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D Borrelli

Publications and source records attributed to D Borrelli.

54 records · Page 3Linked to original sources
PubMedDate not supplied

Intraoperative fall in plasma levels of intact parathyroid hormone in patients undergoing parathyroid adenomectomy.

Intraoperative measurement of intact parathyroid hormone (PTH) can be used to evaluate the success of parathyroid surgery in primary hyperparathyroidism associated with parathyroid adenoma. To evaluate this approach we used a modified immunoradiometric assay (IRMA) to study the kinetic patterns of circulating PTH disappearance in 13 patients undergoing adenomectomy for single adenoma. The rapid and the standard assay for PTH measurement in plasma were used and compared. The two methods showed a highly significant correlation (r = 0.995; p < 0.0001). We reported a decrease in PTH to 18.2 +/- 2.30 (mean +/- SEM) from baseline values at 15 minutes after successful parathyroid adenomectomy in the 13 patients. The biphasic pattern of serum PTH clearance was calculated in 8 of the studied patients with a fast phase showing a half-life (T1/2) of 3.99 (SEM 0.464) minutes and a slow phase with a T1/2 of 91.0 (SEM 33.6) minutes. Half the amount of the basal values was reached between 4 and 9 minutes. Our study concludes that the modified IRMA for intraoperative measurement is feasible, reliable and sufficiently precise for low hormone values. Since it may yield information on the half-life of PTH in the circulation, it may play a role in the surgical guidance for total exeresis of hyperfunctioning tissue.

Adenoma↗
PubMedDate not supplied

[Pulmonary arteriovenous fistula within the picture of congenital angiodysplasias. Clinical case].

The aetiopathogenesis, clinical picture, diagnosis and treatment of pulmonary arteriovenous fistula are examined in the light of a case observed at the Florence University Surgery Clinic in 1970 and marked by multiple truncular fistulae at the middle and inferior lobes of the right lung. The condition is seen as an instance of congenital angiodysplasia with arteriovenous shunt. A clear distinction is drawn between true fistulae, as seen in the reported case, and angioma and aneurysm. Stress is laid on the importance of radical management, though it is conceded that surgery should occasionally be renounced in the absence of symptoms, or where lung hypertension is particularly marked.

Angiocardiography↗
PubMedDate not supplied

[New issues in surgery of adrenal pheochromocytoma].

The adrenal pheochromocytoma still arouses great interest among the experts. The Authors give here a report of a study carried out on the personal case history of 32 patients and the concerning literature. A correct clinical and diagnostic approach is important to detect, at a preoperative level, the benign forms from the malignant ones (10-15% of cases according to literature) and the polyendocrine syndromes (21% of our series). Video-laparoscopy technique is recommended in pheochromocytomas surgery, mainly in asymptomatic and incidental forms and in all benign symptomatic forms less than 5 cm in size. At least, uni- or bilateral adrenalectomy associated with total thyroidectomy is also suggested in case of a polyendocrine syndrome.

Adolescent↗
PubMedDate not supplied

[Current indications of bilateral adrenalectomy in Cushing's syndrome: discussion of personal experience].

Since 1975 we have observed 68 patients with Cushing syndrome, 48 out of which with an ACTH-independent disease and 20 with an ACTH-dependent one, due to hypophisary adenoma. Out of the latter group of patients, which had a relapse of the disease after a previous trans-sfenoidal procedure, 16 underwent an open bilateral adrenalectomy and 4 a laparoscopic monolateral or bilateral adrenalectomy. Patients from the former group had an open or laparoscopic adrenalectomy, or a bilateral adrenalectomy in case of the rare bilateral diseases, as McCune-Albright syndrome. All patients had a complete healing, except for 2 patients affected by McCune-Albright syndrome who died for cardiopulmonary complications. We conclude that bilateral adrenalectomy plays a fundamental role in the treatment of Cushing disease, after the failure of the trans-sfenoidal procedures. This surgical therapy has been certainly improved by the introduction of the laparoscopic techniques, which allowed us to exert bilateral adrenalectomies in two times with a significant reduction of perioperative morbidity and mortality because of the less severe traumatism and the absence of addisonian complications.

Adrenalectomy↗
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[Videolaparoscopic adrenalectomy in Conn syndrome. Analysis of 39 case observations].

The authors retrospectively analyse 39 patients affected by Conn's syndrome, which have been observed since 1985, and discuss the results of surgical approach using the new technologies. In particular, the introduction of laparoscopy, technique that has been applied almost exclusively since the last seven years, has revealed being the "gold standard" for the surgical treatment of this disease. The adrenal underlying lesions are indeed almost always monolateral, small in size and present very rarely malignancy in their biological behaviour. Furthermore, the authors, although lacking of personal experience, propose the possibility of a more conservative treatment of the adrenal lesions with a simple "enucleation", whose feasibility also in laparoscopy has recently been shown by some authors. Anyway, the Authors believe that this technique of a partial adrenalectomy could be chosen in selective cases of bilateral adenomas or hyperplasia or in those lesions which are placed in an easily accessible peripheral site.

