Biomedical subjects

C Sciumè

Publications and source records attributed to C Sciumè.

At least 19 recordsLinked to original sources

PubMed2003

60KDa chaperonin (HSP60) is over-expressed during colorectal carcinogenesis.

The aim of the present study was to evaluate the expression of the heat shock protein 60 (HSP60), a mitochondrial matrix-associated protein belonging to the chaperonin family, in colorectal adenomas and cancers, comparing them to normal colonic tissues and hyperplastic polyps. We performed both immunohistochemistry and Western blot analysis for HSP60. Immunohistochemistry resulted positive in all tubular adenomas and infiltrating adenocarcinomas. By contrast, normal tissues and hyperplastic polyps were negative. Quantitative analysis showed that tubular adenomas with different levels of dysplasia did not present statistical differences concerning HSP60 positivity. In addition, carcinomas always showed the highest expression. Western blot analysis confirmed these observations. These data suggest that HSP60 over-expression is an early event in carcinogenesis. We suspect that HSP60 plays a different role in colorectal carcinogenesis with respect to that in normal cells, which foresees its possible use as diagnostic and prognostic tools.

Adenocarcinoma↗

PubMed2000

[Changes in the hemostatic system after laparoscopic cholecystectomy].

A 30 degrees reverse Trendelenburg position and the pneumoperitoneum performed in patients undergoing at Laparoscopic Cholecystectomy (LC) cause haemodynamic modifications in inferior cava vein and in femoral veins producing a venous stasis in lower limbs. So that activation of coagulation with hypercoagulability occurs. The aim of this study is to value the modification of the haemocoagulative and fibrinolytic factors during LC and OC. 18 patients with symptomatic and non complicated lithiasis were examined. They were divided in two groups, nine patients for each group. LC was performed in first group and OC in the other group. Prothrombin time (PT), plasma-activated partial thromboplastin time (PTT), Antithrombin III (AT III) fibrinogen degradation products (FDP) were valued before and at 6, 12, 24, 48 hours after operation. For the statistical analysis Student "t" for average comparison was used. There were no relevant alterations of PT, PTT and ATIII after operation in the two groups. FP was increased after surgery, especially at 24th-48th hours in the group in which OC (p < 0.05) was performed. FDP were increased in both groups but only at 24 and 48 hour after OC (p < 0.05) the result was significant. Earlier mobilization and reduced invasivity of laparoscopy could contrast thrombotic effects of the blood stasis in the lower limbs when 30 degrees-45 degrees reverse Trendelenburg and pneumoperitoneum are performed.

Blood Coagulation↗

PubMed2000

[Fibrinolytic system after laparoscopic cholecystectomy].

BACKGROUND: Deep-vein thrombosis (DVT) and pulmonary embolism (PE) are the most important causes of morbility and mortality in patients submitted to surgical intervention: some peculiar factors of laparoscopic surgery can modify their risk. The aim of this study is to evaluate possible variations of the fibrinolytic system after cholecystectomy. METHODS: Eighteen patients affected by symptomatic and non-complicated gallstones have been included in this study. They were divided into two groups of nine patients each: the first group was submitted to laparoscopic cholecystectomy (LC) and the second to open cholecystectomy (OC). Antitrombin III (ATIII), fibrinogen degradation products (FDP), tissue plasminogen activator (tPA), and plasminogen activator inhibitor (PAI) have been evaluated preoperatively and 6, 12, 24 and 48 hours after the operation. RESULTS: The levels of ATIII did not present significantly variations. The FDP in both groups were significantly increased 48 hours after open cholecystectomy. Levels of PAI instead were increased in comparison to the basal values at 6, 12, 24, 48 hours with p < 0.05; p < 0.01 and p < 0.05 respectively in patients submitted to OC, in the LC group no variations were observed; a comparison between the groups showed a significant modification (p < 0.05) only at the 12th hour. CONCLUSIONS: The early mobilization of patients in the postoperative course and the lower invasion of LC can oppose the prothrombotic effect in the lower limbs.

