Percutaneous gall bladder aspiration as an alternative to laparoscopic cholecystectomy in Child-Pugh C cirrhotic patients with acute cholecystitis.
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Cholecystectomy, Laparoscopic↗
Biomedical subjects
E Cucinotta
Publications and source records attributed to E Cucinotta.
Laparoscopic cholecystectomy in children with chronic hemolytic anemia. Is the outcome related to the timing of the procedure?
BACKGROUND: The aim of this study was to evaluate whether the outcome in children with chronic hemolytic anemia (CHA) and cholelithiasis undergoing laparoscopic cholecystectomy (LC) is related to the operation timing. METHODS: From June 1995 to December 2004, 46 children with CHA were referred to our division of surgery for cholelithiasis. All 46 children were asymptomatic at the time of the first visit, and an elective LC was proposed to all of them before the onset of symptoms. The operation was accepted in the period of study by 24 children and refused by 22. The patients were divided into three groups (group A, asymptomatic; group B, symptomatic; and group C, emergency admitted) depending on clinical presentation and operation timing, and the respective outcomes were compared. RESULTS: Elective LC in asymptomatic children (group A) is safe with no major complications reported. In children who refused surgery (groups B and C), we observed four sickle cell crises, four acute cholecystitis, and two choledocholithiasis, and all these complications were related to waiting. Two sickle cell crises occurred in symptomatic children waiting for surgery during biliary colic. The risk of emergency admission in children with cholelithiasis and CHA awaiting surgery was found to be high: 28% of the children admitted in emergency after a mean of 32 months (range, 22-36). Morbidity rate and postoperative stay increased when children with hemoglobinopathies underwent emergency LC. CONCLUSIONS: Elective LC should be the gold standard in children with CHA and asymptomatic cholelithiasis in order to prevent the potential complications of cholecystitis and choledocholithiasis, which lead to major risks, discomfort, and longer hospital stay.
Adolescent↗
Laparoscopic cholecystectomy in cirrhotic patients.
BACKGROUND: This study aimed to evaluate the safety of laparoscopic cholecystectomy for patients with cirrhosis. METHODS: The records of 22 laparoscopic cholecystectomies performed in patients with cirrhosis Child-Pugh A and B, from January 1995 to July 2001 were retrospectively reviewed. RESULTS: No deaths occurred. Conversion to open cholecystectomy was necessary in two cases. The average operative time was 115 min, which was significantly shorter than that for patients undergoing open cholecystectomy. None of the patients required blood transfusion. Intraoperative problems occurred in two patients who experienced liver bed bleeding. Postoperative morbidity occurred in 36% of the patients and included hemorrhage, wound complications, intraabdominal collections, and cardiopulmonary complications, but all were controlled. The patients were dismissed after an average of 4 days. CONCLUSION: The authors believe laparoscopic cholecystectomy can be performed safely in selected patients with cirrhosis Child-Pugh A and B who manifest indication for surgery. Laparoscopic cholecystectomy offers several advantages over open cholecystectomy: lower morbidity, shorter operative time, and reduced hospital stay.
Adult↗
Short-term variations in bone remodeling biochemical markers: cyclical etidronate and alendronate effects compared.
