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Biomedical subjects

F Mosca

Publications and source records attributed to F Mosca.

At least 181 records · Page 10Linked to original sources
PubMed1999

Nonoperative management of pancreatic pseudocysts. Problems in differential diagnosis.

CONCLUSION: The evaluation of pancreatic cystic lesions entails a misdiagnosis risk. Awareness of the problem, knowledge of the natural history of these lesions, and meticulous posttreatment follow-up can reduce the consequences of diagnostic errors. If all these precautions are adopted, pancreatic pseudocysts can be safely treated nonoperatively. BACKGROUND: The accurate diagnosis of pancreatic cystic lesions remains a problem. The aim of this study was to ascertain the incidence of and the reasons the diagnostic errors occurred in a series of pseudocysts drained percutaneously and to compare these data to those reported in the literature. METHODS: Data from 70 patients bearing one or more pseudocysts who underwent a percutaneous drainage were reviewed. The pretreatment workup included medical history, physical examination, ultrasound (US) and computed tomography (CT) scans, amylase assay in both the serum and the cystic fluid, culture and cytology of the cystic fluid. After removal of the drainage, the minimum follow-up period was 12 mo. RESULTS: Four patients died, and two cancer-associated pseudocysts were identified before removal of the drainage. Sixty-four patients were followed up for a mean of 51.9 mo (range 12-154 mo). A third cancer and a mucinous cystic tumor, fully communicating with the main duct, were further detected during this period.

Adult↗
PubMed1999

External jugular vein hemangioma occurring as a lateral neck mass.

Hemangioma is an extremely frequent tumor, accounting for 7% of all benign neoplasms. In contrast, hemangioma arising in blood vessels is rare and should be differentiated from other neoplasms of vascular origin, such as hemangioendothelioma, hemangiopericytoma, hemangiosarcoma, and leiomyosarcoma. The case we report has the peculiarity of occurring as a lateral neck mass in which color-coded duplex sonography contributed significantly to diagnosis.

Female↗
PubMed1999

A new technique for total hepatectomy in the pig for testing liver support devices.

BACKGROUND: A large animal model of total hepatectomy is suitable to test the efficacy of any system designed to support patients in hepatic coma. The models previously described in the pig entail a significant degree of surgical trauma, which might alter the evolution of the ensuring hepatic failure and compromise the reproducibility of the model. METHODS: Twenty-eight pigs underwent a total hepatectomy according to a new technique. A model was considered satisfactory when it required no blood transfusions and when hematologic and hemodynamic parameters determined before, during, and until 4 hours after hepatectomy showed no significant variations. Moreover, to revive the pattern of hepatic coma produced in the anhepatic model, 7 pigs were monitored until brain death occurred. RESULTS: Twenty-five pigs (89%) underwent a smooth total hepatectomy with minimal variations of the selected parameters. They constituted a highly homogeneous group. Survival of the 7 pigs, followed up until brain death occurred, ranged from 625 to 1595 minutes (mean 1013.57 minutes). The animals remained stable until a few hours before brain death, an event heralded by a final sharp increase of the serum ammonia level and by a well-evident decline of both arterial pressure and liver-dependent clotting factors. CONCLUSIONS: This technique of total hepatectomy allows the construction of a reproducible model of anhepaty suitable to test the efficacy of any system conceived to temporarily replace hepatic functions.

Anastomosis, Surgical↗
PubMed1999

[Early tracheal extubation ofter orthotopic liver transplantation].

BACKGROUND: To evaluate an early tracheal extubation feasibility in previously unselected orthotopic liver transplantation (OLT) patients. METHODS DESIGN: retrospective analysis. SETTING: National Health System Intensive Care Unit. PATIENTS: all the patients who underwent OLT during 1997 at our institution were evaluated. The anesthestic management was the same for all of them and a veno-venous bypass was always used during the anhepatic phase. Tracheal extubation was performed when metabolic and haemodynamic parameters were stable; the following extubation criteria were also considered: no residual curarization, normocarbia, ability to keep the airway patent, good respiratory drive, ability to carry out simple orders. No pre- or intraoperative criteria, as previously reported in the literature for OLT patients, were followed to perform tracheal extubation in the postoperative period. RESULTS: During 1997 forty OLTs were performed in 38 patients. Twenty-eight patients were successfully extubated within 3 hours from the end of the surgical procedure; three patients were extubated within 6 hours and three within 24 hours from the end of surgery; four patients needed more then 24 hours of ventilation or were impossible to wean. No patient was re-intubated. A correlation appeared evident between early extubation and the amount of the transfused red cell units, kidneys and lungs function, cardiovascular efficiency; no correlation emerged with patients age or the pre-transplant severity of the hepatic disease. CONCLUSIONS: To perform a safe early tracheal extubation in previously unselected OLT patients is feasible and it can be carried out in a wide number of them. The previously reported timing characterizing as "early" a tracheal extubation should be moved from 8 to 3 hours.

Adult↗
PubMed1999

[Paroxysmal vertigo of the lateral canal: proposed treatment method. A proposal of a treatment method].

The etiopathogenesis of benign paroxysmal vertigo (BPV) lies in the accumulation of otoconial or other debris in an abnormal site (the cupola or semicircular canal). The present work proposes a treatment for BPV located in the horizontal semi-circular canal aimed at moving the debris out of the canal. This maneuver involves performing a series of movements with the patient's head so that the debris is moved toward the non ampular end of the canal and, from there, into the utricle. The maneuver is programmed differently according to the variation of the disorder. This method was performed on 18 patients with BPV of the lateral canal and compared with the use of two other techniques and with another group of untreated controls. The results showed a high percentage of recovery (83%), comparable to that achieved with other techniques found in the literature, and significantly higher than the percentage of spontaneous healing.

