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G Rotondano

Publications and source records attributed to G Rotondano.

34 records · Page 2Linked to original sources
PubMed1998

Somatostatin in the prevention of recurrent bleeding after endoscopic haemostasis of peptic ulcer haemorrhage: a preliminary report.

OBJECTIVE: Although endoscopic injection therapy provides excellent initial haemostasis in actively bleeding ulcers, the incidence of recurrent haemorrhage is not negligible. The aim of this study was to compare somatostatin, omeprazole and ranitidine in preventing further haemorrhage after endoscopic injection haemostasis. METHODS: Seventy-three patients with major stigmata of ulcer haemorrhage at endoscopy were treated with epinephrine injection and randomly assigned to receive either omeprazole (n = 24) or ranitidine (n = 24) or somatostatin (n = 25). The three groups were similar in all background variables including mean age, clinical and endoscopic features, severity of bleeding and timing of the haemostatic procedure. All patients underwent a second endoscopic look at 48 h. Failures of treatment or retreatment underwent emergency surgery. RESULTS: There were no statistically significant differences between the groups in terms of initial haemostasis, need for emergency surgery, transfusion requirements, length of hospital stay or mortality. Early recurrent haemorrhage was 5/22 (22.7%) in the ranitidine group, 5/23 (21.7%) in the omeprazole group and 2/23 (8.7%) in the somatostatin group. No major side-effect was noted with drug therapy. CONCLUSIONS: The preliminary results suggest that somatostatin might be more effective than ranitidine and omeprazole in the prevention of recurrent haemorrhage following endoscopic injection therapy of bleeding peptic ulcers.

Adult↗
PubMed1997

Early detection of locally recurrent rectal cancer by endosonography.

After curative surgery for rectal cancer, the goal of an aggressive surveillance programme is the detection of local recurrence (LR) at an early and potentially curable stage 62 patients (mean age 66.2 years) operated on for rectal cancer were prospectively enrolled in a follow-up study including endorectal ultrasound (EUS), serial CEA levels, digital examination, colonoscopy and pelvic CT. A total of 192 sonographic scans were performed, with a mean of three (range 2-7) for each patient. LR occurred in 11 patients; in all cases this was suggested by EUS. In two patients (18%) other techniques had failed to detect recurrent disease, which was identified solely by EUS. These two were treated radically and the remainder received radiotherapy or other palliative management. Five patients are alive at, on average, 18 months after LR (range 4-26 months). These include both cases treated with salvage surgery and who remain disease free. EUS is a valuable tool in the detection of locally recurrent rectal cancer.

Aged↗
PubMed1997

Endoscopic retrieval of a surgical gauze from the common bile duct.

Non-parasitic foreign bodies in the common bile duct are rare and usually require laparotomy. We report the successful removal by endoscopy of a surgical gauze seven years after a simple cholecystectomy. The foreign body had been cholangiographically misdiagnosed as a large stone. The possibility of a foreign body that has migrated into the common bile duct should be considered in patients with cholangitis. Endoscopic sphincterotomy is the procedure of choice, though other extraction techniques may occasionally be necessary.

Cholangiopancreatography, Endoscopic Retrograde↗
PubMed1997

Endoscopic mechanical lithotripsy of difficult common bile duct stones.

BACKGROUND: Mechanical lithotripsy for the management of difficult common bile duct stones has sometimes yielded conflicting results. METHODS: A series of 162 consecutive patients who underwent mechanical lithotripsy was evaluated retrospectively and a large number of variables tested for their association with successful outcome. RESULTS: The procedure was safe (morbidity rate 1.8 per cent) and effective (84.0 per cent stone clearance rate). Univariate and multivariate analysis showed that stone size was the only outcome predictor (mean(s.d.) diameter of grasped versus non-grasped stones 21.7 (6.7) versus 28.3(10.4) mm; F = 10.72, 98 d.f., P = 0.002). The cumulative probability of bile duct clearance ranged from over 90 per cent for stones with a diameter less than 10 mm to 68 per cent for those greater than 28 mm in diameter (P < 0.02). CONCLUSION: Patients at high risk of lithotripsy failure (stone diameter of 28 mm or more) might more wisely undergo surgery or other non-surgical procedures, such as extracorporeal shock-wave lithotripsy or long-term biliary stenting.

Adult↗
PubMed1997

Isolated agenesis of the gallbladder. An intraoperative problem.

