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Biomedical subjects

G Occhigrossi

Publications and source records attributed to G Occhigrossi.

12 recordsLinked to original sources
PubMed2006

Placement of two overlapping uncovered metallic stents for malignant gastric outlet and duodenal obstruction due to colon cancer.

Malignant obstruction of the gastric outlet and duodenum is frequently due to extrinsic involvement by tumors from contiguous organs, in particular from pancreas and gallbladder. The treatment of malignant gastroduodenal stenoses is difficult. Many patients have advanced malignant disease and are too ill to undergo surgical approach. Surgical gastrojejunostomy has been considered the palliative treatment of choice. Metallic stents can be useful in this condition with adequate palliation obtained in most cases. We report a case in which self-expanding metallic stents were placed for stenoses of the gastric outlet and duodenum due to a colon cancer.

Adenocarcinoma↗
PubMed1998

[Endoscopic sphincterotomy in acute biliary pancreatitis. A multicenter study].

BACKGROUND: Severe acute pancreatitis are still dangerous, as can be seen from the high mortality rate (around 30%). It's commonly known that in the last years diagnostic ability, precise stadiation and control over the disease development were increased. Surgical therapy is directed mainly to achieve the control over septic evolution, and in biliary pancreatitis to resolve hypertension and infection inside the biliary tree (now widely accepted as the real cause of this disease). Recently, some authors demonstrated that the prognosis of a pancreatitis can be greatly improved by stopping the evolution toward a severe phase with necrosis and multiple organ failure without any surgical operation. They believe that's possible to achieve this result performing an early endoscopic sphincterotomy in all biliary pancreatitis (recognised by means of echography and CT scan), before the development of necrosis. METHODS: In our department, following this address, very good results have been obtained: that's why a multicentric trial has been carried out to appraise the results obtained by endoscopic sphincterotomy within 48 hours from the disease onset. Answers from 114 hospitals were received, with a total survey of more than 10,000 pancreatitis. Endoscopic sphincterotomy was performed in 55% of billiary pancreatitis, which were estimated at the onset, on second or third degree of Balthazar classification. RESULTS: In 86% of patients, endoscopic sphincterotomy was performed within 48 hours from symptoms onset. Complications related to this treatment are reported in less than 4% of patients. CONCLUSIONS: The procedure, avoiding the evolution toward necrosis and sepsis, allowed the reduction of surgical operations to 6.7%, and of the mortality amongst all cases gathered to 2.5%.

Acute Disease↗
PubMed1990

[Diverticula of the cecum. Our experience].

On the basis of their experience in right colonic emergencies, the Authors report two cases of diverticular disease presenting with acute abdomen. Pointing out the difficulty of a correct pre- and intraoperative diagnosis, different surgical procedures are analysed.

Aged↗
PubMed1989

[Supplemental proposal in the surgical treatment of liver injury. Experimental studies].

Liver resections pose a great variety of problems, not least repair of the cut. The various reconstruction modalities are reviewed and personal experience in twenty rats submitted to surgical removal of the median lobe of the liver with cover of the sectioned surface by means of omental mesh autograft is reported. The results were flattering for the absence of significant complications and for the haematological and haematochemical data obtained which confirm low easily the graft takes, its regenerative potential and the modulator action of peritoneal repair processes.

Animals↗
PubMed1989

[Surgical proposals concerning omental mesh graft. Experimental studies].

In general surgery, the advantages deriving from the utilisation of omental graft are attributable to the ease with which it takes, its regenerating potential and the modulator action on tissue repair. Personal experience regarding the peritoneization and covering of surgical liver surfaces is reported and the use in various sectors of surgery of omental mesh graft is recommended.

Animals↗
PubMedDate not supplied

[Endoscopic treatment combined with adrenaline injection and coagulation with argon plasma in gastroduodenal peptic ulcer bleeding].

Although endoscopic injection therapy is an effective method for bleeding peptic ulcers, it is associated with significant re-bleeding rate; whether the addition of thermal method improves the outcome is still unclear. Our previous experience showed that Argon Plasma Coagulation (APC) alone is not sufficient in stopping spurting haemorrhage, and potentially dangerous for large non bleeding visible vessels (NBVV). Our hypothesis was that combination of adrenaline injection (AI) and thermal therapy could be more efficient than thermal therapy alone for permanent haemostasis of active bleeding peptic ulcers, and particularly appropriate for NBVV treatment. From October 1998 to February 2000 we examined two hundred patients with upper gastrointestinal bleeding. Fifty-three patients with major peptic ulcer haemorrhages received combined injection therapy with adrenaline 1:10.000 and Argon plasma coagulation; there were 34 male and 19 female with a mean age of 63.2 +/- 1.2 years (range 22-93). The bleeding site was duodenal in 30 patients, gastric in 17 patients, anastomotic in 5 patients and esophageal in 1 patient. Endoscopic findings were the following: active bleeding in 23 patients (6 spurting, 17 oozing), non bleeding visible vessels in 12 patients and fresh adherent clots in 18 patients. Initial haemostasis was achieved in 52/53 patients (98.1%). Re-bleeding was observed in 5/52 cases (9.6%). Surgery was necessary in 3/53 patients (5.6%). Mortality was 7.5% (4 cases). No major complications resulted from this treatment. Primary adrenaline injection provided initial bleeding arrest, facilitating the following application of APC, because of a more precise definition of the active bleeding site. Rates of initial hemostasis were significantly higher with combined therapy (injection + APC) compared to APC treatment alone. We believe that Adrenaline and APC combined therapy is an effective and safe method for treatment of non-variceal gastrointestinal bleeding.