Adrenalectomy↗
PubMedDate not supplied

[Surgical strategy in the treatment of adrenal cortex cancer. Expanded and repeated interventions].

AIM OF THE STUDY: To analyze our patients affected by adreno-cortical carcinoma (ACC) considering in particular the therapeutical approach in case of local recurrence or metastasis, and to compare our results with those from literature. PATIENTS AND METHODS: Since 1975 up to 2001, 35 patients with ACC were observed, 27 female and 8 male, aged between 3 and 76 year. All patients were surgically treated, 3 out of which laparoscopically. Thirty patients underwent radical and 5 palliative surgery. Twenty-two patients had extended resections to surrounding infiltrated organs, such as spleen, pancreatic taIl, vena cava, left colon and liver. The intervention was always completed by regional lymphadenectomy. Adjuvant treatment was administered in 17 patients, 4 out of which were re-operated. RESULTS: Only one patient died in the perioperative period for hyperacute adrenal failure. The survival rate was 85.7% at one year, 76.5% at two years, 70.8% at three and 28.3% at five years. Out of the 30 patients radically treated, only 3 are disease-free up to now. Local recurrence or metastatic disease was observed in 27 patients, out of which only 9 were eventually surgically treated, once or more times. All non-operated patients died between 1 and 6 months from the recurrence. The survival rate of the 9 re-operated patients was 51% at 2 years, and 22.1% at 5 years. Interestingly, one patient who has been re-operated three times, is still alive and disease-free after 7 years from the first recurrence. No significant difference was observed between Mitotane-treated and non-treated patients. CONCLUSIONS: According with data from literature, we conclude that surgical therapy of recurring local or metastatic ACC is up to now the best treatment, independently from the original stage of the disease. Controversies still remain about the utility of adjuvant chemotherapy in the primary and the recurrent disease.

Adolescent↗
PubMedDate not supplied

Fine needle aspiration cytology of parathyroid adenoma. A review of seven cases.

The value of fine needle aspiration (FNA) cytology in the diagnosis of parathyroid adenomas was demonstrated by a cytohistologic review of seven cases. The cytologic patterns, which were characterized by numerous, mostly isolated epithelial cells and naked nuclei showing anisokaryosis and multiple nucleoli, were consistent with the histologic findings in this neoplasm, which should be considered in the differential (FNA) diagnosis of masses in the neck region. The only diagnostic problem is its differentiation from follicular thyroid neoplasms.

Adenoma↗
PubMedDate not supplied

Intra-arterial hepatic chemotherapy with 5-fluorouracil and 5-methyltetrahydrofolate in the treatment of unresectable liver metastases from colorectal cancer.

Treatment of patients with hepatic metastases from colorectal cancer using hepatic artery fluorodeoxyuridine (FUDR) has been reported to induce high remission rates but also a high incidence of limiting hepatobiliary toxicity. In an attempt to obviate the limiting FUDR toxic effects, a phase I-II study was undertaken to establish the efficacy and tolerability of intra-hepatic 5-fluorouracil (5-FU) when given in combination with 5-methyltetrahydrofolate. Patients with colorectal liver metastases (n = 17) received escalating doses of 5-FU as a 1 h infusion with a fixed dose (100 mg/m2) of intra-hepatic 5-methyltetrahydrofolate (4 h infusion) once a week. Dose limiting toxicity was hepatic and gastrointestinal (diarrhea) and occurred at doses > or = 350 mg/m2 5-FU. Other adverse effects included nausea/vomiting and cutaneous toxicity. One patient achieved a complete response and 2 a partial response (mean duration = 9 months) while 11 had stable disease. Patients with complete or partial responses had a mean survival of 17 months, while patients with stable disease survived 13 months and those with disease progression 5.5 months on average. These results suggest that this is a well tolerated regimen although with efficacy at the lower level of the range observed with fluoropyrimidines.

Adult↗
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[Indications for hepatic resection: personal experience].

The Authors, before examining their case history, which includes 103 major and minor hepatic resections performed during the last decade, briefly show the surgical technique concerning hepatic ischaemia and the new technologies proposed to reduce the hematic loss during hepatic resections. The constant adoption of these techniques and the careful evaluation of some parameters concerning hepatic functionality allowed to decrease postoperative complications and mortality, which currently is around 5-10%. These data are confirmed by the Authors experience.

Animals↗