Biomedical subjects

G Citone

Publications and source records attributed to G Citone.

At least 19 recordsLinked to original sources

PubMed2004

[The surgical needs of elderly patients in day-surgery].

AIM: The possibility of carrying out surgery in day-surgery (DS) conditions is gradually becoming reality in most branches of surgery; in recent years, DS has also found a place in general surgery, with unquestionable advantages for the management of patients, particularly the elderly. The purpose of the present study is to investigate general surgery needs in DS conditions in elderly patients in order to analyse the clinical-administrative feasibility of DS procedure and the level of its acceptability in this group of patients. METHODS: A specially drafted questionnaire was submitted to patients admitted over a period of 18 months to the General Surgery Division of the University of L'Aquila. The details investigated in the questionnaire were: age, sex, educational qualification, working activity (independent or employee), presence in the patient's relational entourage of health workers willing to serve the patient at home, the patient's willingness to undergo the surgery for which he was admitted to the DS. The questionnaires of the over-64s were examined and the percentage of patients willing to undertake DS intervention instead of normal hospitalisation was evaluated; this willingness was then compared with the parameters sex, educational qualification, working activity and presence in the patient's relational entourage of health workers willing to assist the patient at home. RESULTS: 317 questionnaires were compiled. In 78 cases (24.6%) the patient was older than 64; the data for these patients were extrapolated. Willingness to undergo surgery in DS conditions was expressed by 23 patients (29%), whereas 55 patients (71%) stated that they were not available. In relation to sex, willingness to use the DS was 29.7% in the 37 male patients and 29.2% in the 41 females. With reference to the qualification, willingness was expressed by 71.4% of patients with a degree, 26.9% of patients with a high school leaving certificate and 15.7% of patients with a lower qualification. DS-willingness was 28% in the 75 pensioners and 66.6% in the 3 patients who worked for themselves. As regards the presence in the relational entourage of the patient of health workers ready to assist at home, DS-willingness was 23.9% in the 71 patients who did not have anyone in their relational entourage and 85.7% in the 7 patients who had such a health worker in their entourage. CONCLUSIONS: Willingness to undergo DS by elderly patients is mainly influenced by three factors: educational qualification, working activity and possibility to have home assistance from someone in the relational entourage; these parameters can be considered veritable selection criteria for DS in the elderly. The quality improvement in assistance levels and the introduction in the near future of telematic communication system could lead to an extension of DS indications to the elderly.

Aged↗

PubMed2003

[Intraoperative cholangiography during laparoscopic cholecystectomy: selective or routine?].

Since its presentation by Mirizzi in 1931, the role of intraoperative cholangiography (ICHO) has been controversial and has become an argument even more disputed with the introduction of laparoscopic cholecystectomy (VLC) in 1988. The Authors reviewed their experience to determine the most appropriate use of ICHO during VLC on the basis of a retrospective analysis of cases of selective ICHO. From December 1991 to January 2001, 597 patients, 552 elective procedure and 45 emergency procedure, were reviewed. Of 552 patients 62 presented with at least one diagnostic criterion for symptomatic gallstone disease and were treated by means of ERCP completed with endoscopic sphincterectomy (ES) when a stone of the common bile duct was found, while the remaining 490 patients underwent VLC; a total of 10 ICHO were performed, two of which in the ERCP group and 8 in the VLC group. The 45 patients treated in emergency underwent VLC; in 43 cases ICHO was performed. Of all patients, there were 2 cases of common bile duct injuries (0.33%) and in both cases ICHO was not performed. A cholangiogram added 27 min to the average duration of surgery. On the basis of both the literature and Authors' experience, it can be stated that the routine use of ICHO is not useful to reduce bile duct injuries, while it significantly increases the cost of the surgical procedure due to the increase of average operative time. The use of ICHO seems to be effective to demonstrate clinically unsuspected choledocholitiasis, although, at present, the real clinical advantage deriving from the detection of these stones is not clear. The Authors conclude that further prospective, randomized studies are necessary to assess the precise role of ICHO with regard to VLC.