Adult↗
PubMedDate not supplied

[Difficult endoscopic extraction: pneumomediastinum and bilateral pneumothorax after attempted endoscopic extraction of needle incarcerated in hiatal hernia].

From June 1987 to April 2000, 167 (74%) of 223 patients suspected of swallowing foreign bodies were treated. Hundred-sixty-three were successfully treated endoscopically. The surgery rate was 2.4%. There was failure to remove a tablespoon, a tooth-brush, a dental prostheses with metallic hook, a knitting-needle. The sharp and pointed foreign bodies were 35 (20.9%). Endoscopic removal of sharp and pointed foreign bodies in the upper gastrointestinal tract can be very difficult to manage. The Authors report iatrogenic perforation of esophagus-gastric-fundus in a patient with hiatus hernia who ingested a big knitting-needle in order to suicide. They think that it is absolutely necessary to use special endoscopic equipment during the taking out of foreign-body procedure, especially when pointed and sharp-edge shaped bodies are involved and when there is high risk of iatrogenic lesions.

Adult↗
PubMedDate not supplied

[Peritoneal oxygenation-dialysis as a temporary treatment of intestinal infarction].

The interval preceding the growth of irreversible lesions in an abdominal apoplexy is variable (3-48 hours). It may be used to improve the ischaemic viscus oxygenation, also compensating possible metabolic imbalances. 16 rabbits were used for research, in which apoplexy by the ligature of the arteria mesenterica superior was induced. Dialysis-oxygenation peritoneal treatment was carried out for 8 rabbits, the results of which were evaluated on the basis of the intestine macroscopic morphologic aspect; on the basis of the hematic phosphates values and in enteral biopsy. The oxygenation-dialysis produced a rapid improvement in enteral hue and in enteral motility, an important increase of PO2 and a reduction of hematic phosphates compared with the control group. Histologic examination did not show any significant variation. The attempt to increase general oxygenation by supplying PO2 via the peritoneum, was partly successful (10-15%). The aim of oxygenation the ischaemic enteral zone was successful. This due to elimination of CO2 and toxic products using dialysis. This simple method seems to be effective but further tests on swine would be necessary for clinical applications.

Animals↗
PubMedDate not supplied

Large aneurysm of the superior mesenteric artery.

This report describes a rare case involving a large aneurysm of the superior mesenteric artery (S.M.A.) in a 53-year-old female. Diagnosis was made by X-ray and echography and confirmed by CT-scan and arteriography showing the lesion to be atherosclerotic in origin with several thrombi on the wall of the artery. Resection of the aneurysm and venous reconstruction was performed. Recovery was uneventful. Angiography one month later demonstrated patency of the bypass. At six months the patient is presently asymptomatic.

Aneurysm↗
PubMedDate not supplied

[Endoscopic sphincterotomy in acute biliary pancreatitis: the complications].

The authors report on a multicentric trial performed on early endoscopic sphincterotomy in severe pancreatitis. A large figure (7.764) of biliary pancreatitis was collected and 4.285 sphincterotomies were carried out. The results have been highly satisfactory: removal of hypertension and infection in biliary tree, stopped the trend toward necrosis and infection in almost all cases precociously treated. However, answering to the many doubts raised by some colleagues about the danger of this method, the authors examined all the complications that were reported. Hemorrhages and perforations of the biliary tree were the most common one. There were 120 (2.8%) hemorrhages, most frequently treated by medical means; in 20 cases a surgical hemostasis (1 death) had to be performed. Perforations, 24 (0.56%) were treated by medical therapy in 18 cases; 6 patients underwent surgical approach, with no deaths. Other complications (cholangitis, stent ruptures), less frequent, were treated successfully without surgical operations. The authors believe the main cause of this complications to be lack of experience and delay of endoscopic procedure (papillary oedema, fragility). What they suggest, is that endoscopic sphincterotomy has to be performed by an expert endoscopist, and within 48-72 hours from disease onset. Observing also that contrast introduced in the biliary tree could be harmful, they suggest to practice cholangiography at low pressure, and always leaving a nose-biliary drain. Endoscopic sphincterotomy, therefore, if correctly performed, reduces the necessity of surgery in severe pancreatitis. In this way, operations have to be carried out only in those patients with septic complications, with encouraging results and a sharp reduction of mortality.

Acute Disease↗