Gastric carcinoid tumors.
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Carcinoid Tumor↗
Biomedical subjects
Francesco Stilo
Publications and source records attributed to Francesco Stilo.
[Radiofrequency ablation in primary and secondary liver tumors].
The authors report the preliminary results of a new treatment for primary and secondary hepatic malignancies called radiofrequency ablation. Seven patients undergoing the new radiofrequency ablation procedure (4 M and 3 F; mean age 62 years) were studied. The 3 female patients were suffering from breast cancer metastases (1 case), left colon cancer metastases to the first hepatic segment with caval and portal compression (1 case), and metastases to the eighth hepatic segment from an operated left colon cancer (1 case). The 4 male patients were suffering from carcinoma of the first hepatic segment on a cirrhotic liver (1 case), two liver metastases from left a colon cancer (1 case), a single 3-cm diameter metastasis treated by laparotomic radiofrequency ablation after resection of a gastric cancer (1 case), and one metastasis to the eighth hepatic segment from an operated left colon cancer (1 case). Prior to treatment all patients were subjected to investigation of routine blood-chemistry parameters, hepatic enzymes, cancer markers (Ca 19.9, alphafetoprotein, cytokines), abdominal spiral CT or MRI or PET (18 FDG); and thorough ultrasonography. Four patients underwent percutaneous radiofrequency ablation; one patient with concomitant gastric cancer underwent laparotomic radiofrequency ablation and simultaneous removal of the tumour; one patient was treated by celioscopic radiofrequency ablation in the course of laparoscopic cholecystectomy; and one underwent transpleural-diaphragmatic radiofrequency ablation for metastases to the seventh and eighth hepatic segments. None of the patients undergoing ultrasonography and CT follow-up examinations after 6 months presented recurrence of hepatic metastases. This treatment, though its use has so far been limited to only a few cases with a short follow-up, opens up new prospects for the surgical treatment of primary and secondary malignancies, also in the light of experience based on a substantial number of patients, recently reported in the literature.
Aged↗
[Mucin-secreting tumor of the appendix with large gelatinous effusion].
The authors report a case of a mucinous tumour of the appendix with a large muco-gelatinous effusion detected as a result of massive abdominal compression. The mucinous mass occupied the entire abdominal cavity and was compressing the abdominal vascular trunks. Increases in CEA, Ca 19.9 and Ca 50 were recorded. The abdominal CT scan was of fundamental importance for diagnosing the condition. Surgery was performed consisting in removal of the mucinous abdominal mass, the appendix and part of the caecum. The postoperative course was favourable with rapid restoration of abdominal organic functions and normalisation of CEA. The rarity of these tumours is stressed.
Adenocarcinoma, Mucinous↗
[Surgical treatment of acute respiratory failure caused by mediastinal goiter. Clinical experience and results].
In the regions where goitre is endemic, onset of the disease with acute respiratory insufficiency caused by thyroid compression is an uncommon situation requiring a rapid diagnosis and urgent surgical treatment. From January 1997 to December 2000 we observed 81 patients with thyroid pathologies, (69 males and 12 females; mean age 64 years). We found colloid-cystic goitre in 39 cases, adenomatous goitre in 26, carcinoma in 12, Hürthle's cell tumours in 3 and inflammatory disease in 1. All patients underwent thyroidectomy. Nine patients (11%) presented acute respiratory insufficiency caused by thyroid compression, with various associated phonesis disorders; in these cases we performed emergency surgery with postoperative maintenance of tracheal intubation or tracheotomy or the possible positioning of a self-expanding tracheal stent. In these 9 patients there were 4 deaths (44%), 3 in the immediate postoperative period and one after 10 months. We also observed one hydropneumothorax. Functional recovery was achieved in the remaining 5 patients. The treatment of this clinical picture requires urgent tracheal intubation, before the use of diagnostic tools, and it is important to maintain it after the surgical procedure for as long as is necessary for the tracheal wall to be reconstituted. In the severest cases a temporary tracheotomy is needed or the positioning of a tracheal stent, which offers a valid and effective alternative.
Acute Disease↗
[Surgical treatment of anal stenosis following hemorrhoid surgery. Results of 150 combined mucosal advancement and internal sphincterotomy].
The aim of the study was to evaluate the efficacy of anoplasty by mucosal advancement combined with internal sphincterotomy for the treatment of iatrogenic anal stenosis. From January 1990 to December 2000, 149 patients with post-haemorrhoidectomy anal strictures underwent internal sphincterotomy and mucosal advancement flap anoplasty. Seventy-one percent of patients were operated on under local anaesthesia by perineal block according to Marti. In 90 percent of the patients, postoperative pain was mild. No significant complications were seen. The mean hospital stay was two days. Ninety-seven percent of patients were well satisfied with the surgical result one year after operation. Current surgical options for the treatment of post-haemorrhoidectomy anal stricture are reported and the advantages of mucosal advancement flap anoplasty outlined.
Anal Canal↗
[Abdominal artery aneurysm and associated surgical abdominal diseases: towards optimal timing].
