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Biomedical subjects

F Zaraca

Publications and source records attributed to F Zaraca.

At least 19 recordsLinked to original sources
PubMed2000

Changes in bone turnover after parathyroidectomy in dialysis patients: role of calcitriol administration.

BACKGROUND: Available data on changes in serum levels of bone markers after parathyroidectomy (PTx) in dialysis patients are not uniform. Changes are thought to be due to either a reduction in PTH activity per se or to a direct effect of vitamin D therapy on bone cells. We aimed to verify whether treatment with vitamin D modifies serum levels of markers of bone synthesis (alkaline phosphatase (AP), osteocalcin (BGP), procollagen type I C-terminal peptide (PICP)) and resorption (collagen type I C-terminal peptide (ICTP)) within a period of 15 days in haemodialysis patients with severe secondary hyperparathyroidism following PTx. METHODS: We randomized two groups (A, treatment and B, placebo, 10 patients each) with comparable basal PTH values and measured bone markers 3, 7 and 15 days after surgery. All patients were treated with calcium supplements (i.v. and p.o.), and group A also received calcitriol (2.4+/-1.0 microg/day, p.o.). RESULTS: In both groups, PTx induced significant changes in all the markers evaluated, except for BGP in group B. Compared to basal values, ICTP decreased from 481+/-152 ng/ml in group A and 277+/-126 ng/ml in group B to 267+/-94 and 185+/-71 ng/ml (M+/-SD) respectively, and PICP increased from 307+/-139 ng/ml in group A and 309+/-200 ng/ml in group B to 1129+/-725 and 1231+/-1267 ng/ml (M+/-SD) respectively, within 3 days of surgery. AP values increased after 15 days from 1115+/-734 mU/ml in group A and 1419+/-1225 mU/ml in group B to 1917+/-1225 and 1867+/-1295 mU/ml (M+/-SD) respectively. On the contrary, mean values of BGP were never different from basal levels after PTx in either group. In the two groups, the pattern of changes of all the bone markers after PTx was almost identical. Group A patients predictably required lower doses of oral calcium supplements to correct hypocalcaemia (16. 9+/-5.7 vs 22.1+/-5.0 g/10 days; M+/-SD, P<0.04). CONCLUSIONS: The opposite behaviour of serum PICP and ICTP after PTx, in both the treated and untreated groups suggests that quantitative uncoupling between bone synthesis and resorption is responsible for hypocalcaemia. This phenomenon, as reflected by the evaluated bone markers, is unaffected by calcitriol. Based on our data we conclude that immediately after parathyroid surgery, vitamin D therapy does not influence bone cell activity, but improves hypocalcaemia mainly through its known effect on intestinal calcium absorption.

Adult↗
PubMed1999

Prospective evaluation of total parathyroidectomy and autotransplantation for the treatment of secondary hyperparathyroidism.

OBJECTIVE: To evaluate the clinical effectiveness of total parathyroidectomy with autotransplantation for the treatment of hyperparathyroidism and the recurrence rate of hyperparathyroidism after this procedure. DESIGN: A prospective study of total parathyroidectomy and autotransplantation in 19 consecutive patients with severe secondary (renal) hyperparathyroidism. SETTING: University hospital department of surgery. PATIENTS: Nineteen patients operated on for the treatment of secondary hyperparathyroidism between March 1993 and March 1996. Eighteen had been receiving longterm hemodialysis, and 1 had a functioning renal graft. INTERVENTION: Total parathyroidectomy and autotransplantation of excised parathyroid tissue into the brachioradialis muscle of the arm opposite that in which the arteriovenous fistula had been placed for dialysis. MAIN OUTCOME MEASURES: Clinical and biochemical improvement, morbidity, mortality, and recurrence rates of hyperparathyroidism after the procedure. RESULTS: The conditions of 13 (72%) of 18 patients followed up improved, and the clinical and laboratory variables indicating secondary hyperparathyroidism returned to normal. One patient died 50 days after surgery. In 2 patients (10%), mild hypoparathyroidism developed, and in 1 patient (5%), persistent hyperparathyroidism developed and required reoperation. In 2 patients (10%), recurrent hyperparathyroidism developed, and 1 (5%) required reoperation. CONCLUSIONS: Total parathyroidectomy with autotransplantation effectively relieves the symptoms of hyperparathyroidism, and the recurrence rate of hyperparathyroidism is low. Because all procedures used resulted in good control of clinical and biochemical variables, the method used for the surgical treatment of secondary hyperparathyroidism depends on the surgeon's preference.