Cholecystectomy, Laparoscopic↗

PubMedDate not supplied

[Myelolipoma of the adrenal gland].

Adrenal myelolipomas are rare, nonfunctioning, benign neoplasms of the adrenal gland. The authors describe their experience of a case and they report the review of the literature. They illustrate what's etiopathogenetic theories, modern diagnostic technology "of imaging" and different surgical approaches need to be adapted to the excision of the adrenal myelolipomas.

Adrenal Gland Neoplasms↗

PubMedDate not supplied

[Agenesis of the gallbladder].

The authors report a case of agenesis of gallbladder associated with lithiasis of common bile duct. A review of the literature confirms the rarity of this congenital malformation. In 40-60% of cases it is associated with other gastrointestinal, skeletal, cardiovascular and genitourinary malformations. In 20-50% of cases it can be associated with common bile duct stones. Patients are asymptomatic in the majority of cases. A preoperative diagnosis is difficult despite of high accuracy of the modern diagnostic imaging techniques.

Aged↗

PubMedDate not supplied

[Cell-mediated immunity after laparoscopic cholecystectomy].

Cell-mediated immunity (CMI) is temporarily decreased after major surgical procedures in relation to type of anaesthesia, length and severity of an intervention. In this study it has been evaluated CMI response in vivo, after laparoscopic (LC) and open cholecystectomy (OC). 5 healthy persons and 16 patients with symptomatic and uncomplicated gallstones were studied. They were subdivided in two groups: 8 were treated by OC, 8 by LC. A skin test system (Multitest, IMC-Institute Merieux, Lyon, France) consisting of a plastic disposable multiple-puncture device capable of simultaneous application of seven delayed-type hypersensitivity antigens and a glycerin and saline diluent (negative control) was used. The test was performed 48 hours before and 24 hours after the surgical procedure. A diameter of 2 mm or more of the induration was considered as a positive response. A score expressed, as the sum in millimeters of all the mean diameters (DM) of positive reactions and as numbers of antigens (NA) positive was calculated. Statistics was assessed by Student's t test for comparison of averages. There was no difference of age, sex, anesthesiologic risk, length of the operation between the two groups. We observed a significative reduction of DM (P < 0.05) and of NA (P < 0.05) in patients in which OC was performed while there were no significant in the group treated by LC. Results show a significant suppression of the CMI after OC, no particular changes after LC according to other studies in vitro.

Cholecystectomy↗

PubMedDate not supplied

[Dieulafoy's ulcer: unusual cause of upper gastrointestinal tract. Our experience].

OBJECTIVE: The authors report their experience about the endoscopic treatment of upper gastrointestinal bleeding from Dieulatoy's ulcer (non variceal bleeding). DESIGN: Report of 5 cases; evaluation of mortality and effectiveness of the treatment. SETTING: Operative Unit of General and Thoracic Surgery, Department of Surgical, Anatomical and Oncological Disciplines. Policlinico, University of Palermo. INTERVENTIONS: EGDS + sclerotherapy (emergency room) in all 5 patients. RESULTS: 80% successful (stop bleeding). CONCLUSIONS: Endoscopic sclerotherapy is choice treatment of upper gastrointestinal bleeding from Dieulafoy's ulcer, only in well experienced teams and rapidly.

Aged↗

PubMedDate not supplied

[Bacterial endocarditis. Unusual complications of acute diverticulitis].