The purpose of this study was to assess which modalities offered the best timing in the treatment of abdominal aortic aneurysms associated with other abdominal surgical diseases. From January 1984 to December 2002, 372 patients underwent surgery for abdominal aortic aneurysms, 350 men (94%) and 22 women (6%), mean age 72 years. Of these 10% were operated on urgently. The traditional open technique was used in 307 patients, and the endovascular method in the remaining 65 cases. In 40 patients (11%) we observed other associated abdominal diseases which were treated during the same operation in 34 cases (85%). We had three deaths in the 34 cases treated in the same operation (9%). In the remaining cases no perioperative mortality was registered. There were no cases of prosthesis infection. The mean hospital stay was 9 days. Simultaneous treatment appears, on the one hand, to carry an increased operative risk and increased mortality and, on the other, to present the advantage of having to perform only one surgical procedure. The advent of the endovascular method allows us to postpone the treatment of the associated disease without increasing the technical difficulty of the second operation.
Aged↗
[Surgical treatment of rectal prolapse with transanal resection according to Altemeier. Experience and results].
In recent years the number of patients with partial or total rectal prolapse has increased. Numerous techniques and surgical approaches have been described for its treatment. In this study we examine the main ones and stress the advantages of the transanal-perineal resection technique according to Altemeier and modified by Prasad, which we have used to treat the condition in the last 15 years. From 1988 to 2002, 269 patients with "haemorrhoidal prolapse" were referred to our department; 146 were females (54%), and the mean age was 58 years. Clinical examination and proctosigmoidoscopy revealed the presence of total rectal prolapse in 41 patients (15%, 32 F, 9 M), complicated in 4 cases by moderate incontinence and associated in 3 cases with post-haemorrhoidectomy stenosis. These 41 patients underwent transanal resection according to Altemeier. Thirty-four of them (83%) were operated on under local anaesthesia with sedation, 5 patients (12%) under peridural anaesthesia and 2 patients (5%) under narcosis. The mean hospital stay was 5 days and depended on the time of the first spontaneous evacuation. Check-ups were performed after 7 days, 1 months and every 3 months for 1 year. There was no postoperative mortality, and only 1 case of postoperative haemorrhage, which did not require reoperation, in a patient with a previous myocardial infarct who spontaneously continued to take salicylates up to 24 h before surgery. Thirty-three patients (80%) had their first postoperative evacuation within 48 h of surgery after taking sorbitol orally in the evening, 6 patients (15%) within 72 h, and 2 patients (5%) on postoperative day 4. No evacuative enemas were performed. We observed clinical healing in all patients 1 month after the operation, and regular, spontaneous evacuations without the use of oral laxatives. Stool or gas incontinence were never observed or reported. During the follow-up, only in 2% of cases did we observe partial recurrence of the prolapse. The choice between the numerous surgical techniques for correcting rectal prolapse, depends on the state of the disease, on the patient's general condition and on the surgeon's experience with the various techniques. The perineal approach proposed by Altemeier and modified by Prasad presents a low risk of mortality and immediate complications, as confirmed by our experience, even in high risk patients, and relatively easy execution. It would appear, moreover, to be the only technique capable of correcting the preoperative incontinence sometimes present.
Adult↗
[Varicose vein recurrence after surgery of the sapheno-femoral junction: color Doppler ultrasonography study].
The aim of this study was to evaluate the accuracy and sensitivity of colour Doppler ultrasonography for the diagnosis of postoperative recurrent varicose veins in patients submitted to surgical ligation of the saphenofemoral junction with a view to classifying the recurrences according to the causes. We studied 401 lower limbs in the orthostatic position with colour Doppler ultrasonography in 318 patients (64 M and 254 F) presenting postoperative varicose vein recurrence during the follow-up (12-60 months). We evaluated the type of reflux at the inguinal level under the Valsalva manoeuvre and divided them into 5 types. We observed an incomplete crossectomy (type 1) in 23.2% of the cases; an incontinent saphenofemoral junction, intact and in an anatomical site in 12.5% (type 2); a major tributary (double saphena) originating from the common femoral vein near to the crossectomy site in 10.2% (type 3); neovascularization in 9.7% (type 4) and the presence of a number of major tributaries from the veins of the perineal and pudendal region or from the abdominal parietal veins in 44.4% (type 5). In all cases it was possible to note and classify the type of recurrence. Colour Doppler ultrasonography is an accurate, reliable tool for the diagnosis and classification of postoperative varicose vein recurrences in patients submitted to surgical obliteration of the saphenofemoral junction. It is decisive in the preoperative evaluation and follow-up of patients. In our experience, more than one half of the cases of recurrence were not due to an error of surgical technique.
Adult↗
[Tubulo-villous rectal tumours. Results of surgical resection in relation to histotype (30 years' experience)].
