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Biomedical subjects

G Siragusa

Publications and source records attributed to G Siragusa.

At least 19 recordsLinked to original sources
PubMed2000

[Ventral hernia surgery].

BACKGROUND: A personal technique for polypropilene mesh implantation in the treatment of massive, boundary and recurrent incisional hernias is described. METHODS. DESIGN: retrospective evaluation of cases observed over the last 3 years. SETTING: division of General, Oncological and Thoracic Surgery, Department of Surgical and Anatomical Sciences, University of Palermo. SUBJECTS: twenty-four patients with massive, boundary and recurrent ventral hernia were selected and treated with this technique. INTERVENTIONS: the patients were submitted to implantation of a polypropilene prosthesis by using a part of the well vascularised hernial sac in order to close completely the peritoneal layer under the prosthesis (so as to avoid the contact between prosthesis and viscera) and to close the layer over the prosthesis (avoiding a contact between prosthesis and subcutis). MAIN OUTCOME MEASURES: morbidity and mortality have been evaluated. RESULTS: Patients were discharged from the 7th and 15th postoperative day. No mortality was recorded. In four out of 24 patients the following complications were observed: 1 case of high postoperative fever; 2 cases of superficial infection of the surgical wound; 1 case of wide cutaneous suppuration without prosthesis involvement. No recurrences were observed during the follow-up (6 months-3 year). CONCLUSIONS: Even if a scientific evaluation of the results is not possible due to the poor number of cases, short-term follow-up and unavailable randomized studies, this technique may be useful since it permits to avoid the contact between prosthesis and viscera, with lower postoperative adherences and the isolation of prosthesis from the subcutaneous tissue, sometimes involved in suppuration.

Adult↗
PubMed1999

[Video laparoscopy in abdominal emergencies].

BACKGROUND: Personal experience about the use of video laparoscopy (VL) in abdominal emergencies is reported. METHODS DESIGN: retrospective evaluation of patients observed in the last years. SETTING: General Surgery I. Policlinico, University of Palermo. SUBJECTS: 61 VL have been performed: 30 acute appendicitis, 21 acute cholecystitis, 4 perforated peptic ulcer, 1 haemoperitoneum by haemorrhaged luteal corpus, 2 pelvic inflammatory disease (PID), 1 terminal ileitis, 1 choledochal perforation after ERCP and 1 bleeding after CVL. INTERVENTIONS: the following interventions have been performed: 22 VL appendectomy, 8 VL-assisted appendectomy, 21 VL cholecystectomy, 1 VL duodenal suture, 3 minilaparotomic duodenal suture, 2 prophylactic VL-assisted appendectomy, in 1 patient with terminal ileitis and in 1 PID, 1 VL partial ovarian resection. In the case with choledochal perforation during ERCP a traditional cholecystectomy was performed with an outer biliary drainage. In the patient with bleeding after CVL the spontaneous haemostasis seen during VL was confirmed by laparotomy performed to exclude baro-haemostasis and to prevent from legal motivation. The procedure was only diagnostic in 1 patient with PID. MAIN OUTCOME MEASURES: the diagnostic and therapeutic value, versus traditional surgery have been valued. RESULTS: VL is useful both for a correct diagnosis and to lead a laparotomy if necessary, allowing an adequate peritoneal exploration and toilet without large incisions; the operation is therefore, in any case, less invasive. CONCLUSIONS: In our experience the usefulness of VL is clear in the suspect of acute appendicitis, acute cholecystitis, perforated peptic ulcer, haemoperitoneum and when diagnosis is not sure and in all other situations in which correct preoperative diagnosis is impossible. So this procedure is useful to make easy a correct diagnosis and to surgical treatment.

Abdomen, Acute↗
PubMed1999

[Cervico-mediastinal goiter. Our experience].