BACKGROUND: Colon diverticular disease represents an affection with high prevalence in the western countries. It appears particularly insidious in the elderly population for the presence of concomitant illnesses. CLINICAL CASE: A patient (> 80 years old) is submitted to surgical intervention in emergency sec. Hartman for acute diverticulitis and pelvic abscess. The post-operating time has been complicated for the arising of a fever resistant to the common antibiotic therapy, in absence of abdominal and respiratory objectivity. An accurate clinical examination has set the suspect of bacterial endocarditis, confirmed to the echocardiographic examination. DISCUSSION: The acute complicated diverticulitis therapy variates in according to the clinical presentation, the complications and the experience of the different Authors. A first conservative approach foresees the Total Parenteral Nutrition (TPN) and the wide spectrum antibiotic therapy and the eventual percutaneous drainage. The surgical treatment, realized with "open" or laparoscopic method, foresees the resection of the sick intestinal tract and the packing of a temporary preternatural anus. However, some Authors prefer an intestinal anastomosis performed in single time with the resection. Among all the complications, the most frequent are those affecting the respiratory and cardiovascular apparatus, as well as the sepsis. The bacterial endocarditis is not signalled in most recent international Literature. CONCLUSION: The bacterial endocarditis must be suspected in case of common antibiotic therapy resistant fever, with negative abdominal and pulmonary objectivity, arising after a septic surgical intervention.

Acute Disease↗

PubMedDate not supplied

[Endoscopic treatment of a calculous choledochocele. Report of a case].

OBJECTIVE: The authors report their experience about the treatment of choledochocele. DESIGN: Case report and 6-months follow up. SETTING: Operative Unit of General and Thoracic Surgery, Department of Surgical and Anatomical Disciplines. Policlinico, University of Palermo. INTERVENTIONS: ERCP + ES with complete resolution of pathology. RESULT: Complete resolution of symptoms; 6-months follow up negative. CONCLUSIONS: ERCP is choice treatment of choledochocele, only in well experienced teams.

Aged↗

PubMedDate not supplied

Th1-like and Th2-like cytokines in patients undergoing open versus laparascopic cholecystectomy.

The advantages of laparoscopic (LC versus, open cholecystectomy (OC) seems to be related to minimal invasive procedure and to the moderate inflammatory response. The aim of this study is to define the involvement of Th1 (IFN-gamma) and Th2 (IL-4, IL-6, IL-10, IL-13) cytokines production in vivo and in vitro in patients undergoing OC or LC. In 42 patients undergoing LC (n = 22) and OC (n = 20) Th1-like and Th2-like was evaluated before operation and at 6, 24 and 48 hours after operation for white blood cell counting and cytokines (IL-4, IL-6, IL-10, IL-13, IFN-gamma, TNF-alpha) in the sera and in the supernatants from circulating mononuclear cells stimulated with phytohemagglutinin or lipopolysaccharide. The acute phase response cytokine, IL-6, appeared significantly increased following OC than after LC. All other cytokines did not very significantly. In vitro data shows a reduction of IFN-gamma and increase in Th2-like cytokines in OC patients compared with the basal value. In LC subjects we observed an high production of IFN-gamma associated to an increase of Th2-like cytokines, like IL-10 and IL-13, even though IL-4 and IL-6 were unmodified. In contrast to OC, LC did not significantly affect immunocompetence, maintaining a moderate inflammatory response and an adequate balance between Th1 and Th2 cytokine. Furthermore, the strong activation of cells producing Th1-like cytokines in LC patients following mitogen activation indicated a consistent anti-microbial activity, that was not detectable in OC patients, that showed after activation only a Th2 response.

Adult↗

PubMedDate not supplied

Inflammatory response in open and laparoscopic cholecystectomy.

The modifications of IL-6. CRP, ceruloplasmin, alpha 1 antitrypsin, fibrinogen, transferrin, albumin and leukocytes counts have been evaluated after traditional open cholecystectomy (OC) or laparoscopic cholecystectomy (LC). Forty-two patients were included in this study, 20 underwent to OC and 22 underwent to LC. Serum samples were performed before surgery and at distance of 6, 24, 48 and 168 hours. The results show a more significant increase in acute phase inflammatory response after OC compared with LC as attested by highest values of leukocytosis, IL-6, CRP, fibrinogen and alpha 1 antitrypsin and lower levels of albumin. In conclusion, after LC, the phase acute response is attenuate and it can explain the reduced period of convalescence of patients treated with LC.

Acute-Phase Proteins↗

PubMedDate not supplied

[Surgical treatment of epiphrenic diverticulum based on associated functional changes: report of a case].