Adult↗
PubMed1999

Immunohistochemical study of fatty acid synthase, Ki67, proliferating cell nuclear antigen, and p53 expression in hyperplastic parathyroids.

Patients with secondary hyperparathyroidism following chronic renal disease frequently develop hyperplastic parathyroids. Hyperplastic parathyroids have an increased number of chief cells, a decreased amount of stromal fat, and a nodular or diffuse histologic pattern. Hyperplastic parathyroids may also express higher proliferative activity compared with controls. We evaluated the morphologic features and immunohistochemical expression of fatty acid synthase (FAS), Ki67, proliferating cell nuclear antigen, and p53 protein in 78 hyperplastic parathyroids from 20 patients with secondary hyperparathyroidism. Twenty normal parathyroids incidentally removed during nonneoplastic thyroid surgery were used as controls. Our results showed that hyperplastic glands overexpress FAS (P =.06). Statistical analysis also revealed a significant association between FAS and p53 protein (P =.006) and between FAS and hyperplastic glands with a predominant nodular pattern (P =.02). Hyperplastic parathyroids from patients with chronic renal failure strongly express FAS. Fatty acid synthase may therefore be a potential biological indicator of highly proliferating parathyroid cells.

Adult↗
PubMed1999

Routine use of open laparoscopy: 1,006 consecutive cases.

Blind insertion of the Veress needle and of the first trocar is a significant cause of laparoscopic surgery complications. Despite this risk, the closed technique is still more popular than the open one. The authors retrospectively evaluated 1006 consecutive laparoscopic operations in which Hasson's technique was routinely performed. The overall complication rate was 2.2%, but the vast majority of complications occurred during the first 50 cases (6% vs. 1.9%). They conclude that after a learning phase of about 50 cases, Hasson's technique is a quick and safe procedure.

Humans↗
PubMed1997

Laparoscopic management of acute biliary pancreatitis.

BACKGROUND: The appropriate management of acute biliary pancreatitis has evolved considerably over the past decades. The advent of laparoscopic surgery made it necessary to reevaluate the traditional algorithms. METHODS: This study assesses the outcome of 40 patients laparoscopically treated for gallstone pancreatitis. The severity of pancreatitis was scored by clinical and biochemical evaluation and CT findings. Laparoscopic cholecystectomy was performed during the same admission in all cases. In no case was a preoperative endoscopic retrograde cholangiopancreatography (ERCP) performed. In 32 patients (80%) with mild acute pancreatitis interval cholecystectomy was less than 1 week (group A) and in eight patients (20%) with severe disease it was more than 7 days (group B). All patients underwent intraoperative cholangiography. RESULTS: The rate of common bile duct (CBD) stones was 5% (two cases), both occurring in the group A. There was one perioperative death (2.5%) in group B and one late CBD injury (2.5%) in group A, not requiring surgery. Complication rate was significantly higher in group B (50%) than in group A (9.4%). CONCLUSIONS: We consider that treatment of mild-to-moderate acute biliary pancreatitis can be satisfactorily accomplished by laparoscopy with routine intraoperative cholangiography and laparoscopic treatment of bile duct stones, showing no mortality and low morbidity rate. Laparoscopic treatment of patients with severe acute pancreatitis deserves further investigation.

Acute Disease↗
PubMed1997

The value of somatostatin-receptor scintigraphy in newly diagnosed endocrine gastroenteropancreatic tumors.

BACKGROUND: Conventional imaging techniques do not routinely detect endocrine gastroenteropancreatic tumors preoperatively. The purpose of this study was to determine whether the new technique of somatostatin-receptor scintigraphy would improve the detection rate of these tumors before initial treatment. STUDY DESIGN: In a prospective study, 55 patients with a recent diagnosis of endocrine gastroenteropancreatic tumors (22 intestinal carcinoids, 17 gastrinomas, 10 nonfunctioning pancreatic tumors, and 6 insulinomas), were examined with somatostatin-receptor scintigraphy, computed tomography, and ultrasonography. Results of the three imaging modalities were compared with findings at surgical exploration. RESULTS: None of the insulinomas were localized by somatostatin-receptor scintigraphy, but 4 of 6 insulinomas were detected by computed tomography and ultrasonography. Of 17 gastrinomas, 9 were detected by somatostatin-receptor scintigraphy; computed tomography and ultrasonography localized only 7. Metastases from the gastrinoma were localized by somatostatin-receptor scintigraphy in all cases; computed tomography and ultrasonography detected metastases in only 6 of 9 patients. Nonfunctioning tumors could be localized by somatostatin-receptor scintigraphy, computed tomography, and ultrasonography in 4, 7, and 8 of 10 cases, respectively. Detection rate for corresponding metastases was the same for all three imaging techniques. Primary carcinoids were identified by somatostatin-receptor scintigraphy, ultrasonography, and computed tomography in 7, 8, and 11 of 22 cases, respectively. Extra-abdominal metastases were detected by somatostatin-receptor scintigraphy in only 7 of 19 patients. CONCLUSIONS: In patients with insulinomas, somatostatin-receptor scintigraphy is not indicated because none of the six tumors was imaged. This holds true for nonfunctional pancreatic endocrine tumors and their metastases because no advantage for somatostatin-receptor scintigraphy was found over computed tomography and ultrasonography. In contrast, somatostatin-receptor scintigraphy is superior to computed tomography and ultrasonography for determining the extent of the disease in patients with gastrinomas or carcinoids. The problem of detecting primary tumors in these patients is not solved by somatostatin-receptor scintigraphy.

