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Biomedical subjects

C Casa

Publications and source records attributed to C Casa.

30 records · Page 2Linked to original sources
PubMed1993

Coelioscopic cholecystectomy: experience with 201 initial patients.

Over a 20-month period, 201 patients underwent laparoscopic cholecystectomy, including 159 women and 42 men (mean age, 44.2 years). Indications included symptomatic cholelithiasis (181 cases), acute cholecystitis (15 cases), gallstone pancreatitis (two cases), and cholangitis (three cases). Mean operating time was 78 min. Overall conversion rate was 5.4% (11 cases). Conversion to open procedure was elective in nine patients and enforced in two because of uncontrollable bleeding from the cystic artery. Three of the former nine patients who were converted subsequently had acute cholecystitis. One case of cellulitis at the umbilical stab wound and one case of bile leak, which drained spontaneously, occurred in patients operated on for acute cholecystitis. Laparotomy was performed on the 7th postoperative day for a liver bed hemorrhage in a patient presenting with cholecystitis. One common bile duct injury occurred in a patient with cholecystitis necessitating a biliary reconstruction. No perioperative deaths occurred. Mean hospital stay was 3.4 days. Despite several advantages, laparoscopic cholecystectomy must be performed by surgeons experienced in biliary tract surgery.

Acute Disease↗
PubMed1993

[Pseudomyxoma peritonei. Apropos of 19 cases].

Nineteen patients, 15 women, 4 men, mean age 65 years, were treated for pseudomyxoma peritonei between 1971 and 1991. The clinical onset was generally insidious, predominant signs being ascites (9 cases), a mass (9 cases), distension (8 cases) and abdominal pain (8 cases). Diagnosis was assisted by scan imaging and alteration in serum ACE levels. The initial mucosecreting tumor was appendicular (12 cases), ovarian (11 cases) or both (4 cases). Histology was benign in 17 of the 19 patients. After surgical treatment in all cases, 10 patients relapsed, global survival at 5 years being 65% and at 10 years 49%.

Adult↗
PubMed1993

[Cholecystectomy by celioscopy. Apropos of 126 cases].

One hundred twenty-six cases who underwent laparoscopic cholecystectomy were included in the study: 28 males and 98 females with a mean age of 44.2 years. Laparoscopic cholecystectomy was performed for uncomplicated cholelithiasis (111 cases), acute cholecystitis (10 cases), biliary pancreatitis (2 cases) and cholangitis (3 cases). The mean operative time was 78 minutes. In 7 cases, a transformation into open surgery was necessary (5.5%). There were no deaths and one major complication was reported: an iatrogenic injury to the bile duct requiring secondary laparotomy. The mean hospital stay was 3.4 days. However, despite several advantages, this new technique must be performed by a surgeon with experience of biliary tract surgery.

Acute Disease↗
PubMed1992

[Trans-suture anastomosis. Choice of procedure in the management of colorectal anastomosis].

The double stapling technique was used to perform low anterior resection for rectal tumors in 122 patients (68 men, 54 women) with a mean age of 65 years (range, 28 to 87 years). There was no perioperative death. Technical problems related to the stapling technique and requiring transitory colostomy occurred in one patients. The clinical anastomotic leak rate was 5 per cent (six patients); in 2 patients, the fistula was treated successfully with a defunctioning transverse loop colostomy. Hospital stay ranged from 6 to 23 days (mean 10.2 days). Continence was normal in all patients at 6 weeks. One soft colo-anal anastomotic stenosis required dilatation. These results appear promising. The double stapling technique appears to facilitate low anterior resection of the rectum with safety.

Adult↗
PubMed1990

[Contusions of the liver in adults. Initial non-operative management with computerized tomography follow-up is a reasonable therapeutic option. Report of 16 cases].

Nonoperative management of blunt liver injury in adults still remains controversial. From February 1985 through September 1989, 27 patients were treated for blunt hepatic trauma: 11 required immediate operation and 16 (59%) were initially managed nonoperatively after evaluation of intraabdominal injury by computerized tomography. All of these 16 patients were hemodynamically stable and had no significant peritoneal signs. CT criteria for nonoperative management included subcapsular and intrahepatic hematoma, capsular tear or unilobar fracture, absence of large hemoperitoneum, absence of large devitalized liver and absence of other intraabdominal organ injuries. Clinical follow-up, repeated radiologic examinations and surgery confirmed the accuracy of CT. Only 2 patients required delayed operation (12.5%). Serial abdominal CT studies are an integral part of the conservative treatment of blunt hepatic injuries and showed complete resolution of hepatic injuries in the fourteen nonoperated patients in less than six months. No death and no delayed septic or biliary complications were noted. Mean hospital stay was seventeen days for all of the patients (multiple injuries or not) and only ten days for isolated blunt liver injury. These good results depend on identification of candidates for nonoperative management on strict clinical and CT criteria. Nonoperative management of adult blunt liver injury based on these findings is a useful alternative in a selected group of hemodynamically stable patients and decreases the rate of non-therapeutic coeliotomy.