Cholangiography↗

PubMed2001

[Laparoscopic appendicectomy: an 8-year clinical experience].

BACKGROUND: For more than a century, open appendectomy through a laparotomy has been the golden standard for the surgical removal of the appendix. Nowadays, many surgeons question the utility of laparoscopic surgery to perform appendectomies because it is commonly stated that the appendix can be removed through a small surgical incision carrying a minimal surgical trauma to the patient. Although open appendectomy is really safe, on the other hand it carries a considerable risk of postoperative complications, is associated with postoperative pain and affects patient s normal activity. Laparoscopic appendectomy was first described in 1983 and, in many studies, it is described to be better than open standard technique for the treatment of appendiceal diseases. The aim of the present study is the retrospective analysis of laparoscopic appendectomies performed in a 8-year period. METHODS: The authors report on 129 patients who underwent laparoscopic appendectomy. RESULTS: Conversion rate was 0.7 %, while the laparoscopic procedure was completed in 96 female and 32 male patients. The position of the appendix was behind the cecum in 37 cases, associate diseases were found in 15 cases. Mean operative time was 51 minutes; kind of laparoscopic instrumentation affected the operation time. Histologically there were 71 (55.5 %) focal appendicitis, 22 (17.1 %) suppurative appendicitis, 11 (8.6 %) gangrenous appendicitis, 18 (14.1 %) chronic appendicitis showing signs of previous suppurative episodes and 6 (4.7 %) normal appendix. There were neither in-hospital morbidity nor mortality. Follow-up showed reduced postoperative pain, short hospital stay, fast return to complete social activity. CONCLUSIONS: The authors conclude that laparoscopic technique can be considered a safe and effective procedure for the removal of the appendix as it has the advantage of allowing faster postoperative recovery; moreover the author recommend a wider and routinely use for appendectomy.

Adolescent↗

PubMed2001

[Efficacy of somatostatin and its analogues in the treatment of acute pancreatitis: clinical retrospective study].

Acute pancreatitis is an acute inflammatory disease of the pancreas, with variable involvement of other regional tissues or remote organ systems. Acute pancreatitis is mild in 80% of cases; virtually all patients with this form of disease will survive, because it's associated with minimal organ dysfunction and uneventful recovery; the severe pancreatitis develops in 20% of cases and is associated with higher morbidity and mortality. It's most important to identify the severity of disease at the moment of hospital admission; many scoring systems have been developed to serve as early prognostic signs: Ranson's criteria, Imrie's criteria, Apache II score, Balthazar's TC score. Recently, new drugs have been proposed in the treatment of acute pancreatitis, as, for example, calcitonine, glucagon, systemic antioxidants, antagonists of the receptors of interleukines, antiproteases (aprotinin and gabexate-mesilate) and the inhibitors of pancreatic secretions (somatostatin and its analogues). However, many controversies still exist concerning the real efficacy of these drugs in the treatment of acute pancreatitis, particularly regarding the inhibitors of pancreatic secretions: recently, some studies showed that somatostatin is able to actually reduce the local complication of the disease and the development of severe forms of acute pancreatitis; on the other hand, other studies failed to show real advantages of somatostatin reducing morbidity and mortality for pancreatitis. The aim of present study is a retrospective analysis of patients affected by acute pancreatitis in order to evaluate efficacy of somatostatin and its analogues. All patients subdivided in two groups: group A, patients treated with conventional therapy plus somatostatin and/or octreotide (SS/LS), and group B, patients treated only with conventional therapy. Results seem to show that somatostatin does not positively affect morbidity and mortality in patients with acute pancreatitis. The Authors conclude that, at present; somatostatin cannot be considered surely effective in preventing complications and mortality in acute pancreatitis. Further studies are still necessary to verify the effectiveness of somatostatin and its analogues in the therapy of acute pancreatitis.

Acute Disease↗

PubMed2001

[Total thyroidectomy in the surgical treatment of thyroid disease a retrospective clinical study].

