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Biomedical subjects

E Leopaldi

Publications and source records attributed to E Leopaldi.

9 recordsLinked to original sources
PubMed1994

[Asymptomatic hyperparathyroidism. Influence of PTH values on the therapeutic decision].

The majority of patients affected by primary hyperparathyroidism present now in surgical series are little or totally asymptomatic. This is due to widespread use of multiphasic screening for hypercalcemia as far as to more liberal indications for parathyroid exploration. The debate about the need for parathyroidectomy is open in these patients, having few or no signs at all of primary hyperparathyroidism, because conservative treatment has yielded confused results. The authors analyzed preoperative biochemical values and surgical outcome from 26 patients affected by primary hyperparathyroidism. Thirteen cases had overt primary hyperparathyroidism (group A) and 13 had asymptomatic disease (group B). Patients in group A had higher preoperative PTH values than patients in group (p < 0.05). After surgery, the patients in group A showed parathyroid glands which weighted significatively more than ones in group B (p +/- 0.01). Further, a significant correlation between preoperative PTH value and glandular weight was demonstrated in all cases. The authors conclude surgery for patients having mild primary hyperparathyroidism may give some problems related to the very small size of abnormal glands found during operation. We advise a close follow-up for these patients initially without treatment: surgery should be recommended for those showing PTH values higher than 150 pg/ml.

Adult↗
PubMed1991

[Pyloric stenosis caused by gallstone (Bouveret's syndrome). Presentation of a further case].

The Bouveret's syndrome is a rare complication of a bilio-digestive fistula, where a big stone occludes the pyloro-duodenal region. The clinical symptomatology is atypical, symptoms of the disease are acute and only in fifty per cent of cases it is possible to have a positive anamnesis for biliary lithiasis. The evolution of the occlusion is generally rapid. The clinical case we are in possession of, shows a particularly chronic evolution with a 15 month sub-occlusive symptomatology that caused a massive gastric dilatation. The diagnosis of Bouveret syndrome was set forth during operation, as generally happens in about 50% of cases. The surgical treatment is still the only one capable to solve the obstruction of the alimentary canal and the bilio-digestive fistula at the same time.

Biliary Fistula↗
PubMed1981

[Current indications for lumbar sympathectomy in obstructive arteriopathies of the lower extremities].

Reference is made to personal experience (421 lumbar sympathectomies in 1640 vascular operations carried out over the last ten years) and the results of an enquiry addressed to more than 200 Italian surgeons are cited for the proposition that the indications for this operation are still the subject of disagreement, while its results occasionally appear to be contradictory. It is felt that the procedure is best reserved for cases in the second initial or intermediate stage, and should only be employed in advanced 2nd-stage, and 3rd and 4th stage patients whose poor general condition is a contraindication to reconstruction (indication of necessity). Other parameters to be taken into consideration include: age, site and type of the obliterating disease, ineffectiveness of drug management, and concomitant diseases (if any). Sympathectomy plus reconstructive surgery should only be used in cases where the run-off seems unsatisfactory.

Amputation, Surgical↗
PubMedDate not supplied

[Current approaches in the treatment of gastrinoma metastases].

In the last years the therapeutic behaviour with regard to gastrinomas, has deeply changed becoming more and more aggressive. Nowadays, almost all authors recommend, after a serious treatment of the hypersecretion with omeprazole, an explorative laparatomy in all patients affected by gastrinoma even without a preoperative tumor localization. The multiple endocrine syndrome (MEN I) and the metastatic disease are excluded from the above practice. A careful examination of the most recent data available today in literature accompanied with our experience, even if limited, shows that only the surgical treatment allows a better survival also in metastatic disease. The surgical treatment is surely recommended in gastrinoma with pancreatic and duodenal lynphonodal metastasis. For hepatic metastasis all types of hepatic resection, the "wedge resection" included, can be suggested. After the first positive experiences, the hepatic transplantation can find a place among the therapeutic means against this kind of tumors.

Gastrinoma↗
PubMedDate not supplied

[Validity, limitations and indications of intraoperative dosage of parathyroid hormone (I-PTH) in the surgical treatment of primary hyperparathyroidism].

INTRODUCTION: Recently new methods have been experienced to achieve the best surgical results in complete removal of pathological parathyroid tissue; serum I-PTH (1-84) rapid dosage is the most interesting and reliable method. MATERIAL AND METHODS: In a group of 11 patients with IPP, diagnosed by high levels of I-PTH, total and ionized serum calcium, 7 were paucisymptomatic, 3 presented nephrolityasis, 1 acute pancreatitis and severe hypercalcemic crisis. No MEN were found. A systemic research of all parathyroid glands was always performed, then 10, 20, 30 and any 30 minutes after each parathyroidectomy serum I-PTH rapid dosage was made (rapid IRMA method) until the end of surgical treatment. RESULTS: Eight single adenomas parathyroid were diagnosed, 1 double adenoma and 2 hyperplasia. All patients had high levels of serum I-PTH during pathologic parathyroid removal. The decrement of I-PTH level to 40% 10 min after parathyroidectomy, and 50% after 20 minutes confirmed the efficacy of surgery. DISCUSSION: Intraoperative rapid dosage of I-PTH associated with anatomopathologic results leads to a successful diagnosis and therapy. Sometimes in multiglandular disease serum level of PTH decreases after first parathyroidectomy as in a single adenoma: this underlines the importance of systematic surgical research of all glands in any case. CONCLUSION: In our experience serum I-PTH rapid dosage in IPP would be applied by specialized surgical equipments only in selected patients, such as reoperation or those few cases of first surgical treatment when ectopy is suspected.

Adenoma↗