OBJECTIVE: The authors report their experience about the surgical treatment of a epiphrenic diverticulum (ED) associated with motor disfunctions and gastroesophageal reflux. DESIGN: Report of 1 case; evaluation of effectiveness of the treatment. SETTING: Operative Unit of General and Thoracic Surgery, Department of Surgical, Anatomical and Oncological Disciplines. Policlinico, University of Palermo. INTERVENTIONS: Thoracotomic diverticulectomy + esophageal extramucosal myotomy + antireflux procedure. RESULTS: Resolution of syntomatology. Negative the follow up. CONCLUSIONS: ED is the epiphenomenon of esophageal motor disfunctions. The surgical procedure is based on their comprehension and on the study of this factors.

Diverticulum, Esophageal↗

PubMedDate not supplied

[Integration of operative endoscopy and laparoscopic surgery in the treatment of cholecysto-choledocholithiasis].

UNLABELLED: Laparoscopic cholecystectomy has become first choice for symptomatic gallstones, but there are not agreement about therapy of supposed synchronous choledocholithiasis. We report our experience about the sequential treatment (endoscopic-laparoscopic) of the gallstone and the associated common bile duct stones. METHODS: During the period Jan. 1992 Dec. 1997 we have evaluated 128 patients that were submitted to ERCP for suspicion CBDS and gallstone. All patients undertook a systematic assessment: Patient age, sex, history of jaundice, history of pancreatitis, levels of serum alanine aminotransferase, alkaline phosphatase, amylase, total and direct bilirubin and CBD diameter on ultrasonography. RESULTS: In the 96 (75%) cases of choledocholithiasis endoscopic sphincterotomy has been performed and combined with laparoscopic cholecystectomy. Thirty-two patients (25%) submitted to ERCP have been negative for stones. Only 4 patients have needed surgery because of big stones inside the CBD after ESWL failure. The incidence of complications of ERCP-ES has been, in our experience, 7.1% and mortality 0.8%. All the complications have been treated conservatively and did not need surgery. CONCLUSIONS: The sequential treatment (endoscopic-laparoscopic) of synchronous CBDS and gallstone, in hands of expertise, is efficient with high rate of success and low rate of complications in order to morbidity and mortality. Finally we believe that it is very important to discover CBDS preoperatively with the non invasive methods as the MRI-Colangiography and to assay the liver tests in order to avoid negative ERCP for choledocholithiasis.

Adult↗

PubMedDate not supplied

[Unusual case of intestinal obstruction at the ileal level: strangulated obturator hernia. A case report].

OBJECTIVE: The authors report their experience about treatment of a rare case of intestinal (ileal) obstruction by strangulated obturator hernia. DESIGN: Report of 1 case; evaluation of effectiveness of surgical treatment, 2-years follow-up and revision of literature about its clinical presentation and treatment. SETTING: Operative Unit of General and Thoracic Surgery, Department of Surgical, Anatomical and Oncological Disciplines. Policlinico, University of Palermo. INTERVENTIONS: The patient was submitted to curative and radical surgery. RESULTS: Resolution of the pathology. Follow up (2 years) negative. CONCLUSIONS: Obturator hernia is a rare pathology, with difficult and delayed diagnosis: all these character make dangerous this hernia, with a risk of high morbidity and mortality (delayed diagnosis and treatment). The only useful treatment is surgery, especially in front of intestinal obstruction, with a wide median laparotomy.

Aged↗

PubMedDate not supplied

[Atypical presentation of a case of Mirizzi syndrome simulating cholangiocarcinoma].

OBJECTIVE: The authors report their experience in the treatment of a case of Syndrome of Mirizzi (SM) that it simulates a cholangiocarcinoma. EXPERIMENTAL DESIGN: Report of 1 case. Evaluation of the effectiveness of the treatment and 2 years follow-up. SETTING: Operative Unit of General and Thoracic Surgery, Department of Surgical, Anatomical and Oncological Disciplines. Policlinico, University of Palermo. INTERVENTION: Surgical treatment of the suspicious neoplastic lesion. RESULTS: Complete recovery with "restitutio ad integrum". CONCLUSIONS: The SM constitutes one important challenge from the diagnostic and therapeutic point of view, since it is not infrequent that the correct definition of this pathology is only intraoperative. The role of the videolaparoscopic cholecistectomy is not still well defined. To reduce the risks of lesion of the biliary tree during surgical intervention, also in case of diagnostic doubt, we propose an integrated approach of sequential type, with the exploration preoperative through ERCP and following surgical intervention.

