Biomedical subjects

F Puma

Publications and source records attributed to F Puma.

24 records · Page 2Linked to original sources

PubMedDate not supplied

[Surgical treatment of thyroid cancer in 243 cases].

The incidence of thyroid cancer, which accounts for 1-2% of all malignancies, constantly increasing. Its management requires an integrated approach, in which the surgeon plays a pivotal role, providing the basis for further treatment. At present, the extent of exeresis, the lymph-node dissection technique and the management of upper respiratory-digestive tract infiltration are still debatable issues. The authors report on their experience with 243 surgically treated thyroid malignancies over the period from January 1986 to December 1999. The operations performed were: total thyroidectomy 226 cases, lobo-isthmectomy 3 cases, total thyroidectomy + lung metastasectomy 1 case, total thyroidectomy + SE quadrantectomy 1 case, total thyroidectomy + monolateral modified neck dissection 30 cases, total thyroidectomy + bilateral modified neck dissection 17 cases, total thyroidectomy + radical neck dissection 1 case, total thyroidectomy + tracheal sleeve resection 5 cases. In 9 cases, extensive tracheal involvement (5.5 cm), age or neoplastic histology allowed only palliative treatment (endoscopic recanalization + tracheal endoprosthesis or tracheostomy. Nd-Yag laser endoscopic recanalization was performed in 2 patients as a preliminary stage in subsegmental radical treatment, and in 5 cases for palliation. Recurrent laryngeal nerve palsy occurred in 3 cases, long-term hoarseness in 2, and hypoparathyroidism in 4. The overall mean hospital stay was 4.8 days. Of 299 patients still alive, 215 are free of disease. Surgery is the treatment of choice, with the goal of completely removing the neoplasm, together with any anatomical structures involved in infiltration (muscles, respiratory-digestive tract, lymph nodes). Satisfactory palliation can be achieved by endoprosthesis deployment or tracheostomy in all cases where surgery is ruled out due to extent of disease, patient age or histological type.

Adult↗

PubMedDate not supplied

[Acquired abnormalities of the biliary tract. Preoperative diagnosis and surgical risk in the laparoscopic era].

Acquired anomalies of the biliary tract are rare. The aim of this work was to examine their frequency and to assess potential associated danger when performing a laparoscopic cholecystectomy. A retrospective analysis of clinical charts of 3.870 patients undergoing elective cholecystectomy between 1959 and 1997 was performed. Eighteen cases of choledoco-duodenal fistula, 9 of cholecysto-duodenal and 12 of cholecysto-choledochal fistulas were observed. Two cases of acquired absence of the cystic duct and one cholecysto-colic fistula were also encountered. The traditional contrastographic radiology showed to be more accurate in defining presence and nature of the acquired anomalies. Etiopathogenesis of the main anomalies and consequent risks in performing laparoscopic cholecystectomy were discussed.

Aged↗

PubMedDate not supplied

[Use of the Dynamic Stent in the palliation of carinal and distal tracheal stenosis].

Satisfactory palliation of the lesions involving the carinal region is difficult to achieve because the stenting is conducted in an unsuitable anatomy, in highly symptomatic patients. During the period 1987-2000 we performed 785 operative rigid bronchoscopies in 524 patients, 184 of whom received a respiratory stent. The stenting of the carinal region was carried out in 27 patients with the use of the Frietag Dynamic stent. In this group of patients indication for stenting was as follows:--advanced lung cancer (22);--esophageal cancer invading the lower trachea (1);--severe tracheobronchomalacia (2);--postintubation stenosis of the lower trachea (2). No perioperative mortality was observed. All patients experienced symptomatic improvement. Follow-up ranged from 1 to 60 months: all neoplastic patients died for advanced disease without significant respiratory problems with a median survival of 5.6 months; three patients treated for benign diseases are still alive at 2, 31 and 65 months from stent deployment. No major complications were observed: in two patients the stent was removed after few days due to mucous retention; furthermore we observed symptomatic respiratory infections caused by a residual space between the tracheal wall and the prosthesis in other two patients with severe COPD. Dynamic stent is to be considered the stent of choice for palliation of the carinal region because it is effective and well tolerated with a low complications rate. The main limitations of such prosthesis are the shortness of the right bronchial branch and the size, sometimes inadequate.

Adult↗

PubMedDate not supplied

[Cecal volvulus].

A retrospective study on 18 patients with cecal volvulus surgically treated was made. Demographics and clinical data, as well as treatment were determined from clinical reports. The operative procedures employed were cecostomy (56%), cecopexy (22%) and right colectomy (22%). The length of follow up averaged 63 months and there was one recurrence. The Authors suggest that cecostomy should be employed in patients with viable bowel, and resection should be limited to cases with gangrene.

Cecal Diseases↗

PubMedDate not supplied

[Surgery of pulmonary and hepatic metastases].

In recent years surgery for hepatic and pulmonary metastases has been undertaken with a curative intent in a growing percentage of cases. In the present study the Authors evaluate their own experience in such a field, and summarize the state of the art, as it appears from a review of the international literature. At present, the subject is not settled, as several aspects are matter of debate (prognostic significance of free interval, tumor doubling time, number and location of metastatic lesions, histologic type, and stage, of the primary tumor, approach to synchronous metastases, accuracy of preoperative diagnosis), with different therapeutic implications according to the hepatic or pulmonary site. Pulmonary metastases should be managed by resection through a median sternotomy, in order to allow thorough exploration of both lungs. Hepatic lesions (from colorectal primaries) should be resected with a free margin not less than 1-2 cm. The need for uniformity of selection criteria and for the establishment of protocols including adjuvant therapy is strongly felt.

Adult↗

PubMedDate not supplied

Synthetic prostheses in repair of chest wall defects after exeresis of malignancies.

Five cases of chest wall repair with synthetic prostheses following thoracectomy for malignant tumours are reported. Two patients were submitted to partial sternal resection (manubrium); in the first case Marlex mesh alone and in the second a composite graft with Methyl-methacrylate were used. The remaining cases underwent extended thoracectomy and reconstructive procedure based upon Marlex prosthetic replacement and myoplasty. No postoperative complications were observed and satisfactory stabilization of the chest wall with good cosmetic results were obtained.

Bone Neoplasms↗