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G Candela

Publications and source records attributed to G Candela.

At least 19 recordsLinked to original sources
PubMed2006

[Nearly total thyroidectomy: versus total thyroidectomy: our experience].

AIM: Generally, the classification of thyroidectomy as benign pathology is: multinodular toxic goitre, simple goitre, toxic adenoma, Base-dow disease, Hashimoto's tyroiditis Subtotal thyroidectomy provides for the removal of the gland except for a bilateral residue of about 6-10 g, near total thyroidectomy provides for the near total removal of the gland except for a residue inferior to 5 grams. Near total thyroidectomy has taken the place of the subtotal thyroidectomy. METHODS: In two years, in our institute, there have been exeuted: 96 near total thyrodectomies, 96 total thyroidetomies, 8 lobectomies ad two revues for recurrencies. RESULTS: In 2 cases there have been haemorrhagies after nearly total thyroidetomy. Only in 1 case we practiced tracheotomy for follicular carcinoma infiltering thiroidic cartilage. In 2 cases treated with nearly total thyroidetomy and in 4 cases treated with total thyroidetomy, there has been temporary hypoparathyroidism. In no case treared wih nearly total thyroidetomy and in 2 cases treated with total thyroidetomy, there has been permanent hypo-parathyroidism. In 5 cases treated with total thyroidetomy and in no case treated with nearly total thyroidetomy, there has been, monolateral, temporary paralysis of the inferior laryngeal nerve that solved in 6 months for 3 patients and in 2 months for 2 patients. CONCLUSIONS: There has not been permanent paralysis of the mono or bilateral inferior laryngeal nerve. Even if the surgical approach to the benign disease is now orientated to the total thyroidectomy, a more conservative surgery is, in our opinion, justified when a malignant pathology is excluded and considering also the low effect of recurrencies and hypothyroidism.

Adolescent↗
PubMed2006

Carcinoid of the vermiform appendix. Description of three clinical cases and review of the literature.

Carcinoids of the appendix represent a separate class of tumours with characteristics that vary between benign (adenomas) and malignant (carcinomas) neoplasias. A recent nomenclature identifies them as diffuse neuroendocrine system (DNS) and/or, parallely, as neuroendocrine tumours (NET): the gastroenteric tract is the site of about 64.3% of carcinoids, followed by the respiratory tract with 25.3%. Among the gastrointestinals, tumour of the small intestine is the one with the highest incidence with 28.5%, followed by the appendix with 4.77%, the rectum with 13.6% and the stomach with 4.6%. Carcinoid of the colon has an incidence of 8.62%, with the caecum which alone represents 34.5% of colic localisations. The 3 cases described are an example of the behavioural unpredictability of intestinal carcinoids. The first case is that of a female patient in whom the primary tumour was only discovered after liver metastasis was documented. The second case regards a girl who, at admission, presented a picture of acute abdomen with the symptomatological characteristics of acute appendicitis. She was submitted to an appendicectomy. Subsequent investigations carried out in the postoperative period documented the presence of liver metastasis at the V and VI liver segments. The last case, similar to the second from certain points of view, shows the need to carry out a right hemicolectomy with removal of locoregional lymphnodes in the event of an appendicular carcinoid >2 cm. Both laboratory and instrumental examinations contribute to the diagnosis of intestinal carcinoid. The main laboratory examinations are based on the measurement of serotonin and urinary 5-hydroxy-indolacetic acid. First level instrumental examinations for the diagnosis of intestinal carcinoid are represented by CT with and without contrast medium, diagnostic endoscopy and, to better highlight the presence of locoregional metastases, scintigraphy with octreotide and PET. An alternative treatment of liver metastases other than surgery is most certainly chemoembolisation. This latter treatment has also proved very effective as a neoadjuvant treatment for liver metastases before subjecting the patient to liver resection. Treatment with somatostatin, on the other hand, proved effective in controlling tumour secretion, so attenuating the inconveniences of carcinoid syndrome.

Journal Article↗
PubMed2002

[Parietal metastasis in laparoscopic surgery of colorectal carcinoma].

