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Biomedical subjects

G Sgarzini

Publications and source records attributed to G Sgarzini.

At least 19 recordsLinked to original sources
PubMed2006

Laparoscopic treatment of blunt splenic injuries: initial experience with 11 patients.

BACKGROUND: Nonoperative treatment of splenic injuries is the current standard of care for hemodynamically stable patients. However, uncertainty exists about its efficacy for patients with major polytrauma, a high Injury Severity Score (ISS), a high grade of splenic injury, a low Glasgow Coma Score (GCS), and important hemoperitoneum. In these cases, the videolaparoscopic approach could allow full abdominal cavity investigation, hemoperitoneum evacuation with autotransfusion, and spleen removal or repair. METHODS: This study investigated 11 hemodynamically stable patients with severe polytrauma who underwent emergency laparoscopy. The mean ISS was 29.0 +/- 3.9, and the mean GCS was 12.1 +/- 1.6. A laparoscopic splenectomy was performed for six patients, whereas splenic hemostasis was achieved for five patients, involving one electrocoagulation, one polar resection, and three polyglycolic mesh wrappings. RESULTS: The average length of the operation was 121.4 +/- 41.6 min. There were two complications (18.2%), with one conversion to open surgery (9.1%), and no mortality. CONCLUSIONS: Laparoscopy is a safe, feasible, and effective procedure for evaluation and treatment of hemodynamically stable patients with splenic injuries for whom nonoperative treatment is controversial.

Adolescent↗
PubMed1997

Carotid endarterectomy in young adults: is it a worthwhile procedure?

PURPOSE: The aim of the study was to investigate surgical indication and long-term outcome of carotid endarterectomy (CE) in young adults. METHODS: Between 1973 and 1990, 1693 patients underwent CE. Forty-nine patients (group T) 35 to 45 years of age who had carotid artery stenosis greater than 70%, formed the basis for the analysis. They were compared with two additional groups of patients older than 45 years of age selected from the entire series. Group 2 was randomly chosen to determine differences in risk factors, associated diseases, operative indications, preoperative findings, and outcome. Group 3 was matched with patients in group 1 for sex, risk factors, associated diseases, preoperative findings, and operative indications to assess the importance of age in determining the short- and long-term outcome of CE. RESULTS: Postoperative mortality, cerebrovascular accidents, and cardiac complications in patients of group 1 (2%, 2%, and 2%, respectively) were similar to those of the other groups (p = NS). During the follow-up (76.7 +/- 3.6 months; range, 1 to 120 months) the incidence of strokes and transient ischemic attacks in group 1 was lower than in group 2 (p < 0.05) but similar to group 3 (p = NS). Ten-year disease-free intervals were 75.7%, 58.7%, and 77.6%, respectively, for groups 1, 2, and 3. Mortality rate unrelated to cerebrovascular disease was similar between group 1 and group 3 (p = NS) but was higher in group 1 than in group 2 (p < 0.02). Ten-year survival rates were 46.1%, 71.7%, and 55.5%, respectively, for groups 1, 2, and 3. CONCLUSIONS: CE in patients younger than 45 years of age is a safe procedure with low operative risks and good disease-free intervals. However, life expectancy is poor because of the high incidence of deaths resulting from complications of atherosclerosis.

Adult↗
PubMed1997

Management of abdominal aortic prosthetic graft infection requiring emergent treatment.