Bone-remodeling markers have been proposed to monitor antiosteoporotic therapy, as substantial changes in these markers usually occur in a relatively short time interval. In this study we have evaluated the short term effects of two bisphosphonates on bone-remodeling markers with the aim of 1) defining the shortest reliable time interval after which markers should be measured, and 2) comparing the effects of different bisphophonates. To do so, 74 postmenopausal women with a lumbar spine t score of at least -1 were randomly allocated to 4 different treatments: calcium carbonate (500 mg/day; n = 18), 5 mg/day alendronate (A5; n = 18), 10 mg/day alendronate (A10; n = 20), and cyclical etidronate (CE; n = 18). Serum and 24-h urine samples were collected at baseline and 14, 28, 56, and 84 days after the beginning of therapy. Type I collagen N-terminal (NTx) and C-terminal (CTx) telopeptides and total deoxypyridinoline (tDPD) were measured in urine and normalized for urinary creatinine excretion. Osteocalcin and bone alkaline phosphatase in serum were measured. Alendronate (at both doses) and CE significantly decreased bone-remodeling markers, whereas calcium carbonate did not. Bone resorption markers reduction reached a plateau 14 (A10) or 28 (A5 and CE) days after the beginning of treatment, whereas osteocalcin and bone alkaline phosphatase were significantly reduced at 56 (A10) and 84 (CE) days. The global effects of alendronate and CE on NTx and CTx (calculated as the area under the curve) were significantly different from those of calcium (P < 0.05), but were not significantly different from each other. The percent change from baseline obtained with tDPD, NTx, or CTx during bisphosphonate treatment were significantly different (P < 0.05), but this difference disappeared when the variability in the calcium carbonate group was taken into account. In conclusion, this study shows that 1) etidronate and alendronate induce a significant and rapid reduction in bone-remodeling markers; 2) the changes in NTx, CTx, and tDPD urinary excretions reach a plateau after 2-4 wk of treatment; and 3) short term treatments with CE or alendronate induce similar changes in the urinary excretion of NTx and CTx.
Adult↗
Comparison of the clinical performance of the immunoenzymometric assays for N-terminal and C-terminal type I collagen telopeptides and the HPLC assay for pyridinium cross-links.
We evaluated the clinical performances of the immunoenzymometric assays for type I collagen N-terminal and C-terminal telopeptides and the HPLC assay for total deoxypyridinoline, in distinguishing between subjects with a moderately increased bone resorption rate (women in postmenopause) and subjects with normal bone resorption rate (women in premenopause). The postmenopausal group consisted of 61 women who had been in menopause for no more than 10 years, while the premenopausal group consisted of 52 healthy women with normal menstrual cycles. The biochemical markers were measured in a 24 hour urine sample and the results expressed as the molar ratio with urinary creatinine. The clinical performances were estimated by calculating the accuracy (as the area under a Receiver Operated Characteristic (ROC) curve: mean +/- SEM) and the discriminating power (as score) of each assay in distinguishing postmenopausal subjects from premenopausal subjects. Type I collagen C-terminal telopeptide, type I collagen N-terminal telopeptide and total deoxypyridinoline were significantly higher in the postmenopausal than in the premenopausal group (p < 0.01). Accuracies of these three markers ranged from 66.8 +/- 5.1% to 76.8 +/- 4.3%, while Z scores ranged from 3.54 to 5.67. Type I collagen C-terminal telopeptide, type I collagen N-terminal telopeptide and total deoxypyridinoline were not significantly different in their accuracy or discriminating power. All markers were highly correlated with coefficients of correlation ranging from 0.61 to 0.77. In summary, this study shows that 1) the immunoenzymometric assays for type I collagen N-terminal telopeptide and type I collagen C-terminal telopeptide show a high accuracy and discriminating power in distinguishing subjects with different bone resorption rate; 2) the results obtained with these immunoenzymometric assays are comparable to those obtained with the HPLC assay for total deoxypyridinoline. In conclusion our data support the use of the immunoenzymometric assays for type I collagen N-terminal telopeptide and type I collagen C-terminal telopeptide for estimating bone resorption.
Adult↗
[Bilateral carcinoma of the breast].
From 1990 to 1996, a total of 223 patients, with breast cancer, were treated. Out of these patients, 7 (3.04%) developed a second primary carcinoma in the controlateral breast. Two (28.5%) had a synchronous manifestation while the remaining 5 (71.5%) had a metachronous manifestation. The seven patients were followed up for periods between 4-8 years: 80% of the metachronous tumours occur within 5 years of follow-up. The 7-year actuarial survival was 100% in the two synchronous tumours and 60% in the five metachronous tumours (two patients died on account of intervening diseases). The prognosis does not depend on the length of the interval between the development of the two carcinomas but it is in relation with the anatomo-clinical state, to the adequate treatment of each primary tumour and to the rigorous clinical-instrumental follow-up, in which the mammography plays a fundamental role.
Actuarial Analysis↗
[Day-surgery treatment of pilonidal sinus].