The role of videosurgery in the treatment of gastrointestinal cancers is still controversial. However port-site metastases, reported with high rate (0.6-21%) have reduced the enthusiasm and still represent object of research. Port-site metastases pathophysiology is not yet clear. However in the last years the incidence is decreased at a percentage less than 2% and similar to that reported after traditional surgery (0.6-5.3%) due to a patient selection and a better videosurgical technique. Implant for direct contact, pneumoperitoneum, gas utilized, trocar positioning and relative tessutal trauma, visceral manipulation, frequent instrumental reintroduction represent the main pathophysiologic factors involved. Pneumoperitoneum produces an increase of the abdominal pressure with turbulent flows and the CO2 (stimulating of neoplastic cells growth?) transports neoplastic cells at the port site. However metastases occurs only when an elevate cellular concentration is present "gas less" videosurgery is not free from this complication but with a lower incidence. "Chimney effect", due to the leakage of gas or fluid containing aerosol neoplastic cells at port site, represents another important factor. In accord with such studies employing alternative gas (Helium) reduces the implant of neoplastic cells. Port site parietal trauma produces fibrin deposites that represents a substratum for cellular implant, growth and protection against immunitary host defense. Wound ischemia induces a macrophagic activity decrease. In view of these concepts the surgeon must respect some mandatory principles in the videosurgical approach to neoplastic diseases. Safety parietal trocar fixation avoiding gas or fluid port site leakage such as abdominal desuffling only through trocars in site are mandatory. Instrumental cleaning with cytoxic solution (Betadine)--neoplastic cells are isolated from instrumental lavage liquid--such as as irrigation and sterilization (5 FU) of porte site are very important rules. Wound incision--never too small--must be accurately sutured. During operation cutting through or handling tumor are contraindicated, especially when the neoplasm involves serosa. Surgical specimens must be extracted in bags absolutely through parietal protection system. High vascular ligature represents another technical rule to respect in every case like in traditional surgery.

Clinical Trials as Topic↗
PubMed2000

Uncommon left hepatic duct injury during laparoscopic cholecystectomy.

Laparoscopic cholecystectomy is currently the gold standard in the treatment of symptomatic gallstones but has been shown to have a higher incidence of biliary tree lesions (0.3-1%) compared with reported traditional open approaches. Loss of three-dimensional view and of depth perception is the main limit of the laparoscopic approach, especially if particular risk factors are associated (e.g., postinflammatory fibrosis, anatomic variations). Moreover, inadequate training may justify the increase of biliary tract lesions. The authors describe a unique case of left hepatic duct clipped without section of the duct itself during an otherwise "easy" operation. At the reintervention, because of the favorable local condition, a reconstruction was possible after a small duct resection with a ductal-hepatic anastomosis over a T-tube. This was removed after 8 months because of the good patency of the biliary tree and the absence of cholestasys. A long-term follow-up is mandatory for a complete functional evaluation.

Adult↗
PubMed2000

[Giant Spigelian hernia associated with inguinal hernia. Repair with polypropylene prosthesis].

Spigelian or lateral ventral hernia is a rare pathology, representing about 2% of all abdominal wall hernias. This kind of hernia can be found in the area limited from the umbilicus and anterosuperior iliac spine, near the lateral edge of the rectus abdominis. The authors describe a rare case of "giant" Spigelian hernia related with homolateral direct inguinal hernia. A seventy-year-old and obese patient had a painless huge intumescence in the right side of periumbilical area, and besides--he had a homolateral direct inguinal hernia. Abdominal computerized tomography visualized a hernial gap, which diameter is larger than 7 cm, in pararectal subumbilical site and a wide herniated bowel in interaponeurotic site. This double hernial pathology has been treated in an only solution, placing an only subfascial polypropylene prosthesis, overlapping both hernial defects. The authors believe prosthetic "tension free" repair, previous suture of the defect, represents a gold standard in the treatment of Spigelian hernia. Such refined technique allows an effective repair especially when aponeurotic defect is out of size and/or is related with subsequent homolateral hernia, also allowing an early patient's rehabilitation.

Aged↗
PubMed1997

[Substernal goiters: current diagnostic-therapeutic trends].

The Authors report their experience in the management of substernal goitres as classified by Dor, Carcassonne, Merlier and Eschapasse. Through a literature review an accurate identification of both symptomatologic features and diagnostic protocol is stressed. Surgical procedure is represented in the majority of cases by a nearly total thyroidectomy through a cervical approach. A median total sternotomy is the approach needed to assure the best exposure in case of retrovascular goitre.

Adult↗
PubMed1997

[Multidisciplinary treatment of hepatocarcinoma].