The purpose of this study was to investigate mortality and morbidity rates and long-term outcome of patients who underwent emergency treatment of abdominal aortic prosthetic graft infection. Between January 1984 and December 1993, 18 men aged fifty-nine +/- sixteen years were operated on as an emergency for an acute life-threatening complication of aortic prosthetic graft infection. The grafts had been implanted for abdominal aortic aneurysm in 9 patients and aortoiliac occlusive disease in 9, from one to one hundred seventy months previously. Five (28%) patients presented with a hemorrhagic shock due to a fistula between the vascular reconstruction and the small bowel (4 patients) or the right ureter (1 patient) and 13 (72%) had generalized sepsis. The grafts were always radically explanted. Extraanatomic revascularization procedures included 6 axillopopliteal and 12 axillofemoral bypass grafts. Operative mortality was 39% (7 patients), and 3 (9%) limbs were amputated within thirty days. Two (11%) patients died after seven and twelve months, respectively, of septic complications, and 1 (5%) patient died after six months from an unrelated cause. Eight (73%) patients are still alive at a mean follow-up of fifty +/- thirty-four months, but in 3 the extraanatomic bypass was removed for infection and 5 major amputations were performed. Two-year survival and limb salvage rates were 44% and 50%, respectively. Aortic prosthetic graft infections that require emergent treatment continue to demonstrate high early and late mortality and limb loss rates despite aggressive intervention and limb salvage procedures. Newer methods of managing these complications should continue to be investigated.

Amputation, Surgical↗
PubMed1996

Influence of blunt needles on surgical glove perforation and safety for the surgeon.

BACKGROUND: Round-tipped blunt needle (BN) may decrease the risk of needlestick injuries and hand contamination. We prospectively determined the incidence of glove perforations in emergency abdominal procedures and the efficacy of BN in increasing the safety for surgeons. METHODS: Two hundred patients were randomized to undergo closure of the abdominal fascia using sharp needle (SN) or BN. Gloves were tested at the end of the procedure. RESULTS: Surgeons had 14 needlestick injuries and 76 perforations recorded in 69 pair of gloves. Sharp needles were responsible for all injuries and 58 (76%) perforations (P < 0.00004 and P < 0.00001, respectively). This difference was still higher when considering the perforations related to the abdominal fascia closure (BN 7% versus SN 50%; P < 0.0006). CONCLUSION: The risk of glove perforation is sevenfold greater if SN are used. Blunt needles reduce sharp injuries and improve safety for surgeons.

Accidents, Occupational↗
PubMed1995

[Hürthle cell tumors: personal experience].

Hürthle cell tumors of the thyroid gland are uncommon lesions (3% of all well differentiated tumors). Histological diagnosis is often difficult: according to recent criteria only those tumors with almost 75% of oxyphil cells are well recognized as Hürthle cell neoplasms. Extracapsular and blood-vessels invasion, capsular penetration, DNA patterns and tumoral necrosis are indicative for malignancy. The Authors report their experience in the management of 46 patients who underwent thyroid surgery for Hürthle cell neoplasms. Histological findings, surgical approach and post-operative follow up are discussed.

Adenoma, Oxyphilic↗
PubMed1995

[Primary lymphoma of the rectum: diagnosis and treatment].

The authors report a rare case of primary rectal lymphoma non Hodgkin in a young non HIV infected man. Preoperative diagnostic problems, the standards for classification and staging and the proper treatment are briefly discussed. The importance of an accurate histological and immunohistochemical study on preoperative multiple biopsies for a correct diagnosis, staging and treatment, are emphasised in this report.

Adult↗
PubMed1995

Fatal bleeding after fine-needle aspiration biopsy of the liver.

Ultrasonographic-guided fine-needle aspiration (FNA) biopsy has become a routine diagnostic procedure in the histological evaluation of both focal and chronic liver diseases. It is a safe and low-cost procedure that may be quickly and easily performed by radiologists and gastroenterologists. Severe and unexpected complications, of FNA biopsy, are rarely observed, haemorrhage being the most frequent and often fatal (1,2). This report presents the case of a patient with chronic liver disease who died of massive hemorrhage due to a FNA biopsy complication.

Aged↗
PubMed1994

[Palliative treatments in inoperable pancreatic tumors. Technics compared].

The authors experience of palliative treatment of advanced pancreatic cancer is reported. 32 patients underwent palliative surgical procedures of biliary decompression (20 choledochoduodenostomy and 12 cholecystoenteric bypass). In 26 patients a gastroenteric anastomosis was also performed. 8 patients underwent non surgical procedure because of their very poor conditions or short term survival. The authors point out the advantages offered by surgical treatment. Nevertheless a careful selection of patients submitted to this procedure is recommended.

