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F Giuliante

Publications and source records attributed to F Giuliante.

29 records · Page 2Linked to original sources
PubMedDate not supplied

[The surgical risk of laparoscopic cholecystectomy].

Laparoscopic cholecystectomy has become the treatment of choice for gallbladder stones. As a matter of fact, the advantages related to the significant reduction of postoperative pain and the early mobilization of the patient, with a decrease of general surgical risk, have been well demonstrated. Also the complications of the surgical wound have been drastically reduced. On the contrary, iatrogenic trocar-related injuries represent specific complications of laparoscopic technique. However, the incidence of these complications, mostly the more severe ones, may be significantly reduced with routine use of the "open" technique. The increased incidence of common bile duct (CBD) injuries in laparoscopic cholecystectomy compared with the conventional technique may be partly explained with the learning curve related to the rapid diffusion of this new approach. An appropriate training, a meticulous operative technique and an early conversion to open procedure in case of intraoperative difficulties may reduce the risk of a CBD injury. In this work the authors' experience of 400 laparoscopic cholecystectomies without CBD injury and major complications is presented. Conversion rate was 5.2% in patients with simple symptomatic cholelithiasis and 37.5% in patients with acute or subacute cholecystitis.

Adolescent↗
PubMedDate not supplied

[Intrahepatic calculosis].

A review of one-hundred cases of intra-hepatic lithiasis, observed between 1967 and 1996 by the same surgical team, was reported in this paper. There were 61 cases of migrated stones and 39 cases of primary duct stones (31 above a stenosis and 8 associated to biliary malformations). 83 patients underwent surgery: in 31 cases, gallstones were removed through the CBD, while a bilio-enteric anastomosis was required in 47 cases; 5 patients underwent a left liver resection. Finally, 17 patients were treated by non-surgical means (endoscopic or radiologic). In a first period, diagnosis was made intraoperatively by cholangiography or choledochoscopy and surgery was the only therapeutic option. After 1980, diagnostic procedure included ultrasonography, CT and direct cholangiography (endoscopic or percutaneous). Consequently to the development of endoscopic (ERCP) or percutaneous (PTC) approaches to remove intrahepatic gallstones, many patients were treated by these non-surgical means, which, in some cases, were associated with extracorporeal lithotripsy. Abnormalities of intrahepatic biliary tree represented an elective indication for liver resection in the last years. The clinical results improved progressively: mortality was 8.3% in the first ten years (67-76), 7.1% in the second decade (77-86) and there was no mortality in the last ten years. In the first decade, intrahepatic biliary tree was completely cleared from gallstones in the 70.8% of cases, in the second decade in the 80.9% of cases and, in the last ten years, in the 97% of cases.

Adult↗
PubMedDate not supplied

[Experimental model of hepatic tumor in the rat: description and results of intrahepatic implantation technique].

In order to investigate new therapeutic strategies for hepatocellular carcinoma (HCC), an animal model easily reproducible of hepatic tumor is necessary. Several techniques of intrahepatic tumor implantation have been reported in the literature. Many of them have the disadvantage of high rate of artificial neoplastic extrahepatic dissemination, both peritoneal and systemic. These drawbacks interfere with the evaluation of treatment efficacy. In this study we describe a modified technique of intrahepatic tumor implantation in the rat, previously reported by Yang in 1992, which is based on the insertion in the liver, after neoplastic tissue, of a piece of hemostatic sponge (Spongostan) that permits to significantly reduce the rate of artificial neoplastic dissemination. Nine ACI/T rats were used and Morris hepatoma 3924A was implanted in the right hepatic lobe. In all cases an intrahepatic tumor take was documented by MRI and by histological examination. No lung metastases were observed. In only one animal peritoneal and subcutaneous nodules were seen, likely due to a technique mistake. According to tumor growth curve it is possible to observe that, with this technique, a 1 cm tumor nodule is obtainable 10 days after the implantation, without extrahepatic metastases, easily detectable by imaging techniques such as MRI used in this study. In conclusion this modified technique of intrahepatic tumor implantation permits to obtain an intrahepatic tumor animal model which is easily reproducible and suitable for the evaluation of efficacy of experimental therapies for HCC.

Animals↗
PubMedDate not supplied

[Prognostic factors of pancreatic carcinoma: analysis of the 5-year-survivor cases].

Pancreatic carcinoma remains a letal disease with an overall 5-year survival of less than 5%. Recent reports of increases in actuarial survival after resection have determined some optimism. Our objective was to identify the actual 5-year survival rate of patients with pancreatic carcinoma who underwent a resection with curative intent, analyzing those factors associated with a more favorable prognosis.

Adenocarcinoma↗
PubMedDate not supplied

Resection of hepatic metastases from colorectal cancer.

BACKGROUND/AIMS: Long term results of hepatic resection for metastases from colorectal cancer depend upon several factors which are related to both features of primary cancer and of metastases. The aim of this study was to evaluate prognostic factors that best correlate with long-term results. MATERIALS AND METHODS: Fifty-eight hepatic resections were performed for colorectal cancer metastases. Long-term results were evaluated in relation to age of patients, features of primary tumor, features of metastases, section margin, number of intra-operative blood transfusions and execution of adjuvant chemotherapy. RESULTS: Overall 5-year survival rate was 17%. 5-year survival rate in patients with stage B primary tumor was 63%, in patients with late metachronous metastases it was 28%, in patients with section margin > 1 cm it was 33% and in patients who did not receive intra-operative transfusions it was 45%. Patients with a solitary metastasis or with metastases sized less than 4 cm and those who received adjuvant chemotherapy also showed a better survival than the others. CONCLUSIONS: Better results were observed in patients without nodal involvement of the primary tumor. Patients with a small solitary metachronous metastasis that appeared more than one year after the colorectal resection and resected with a section margin of more than 1 cm, also showed good results.

Adult↗