Radical treatment of the hepatocellular carcinoma (HCC) is complete surgical removal; it may be done by resection or total hepatectomy. Although multicentric carcinogenesis predicts that liver transplantation is likely adequate to treat both the hepatoma and the underlying cirrhosis, it doesn't seem justified in the advanced stages or in absence of end-stage liver disease and therefore liver resection remains the treatment of choice for radical cure of HCC. However, low resectability and high recurrence rate make surgery alone ineffective. Unresectable HCC may be converted to resectable by multimodality radiation/chemotherapy, and embolization of portal branch feeding tumour, improving the function of the nonembolized liver, can extend the surgical indications for HCC. Adjuvant chemoembolization has already shown to reduce recurrence rate after radical resection and it should be widely applied. In unresectable or not converted HCCs as well as in postoperative recurrence, alternative therapies, particularly as multimodality treatment, can improve survival rate. To date, multidisciplinary treatment of hepatocellular carcinoma, waiting for further studies on newer modalities (prevention and gene therapy, especially), represents the best way to improve long-term results.

Algorithms↗
PubMed1995

[Fecal incontinence and rectal prolapse. Clinico-functional assessment].

Rectal Prolapse is a rare and distressing condition, with a multifactorial etiopathogenesis. Often, this pathology is associated with fecal incontinence. The recommended approach to the patient with rectal prolapse and fecal incontinence is to repair the prolapse first, then deal particularly with fecal incontinence at a second operation. A retrospective, clinical and manometric study has varying degrees of fecal incontinence. Clinically five of their operation, and a further three patients improved, in two patients the degree of fecal incontinence remained invariable. One patient was worsened after surgery. Manometrically resting and pressure (RAP) was significantly higher in continent patients than in voluntary contraction pressure (MVCP) (p < 0.05) in preoperative testing. Postoperatively, there was a significant increase in the resting anal pressure as well as in maximum voluntary contraction pressure. Patients who remained incontinent had a significantly lower RAP and MVCP than patients who improved our regained continence. In conclusion this study shows an alteration of internal and external sphincteric function in patients with rectal prolapse. The surgical treatment of this disease improves sphincteric function. Incontinent patients with RAP < 10 mmHg and MCVP < 20 mmHg, probably they would be better treated simultaneously either for rectal prolapsus and incontinence. In this kind of patients the perianal proctectomy with total sphincteroplasty could be the elective treatment.

Aged↗
PubMed1995

[Role of the anterior resection in the surgical treatment of rectal cancer. Review of the literature].

In the surgical treatment of rectal cancer, local recurrence has a high incidence up to 40% of cases. The introduction of stapling techniques permit the execution of conservative surgery with increasing frequency, to which are wrongly associated a major rate of local recurrence. In effect in the localization of midrectal cancer, at the same stage, the abdominoperineal resection and the anterior low resection have the same long term results. Residual disease is due to no removing lymphatic perivisceral tissue (mesorectum, pelvic lymphatic cell tissue), when is respected a distal clearance from the tumour's margin of 2 cm. The authors on the base of their experience and reported data, examine pathogenetic factors responsible for local recurrence and curative surgical principles. Anterior resection remains the elective operation in midrectal cancer when it is realized with completely removal of mesorectum and with "en bloc" abdominopelvic lymphadenectomy in selected cases. In Duke's C-D stages the preservation of sphincters is always to be preferred, because abdominoperineal resection doesn't assure a curative result with a better quality of life in low anterior resection.

Humans↗
PubMedDate not supplied

[Surgical treatment of secondary hyperparathyroidism].

BACKGROUND: Surgical treatment in the patient effected by secondary hyperparathyroidism consists in subtotal parathyroidectomy or total parathyroidectomy plus autotransplantation of parathyroid tissue. METHODS: The results obtained with surgical treatment of 6 patients observed in the years 1995-1996 are analyzed. Two glands were hyperplastic in four patients, 3 in the others. Every patient was submitted to a subtotal parathyroidectomy. RESULTS: Postoperative course was marked by transient hypoparathyroidism in one case. After 18 months of follow-up, no recurrences were observed. CONCLUSIONS: It is pointed out that in case of secondary hyperparathyroidism subtotal parathyroidectomy represents the surgical treatment of choice, according with literature data. Otherwise total parathyroidectomy plus autotransplantation, characterized by a more complex surgical technique, lead to the same results.

Aged↗