Agenesis of the gallbladder and cystic duct is a rare congenital malformation. In 40-70% of cases this anomaly is associated with other gastrointestinal, skeletal, cardiovascular and genitourinary malformations. Lithiasis of the common bile duct is present in 25-50% of cases. In the majority of cases patients are asymptomatic or have symptoms compatible with a biliary disorder. A preoperative diagnosis is extremely difficult and the absence of the gallbladder is often an intraoperative finding. The authors report a case of isolated agenesis of the gallbladder. The relative embryology, development, diagnostic pitfalls, intraoperative behaviour and therapeutic strategies are discussed.

Adult↗
PubMed1997

[Surgery for familial polyposis of the colon. A functional follow-up].

Functional assessment of pelvic pouch procedures for FAP is not different from that of UC and consists of clinical, manometric and radiologic investigations. Ileo-rectal anastomosis and pelvic pouch operation are equally effective for the disease, but function is still questionable after restorative proctocolectomy. Based on a personal series of 43 patients, relevant technical aspects influencing functional results are discussed and guidelines for a correct follow-up of these patients are presented.

Adenomatous Polyposis Coli↗
PubMed1996

Primary extrahepatic bile duct carcinoids.

Biliary tact carcinoids are extremely rare: only ten cases have been reported up to now. The Authors describe a successfully treated carcinoid tumour of the proximal bile duct and review the literature about these rare malignancies. Despite extensive preoperative work-up, including ultrasound, CT scan and ERCP, a definite diagnosis is hardly possible prior to histologic examination of the operative or necropsy specimen. Due to the slow-growing nature and the non-aggressive behaviour of these malignancies, surgical resection followed by biliodigestive anastomosis should be the treatment of choice.

Aged↗
PubMed1996

External anal sphincter defects: correlation between pre-operative anal endosonography and intraoperative findings.

In order to correlate operative findings with external anal sphincter (EAS) defects identified on anal endosonography (AES), 30 faecally incontinent patients undergoing overlapping sphincteroplasty or total pelvic floor repair were investigated by AES before and after surgery. Endosonic findings were correlated with the appearance of EAS at operation. 21 out of 22 defects seen at surgery had been pre-operatively detected by AES (one false negative). Post-operatively the sphincteroplasty was clearly evident on AES. In three cases of failure it showed an extensive hypoechoic area and these patients underwent dynamic graciloplasty. Endosonography is the method of choice for pre-operative imaging of EAS, having an established role in identifying sphincter defects and correlating well with intraoperative findings. Post-operatively, it has the potential to identify breakdown of the previous repair, allowing prompt surgical intervention. Endosonography is helpful in planning the best type of operation following sphincter injury and is useful in auditing the results of surgery.

Adult↗
PubMed1995

[Rehabilitation of the colostomy patient].

The Authors report their experience concerning the rehabilitation of patients with temporary or definitive colostomy. Mechanical and psychosocial implications as well as different rehabilitative methods are discussed and literature data are reviewed. Surgery should play a major role in this rehabilitation programme, either in terms of prevention or definitive treatment; nonetheless only through a multidisciplinary approach these patients will achieve a better quality of life.

Aged↗
PubMed1995

Colorectal cancer. Diagnosis of recurrence.

After curative surgery for colorectal cancer, the goal of an aggressive surveillance program is the detection of recurrent disease at an early and potentially curable stage. The routine use of endosonography (EUS) following surgery for colorectal cancer allows a detailed examination of the pelvis not previously possible without more sophisticated and expensive techniques, such as CT scans or MR imaging. EUS gives good information on established recurrence and is the single modality that allows for the detection of asymptomatic extramural local failures. EUS is a valuable tool for the detection of locally recurrent rectal cancer.

Colorectal Neoplasms↗
PubMed1994

A critical appraisal of pathogenesis and morbidity of surgical treatment of chronic anal fissure.

Preoperative and postoperative manometric findings and the results of lateral internal sphincterotomy were analyzed in 44 consecutive patients affected with chronic anal fissure. Preoperatively, resting anal pressure was increased in 32 patients. At one month postoperatively, 23 patients showed normal pressures, whereas 14 were still hypertonic and seven, hypotonic. Only three patients still had a weak sphincter six months postoperatively. The overall morbidity rate was 31.8 percent. Minor complications occurred in 11 patients. Major complications affected three patients. Overall, impaired continence was recorded in eight patients, although only two complained of persistent, albeit lesser, defects of continence not requiring the use of pads. Nonoperative treatment should be reserved for few selected patients with recent, acute fissures. As for chronic and fissures, compared with other operative or nonoperative modalities of treatment, lateral internal sphincterotomy is a highly successful procedure and its minimal morbidity is well accepted by the patient.