BACKGROUND: Thyroid diseases constitute a group of benign and malignant affections, among which the most represented is multinodular goitre. Nowadays, an important question regards routine total thyroidectomy as the treatment of choice for all thyroid diseases. The aim of the present study is to verify if total thyroidectomy can always represent an option for modern surgery of thyroid disease. METHODS: One hundred-thirty-seven patients underwent operations for thyroid disease during an 11-year period. Fifty-three patients underwent total thyroidectomy, 27 affected by a benign pathology and 26 by a malignant one. RESULTS: Both short term and long term results have been analysed. CONCLUSIONS: In conclusion, the authors affirm that a complete resection of the gland is mandatory for the surgeon in the treatment of malignant diseases because the primary aim for oncologic surgery of the thyroid is the reduction of local recurrence and the increase of survival. As far as benign diseases are concerned, some surgeons affirm that morbility of non-total operations is lower than total thyroidectomy; anyway, the authors affirm that the most important factor to prevent morbility after total thyroidectomy is an appropriate surgical technique. In this way, both the identification of parathyroid glands and the identification preparation of recurrent nerve are considered the most valid method to prevent lesions. Another factor in favour of total thyroidectomy is represented by the risk of carcinoma on the residual tissue.

Adult↗

PubMed2000

[The role of melatonin in the immediate postoperative period in elderly patients].

BACKGROUND: Melatonin induces sleep and modulates immune system. Aim of the paper is to show a possible relation between impaired rhythm of melatonin secretion and the onset of postoperative septic complications and insomnia in old patients undergoing surgery. METHODS: Fifty old patients, aged from 60 to 94 years, have been studied; 39.5% of the patients had neoplastic disease. Melatonin serum levels have been evaluated by ELISA technique at 12 p.m., 3 a.m. 8 a.m. immediately before operation. Postoperative clinical findings of insomnia and septic complications have been recorded. RESULTS: The melatonin serum mean values of all the patients were 16.3 pg/ml at 12 p.m., 22.4 pg/ml at 3 a.m. and 7.1 pg/ml at 8 a.m. Neoplastic patients showed the higher values of melatonin (26.696 pg/ml, 33.143 pg/ml, 9.185 pg/ml), long-lived patients (> 90 years) the lower. The melatonin secretion curve of the old patients with postoperative insomnia (19.961 pg/ml, 20.297 pg/ml, 9.378 pg/ml) or postoperative septic complications (20.695 pg/ml, 16.183 pg/ml, 6.036 pg/ml) was significantly different compared with that of other patients. The peak was advanced, lower and decreased slowly in the midnight. CONCLUSIONS: The study seems to show a possible correlation between impaired rhythm of melatonin secretion and postoperative insomnia and postoperative sepsis in old patients undergoing surgery.

Aged↗

PubMed1999

Biological effects of preoperative radiotherapy on metastatic lymph nodes from rectal cancer.

The quantitative description of the proliferative activity of cancer cells correlates with the aggressiveness of malignant tumors. The aim of this retrospective study was to determine the biological effect of adjuvant therapy on metastatic lymph nodes from rectal cancer and to compare the results between patients treated with surgery alone and patients treated with preoperative radiotherapy. Expression of the proliferating cell nuclear antigen (PCNA) was examined in metastatic lymph node samples of 12 rectal cancer patients receiving and 14 patients not receiving preoperative radiotherapy. PCNA immunostaining was performed by an avidin-biotin complex immunoperoxidase technique. The results of the mean proliferation index (PI) between the two groups were compared. A semiquantitative PCNA grading system was also estimated. In patients receiving preoperative radiotherapy, the PI was 22.8 per cent, and only one patient had high proliferative grade. On the contrary, the PI in nonirradiated patients was 67.6 per cent, and nine patients showed high proliferative grade. Although not sufficient to reach significance in terms of prognosis, the present study confirms the clinical value of radiation therapy, and it supports the suggestion to treat Dukes' C patients with preoperative radiotherapy to decrease the risk of local recurrence.

Cell Division↗

PubMed1988