Adult↗
PubMed1995

Senior versus proctored young and resident surgeons' experience in laparoscopic cholecystectomy: is there any need of previous exposure to open biliary surgery?

Since its introduction in 1987 laparoscopic cholecystectomy (LC) has gained rapid acceptance as the preferred management of symptomatic cholelithiasis. In our department, during the past 3 years, the number of open cholecystectomies (OCs) has dramatically decreased. The impact of the introduction of LC as a part of the overall surgical procedures performed by residents is analyzed. To date junior-level residents have already more experience in LC than in OC. Indeed in our teaching unit junior-level residents performed only 5% of biliary surgical procedures in open surgery. Residents participated in the "surgeon's" position in 47.9% of the LCs and as either surgeon or first assistant in 100%. We analyzed both the cases where residents acted as surgeons and where they did not. It appeared that there was no difference in the complication and conversion rates. More intraoperative cholangiographies (IOCs) were performed by residents. This was probably due to the anxiety of making a mistake because of their lack of experience. This report suggests that the decrease in the number of OCs is not a drawback and that it is possible to acquire an adequate knowledge of biliary anatomy and surgery from LC training, if strict proctoring criteria are respected.

Cholangiography↗
PubMed1995

Laparoscopic management of volvulated Meckel's diverticulum.

Laparoscopy in the emergency setting is a logical extension of this technique. Open laparoscopy is particularly useful in the management of the acute abdomen. In our institution, after a sequential work-out that includes physical examination, laboratory data, plain abdominal roentgenograms and ultrasonography, diagnostic laparoscopy is advocated. We present the laparoscopic treatment of an intestinal obstruction caused by a volvulus around Meckel's diverticulum. The efficacy and safety of the diagnostic and/or therapeutic laparoscopic procedures in the emergency setting are discussed.

Adolescent↗
PubMed1994

[Somatostatin receptor scintigraphy in preoperative diagnosis of the site of endocrine gastrointestinal tumors].

To determine the value of somatostatin-receptor scintigraphy in the localization of various endocrine gastrointestinal tumors, we compared the results obtained with this new technique with the results obtained with computed tomography and sonography. We could not find an overall advantage of somatostatin-receptor scintigraphy as compared to computed tomography or sonography in the localization of intestinal carcinoids (n = 13), gastrinomas (n = 12), functionally non-active endocrine pancreatic tumors (n = 8) and various other endocrine pancreatic tumors (n = 4). In 2 patients with endocrine pancreatic tumors however, the tumors were localized preoperatively only by somatostatin-receptor scintigraphy. Somatostatin-receptor scintigraphy may occasionally be helpful in the localization of gastrointestinal endocrine tumors if these tumors are not localized by conventional imaging studies. Somatostatin-receptor scintigraphy does not solve the problem to localize small endocrine tumors.

Biomarkers, Tumor↗
PubMed1994

[Laparoscopic diverticulectomy for ileal volvulus on Meckel's diverticulum].

Laparoscopy in the emergency setting is a logical extension of this technique. Open laparoscopy is particularly useful in the management of acute abdomen. In fact, after a sequential work-out that includes physical examination, laboratory data, plain abdominal x-rays and ultrasonography, diagnostic laparoscopy is advocated. The Authors herein report a case of intestinal obstruction (volvulus due to Meckel's diverticulum) treated with laparoscopy. The efficacy and safety of the diagnostic and/or therapeutic laparoscopic procedure in the emergency setting are discussed.

Adolescent↗
PubMed1994

[Surgical treatment of 4th-stage hemorrhoids: the role of anatomical techniques].