Authors discuss ethiopathogenus of pilonidal disease after a historical background and support acquired-congenital theory. Open and closed treatment are reported on the acute and chronic phases, highlighting economical advantages of closed method. Carbon-dioxide laser on Authors experience was very useful to prevent complications and to shorten healing time in open method.
Adolescent↗
[Primary adenocarcinoma of the duodenum].
Adenocarcinoma of the duodenum represents a rare neoplasia characterized by an indefinite symptomatology, at least early, and deceitful, that, therefore, arrives at surgeon, almost always, in advanced stage. The Authors, taking from a clinical case, recently observed, as a starting point, review the literature, referring the etiopathogenetic hypothesis that explain the relative rarity of this neoplasia. They therefore report the diagnostic and therapeutic procedure to carry out in these patients.
Adenocarcinoma↗
[Ambulatory treatment of inguinal hernia].
The Authors report their experience about the inguinal hernioplasty operation by implantation of prostheses in prolene following the Licthenstein technique. Prolene mesh strengthens the inguinal canal wall, with no suture tension point. The technique is performed under local anesthesia, in day-hospital system, consenting the patient a rapid reinstatement in the social-working ambit.
Adolescent↗
[Hemangiopericytoma: diagnostic-therapeutic considerations].
The Authors report a clinical case of hemangiopericytoma recently observed. The biological behaviour of this tumour presents a character of unforeseeableness and, in every chance, needs a long period of follow-up. Based on literature data, the Authors report some diagnostic-therapeutic precise information and underline the scanty reliability of the prognostic factors.
Abdominal Muscles↗
[Gastric precancerous conditions].
The Authors examine the anatomopathological and clinical features of the main gastric precancerouses and explain the diagnostic therapeutic protocols used. The diagnostic and therapeutic strategy can not leave a strict interdisciplinary collaboration out of consideration between radiologist, endoscopist, anatomist, gastroenterologist and surgeon. They conclude, in fact, affirming that the mentioned collaboration represents the one possibility for improving the results at distance of this neoplasia.
Chronic Disease↗
[Compression suturing devices in surgery of lateral colostomies].
The Authors refer their experience about two cases of colo-colic anastomosis executed by employment of biofragmentable ring BAR (Valtrac). The Authors used, for the bowel fragments preparation, the ASP-50 rake, overcoming the frequent inconvenient of mucosa extroversion thanks to circumferential mucosectomy extensive for a few mm. of colic fragments. Based on BAR (Valtrac) behaviour and the obtained results, in accord with the most other Authors, they conclude affirming that the compression anastomosis represents a simple methodology, sure and reliable for closing of the lateral colostomies.
Anastomosis, Surgical↗
[A case of Merkel's cell tumor].
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Carcinoid Tumor↗
[A case of chorioepithelioma of the spleen].
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Choriocarcinoma↗
[Sulpiride and experimental gastric lesions].
The Authors have conducted some research on the action of Sulpiride in animals which had been previously obliged to search into the gastric lesion caused by the compulsion. According to them above drug determines a reduction of the quantity of animals affected from gastric lesion and attenuates in other animals the entity of the gastric lesion.
Animals↗
[Experimental research on the effect of electro-acupuncture on reparative processes].
With a view to clarifying the mechanism whereby electroacupuncture aids teh repair of trophic ulcers, including inveterate forms resistant to ordinary treatments, reference is made to histochemical findings and histological findings in periulcerous tissues and experimental research into wound healing. Preliminary work showed that electroacupuncture improves the blood supply to ulcerous tissue and the local biochemistry, and accelerates the repair process. Experimental work also made it clear that the method, when use on alternate days with the modalities employed in clinical practice, accelerates the healing of wounds in the experimental animal.
Acupuncture Therapy↗
[Electro-acupuncture and trophic ulcer].
Electroacupuncture was used in the treatment of 50 cases of tropic ulcer of the lower extremities, including 34 following phlebitis, by stimulation with a Roccia VTM apparatus at voltages and frequencies up to the patient's tolerance threshold. The needles stimulation was maintained for a maximum of 7 hr. A cure was obtained in all cases, including those where the ulcers were inveterate and resistant to routine forms of management.
Acupuncture Therapy↗