Adenomas of the rectum are frequently found during endoscopic examination. We report on our 30 years of experience with the treatment of tubulo-villous adenomas based on histotype. Between 1971 and 2001, 104 villous tumours of the rectum were treated surgically. The patients' average age was 65 years. These were sessile tumours in 69% of cases, pedunculated in 17.5% and flowing tumours in 13.5%. The mean tumour size was 3 cm. They were associated with colon cancer in 15% of cases and with polyadenoma in 10%. They were located in the rectum within 0 to 6 cm of the anal margin in half the cases. These tumours were treated by local excision in 74 cases and by wide excision in 30 cases. The malignant potential of the tumours was 30%, including 10% invasive malignancy. There were no surgical fatalities, but a 6% medical fatality rate was registered. There was a 20% complication rate related to the surgical technique. Twenty patients were lost to follow-up. Out of 84 villous tumours, monitored over a mean survival period of 6.5 years, there were 24 recurrences: 18 underwent endoscopic excision and in 6 cases a wide resection. The various tumour resection techniques and the operative indications of variable difficulty are presented. It would seem, at present, that total resection of the rectum with a colo-anal anastomosis is the best treatment for large flowing villous tumours occupying almost the entire rectum. Thorough preoperative examination and the mastering of various surgical procedures should allow the most suitable choice of treatment for each individual case.
Adenoma, Villous↗
[Hypoparathyroid risk after total thyroidectomy].
From January 1970 to December 1999, 881 patients with thyroid pathology underwent surgery consisting in 551 subtotal thyroidectomies and 330 total thyroidectomies. Permanent hypocalcaemia was present in 32 patients (3.6%). The importance of accurate isolation and ultraligature of the branches of the inferior thyroid artery in the prevention of parathyroid damage is stressed.
Adult↗
Iloprost infusion in diabetic patients with peripheral arterial occlusive disease and foot ulcers.
The aim of the study was to evaluate iloprost infusion as an alternative to open surgical revascularisation in diabetic patients with foot ulcers, also as a support measure in conjunction with endovascular procedures. We studied 244 patients with critical ischaemia of the lower limbs, 146 of whom (59.8%) affected by diabetes. A femoro-distal bypass was performed in 175 patients. In the 69 nonsurgical diabetic patients (47.3% of the diabetics) an iloprost infusion was started. These diabetics presented foot ulcers, a palpable or slightly hypo-sphygmic popliteal pulse and high distal arterial flow at the ankle. In 55 of these patients (79.7% of those not operated on and 37.6% of the diabetics) who were non-responders to medical therapy, an endovascular procedure was also performed. The results of the iloprost infusion (69 pts.) were evaluated after one week. In 14 responders treated only with iloprost infusion, complete healing of the lesions occurred during the 3 weeks following the end of the 4-week course of therapy. No severe ischaemia recurrences were reported in the follow-up of these 69 patients. In the 47.3% of subjects with diabetic arteriopathy presenting foot ulcers and high distal flow, it proved possible to avoid an open surgical revascularisation procedure and to resort to medical therapy with iloprost, completed in 79.7% of cases with endovascular procedures. Iloprost infusion improves limb perfusion and, in selected cases may be an important therapeutic tool for the care of ulcerative lesions of the diabetic foot, also as a support measure in conjunction with endovascular procedures.
Angioplasty, Balloon↗
[Symptomatic aorto-iliac aneurysm and situs viscerum inversus: case report].
We report a case of infrarenal symptomatic aorto-iliac aneurysm in a patient with acute abdominal pain. The patient was admitted to the emergency care unit for abdominal pain and CT scans showing an infrarenal aorto-iliac aneurysm in a situs viscerum inversus (SVI) totalis syndrome. The patient underwent open aneurysm repair with an aorto-iliac bifurcated graft. This case shows that situs viscerum inversus cannot be considered a technical problem for the surgical treatment of abdominal aortic aneurysm.
Aged↗
[Haemorrhoidectomy according to Ferguson in day-surgery. Experience and results].
AIM OF THE STUDY: To evaluate of results of 1511 surgical haemorrhoidectomies performed in day-surgery setting (7-24 hours hospital stay) with improvement of both cost effectiveness and patient comfort. MATERIAL AND METHODS: From January 1980 to December 2002, 1511 patients underwent haemorrhoidectomy according to Ferguson, 1011 patients for grade III-IV haemorrhoids 10% of them for recurrence and 5% previous treated by cryotherapy or elastic ligature, 500 patients for grade II haemorrhoids 25% of them previous treated by cryotherapy or elastic ligature and 7% for recurrence. 97.6% of patients were operated on with loco-regional anaesthesia; the others with narcosis and peripheral anaesthesia. The hospital-stay was 24 hours in 34% of patients, while the remaining 66% operated on under loco-regional anaesthesia were hospitalised for 7-10 hours. Twenty-seven patients (1.8%) have had postoperative haemorrhage, only three patients (0.2%) underwent reoperation under general anaesthesia with a hospital stay of 7 days. In 52% of patients clinical recovery was observed at first follow-up (7 days); 48% had recovered at the second follow-up (14 days). RESULTS: In 1286 patients (98% of patients came back to control) anatomical recovery was observed at the follow-up three months after surgery. Patients satisfaction 6 months after operation was high in 73%; good in 26%; low in 1%. CONCLUSIONS: These results seems confirm the feasibility of haemorrhoidectomy in day-surgery in almost all patients, with both a considerably cost reduction and enhanced patient comfort and compliance.
Adult↗