1 cm, respectively. Overall morbidity was 36.7%, with major complications in 30% of patients. Mortality was 3.3%. A comparison of patients treated with preoperative chemoradiotherapy (12 patients) and surgery alone (18 patients) showed no statistical difference in morbidity, mortality, or length of hospital stay. Analysis of these parameters in groups of patients operated via the transhiatal versus thoracolaparotomy approach demonstrated statistically lower morbidity (14.3% versus 56.3%, respectively), with no difference in mortality and a trend toward a shorter hospital stay in the former group. Overall survival at 3 years was 63.9%. In the combined therapy group, 90.9% of patients survived 3 years compared to 40.4% in the surgery only group (P = 0.0177). There was a trend toward better survival in the group of patients treated via the transhiatal approach. This study demonstrated that curative therapy for esophageal carcinoma can be performed with acceptable morbidity and mortality in a community teaching hospital.

Adenocarcinoma↗