Surgical options for fourth-degree hemorrhoids are still matter of debate. The high incidence of the disease encouraged research and brought to technical improvements able to achieve a painless, reliable, harmless and well tolerated surgical treatment. The Authors report a retrospective study of 193 patients who underwent surgery for fourth-degree hemorrhoids. In these cases the Authors advise anatomic techniques using local anaesthesia with i.v. administration of sedatives, thus allowing a 24-hour hospitalization.

Follow-Up Studies↗
PubMed1993

Lost intraperitoneal stones after laparoscopic cholecystectomy: harmless sequela or reason for reoperation?

Laparoscopic cholecystectomy has become the "gold standard" in the therapy of noncomplicated cholelythiasis. Gallbladder perforation with bile and calculi spreading in the abdominal cavity is one of the most frequent intraoperative complications of laparoscopic cholecystectomy. When not recognized during surgery or unproperly treated, it may lead to intraperitoneal abscess formation and may require a reoperation. We report a case of an intraperitoneal abscess with a cutaneous fistula, a site of a mucopurulent exudate, and stone spillage after an unrecognized gallbladder perforation and residual lithiasis in the peritoneal cavity found 3 months after laparoscopic cholecystectomy.

Abscess↗
PubMedDate not supplied

Prospective randomized evaluation of preoperative endoscopic vital staining using CH-40 for lymph node dissection in gastric cancer.

BACKGROUND: CH-40 is a suspension of activated carbon particles that was developed in Japan to carry anticancer drugs to regional nodes and peritoneal seedings of gastric cancer. METHODS: Forty-five consecutive patients who had surgical resection and D2 lymph node dissection for gastric cancer over a 2-year period were randomly assigned to preoperative endoscopic submucosal injection of CH-40 (group A) or no staining (group B). A total of 21 patients in group A and 24 in group B were available for analysis. RESULTS: The number of resected nodes per patient was significantly higher (t = 6.06; 40 df; P < .0001) in group A (mean+/-S.E. = 35.3+/-1.24) than in group B (mean+/-S.E. = 25.5+/-1.02). The rate of metastatic nodes resected was significantly higher (chi2 = 6.903 ; 1 df; P = .009) in stained (22.5%) than in non-stained (14.7%) nodes of group A and also (chi2 = 6.906; 1 df; P = .009) in stained nodes of group A than in group B (15.8%). CONCLUSIONS: Preoperative endoscopic vital staining with CH-40 proved to be rapid, safe, and effective in all cases in this series. Its use allowed surgeons to resect a higher number of lymph nodes. and to identify and examine more metastatic nodes. It also permitted identification of nodal micrometastases on routine histopathologic examination.

Adult↗
PubMedDate not supplied

[Routine use of open laparoscopy: technique and results in 1006 consecutive cases].

Blind insertion of the Veress needle and/or the first trocar is one of the most frequent causes of laparoscopic surgery complications. Nevertheless, the closed technique is still more preferred than the open one. The Authors retrospectively analyzed 1006 consecutive laparoscopic procedures in which Hasson's technique was routinely utilized. The overall complication rate was 2.2%, but the vast majority of complications occurred during the learning curve (6% vs. 1.9%). The Authors conclude that after the first 50 cases the open technique is a quick and safe procedure.

Adolescent↗
PubMedDate not supplied

[Acute biliary pancreatitis. Role of laparoscopy after 30 years of traditional surgery experience].

The authors herein show their own experience in the treatment of acute biliary pancreatitis. Aim of this study is to evaluate the effectiveness and the safety of the "early" laparoscopic approach to the mild to moderate acute biliary pancreatitis. The authors studied sixty cases of laparoscopic cholecystectomy with intraoperative colangiography for acute biliary pancreatitis (M/F 1:1.2; mean age 59.6 yrs, range 29.79). The patients were divided in two groups on the basis of the severity of the pancreatitis, defined through Ranson's score and Balthazar classification. The mortality rate was nil. Intraoperative morbidity rate was 6.6% in the group I (3/45), and 13.3% in the group II (2/15). Postoperative morbidity rate was 6.7% (3/45) in the group I and 40% in the group II (6/15). The authors show an original diagnostic and therapeutic algorithm for the treatment of acute biliary pancreatitis. Early laparoscopic cholecystectomy with I.O.C. is proposed as the gold standard treatment for mild to moderate acute biliary pancreatitis. This approach appears to be effective and safe in their experience. In case of severe acute biliary pancreatitis, further investigations are mandatory to evaluate the role of laparoscopic approach.

Acute Disease↗