Aged↗
PubMed1994

[Neurogenic tumors of the brachial plexus].

The Authors report two cases of solitary neurogenic tumors of the brachial plexus not associated with Von Recklinghausen's disease. Peripheral nerve tumors are relatively rare and only 25% occur above the clavicles. The mass, usually asymptomatic, may cause sensory radicular symptoms or rarely motor deficits in the involved arm. Wide radical excision of a benign neurogenic tumor is the treatment of choice; for malignant tumors, associated with a particularly poor prognosis, a more aggressive surgical approach may be necessary. Adjuvant radiation therapy and chemotherapy do not seem to have any effect on survival rates.

Adult↗
PubMed1993

[Leiomyosarcoma of the small intestine. A rare case of abdominal emergency].

Small bowel leiomyosarcomas are uncommon potentially curable tumors, unfortunately diagnosed at an advanced stage. The Authors report one case of leiomyosarcoma of the small bowel, with an eight-day history of severe abdominal pain, operated on, in emergency, for perforation with peritonitis. A review of English literature on this subject is reported.

Emergencies↗
PubMed1993

[Identification and preservation of the parathyroid glands in thyroidectomy using methylene blue].

The risk to the parathyroids in thyroid surgery is widely known. Postoperative parathyroid insufficiency occurs because of accidental devascularization of one or several glands, or infarction due to manipulation, or resection within the thyroid lobe. The prevention of this complication requires a careful surgical technique which limits any injury of the parathyroids. A simple, safe and cheap method to improve the identification of these glands is the preoperative intravenous infusion of methylene blue, that results in a distinct staining of the parathyroids. The authors describe their experience with this useful procedure which helps to reduce the incidence of hypoparathyroidism after total and near total thyroidectomy.

Adolescent↗
PubMed1993

Multifocal leiomyosarcoma of the gastrointestinal tract requiring emergency surgical treatment for small bowel intussusception.

A case of multifocal leiomyosarcoma of the stomach, duodenum and jejunum presenting as an intestinal occlusion for small bowel intussusception is reported. Complete surgical excision of the tumour was not possible due to the wide dissemination. The patient died two months later for haemorrhage from an ulcerated gastric localization. Surgical and prognostic implications of disseminated gastrointestinal leiomyosarcoma are briefly discussed through a literature review.

Aged↗
PubMed1992

[Drainage in surgery on the thyroid].

The authors report their experience of 534 thyroid operations and underline the importance of neck drainage in this type of surgery. Drainage positioning is very important for the prevention and immediate indication of hemorrhaging complications. Some correct indications, like large goiters, hyperthyroidism, reoperation and the lack of vascular ligature, are considered and discussed.

Adolescent↗
PubMed1992

[The treatment of recurrent inguinal hernias by using Marlex mesh preperitoneally].

Several techniques are utilized in the treatment of inguinal hernia: each type of repair offers advantages, but a variable number of recurrences occurs regardless of the hernioplasty technique used. Treatment of hernial recurrence is a troublesome goal for surgeons. Nowadays, the use of prosthetic materials with a posterior surgical approach simplifies and resolves most of the problems encountered in the past. The authors report their experience with the use of Marlex mesh for hernia repair through a preperitoneal approach pointing out the advantages of such prosthetic material and of the surgical access as well. Finally, the importance of patients selection is stressed.

Adult↗
PubMed1991

[Parathyroid cysts].

The Authors review the world literature on parathyroid cysts and report a case of this uncommon disease. The importance of an early pre-operative diagnosis by ultrasound, blood calcium level and parathyroid hormone assay with fine needle aspiration biopsy is pointed out. According to several surgeons, only the functioning parathyroid cysts require operation; needle aspiration may be appropriate therapy for the nonfunctioning ones.

Adult↗