Bile Duct Diseases↗

PubMedDate not supplied

[Endoscopic removal of a Dormia basket impacted in the biliary tract during treatment of a difficult residual choledocholithiasis. Report of a case].

OBJECTIVE: The authors report their experience about the treatment of a broken Dormia in CBD in elder with "difficult" residual choledocholithiasis, with T tube. DESIGN: Report of case. Evaluation of effectiveness of endoscopic treatment with 2-years follow-up. SETTING: Operative Unit of General and Thoracic Surgery, Department of Surgical, Anatomical and Oncological Disciplines. Policlinico "Paolo Giaccone"--Palermo. INTERVENTION: Endoscopic removal of Dormia broken and impacted in CBD after 2 session of extracorporeal shock wave lithotripsy (ESWL). RESULTS: Resolution of the pathology with 2 session of ERCP and cholangiographic control. CONCLUSIONS: ERCP and ES are the gold standard in the treatment of choledocholithiasis. Rare complication of this method is the rupture of Dormia Basket in CBD: this occurrence can be solved by endoscopy, but only in well experienced endoscopic teams.

Aged↗

PubMedDate not supplied

[Paraesophageal hiatal hernia. Clinical considerations and report of a case].

OBJECTIVE: The authors report their experience about the treatment about a case of paraesophageal hernia and they redefine nosography. DESIGN: Report of 1 case; evaluation of effectiveness of surgical treatment. 1-year follow up. Review of its clinical presentation. SETTING: Operative Unit of General and Thoracic Surgery. Department of General Surgery, Emergency and Transplantation. Polyclinc, University of Palermo. INTERVENTION: The patient was submitted to surgery with radical and curative intention. RESULTS: Complete resolution of the pathology. Follow-up (1 year) negative. CONCLUSION: Management of patients affected by paraesophageal hernia is difficult, because the physiopathology, anatomic basis and clinical presentation are not yet clear. The aim of surgical treatment is to reduce the hernia, to repair the hiatal gap and to make a correct antireflux procedure. According to us, the open surgical approach is very safe and useful because allows more safe surgical dissection, even if there is a big scar on the abdomen, the postoperative staying in hospital is longer. Finally, we emphasise the role of follow-up in these patients: it's the only way to prevent complications.

Adult↗

PubMedDate not supplied

[Gastric antral vascular ectasia (GAVE) or watermelon stomach syndrome: report of 3 cases and clinical and therapeutic indications].

OBJECTIVE: The authors report their experience in diagnosis, treatment and ambulatorial follow up of 3 cases of obscure upper gastrointestinal bleeding by gastric antral vascular ectasia (GAVE). EXPERIMENTAL DESIGN: Complete clinical report of 3 cases. Clinical and endoscopic indication, evaluation of effectiveness of endoscopic treatment with bipolar electrocoagulation and follow-up. SETTING: Operative Unit of General and Thoracic Surgery. University "Paolo Giaccone" of Palermo. INTERVENTION: Endoscopic treatment by multiple session with bipolar electrocoagulation. No complications were registered. RESULTS: Complete recovery with "restitutio ad integrum". No relapse were recorded at follow up. CONCLUSIONS: The objective of the treatment is to recognize the site of obscure bleeding and then stop it. The choice between pharmacological, endoscopic and surgical treatment is individual for each patient. According to us, the endoscopic treatment is the first step in a gradual clinical approach, to detect the site of the lesion, to treat with bipolar electrocoagulation or with Argon Plasma Coagulator (lower wall penetration and minimal risk of perforation).

Aged↗