BACKGROUND: Personal experience about substernal goiter is reported. Stressing laid on the importance of definition: a goiter that is totally or in the most part below the superior thoracic outlet, with normal vascularization. METHODS DESIGN: retrospective evaluation of patients observed in the last six years. SETTING: General Surgery I, Policlinico, University of Palermo. SUBJECTS: four hundred ninety-six thyroidectomies have been performed, 32 patients (6.5%) were found to have substernal goiters. The age was between 42 and 86 years (middle age 59). Male/female = 1/1.9. Asymptomatics were 8 (25%). More frequent symptoms were airway compression (34%), hoarseness (9%), pain (9%), thyrotoxicosis (9%) and dysphagia (3%). INTERVENTIONS: total thyroidectomies have been always performed. MAIN OUTCOME MEASURES: the incidence, symptoms, short and long term complication have been valued. RESULTS: There were no postoperative bleeding or lesion of recurrent nerves or definitive hypoparathyroidism. Postoperative hypocalcemia was observed in 9 patients (28%). Only one temporary hypoparathyroidism (two months) was observed. In 2 patients the histologic examination revealed a papillar carcinoma. There were no intraoperative deaths. CONCLUSIONS: In personal experience the presence of substernal goiter is an indication for total thyroidectomy. The reasons for treating substernal goiter surgically are the following: no effective medical treatment is available; respiratory compromise, thyrotoxicosis, dysphagia, or malignancy can develop in long-standing goiters; surgery, in skilled hands, presents minimal morbidity.

Adult↗
PubMed1999

[The surgical approach to non-neoplastic abdominal pathology in the geriatric patient].

BACKGROUND: The authors evaluate the most suitable approach to be used in elderly patients suffering from non-neoplastic abdominal pathology. METHODS: A retrospective evaluation was made of cases observed over the past two years. Follow-up continued for at least three months after treatment. SETTING: General Surgery 1, Department of Surgical and Anatomic Disciplines, Policlinico, University of Palermo. PATIENTS: A total of 92 patients were treated aged between 65 and 94 years old (mean age 79.5). The most frequently observed pathologies were cholelithiasis and hernia, treated both electively and in emergency. OPERATIONS: 76 patients were treated electively and 16 underwent emergency surgery. Parameters examined: The authors evaluated postoperative progress, morbidity and mortality. RESULTS: Morbidity was equal to 6.5%. Death occurred in three patients, one of whom had been operated a month earlier. CONCLUSIONS: Surgery is considered appropriate in the elderly patient provided an adequate pre-, intra- and postoperative approach is used. The preoperative phase should include a multidisciplinary evaluation to assess surgical risk (ASA and APACHE). During surgery, the most beneficial solution should be found which takes account of the patient's life expectancy; whenever possible, is it advantageous to resort to video-laparoscopy owing to the diagnostic accuracy of this method, as well as the capacity to adjust subsequent surgery whether it is performed using video-assisted laparoscopy or targeted mini-laparotomy. This causes less surgical aggression and therefore a more comfortable postoperative recovery. During the latter phase, vital and biohumoral parameters should be accurately monitored to ensure the prompt recognition of organic collapse and/or metabolic disorders consequent to surgical stress.

Abdomen↗
PubMed1998

[Long-term central venous access. Our experience].

Prolonged venous access devices (PVAD) represent a useful tool for many patients with chronic diseases. In the last 3 years 50 PVAD have been placed. Polyurethane catheters with a subcutaneous tunnel > 6 cm, have been used. There were no complications related to catheter insertion. The average life of PVAD was 95 days (range 7-425).

Aged↗
PubMed1998

[Subtotal thyroidectomy or total thyroidectomy in the treatment of benign thyroid disease. Our experience].

During the period January 1989-December 1994, of 322 thyroid operations, 309 were benign. The pathologic changes in the excised thyroids were 18 benign adenoma, 291 goiter 9 of which with thyroiditis. 25 patients had undergone previous partial thyroidectomy. Total thyroidectomy was performed in 224 patients. There were no operative deaths. 77 (34.3%) patients developed postoperative hypocalcemia, 10 (2.7%) transient hypoparathyroidism, 4 (1.8%) permanent hypoparathyroidism, 3 (1.3%) transient recurrent laryngeal nerve palsies, 2 (0.9%) permanent nerve damages. In our experience total thyroidectomy is the gold standard for diffuse diseases of the thyroid, because, without more specific complication than subtotal thyroidectomy, it ensures: no recurrences, an easy control of postoperative hypothyroidism, the removal of microscopic malignant foci, the stopping of ophthalmopathy evolution.

Adenoma↗
PubMed1997

[Diverticula of the right colon. The diagnosis and treatment of complications].