Adolescent↗
PubMedDate not supplied

CT and anal endosonography in the evaluation of electrically stimulated neoanal sphincter: a preliminary report.

We report a preliminary experience concerning the postoperative assessment of three patients who underwent gracilis neosphincter operation for severe fecal incontinence and were studied by computed tomography and anal endosonography soon after gracilis transposition and later after 6-8 weeks of neuromuscular training. Morphologic assessment was correlated with physiologic testing (manometry). Continence was satisfactorily improved in all patients. Both imaging techniques demonstrated the anatomy of the transposed muscle. Computed tomography also assessed lead placement onto the gracilis nerve root and the completeness of muscle transposition around the anal canal. Anal endosonography provided a more accurate assessment of the relation between the neosphincter and residual external sphincter.

Adult↗
PubMedDate not supplied

Somatostatin in the treatment of non-variceal upper gastrointestinal bleeding.

The efficacies of somatostatin and octreotide have been widely studied in the control of bleeding from oesophageal varices. It has also been suggested that these drugs may be useful for the control of non-variceal upper gastrointestinal (UGI) bleeding, including that from peptic ulcers. In approximately 80% of patients presenting with non-variceal UGI bleeding, haemorrhage ceases spontaneously and does not recur. However, the remaining 20% of patients require active treatment. Results from recent studies have indicated that somatostatin is an effective treatment for the control of non-variceal UGI bleeding in high-risk patients, i.e. those in whom haemorrhage does not cease spontaneously or is likely to recur. In contrast there is no good evidence available at present to support a role for octreotide in this indication. The efficacy of somatostatin in controlling bleeding in patients with non-variceal UGI bleeding at high risk of mortality upon admission, or rebleeding following endoscopy, coupled with an excellent safety and tolerability profile, suggests that it may be a valuable therapeutic option in the management of non-variceal bleeding.

Digestive System↗
PubMedDate not supplied

Transanal excision and postoperative radiation therapy in selected patients with cancer of the low rectum.

Preliminary results of 24 patients (15 males, 9 females; age range 30-81 years) with localized low rectal cancer treated with transanal excision and postoperative radiation therapy are reported. Preoperative endosonographic staging was T1 (10), T2a (12) and T2b (2). All had negative resection margins, except one patient who underwent salvage major resection (no tumor found in the specimen). The mean follow-up was 33 months (range 29-61 months). Twenty patients (83.3%) are alive with no sign of local or distant failure. Two patients (9%) developed a local recurrence and were both salvaged with major surgery. Operative and radiotherapy-related morbidity was minor, with diarrhoea and perianal discomfort occurring in most patients following irradiation. Long-term sphincter function was satisfactory in 90% of cases. Rectal endosonography provided a reliable preoperative staging of T (100% correlation with histology) and, indirectly, N parameter, appearing as the key investigation in selecting candidates for conservative treatment. Postoperative radiotherapy might also be proposed after excision of T1 cancers as it produced few side effects and has the potential to control any residual disease. Additional experience is needed to determine long-term results of this combined radiosurgical approach.

Adenocarcinoma↗
PubMedDate not supplied

Pelvic recurrence following resection of rectal cancer: a multivariate predictive model.

Local recurrence of rectal cancer (LR) after "curative" surgery is a major clinical problem, with a low resectability rate and a dismal prognosis. Prediction of LR might permit more targeted postoperative surveillance with earlier diagnosis of recurrent disease and might help in selecting the patients to be assigned to the most suitable adjuvant treatment protocol. To evaluate if a simple multivariate model could predict the LR and survival probability in the single case, we retrospectively evaluated 118 consecutive patients (63 males, 55 females; mean age 62 +/- 12 years) operated on for rectal cancer and followed up for a minimum of 4 years (range 51-111 months). Local recurrence rate was 28%, with a 6% of local + distant failure. Age and sex of patients, type of surgery, location of tumour in the rectum, size, morphology and grading of the tumour were all unrelated to the event under investigation. At Cox regression, the Dukes' stage and the postoperative radiotherapy were the only independent prognostic factors for LR (p < 0.001). The multivariate model was able to correctly reclassify the patients and predict local recurrence in 86.2% of the cases. Prevention of LR by adequate surgery and adjuvant therapy as well as its early detection offer the best prospect of improving the results of surgery for rectal cancer.

Adenocarcinoma↗