Humans↗
PubMed1999

[Clinical-diagnostic and therapeutic considerations in a rare case of mesenteric cyst].

The authors report a rare case of mesenteric cyst in a 36 years old woman. These cysts have a pathogenesis that primarily may be ectopic lymphatic tissue and their most common site is in the small bowel mesentery, especially of the ileum. In the case reported the cyst was located in the right mesocolon. Mesenteric cysts can appear as chronic abdominal pain, a painless abdominal mass, or acute abdomen. Diagnostic aids include abdominal computed tomography and sonography, that usually make diagnosis of mesenteric cyst. Treatment of choice is enucleation; resection of the adjacent bowel may occasionally be necessary.

Adult↗
PubMed1999

Laparoscopic Nissen fundoplication complicated by late gastroesophageal herniation and intrathoracic perforation: a case report with review of the literature.

We report the case of a 38-year-old man who, 2 weeks after a laparoscopic Nissen fundoplication, was referred to our Unit because of acute wrap herniation and intrathoracic gastric perforation. Although both of these complications have already been described, this is the first case in which they have occurred simultaneously and not as an immediate consequence of the operation. Intraoperative findings suggested that diaphragmatic crura had not been reapproximated and that the gastric wrap had not been fixed to them. This observation and the fact that immediately after hospital discharge the patient had sustained intense physical efforts can explain acute wrap herniation. Placement of full-thickness sutures may account for gastric perforation. These pathogenetic determinants and their preventive measures are discussed in the light of a review of the literature.

Adult↗
PubMed1998

Water-glove balloon system: a useful option to salvage liver grafts with postreperfusion suprahepatic vena caval kinking.

BACKGROUND: Although exceedingly rare, kinking of suprahepatic vena cava after liver transplantation can lead to both graft failure and patient demise. The features of a case of suprahepatic vena caval kinking are herein reported along with the description of an original solution adopted to rescue the graft. METHODS: In order to correct vascular kinking, two surgical gloves filled with sterile saline solution were placed in appropriate positions in the subdiaphragmatic space. RESULTS: Caval obstruction was immediately relieved. Over a period of 7 days, gloves were progressively deflated and eventually removed without need for laparotomy. Vena caval kinking did not recur. CONCLUSIONS: The "water-glove balloon system" described in this report seems to be an efficient and inexpensive method to rescue liver grafts in the presence of kinking or torsion of the suprahepatic vena cava. Surgeons dedicated to the transplantation of the liver should therefore retain this option in their cultural background.

Adult↗
PubMed1998

Catechol-O-methyltransferase: variation in enzyme activity and inhibition by entacapone and tolcapone.

OBJECTIVE: The aim of this investigation was to study the variation of catechol-O-methyltransferase (COMT) activity in the human liver, duodenal mucosa and renal cortex, and to investigate the inhibition of COMT by entacapone and tolcapone. This study included 87 samples of human liver, 94 samples of the duodenum and 72 samples of the renal cortex. RESULTS: The activity of COMT was measured with 3,4-dihydroxybenzoic acid (242 micromol x l(-1)), the methyl acceptor substrate, and adenosyl-L-methionine (44 micromol x l(-1)), the methyl donor substrate. The hepatic activity of COMT activity was significantly higher in men than in women, whereas it was not sex-dependent in the duodenum or renal cortex. The activity of COMT varied 4.4-fold in the liver of men, 2.6-fold in the duodenum and 5.3-fold in the renal cortex. The median estimates of COMT activity were 577, 499, 103 and 159 pmol x min(-1) x mg(-1) in the liver of men and women, in the duodenum and in the renal cortex, respectively. CONCLUSION: Entacapone and tolcapone were powerful inhibitors of COMT and their IC50 estimates were 151 and 773 nM (P = 0.008), respectively, in the liver; consistent results were obtained with the other tissues.

Adult↗
PubMed1998

Operative technique for thoracoscopic transmyocardial laser revascularization.

We describe herein the operative steps used to perform a transmyocardial laser revascularization by thoracoscopy. A special technique and specific equipment are required for the efficacy and safety of the procedure. Our preliminary results with this novel approach suggest that it could be a valid alternative to the thoracotomic procedure.

Coronary Disease↗
PubMed1998

Fetal and neonatal echocardiographic findings in twin-twin transfusion syndrome.

OBJECTIVE: The study's aim was to analyze the type of cardiac involvement in fetuses or infants with twin-twin transfusion syndrome. STUDY DESIGN: Seventeen pairs of monochorionic diamniotic twin fetuses with twin-twin transfusion syndrome underwent serial Doppler echocardiographic studies. Repeated decompressive amniocenteses were performed in all pregnancies. RESULTS: No specific cardiac involvement was seen in donor twins in utero or after birth. All recipient twin fetuses showed variable degrees of biventricular hypertrophy and dilation with tricuspid regurgitation. These features were also evident in 45% of the recipient twin neonates. The fluid unbalance resolved with serial amniocenteses in 9 cases and in a further 2 after the death of the donor twin; in all 11 of these recipient twin fetuses there was some degree of improvement of the cardiac involvement, which became normal in all surviving recipient twin infants within 40 days to 6 months after birth. CONCLUSION: Features of cardiac hypertrophy with signs of a prehydropic or hydropic state develop during fetal life in recipient twins in twin-twin transfusion syndrome; this impairment is reversible with the resolution of the fluid imbalance or after delivery.

Diseases in Twins↗