BACKGROUND: Diverticula are localized in the right colon with a rate of 6.7-14% in Western countries. Two types of diverticula have been described in the right colon, on the basis of etiologic and pathological features: multiple diverticula and solitary diverticulum of the caecum. The most common clinical presentation of the right-sided colonic diverticula is an acute inflammatory complication, which is difficult to distinguish from other causes of right iliac fossa pain. METHODS: A survey of the literature is presented and personal experience relative to 4 cases of acute diverticulitis of the right colon observed over a 10-year period is described. RESULTS: In all the patients the preoperative diagnosis was acute appendicitis. In two cases the poor clinical conditions of the patients were associated with the free perforation of a solitary caecal diverticulum and diffuse faecal peritonitis. A temporary caecostomy was therefore required. In two cases a localized inflammatory mass was found around a perforated solitary diverticulum of the caecum. An ileocaecal resection was performed. CONCLUSIONS: The purpose of this study is to emphasize the epidemiological, etiologic and clinical features of right-sided colonic diverticula, and the diagnostic and therapeutic management of their complications.

Acute Disease↗
PubMed1991

[A comparative study of Billroth II and Roux-Y gastrojejunostomy. The mucosa of the gastric stump].

Thirty-five patients who had undergone gastric resection between two and five years earlier were included in the study. Digestive continuity had been achieved in 18 cases using the BII method, and in 17 using a Roux en Y loop. Vagotomy was not performed in any patient. All patients were assessed using endoscopy and multiple biopsies of the gastric mucous were taken. No postoperative peptic ulcers were observed. Mucous close to the stoma appeared to be hyperemic and edematous in 16 of the patients who underwent gastric resection using the BII method and in 5 of those in whom a Roux en Y loop was used. In BII patients, the histological analysis of endoscopic biopsies revealed mucous alterations in 94.4% of cases, and the most frequent finding was chronic atrophic gastritis; in the Roux en Y patients signs of inflammation were only observed in 58.8% of patients and in the majority of cases it was limited to superficial chronic gastritis.

Adult↗
PubMed1991

[Br-IDA in the evaluation of papillo-sphincterotomy and choledochoduodenostomy].

Twenty-three patients who had undergone surgery for non-neoplastic pathologies of the terminal choledochus were studied using 99mTc Br-IDA. This method is used to study patients operated for PST of CDS because: 1) is not invasive and does not cause allergies; 2) it allows a physiological evaluation of biliary flow to be obtained; 3) it is not influenced by the patient's body structure, by the presence of intestinal gas or costo-chondral calcification; 4) the radiation dose absorbed by the patient is very low; 5) it does not require any special preparation of the patient. Papillosphincterotomy was performed in 16 patients and choledochoduodenostomy in 7 patients. Follow-up varied between a minimum of two and maximum of eight years. The morphology of the biliary tract remained normal in all cases or was only slightly dilated. Captation and excretion time remained within normal values. Marker activity in the duodenum appeared early in all cases. A duodenogastric reflux was only observed in one patient among those undergoing PST, whereas it was observed almost constantly following CDS.

Adult↗
PubMed1990

[Pyoderma gangrenosum and Crohn's disease].

A careful survey of the literature on the relationships between pyoderma gangrenosum and Crohn disease is made. The pathogenetical and clinical aspects are analysed and a case, personally observed, is presented.

Adrenal Cortex Hormones↗
PubMed1990

[Role of aminophylline and allopurinol in the reformation of peritoneal adhesions].

The role of aminophylline in the re-formation of peritoneal adhesions was considered in 23 rats. Since the adhesions were obtained, the animals were subsequently divided into three groups, the first one containing seven units, the others containing eight animals each. During the four days prior the surgery, allopurinol at the dose of 50 mg/kg/die was added to the regular ground laboratory chow in the animals of the second group; aminophylline at the dose of 40 mg/kg/die was administered four hours and immediately prior the surgery, to the animals of the third group. The adhesions that we observed, were graded and evaluated assigning them a score. At the moment of the lysis of adhesions, we observed the score of 2.71 +/- 1.11 in the first group, 3.12 +/- 1.13 in the second group, and 2.75 +/- 1.03 in the third one. Matching each group one another no statistically significant difference was found. At the end the experiment, we observed a score of 3.71 +/- 0.49 for the adhesions in the first group, 2 +/- 0.75 in the second group, and 3.87 +/- 0.35 in the third one. Matching these scores with those observed at the moment of their lysis, they appeared significantly higher in the animals of the first group (p less than 0.02) and of the third group (p less than 0.05), but they were lower in the second group (p less than 0.05). Such results indicate that the re-formation of peritoneal adhesions following their lysis is constant, that allopurinol decreases the intensity of the process, while aminophylline increases it.