Adult↗
PubMed1990

[Diagnostic splenectomy. Apropos of 38 cases].

The authors report a retrospective study of 38 splenectomies performed as a diagnostic procedure. In the first group, the diagnosis was made by surgery: 27 cases (71.1%) included the usual large number of lymphomas. In the second group, there was no conclusion: 11 cases (28.9%), patients were younger and the spleen was lighter with a statistical significance (p less than 0.006 and p less than 0.003). Three of the 11 patients in the second group subsequently developed a malignant blood disease. Morbidity was high: out of 38 cases, 14 complications occurred in 11 patients (28.9%). One patient died on the fifty fifth postoperative day. The authors consider that splenectomy for undiagnosed splenomegaly is an effective procedure for diagnosing lymphoma, but not without risk. Indications for surgery must be carefully evaluated. It is more questionable in young, asymptomatic patients or in the case of moderate splenomegaly. After surgery, with no histologic diagnosis only a long-term survey will differentiate patients with malignant blood diseases from patients with idiopathic splenomegaly.

Adolescent↗
PubMedDate not supplied

[Splenectomy for massive splenomegaly. Apropos of 36 cases].

Thirty-six splenectomies for splenomegaly exceeding 1000 grams are reported. The enlargement of the spleen most often was related with a malignant disease (n = 32). Cytopenia was the main indication in 14 cases, and splenectomy was contemplated for diagnosis (n = 12), initial treatment (n = 6), or due to pain (n = 3) or spontaneous rupture (n = 1). Ten patients (27.8%) had an associated surgical treatment. One patient died postoperatively (2.8%) and 12 patients presented with 14 complications (33%) usually with a rapidly favorable evolution. In 11 of 12 cases (91.6%), the operation allowed establishing the diagnosis in cases of splenomegaly with an unknown origin. Lastly, it was always effective to relieve pain and in most cases improved cytopenia. The authors conclude that the patients with massive splenomegaly are improved by splenectomy, although it most often is merely a palliative treatment in cases of malignant hemopathy.

Adult↗
PubMedDate not supplied

[Pancreato-gastric anastomosis after cephalic duodenopancreatectomy. Apropos of 36 cases].

After pancreaticoduodenal resection, a pancreatic fistula is observed in 10% of cases with a mortality rate of 20-30%. The pancreatogastrostomy was evaluated as an alternative method of restoring pancreaticointestinal continuity. From 1989 to 1991, 36 patients have undergone pancreatogastrostomy, after pancreaticoduodenectomy. The mortality rate was 2.7% (one pulmonary embolism). The morbidity rate was 2.7% (one pancreatic fistula). A endoscopic examination with injection of pancreatic duct was performed in 12 patients: in 9 cases we had a visualization of the anastomosis between the stomach and the pancreatic duct. These results confirm that pancratogastrostomy is a safe method of pancreatic drainage after pancreatoduodenectomy.

Adult↗
PubMedDate not supplied

Pancreatogastrostomy following pancreatoduodenectomy: a safe drainage procedure.

The propensity for leakage and disruption at the site of the pancreatojejunostomy is a major reason for morbidity and death after pancreatoduodenal resection. The purpose of this study was to evaluate the safety of pancreatogastrostomy as an alternative method of restoring pancreatointestinal continuity. From January 1989 to June 1991, 32 patients (28 with malignant tumors and 4 with chronic pancreatitis) underwent pancreatogastrostomy following pancreatoduodenectomy. There were two postoperative deaths (6.2%) one of which could in part have been due to the anastomotic technique, too tight with postoperative pancreatitis as a result. There was one pancreatic fistula (3%) which recovered with further surgery. That pancreatogastrostomy is safe is well documented in the literature. That it is safer than the conventional anastomosis or provides a better functional result is still to be proved.

Anastomosis, Surgical↗
PubMedDate not supplied

Primary carcinoma of the gallbladder--review of 143 cases.

BACKGROUND/AIMS: We reviewed a consecutive series of patients with primary cancer of the gallbladder and looked for specific symptoms, signs, laboratory tests, radiological examinations, operative procedures, operative findings and survival. MATERIAL AND METHODS: The records of 143 patients with gallbladder carcinoma operatively treated between 1975 and 1990 were retrospectively reviewed. RESULTS: Abdominal pain was the most common symptom and present in 72% of our patients. Jaundice was present in 83 patients (58%) and weight loss in 68 (47.5%). The pre-operative diagnosis was made in only 28.7 per cent of the cases. Surgical procedures included cholecystectomy alone (24 patients), cholecystectomy and resection of the hepatic bed (17 patients), and exploration with biopsy or bypass (20 patients). Only 21.5% of patients underwent curative surgery. Overall five year survival rate was 11%. For patients whose tumor was limited to the gallbladder wall (T1, T2, T3), the acturial 5-year survival rate was respectively 100%, 29% and 23%. For patients with T4 and T5 tumor, the 5 year survival rate was nil.

Actuarial Analysis↗