Biomedical subjects
Publications and source records attributed to F Sciannameo.
The incidence of inguinal hernias in pregnancy is 1:1000 about. Much more frequent are uterine leiomyomas, reported in 0.5-2.6% cases. We describe a rare case of a 31 old woman at the 20th week of pregnancy affected with a torsion of uterine leiomyoma associated with right inguinal incarcerated hernia, operated urgently (myomectomy and Bassini inguinal plastic).
Principal local complications of ostomies are examined. Etiologic factors and possibilities of treatment are analyzed. These pathologies are often extremely troublesome and their resolution very difficult, unless appropriate therapy is established and, when possible, causal factors removed. However, because of the particular problems of these patients it would be better for them to be assisted by a specialized staff, in qualified centers.
An experience of 1240 patients suffering from varicose veins of the lower limbs and operated from December 1987 to October 1992, is reported. In order to obtain an objective valuation of functional and aesthetic results, a table with subjective symptoms and clinical and instrumental signs was filled in, before the surgical operation. The correction of anatomic and functional defects and the results so obtained were evaluated by filling in another table after the operation and comparing the postoperative to the preoperative situation. We gave different scores to each parameter considered according to the results obtained and the overall result was obtained by adding up all the different scores for each parameter. In 73.6% of the patients we registered the maximum score, 15 (excellent result), in 1.9% of the patients the score obtained was 10 (sufficient result) and in the remaining 24.5% of the patients the score was variable from 14 to 11 (good result).
A diagnostic-therapeutic protocol which can be used in patients affected with varicocele, in order to obtain a complete clinical study of them and try to improve functional results of therapy, is described. The aims of this protocol are: precise diagnosis of venous refluxes, examination of testicular functionality, detection of possible associated pathologies which can cause infertility, establishment of correct indication to hormonal postoperative therapy. The rapid surgical correction of venous stasis, the treatment of prostatic phlogosis, often concomitant, and, in selected patients, the use of hormonal therapy, can improve functional results in the treatment of this pathology.
The main methods for cerebral monitoring and protection during surgical operations of extracranial carotid are examined, analyzing for everyone advantages and limits. Particularly, the authors discuss benefits and disadvantages of cerebral monitoring using somato-sensorial evoked potentials (EP) associated with the measurement of the stump pressure in patients in which general anaesthesia was performed, comparing this method to the monitoring of patients operated using locoregional anaesthesia. The results obtained allow us to say that EP are a very good method for cerebral monitoring and that, if they are not pathological, also with stump pressure values lower than 40 mmHg, a shunt is not necessary.
The therapy of perforated gastroduodenal ulcer is still discussed, especially today that good drugs and new surgical devices are available for the treatment of this disease. The authors try to establish a valid protocol for the diagnosis and the therapy of patients affected with this disease.
The authors describe their experience in 15 cases of acute cholecystitis treated with laparoscopic cholecystectomy in emergency. Only in one patient, affected with an abscess of the upper right abdominal space, a laparotomy was performed. The results were excellent. The 14 patients treated with laparoscopic cholecystectomy were quickly discharged from the hospital (on an average 4 days after the surgical treatment) and the convalescence period was very short (range 10-15 days). In the patient treated with laparotomic cholecystectomy the postoperatory period was regular.
The clinical records of all consecutive patients aged 65 and older undergoing surgical treatment for pancreatic neoplasms between January 1980 and January 1992 were reviewed in order to establish a clinical trial based on the morbidity and mortality rates related to the different surgical procedures. In early diagnosed neoplasms, in patients in good general condition, even in the geriatric age a radical surgical procedure is preferred. In other cases, a palliative surgical procedure has to be performed if possible, namely a bilio-digestive anastomosis, associated if necessary with a gastro-enteric anastomosis.
The Authors examine the endocrinological, mechanical and constitutional factors which are involved in the pathogenesis of varicose veins in pregnancy. Discussing the results of their experience (328 pregnant patients observed, 158 of which affected with various degrees of varicose veins) they suggest a protocol of treatment in the different situations in order to obtain an improvement of the clinical conditions and, if necessary, postpone a surgical operation after delivery, so avoiding useless risks during the pregnancy.
This study describes the use of staplers during surgical treatment performed in emergency from January 1980 to December 1991. For the different, possible operations, some technical notes are examined and results reported. The advantages and risks related to the use of these devices are analysed.
We report a case of a very large (size cm 33 x 41) dermoid cyst in the right ovary in a 11 year old child, causing a complete atrophy of the remaining right ovarian parenchyma and ipsilateral salpinx. Sonography and CT allowed us to diagnose this disease and also showed an associated ureterohydronephrosis. The patient underwent a surgical operation during which a right ovarosalpingectomy was performed. A rapid regression of the ureterohydronephrosis was observed and the patient was discharged from the hospital six days after operation.
The authors describe their experience of anastomotic aneurysm diagnosis and treatment. They are classed into two groups: slowly growing anastomotic aneurysms, which are the most common; and rapidly growing anastomotic aneurysms, which are more infrequent. A follow-up is proposed in order to detect this involvement early, in election. Urgent diagnostic timing is also proposed. Moreover an analysis is made of criteria to follow in their therapy and indications to surgical treatment. In the period from January 1988 to October 1992 we observed 413 patients and 876 anastomosis or arterial sutures in election, discovering 27 anastomotic aneurysms whereas in 6 cases we had patients who were affected with rapidly growing anastomotic aneurysms. These were urgently operated, whereas of the 27 patients with slowly growing anastomotic aneurysms, 22 were operated and in 5 cases we preferred to check them by a close follow-up.
The authors describe their experience in the treatment of arterial occlusive disease of the lower limbs in the femoro-popliteal and tibioperoneal districts, by surgery (proximal or distal femoro-popliteal by-pass or segment by-pass) and Percutaneous Transluminal Angioplasty (PTA), analyzing indications, advantages, limits and complications of the two methods. Immediate and after one and three year results of surgical by-pass and PTA are compared. On the whole, in the patients in which we performed a surgical by-pass, we obtained slightly better results. Anyway, in the second stage of the arterial occlusive disease and in patients affected with short arterial stenosis and/or obstructions, PTA represents the best treatment.
The indications for the execution of a second look in patients affected with ovarian cancers and the possible benefits of this procedure, related to the stage of the neoplastic disease, are examined. The second look, at first largely used in patients in which had been performed adjuvant chemotherapy with drugs containing platinum and with no evidence of residual disease, has been later strongly criticized and the effective usefulness of this invasive procedure discussed. At the moment, we think that the indications for its execution are still large because with the second look it is also possible to put into the abdomen a catheter which can be used for locoregional chemotherapy and there is now the opportunity to perform this procedure also in video-laparoscopy.
The Authors report a case of a 49 year old female patient with Gardner's Syndrome and adenocarcinoma of the Ampulla of Vater. In this case, adenocarcinoma of the Ampulla of Vater was associated with duodenal polyp (adenoma), which suggests that adenocarcinoma is the consequence of malignant of duodenal polyps. The world medical literature was reviewed and 29 cases of periampullary carcinoma complicating familial polyposis or Gardner's Syndrome were analyzed.
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