Allopurinol↗
PubMed1989

A computerized program of skin test evaluation and its predictive value in immunotherapy.

The present study describes a computerized methodology for the assessment of specific skin testing which is both sensitive and reproducible. We evaluated the predictive value of this technique in identifying patients at great risk for developing undesirable reactions during hyposensitization. In 11 of 93 patients we were able to detect an unusual dermal response in the patients who developed either generalized or local generalized adverse reactions.

Adolescent↗
PubMedDate not supplied

[Video laparoscopic appendectomy. Our experience].

OBJECTIVE: Personal experience with the use of VL in the treatment of acute appendicitis (AA) is reported. The main advantage of this method is its high diagnostic reliability. SETTING: Chirurgia Generale I. Dipartimento di Discipline Chirurgiche e Anatomiche. Policlinico Università Palermo. SUBJECTS: The VL method has been used in 36 patients with diagnosis of suspect acute appendicitis. INTERVENTIONS: In the cases in which the diagnosis has been confirmed, a VL appendectomy with endoabdominal technique according to Semm has been performed in 23 cases, and an assisted VL appendectomy, trough a minimal and guided laparotomy, in 8 cases. In order to avoid vascular and visceral injuries, an "open" laparoscopy technique is always used. RESULTS: The diagnosis has been confirmed in 31 cases, 21 women and 10 men. The diagnosis has not been confirmed in 5 cases, a man of 74 years with sigmoidal diverticulitis and 4 women with terminal ileitis in a case, torsion of right ovarian cyst in another and, finally, pelvic inflammatory disease in 2. CONCLUSIONS: From this brief experience it is evident the diagnostic advantage of VL particularly in the female and in elderly patients. Other advantages of this method are the excellent aesthetic result, light postoperative pain, the rapid functional resumption, the small impact of adherences, wound infection, and incisional hernia, and the lower cost, when staplers are not used. The disadvantages are the extension of the operative time, using the "open" laparoscopy technique, and the difficulty to find Meckel diverticulum.

Acute Disease↗
PubMedDate not supplied

[The treatment of inguinal hernia in a one-day surgery protocol. Our experience].

BACKGROUND: Personal experience in the treatment of inguinal hernia in "One day Surgery" is reported. METHODS DESIGN: retrospective evaluation of cases treated in a twelve months period. The follow-up has been programmed at 1, 3, 6 and 12 months after the treatment. SETTING: general, thoracic and oncological surgery, Department of Surgical and Anatomical Disciplines. Polyclinic, University of Palermo. SUBJECTS: 54 patients aged between 17 and 86 years (middle age 51.9), 48 male have been treated; in 3 cases recurrent hernias were found. INTERVENTIONS: in every case Trabucco's procedure with local anaesthesia has been performed. Premedication with Midazolam 10 mg i.v. has been associated. MAIN OUTCOME MEASURES: postoperative course and morbidity have been valued. RESULTS: Twice general anaesthesia has been necessary. No case of allergic reactions has been found. All the patients but three have been discharged before the sixth hour. Wound infections, seromas, deep hematomas, neuralgias and short-time recurrences have not been observed. CONCLUSIONS: Tension-free procedures and local anaesthesia, in personal experience, are mandatory to perform the treatment of inguinal hernia in "One Day Surgery".

Adolescent↗
PubMedDate not supplied

[Surgical treatment of varicocele in day hospital. Our experience].

OBJECTIVE: The authors report their experience about surgical treatment of varicocele in Day Hospital (DH). DESIGN: Report of 10 cases; evaluation of effectiveness of the surgical treatment. SETTING: Operative Unit of General and Thoracic Surgery, Department of Surgical, Anatomical and Oncological Disciplines. Policlinico, University of Palermo. INTERVENTIONS: Surgical procedure according to Ivanissevich in all 8 patients. RESULT: 100% successful. CONCLUSION: Surgery in DH is a valid treatment option in varicocele, by the technical and economic point.

Adult↗